Common Causes for Differences in Abstracted vs Electronic Measures

What frustrates you about eCQMs? And don’t say everything. You are probably experiencing many of the same problems that other hospitals face. One common frustration can stem from comparing your abstracted measure results to your eCQM rates.

At a glance, the measures probably appear to be similar because the measure descriptions and intents align.  So why are the eCQM results so different and how can we improve them?  Let’s review three common causes for differences in abstracted vs electronic measures that hospitals discover during the comparison and validation process.

The eCQMs are new and unfamiliar territory for many hospital Quality departments, and in working with our clients to analyze their performance results, we have found that the abstracted measure rates are typically higher than eCQM rates.  It is important to understand the differences in the two types of measures, as these differences typically explain the variance in performance rates.

Common Scenarios for Quality Measure Differences

The patient qualifies for the numerator in the abstracted measure, but fails the corresponding eCQM

Different sources & methods of documentation: The allowed sources of documentation are different for the abstracted vs. electronic measures.  The abstracted data can come from many different sources including notes, discharge summaries, patient history, etc. and can be structured or unstructured (free text).  In addition, the documentation for abstracted measures can be completed electronically or on paper.  The eCQM logic requires that data be documented electronically via the EHR, and all data must be structured (no free text!) and mapped to the correct codes per the spec value sets.

Workflow compliance: Any variance from standard electronic processes and workflow can potentially cause a difference in measure results.  In our experience, ‘problem list’ compliance, timing in documentation (documentation after discharge does not “count” for eCQM qualification) and documenting in an unstructured note are common issues.

Specification differences: Measure specifications for abstracted and electronic measures may appear similar, but there are subtle differences that can create significant differences in results.

If we look at STK-10 - Assessed for Rehabilitation, the measure logic is simple:  A patient who is being discharged home after having a stroke must be assessed for or receive rehab services.

In the abstracted specifications, a patient will qualify for the numerator as long as the rehabilitation assessment is documented. However, the eCQM measure logic is more specific; there is a timing element to the documentation. The eCQM rehabilitation assessment must occur ‘during’ the inpatient encounter. If the rehabilitation assessment was documented during the ED visit or after discharge, the patient will not qualify for the Numerator.  Many of the eCQMs have timing requirements such as this one, and some of the eCQMs have required data elements that are not found in the comparable abstracted measure.

A patient fails the abstracted measure, but qualifies for the numerator in the corresponding eCQM

As electronic documentation requirements and workflow change frequently, this difference typically occurs when an abstractor is not familiar with where to find the documentation in the EHR.  This scenario is less common, but still does occur.

A patient is excluded in the abstracted measure, but is included in the eCQM

The abstracted measures allow for sampling, so some of the patients that qualify for the eCQMs may have been excluded by sampling in the abstracted measures.

The differences are real. Now what?

Understanding the differences between abstracted measures and eCQMs is necessary in order to both understand your results and to successfully implement changes that will narrow the gap between the electronic and abstracted measure results.  

Medisolv’s ENCOR solution offers a dashboard to easily monitor and compare your electronic versus abstracted measure results. But the best part? Our subject matter experts help you analyze and understand the differences in your results.