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

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.