As soon as the IOM Quality Chasm results become known effort began at the most logical point, collecting data that describes the healthcare environment and identifying other areas of need for data collection. Some professionals have begun to express some concern about the myriad of quality reporting domains and systems, thus calling for national coordination. Others have expressed frustration that efforts might lead to even more expectations, such as an increase in the "Never Events". Both areas are important and reflect transitional attitudes to what is most likely going to be a "continuuous improvement" effort.
What is most troubling about current efforts is that many users of quality reporting systems are beginning to question their value. In part this may be the result of the number of choices, but it seems more the result that too few if any of these quality systems leverage the data collected and have offered infrastructure and expertise to move into the real areas that impact changes to quality - assessment and re-engineering.
We have direct experience with two popular quality reporting systems focused on the Critical Access Hospital domain. One is very comprehensive and supports traditional, periodic financial, operational, productivity and quality metrics but also integrates in a SOA with quality incident reporting as well as patient surveys. Both focus on the collection and reporting aspect and struggle to produce value primarily on the reporting side either identifying new metrics or trying to find a more appealing method to show results. Unfortunately, the user base is neither knowledgeable or motivated enough to ensure this approach. What is missing in both situations is the expertise to surround these users with the ability to assess the reports and the re-engineering capacity.
Substantial effort is still needed on the data collection aspect of CARe. Focus in collection needs to focus on EMR/EHR direct capture of data and population of aggregation at the HIE level as well as HIE facilitation of Quality Use Case where multiple reporting systems are populated. The effort must continue to demonstrate the substantial power a provider will create by knowing quality aspects earlier than that supported by the more national reporting systems.