Digital Quality Transformation Made Simple

Continuing the last Quality Matters episode, host Andy Reynolds and NCQA Chief Technology Officer, Ed Yurcisin, break down the complexities of the digital transformation in health care quality and explore the importance of high-quality data exchange, particularly in the context of HEDIS reporting and the FHIR interoperability standard. Ed explains how NCQA’s work in digital HEDIS measurement not only improves health care quality reporting, but also lays the groundwork for broader industry advancements. By ensuring consistent, standardized data for digital HEDIS, NCQA is setting the stage for better measurement of public health, smoother prior authorization and general data accessibility. The conversation also explores the technical side of digital quality measurement, focusing on Clinical Quality Language (CQL) and the role of HEDIS “engines” in the health care data ecosystem. Ed clarifies the difference between SQL and CQL, and underscores that NCQA’s focus is on measures’ content, not on building the end-to-end software systems that run measures. Through collaborations like the Digital Quality Implementers Community, NCQA is working to ensure alignment across CQL platforms so everyone is “doing the same math.” Amol Vyas, NCQA Vice President for Interoperability, joins the conversation to explain how a public-private partnership is bringing choice and confidence to the market for CQL engines. Ed reflects on how his international perspective and personal experiences shape his passion for health care data interoperability. He shares how challenges accessing medical records for his family members underscore the need for a seamless, patient-centered health care system. His real-world perspective highlights why creating standardized, high-quality data isn’t just a technical challenge, but a crucial factor in helping to ensure better, safer care for all. As the episode wraps, listeners are encouraged to explore NCQA’s resources and upcoming events to stay informed on the future of digital quality. Key Quote: “ HEDIS measures are incorporated into government payment programs—for example, Medicare Star Ratings. There’s incentive to enable digital HEDIS because it is tied to your CMS Star Ratings and the money a Medicare advantage plan might receive from the government. That’s not the case for other important use cases, whether it be public health or prior authorization. So our infrastructure is tied to financial returns incenting organizations to make higher quality data accessible for digital HEDIS. And that means if it’s good enough for digital HEDIS, it’s been cleansed and analyzed in a way that could be used for public health, could be used for prior authorization—all of these different use cases.” Ed Yurcisin Time Stamps: (02:10) Clearing a Path for Data Quality (05:30) HEDIS “Engines” vs. HEDIS “Calculators” (07:17) Measures’ Content vs. Software that Runs Measures (11:18) Digital Quality Implementers Community (19:35) The Need for Data Quality Cuts Close to Home Links: Bulk FHIR Quality Coalition Digital Quality Implementers Community NCQA Digital Hub Connect with Ed Yurcisin Connect with Amol Vyas