Implementation activities (IMPL) refer to configuration, customization and other steps that are needed for health information technologies to function for a specific organization or group of end-users. For example, with clinical decision support, the local implementation will consider end-user workflows to identify the points at which to present the CDS, determine which data fields in local databases will map to data fields that drive the CDS, and educate end-users about important features of the CDS. Typically this involves translation of guideline recommendations from L3 to L4 or other local adaptation (localization).
The importance criterion is the extent to which the specific measure focus is important to making significant gains in healthcare quality (e.g., safety, timeliness, effectiveness, efficiency, equity, patient centeredness), and improving health outcomes for a specific high-impact aspect of healthcare where there is variation in or overall poor performance.
The Importance criterion is the extent to which the specific measure focus is evidence-based and important to making significant gains in healthcare quality where there is variation in or overall less-than-optimal performance. Source: National Quality Forum. (2019). Measure Evaluation Criteria and Guidance for Evaluating Measures for Endorsement.
Industry Standard Modeling Techniques use a standard visual approach to facilitate communication related to business models and software design. For example, Unified Modeling Language (UML) uses integrated diagrams to specify and document the structure and dynamic behavior of information system and software artifacts.
Informatics activities (INFO) include tasks related to knowledge engineering and technical development of CPG artifacts (L2 to L4). These may include, but are not limited to: developing use case diagrams, flow diagrams, and decision trees; identifying relevant data elements, FHIR profiles, terminologies, value sets, libraries, rules, and logic representations; writing software code (e.g., for CDS); and developing comprehensive test cases and testing resources.
With an integrated process, steps related to guideline development, informatics activities, implementation, evaluation, and communications are conducted in parallel, insofar as possible, rather than in sequence.
An intermediate outcome measure is a measure that assesses the change produced by a healthcare intervention that leads to a long-term outcome.
An inverse measure is a measure where a lower performance rate is better. Therefore, a zero performance rate for these measures is a good score. For example, the National Healthcare Safety Network calculates most healthcare-associated infections (HAIs) as a standardized infection ratio (SIR). The SIR compares the actual number of HAIs (the numerator) with the predicted number based on the baseline U.S. experience (e.g., standard population), adjusting for several risk factors that have been found to be most associated with differences in infection rates. The goal is to have the numerator equal to or very close to zero thereby having an SIR equal to or very close to zero.