HEDIS (Healthcare Effectiveness Data and Information Set) is a widely used tool for measuring and evaluating the performance of healthcare organizations and health plans. It provides a standardized and evidence-based set of measures designed to assess the quality of care. This standard is maintained by the National Committee for Quality Assurance (NCQA). HEDIS is also increasingly used to track the year-to-year performance of healthcare plans.
HEDIS Approach
HEDIS measures cover many topics, including preventive care, chronic disease management, access to care, patient satisfaction, and others. The data collected through HEDIS is used to compare the performance of different health plans, identify areas for improvement, and track progress over time. HEDIS is considered an essential tool for promoting high-quality, evidence-based care and improving the overall health of communities.
Building your HEDIS calculation engine
HEDIS consists of over 90 measures across several domains, including preventive care, treatment of specific conditions, and utilization of health services. The first step of building a calculation engine is determining which measures are relevant to your organization.
Once we have decided on the measures we want to incorporate into our calculation engine, we need to understand the components involved in its creation.
Components of a HEDIS calculation engine
- Data ingestion
This component is used to ingest patients’ information that can be used to calculate HEDIS measures. This may include claims data, electronic health records (EHRs), and other sources of health information.
- Clean and standardize the available data
This component is used to clean and standardize data. Steps may involve removing duplicates, standardizing names and codes, and filling in missing data.
- Calculate HEDIS measures
This component is core to calculating HEDIS measures. All HEDIS measurement formulas are defined by eligible populations, numerators, denominators, and exclusions criteria. We will need to create the list of clinical codes against every Hedis’s quality measure of these criteria before we can actually start the calculations.
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- Report results
Once you have validated your results, you’ll need to report them in a way that is meaningful and actionable for your organization. This may involve creating dashboards, reports, or visualizations that highlight your HEDIS performance.
Read how to create a Dashboard in React using D3
The TechVariable team has built a HEDIS quality measures calculation engine for a Chicago-based client. Learn more about the approach we have adopted, the steps undertaken, and the final result of the project.
