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Federal Register / Vol. 86, No. 164 / Friday, August 27, 2021 / Notices overarchlng Issue of EHR data quality ldenlfled by the TEP Is the challenge of ellcltlng multfple.
stakeholders e.g., vendors. and providers to participate with measure developers early and throughout the development life cycle In a way that balances the cost of participation with the downstream benefit of reduclngworkflow and Implementation costs once the tested measure ls In each program. Although the final report focuses on opportunities for HHS, CMS. and NQF, additional work In this area does not only lie with these stakeholder groups. It Is recommended that future work should focus on oppcrtunlties for other stakeholders who can have an Impact 011 EHR data quality Issues beyond HHS, CMS, and NQF; Untrtthen, NQF will share the r:ecomrnendatlons in the flnal report With HHS, CMS, and other external stakeholders tor consideration and pctential implementation.

Reducing Diagnostic Error The delivery of high quality healthcare is predicated upcn an accurate and timely diagnosis. Diagnostic errors; which are defined as the failure to establish or communicate an accurate and timely assessment of a patients health problem, contrlbOte to an estimated 40,000-80,000deaths,each.yearLeapeet al., 2002.Approximately 12 million Americans suffer a diagnostic error each year, and.the National Academies of science, Engineering, and Medicine NASEM committee on D1agnosttc Error In Health Care suggested that most people wlll experience at least one diagnostic error in their lifetime Singh et al., 2014.
In 2017, lllf convened a multlstakehoider Expert committee to develop a conceptual framework fer measuring diagnostic quality and safety and to identify priorities for future measure development, The 2017 Measurement Framework included three domains: 1 Patients,FamUies, Caregivers; l Diagnostic Process and Outcomes; and 3 Organ12atron and Polley Qpportunltles. To further advance patient safety and reduce diagnostic error, NQF convened a new multlstakeholder Committee: In 2015t to. revisit and build on the prevTous Committees work.
The lmprovlng Diagnostic. Quality & Safety/Reducfng Diagnostic Error: Measurement tcnslderations Committee first reviewed the Diagnostic Process and Outcomes.domain of the 2011 Measurement Framework to ldentlfy any needed updates. The Committee also Identified high-priority measures, measure concepts, current performance measures, and areas for future measure develcpment that have emerged since the initial development of the 2017 Measurement Framework. Informed by these activities and over a series of web meetlngs-flve of which occurred ln 2020-the Committee developed practical guidance, including specific use cases to demonstrate how the framework can be operationalized In practice, as well as detailed tecommendatlons for measurliig and reducing dlagnostlc error,
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The tcmmlttee designed four use cases to support the practical appllcatlon of the Diagnostic Process and Outcomes domain of the 2017 Measurement Framework. The use cases were developed by the Committee asan opportunity to Identify comprehensive resolutions to specific types of diagnostic errors. The tour use.case topics selected I.e., missed subtle cllnlcal findings, tommunlcation failures, information overload, arid. dismissed patients reflect high-priority problems and examples of diagnostic errors that cause patient harm. Each use case describes a type of diagnostic error; Its causal faetors, key stakeholders who can help overcome and prevent the error, arid globai and granurar sOlutions to the error. The solutions within the use cases reflect opportunities for stakeholders to reduce diagnostic errors In the subdomalns of the Diagnostic Process and Outcomes domain of the 2017 Measurement Framework, allowing. for stakeholders to drive Improvement In multiple areas, Including Information gathering and documentation, information Integration, Information lnterpretatlon,. diagnostic efftclency,