The future of healthcare data integrity

The importance of accurate and reliable data cannot be emphasized enough in the healthcare industry. Clinical data fuels critical decisions, from improving patient outcomes to meeting regulatory standards for quality reporting. Yet, the challenge of aggregating healthcare data from diverse sources has never been greater. Hospitals and providers rely heavily on electronic health records (EHRs) and over 96% of U.S. hospitals use certified systems.^[1] However, inconsistencies in the quality of data shared across the healthcare ecosystem continue to undermine the potential to drive better care. The NCQA's DAV program represents a significant advancement in ensuring healthcare data integrity. DAV equips healthcare organizations to overcome data aggregation challenges while enabling seamless, trustworthy data exchange. 

Key challenges in healthcare data management

The challenges span technological, operational, and regulatory domains, impacting the ability to deliver high-quality care and maintain operational efficiency. The following are the primary hurdles encountered in healthcare data management.

• Data volume and complexity: Healthcare organizations grapple with an ever-increasing volume of data from diverse sources, including EHRs, wearable devices, and patient-reported outcomes. Managing and deriving meaningful insights from this vast and complex data landscape poses significant challenges.
• Interoperability issues: Despite advancements in health information technology, many healthcare systems still operate in silos. The lack of standardization in data formats and exchange protocols hinders seamless data sharing and integration across different platforms and organizations.
• Data quality and consistency: Ensuring the accuracy, completeness, and consistency of healthcare data across various sources remains a persistent challenge. Inconsistencies in data entry, coding practices, and terminology used can lead to errors in reporting and clinical decision-making.
• Privacy and security concerns: With the increasing digitization of healthcare data, organizations face growing challenges in safeguarding sensitive patient information. Compliance with regulations like HIPAA while maintaining data accessibility for authorized users requires robust security measures and governance frameworks.
• Regulatory compliance: Healthcare organizations must navigate a complex web of regulatory requirements, including those related to quality reporting (e.g., HEDIS) and value-based care initiatives. Ensuring compliance while maintaining operational efficiency poses significant challenges.
• Legacy system integration: Many healthcare providers and payers still rely on legacy systems that are not easily integrated with modern data management platforms. This technological gap complicates efforts to achieve comprehensive and efficient data management.
• Resource constraints: Implementing advanced data management solutions often requires significant financial investment and specialized expertise. Many healthcare organizations, particularly smaller ones, struggle with resource limitations in adopting and maintaining sophisticated data management systems.
• Rapid technological advancements: The fast-paced evolution of healthcare technology, including AI and machine learning applications, creates challenges in keeping data management practices up-to-date and aligned with the latest innovations.

Addressing these challenges requires a multifaceted approach, combining technological solutions, strategic planning, and organizational commitment.

Understanding NCQA's DAV program

The NCQA’s DAV program, launched in 2021, sets a new standard for ensuring the integrity of clinical data. Success in the healthcare industry increasingly depends on data quality reporting, compliance, and improved patient outcomes. The DAV program helps by evaluating how clinical data is collected, processed, and shared. It ensures that data streams meet stringent accuracy and reliability standards. The key components of the DAV program include:

• Primary source verification, ensures that aggregated data aligns with its sources, minimizing the risk of errors.
• Data ingestion, transformation, and governance processes are assessed for consistency and security.
• Output formats like FHIR (Fast Healthcare Interoperability Resource) and CCD (Continuity of Care Document) are evaluated to meet NCQA’s interoperability guidelines.

Early adopters have demonstrated the program's impact. For instance, Azara Healthcare^[2] improved HEDIS reporting efficiency through validated data streams, reducing the need for costly audits. Similarly, the Wisconsin Statewide Health Information Network (WISHIN)^[3] increased administrative HEDIS rates by over 10 points in just one year.

Implications for stakeholders

The NCQA's DAV program has far-reaching implications across the healthcare ecosystem. DAV is set to transform how various stakeholders operate and make decisions by ensuring the integrity and reliability of clinical data.

Let's explore the specific benefits for key players in the industry:

• Providers: Validated data streams enable better clinical decision-making and patient outcomes by offering actionable insights while reducing the administrative burden of quality reporting for providers. This allows healthcare professionals to focus more on patient care and less on data management.
• Data aggregators: Data aggregators benefit from enhanced credibility and market differentiation, with DAV certification showcasing their ability to meet rigorous standards for data integrity. This certification can be a powerful tool for establishing trust with potential clients and partners.
• Payers: Trusted data supports accurate HEDIS reporting, strengthens value-based care models, and reduces costs tied to manual validation processes. This improved efficiency can lead to better resource allocation and potentially lower healthcare costs for patients.

The ripple effects of DAV extend beyond these immediate benefits. As more organizations adopt DAV-certified processes, we can expect to see a shift towards more standardized, high-quality data across the entire healthcare industry. This standardization has the potential to accelerate innovation, improve interoperability, and lead to better patient outcomes. 

The role of a Center of Excellence (CoE) in NCQA programs

A CoE plays a pivotal role in helping healthcare organizations navigate the complexities of NCQA programs, particularly the DAV initiative. With a team of seasoned experts spanning multiple NCQA domains, a CoE brings unparalleled insight into the intricacies of achieving DAV certification.

• Comprehensive guidance to organizations pursuing DAV status, from understanding NCQA standards to optimizing workflows and data governance. Their experience helps stakeholders streamline the certification process and minimize inefficiencies.
• Constant support in developing robust systems and processes that meet NCQA's rigorous standards for data accuracy and interoperability. This includes aligning data management practices with evolving frameworks such as FHIR.
• Bespoke strategic solutions tailored to improve data quality. For example, healthcare clients have reported enhanced HEDIS rates and reduced audit burdens through their tailored support.

A CoE serves as a critical partner in the journey toward DAV certification and broader NCQA compliance. Its expertise not only streamlines the certification process but also helps organizations with the benefits of validated data streams, contributing to improved healthcare outcomes and operational efficiency. CitiusTech with its in-house CoE for NCQA certification and accreditation programs can assist data aggregators in obtaining NCQA DAV certified status for their patient data feeds–resulting in bridging any gaps between providers and payers while facilitating operational efficiencies. 

Future outlook: The path ahead for the DAV program

The future of NCQA's DAV program reflects the rapid evolution of healthcare data management and interoperability. One key development is the inclusion of FHIR® (Fast Healthcare Interoperability Resources) exchange. This addition aligns with the industry's shift toward modern data standards that promote seamless sharing and integration across platforms. With FHIR's growing adoption, this evolution will allow stakeholders to harness more interoperable and actionable data.

• As healthcare organizations increasingly rely on real-time data exchange, the incorporation of FHIR into the DAV program is expected to improve the consistency and usability of data streams.
• FHIR's structure supports enhanced data-sharing capabilities, which are critical for advancing population health initiatives and value-based care models.

The broader adoption of DAV is inevitable as the industry recognizes the value of validated data streams. According to NCQA, the demand for data-driven insights is set to increase, with organizations prioritizing investments in technologies that ensure data reliability and compliance.

Conclusion

The NCQA's DAV program represents a significant leap forward in healthcare data management. Organizations embracing DAV standards position themselves at the forefront of data-driven healthcare transformation. This approach ensures not only regulatory compliance but also unlocks the potential for enhanced patient outcomes and operational efficiencies.

References

1. National trends in hospital and physician adoption of electronic health records (healthit.gov)
2. Achieving certified data stream status: A mark of excellence (azarahealthcare.com)
3. Validated data improves HEDIS measure reporting (healthcatalyst.com)