Our primary means for exploring how care coordination might be measured in novel ways using data from electronic data sources was through discussion with a panel of experts. Details of the panel selection process and discussions are outlined below. We also investigated additional sources that panelists suggested would help inform our discussion, and consulted with additional informants who provided background information and feedback on conclusions from the panel review. We synthesized information learned from all these sources and present results and conclusions in this report.
The project team sought to assemble a panel of experts in electronic data sources that might be used today or in the near future to measure care coordination. To identify these experts, we first sought the input of AHRQ, which has an extensive research portfolio in health IT. We received a list of AHRQ-recommended individuals and began our outreach with these potential participants. As we progressed through initial calls and learned of additional potential avenues to explore, we grew the list of individuals we sought to engage in the panel. These additional means of identifying potential panelists included:
- Association with reports, workgroups, or other materials reviewed as part of our background research.
- Referrals from other panelists.
- Referrals from individuals we contacted, but who were unable to participate in the panel themselves.
- Web research for individuals associated with organizations of interest.
The following individuals participated in our expert panel review and have agreed to have their names appear in this report.
Table A-1. Expert Panelists and Affiliations
|Hunt Blair||Deputy Commissioner, Division of Health Reform & State Health Information Technology Coordinator||Department of Vermont Health Access|
|Carmella Bocchino||Executive Vice President||America's Health Insurance Plans|
|Keri Christensen, M.S.||Senior Policy Analyst, Performance Improvement||American Medical Association|
|Joanne Cuny, R.N., M.B.A.||Director, PCPI Measure Testing and Quality Improvement||American Medical Association|
|Aaron N. Cutshall, M.S.C.I.S.||Senior Data Architect||Indiana Health Information Exchange|
|Floyd Eisenberg, M.D., M.P.H., FACP||Senior Vice President for Health Information Technology||National Quality Forum|
|J. Michael Fitzmaurice, Ph.D., FACMI||Senior Science Advisor for Information Technology, Office of the Director||Agency for Healthcare Research and Quality|
|Valerie Fong, R.N., M.S.N.||Senior Manager, Care Delivery Transitions||Kaiser Permanente|
|Craig Jones, M.D.||Director||Vermont Blueprint for Health|
|Melanie P. Mastanduno, B.S.N., M.P.H.||Director, Population Health Measurement||The Dartmouth Institute of Health Policy and Clinical Practice|
|Patrick Miller, M.P.H.||Research Associate Professor; Co-Chair, All-Payer Claims Database Council||New Hampshire Institute for Health Policy and Practice|
|Jon D. Morrow, M.D.||Senior Medical Leader, Clinical Data Services||GE Healthcare|
|Wilson D. Pace, M.D., FAAFP||Professor, Green-Edelman Chair for Practice-based Research||University of Colorado School of Medicine|
|L. Greg Pawlson, M.D., M.P.H.||Executive Director of Quality Innovations||BlueCross BlueShield Association|
|Fred Rachman, M.D.||CEO||Alliance of Chicago Community Health Services|
|Elizabeth Schofield, B.S.N., M.B.A.||Clinical Product Specialist||Siemens Medical Solutions|
|Claudia Steiner, M.D., M.P.H.||Research Medical Officer||Agency for Healthcare Research and Quality|
|Paul Tang, M.D., M.S.||Chief Innovation and Technology Officer||Palo Alto Medical Foundation|
|Charlene S. Underwood, M.B.A., FHIMSS||Senior Director, Government and Industry Affairs||Siemens Healthcare|
*One individual who was unable to be publicly affiliated with this work represented an additional health IT solutions vendor perspective. Additional panelists who do not appear above represent a payer perspective and national-level involvement and expertise with Meaningful Use.
The expert panel review process consisted of individual calls held over approximately 3 months, followed by two group panel discussions.
We held 19 individual calls with panelists during the period of April through July 2011. Each call was between 30 and 60 minutes in length. The team spoke with a total of 21 panelists through these initial calls. These calls were geared toward information gathering and were tailored to each individual's area of expertise. Information we sought from most individuals included:
- Feasibility of measuring care coordination processes using electronic data.
- Anticipated time horizon for care coordination measurement using electronic data.
- Most promising possibilities (near-term and long-term) for care coordination measurement using electronic data.
- Challenges in using electronic data for care coordination measurement.
- Data elements typically available in health IT systems.
- Format (structured vs. unstructured) and accessibility of key data elements.
- Standards for coding or capturing key data elements within health IT systems.
The project team convened two 2-hour group conference calls in July 2011. Each call had unique participants with an identical agenda that included background material (Appendix B). A project team member moderated the calls guided by the call agenda and the particular comments and discussion of each call. The distribution and participation of panelists across the two calls was based solely on the panelists' availability. A total of 14 individuals participated in one of the two group calls.
We assembled our panel of experts by soliciting recommendations from AHRQ based on a list of desired expertise areas, then used a "snowball" technique to identify additional informants by asking each panelist we spoke with for recommendations of other experts or organizations to contact. While effective in covering our desired expertise areas, this method is limited in its reliance on personal contacts. Although not within scope of expertise sought, additional perspectives from provider organization operations, finance administrators, and front-line clinicians may have supplemented our findings in useful ways.