Healthcare Effectiveness Data and Information Set (HEDIS) as a Quality Measure in Nursing Documentation

This article discusses the Healthcare Effectiveness Data and Information Set (HEDIS) as a quality measure in nursing documentation. It covers the data collection plan, the role of nurses in capturing accurate data, professional, ethical, and regulatory standards, and communication of changes in plan to stakeholders. The article also emphasizes the importance of distributed leadership style in collaborating with the interprofessional team to implement HEDIS.

Introduction
Informatics are useful in acquiring the data to promote quality improvements in practice. Nurse leaders
are at the center of leading and managing quality initiatives that affect patient outcomes, safety,
and health care organizations’ adherence with regulatory bodies. In the healthcare, quality
measures are the tools which uses data to evaluate the care plans, processes, outcomes,
healthcare providers, and organizational systems against acknowledged quality standards (Morris
& Bailey, 2014). In the US, the care quality is often substandard, so quantifying the quality of
health care is a vital initial step in the process of improving the quality of health care. Centers for
Medicare and Medicaid Services (CMS) makes use of quality measures to improve its quality,
for public reporting, and pay-for-reporting programs for particular care providers. In this
assignment a quality measure identified and it is essayed that how that measure will be
incorporated in nursing and provider documentation. Data collection and reporting plan is also
mentioned. Further, the manner in which this project will be led is also discussed.
Identification of the quality measures
The quality measure which will be discussed is the Healthcare Effectiveness Data and Information Set
(HEDIS). It is a frequently used set of standard performance measures which provides an
individual information regarding the quality of a health plan. It is formulated and maintained by
the National Committee for Quality Assurance (NCQA) (cms.gov, 2017). It includes details
about the quality of care, access, cost, and other measures to compared care plans. It was
developed to enable the service users to compare the care plan performance to other

corresponding plans or other recognized national guidelines. But, the HEDIS data is continued to
be used for tracking yearly performance (Saver, et al., 2015). NCQA's accreditation process
utilizes the HEDIS data, however certain plans submit HEDIS data without obtaining
accreditation. HEDIS data is collected by CMS for Medicare plans.
HEDIS includes over 90 measures across six domains of care which include care efficiency, care
accessibility, care experience, application and relative resource use, descriptive information of
health plan and measures gathered using Electronic Clinical Data Systems (NCQA, 2018). The
measure are updated every year based on relevance and requirement. Like a specific measure on
the length of stay post child birth was removed when the law authorized the minimum length of
stay made that measure of almost no use. Likewise, the enhanced focus on health care for elderly
population encouraged the adding of measures for glaucoma assessment
and osteoporosis management for aged individuals.
Data collection plan
The data from HEDIS is used to quantify the national performance statistics and benchmarks, and
place criteria for measures in NCQA Accreditation. The data is gathered by a range of methods
including surveys, health charts and insurance dues for hospital stays, medical office visits and
procedures. Survey measures should be done by an outside survey agency which is approved by
the NCQA. Clinical measures make use of the administrative or hybrid data collection process
which is laid down by the NCQA. Administrative method include electronic records of services.
The hybrid process is more expensive, takes more time and needs nurses or reviewers who are
sanctioned to appraise private medical documents. The results of HEDIS are audited for public

reporting by an auditing agency which is approved by NCQA. NCQA has a digital reporting
instrument known as Quality Compass which is accessible for several thousand dollars. The
Quality Compass gives comprehensive data on every measure and is planned for employers,
consultants and insurance agents who buy health insurance for firms. Website of NCQA
comprises of a summary of results of HEDIS sorted by health plan. The "Best Health Plans" list
is printed in the magazine in the issue of October and can be found on the online site of the
magazine. Other regional business firms, government bodies and media state the outcomes of
HEDIS commonly after they are announced.
Role of nurses in capturing accurate data
Nurses play a significant role in the process of data collection as they are directly involved in it. Nurse
captures the clinical HEDIS data which is reportable and quantifiable as this data is sent o CMS.
Apart from the nurses, practice managers are also hugely involved in the quality measurement
process. The healthcare needs to familiar with and adhere to several federal regulations, care
practice managers assist the care professionals in complying with the current government
regulations. Apart from nurses and practice managers, several settings have Subject Matter
Experts for different units who help the care team to develop the system particular to their
workflow and to make sure that providers will meet quality measures. These are nurses who are
specialized in patient-care delivery and can express the requirements of the patients, families,
and nurses. The planning, building, and implementation of HEDIS in the organization must
reinforce the meeting of requirements of the patients, families’ nurses, and other professional
involved in service provision.

Professional, ethical, and regulatory standards
There are a range of professional, ethical, and regulatory standards that needs to integrated into the
planning and implement the plan. During the process of designing, formulating, and
implementing quality measures, one of the most significant standards to be followed is the
Nursing code of ethics. The Code of Ethics for Nurses (2013) proposes that nurses have the
responsibility to provide their patients with care which is exceptional. In addition, various
significant principle which should be regarded in nursing practice are giving respect to the
service users, to preserve their dignity and privacy, and obligation to confidentiality, and trust
and committing to the autonomy of the service user. For the quality measure of HEDIS also,
patient care is at the core for the care and IT employees. This measure aims at improving patient
outcomes and enhance their satisfaction. Further, the regulations put forward by Government
also needs to be considered while implementing the quality measures.
Communication of changes in plan to stakeholders
In the business scenario including the healthcare industry, communication plays a vital role in satisfying
all the relevant stakeholders. In the given scenario customers will involve every end user such as
practitioners, nurses, pharmacists, administration employees, billing workers, managers, and
directors. But it should be kept in mind that the customers are not overly and continuously
informed as when they receive too many documents, it may lead to fatigues, stress or frustration
for them. It may also happen that when customers will receive too many notifications in a day
with irrelevant information, they may ignore it without even opening or reading them. So, the
message that needs to be communicated should be timely and well-articulated which gives out

the details and at the same time not very time-consuming. Every stakeholder must be provided
with the information they are affected with.
Employment of Leadership skills to collaborate with the inter-
professional team successfully
Nurse leader can adopt distributed leadership style to collaborate with inter-professional team to make
sure that the organization is offering evidence-based acre to patients. Distributed leadership style
will emphasize on the planned outlook that identifies leadership as a shared social process which
builds the relations of various factors rather than individual traits and behavior of the nurse
leader. This leadership style is particularly useful in the given scenario as the leadership duties
are distributed among the employees of the healthcare organization. Distributed leadership style
will enhance the autonomy of the health workers in the organization and give them
empowerment so that they can be leaders and involve in partnership with other professionals to
build a team which directs at implementing the HEDIS. Distributed leadership will encourage the
partnership practice and at the same time following the ethical code of conduct. This leadership
style discourages isolation linked with the absence of power by the followers/employees. So a
leader with this leadership style in a care organization would help in distributing the required
knowledge. The nurse leader can make use of team work to push HEDIS. Evidence from
literature reveals that this style of leadership and team work together can to bring about many
changes in the healthcare settings (Boak, et al., 2015).

Conclusion
HEDIS is a detailed set of regulated quality performance measures planned to offer buyers and
consumers with the information they require for authentic comparison of care plan performance.
HEDIS quality initiative makes preventive and self-management care accessible to the service
user. In addition, it increases the professional-patient relationship and lead to improved
outcomes. For, the care providers, HEDIS aims to improve the health of the member population
and have a constructive influence on their communities. When this measure is implemented and
evaluated for compliance, it is essential to ensure that care settings have leaders who follow
distributed leadership style. The Nurse leader must communicate the necessary information to
relevant stakeholders. They must also convey the significance of the quality measures and assist
with the data collection process and build. The evidence proving the value of these quality
measures is limited but these are increasingly utilized in health facilities.
References
Boak, George, Dickens, Victoria, Newson, Annalisa, . . . Louise. (2015). Distributed leadership,
team working and service improvement in healthcare. Leadership in Health Services,
28(4), 332-344.
cms.gov. (2017, June 7). Healthcare Effectiveness Data and Information Set (HEDIS). Retrieved
from Cms.gov: https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans/SNP-
HEDIS.html
Morris, C., & Bailey, K. (2014). Measuring Health Care Quality: An Overview of Quality
Measures. Families USA.

NCQA. (2018). HEDIS and Performance Measurement. Retrieved from NCQA:
https://www.ncqa.org/hedis/
Saver, Martin, Adler, Candib, Deligiannidis, Golding, . . . Topolski. (2015). Care that Matters:
Quality Measurement and Health Care. PLoS Med, 12(11).