Abstract
Objectives: To update the sets of patient-centric outcomes measures (“standard-sets”) developed by the not-for-profit organization ICHOM to become more readily applicable in patients with multimorbidity and to facilitate their implementation in health information systems. To that end we set out to (i) harmonize measures previously defined separately for different conditions, (ii) create clinical information models from the measures, and (iii) restructure the annotation to make the sets machine-readable.Materials and Methods: First, we harmonized the semantic meaning of individual measures across all the 28 standard-sets published to date, in a harmonized measure repository. Second, measures corresponding to four conditions (Breast cancer, Cataracts, Inflammatory bowel disease and Heart failure) were expressed as logical models and mapped to reference terminologies in a pilot study.Results: The harmonization of semantic meaning resulted in a consolidation of measures used across the standard-sets by 15%, from 3,178 to 2,712. These were all converted into a machine-readable format. 61% of the measures in the 4 pilot sets were bound to existing concepts in either SNOMED CT or LOINC.Discussion: The harmonization of ICHOM measures across conditions is expected to increase the applicability of ICHOM standard-sets to multi-morbid patients, as well as facilitate their implementation in health information systems.Conclusion: Harmonizing the ICHOM measures and making them machine-readable is expected to expedite the global adoption of systematic and interoperable outcomes measurement. In turn, we hope that the improved transparency on health outcomes that follows will let health systems across the globe learn from each other to the ultimate benefit of patients.
Highlights
Value-based healthcare aims to transform care by aligning different stakeholders to focus on patient centric outcomes
The harmonization of the international consortium for health outcomes measurement (ICHOM) measures for the 28 standardsets resulted in 3,421 original concept-usages (3,178 unique measures) being consolidated onto harmonized measures
Several initiatives aiming at achieving standardization of meaning in healthcare data exist, we argue that ICHOM is unique in its global and patient-centric approach to defining health outcomes, as well as in prescribing a sequence of measurement required to create transparency on health outcomes
Summary
Value-based healthcare aims to transform care by aligning different stakeholders to focus on patient centric outcomes. Data quality issues [6, 14, 15] and challenges in repurposing data have caused concerns on validity [6, 14] of the wealth of data available in clinical information systems [16] The latter is frequently discussed in relation to electronic health records (EHRs), which many argue are tailored to support billing processes, rather than quality improvement efforts. The resulting challenges in extracting, sharing and validly analyzing data remain a barrier to standardized and cost-effective quality measurement [7] Such lack of interoperability may explain why the impact of digital technology on healthcare systems remains equivocal [17, 19,20,21], despite having been projected to partly “replace the intellectual functions of the physician” 50 years ago [22]
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