Overview of HEDIS and ORYX Measures

Health Plan Employer Data and Information Set (HEDIS) created by the National Committee for Quality Assurance (NCQA) has for several years been the most popularly utilized battery for evaluating performance of health plan by use of clinical records and administrative data. HEIDS is an instrument utilized by over 90% of health plans in America for performance measure on essential dimensions of service and care.  HEDIS contains 81 measures across five care domains. HEDIS increases the possibility to compare the health plans performance on basis of apples-to-apples, since HEDIS data are gathered by so many plans and measures are defined specifically. To develop measures the healthcare organization will need to identify the clinical section to be assessed, perform a wide literature review, use suitable MAP to develop measures among other panels, this should be followed by vetting the developed measure with different stakeholders, and conducting a field-test which determines validity, reliability, and feasibility. The acute health care organization thus needs to determine the best clinical areas that may need to be evaluated and follow this procedure to evaluate them. The main aim would be to determine their actual level of performance with intention defining causes of poor performance and hence the best strategies to improve it to the right or desired level.

ORYX is regarded as an entity with processes for analyzing and colleting measure data from a number of organization and distributing the analysis results to its client base. It contains an automated database which can be utilized to enhance improvement of performance in health care organizations. ORYX contains the aptitude to generate internal comparisons of performance of every participating organization over time and conducting external performance comparison among the involved organizations. It also has the aptitude to transmit data for a particular period of time. Joint Commission accredited hospitals are needed to gather and report performance data for some or all of core measure sets(The Joint Commission, 2014). In acute care setup, the hospital may be needed to gather and report data on performance of all its operational sections. These include data on patient outcomes and satisfaction, rate of admission, readmission, medical errors, death rates in different medical condition, data on patients’ drug interactions, drug efficiency in handling a certain health issue, and the rate of preventable deaths. To improve performance, the hospital will need to collect the above stated data and compare it with the past year performance to determine the trend for internal assessment. This will show whether there is need to employ new operation methods to better the performance. The data can also be compared with other nearby similar organizations to determine if the hospital is doing its best to get the best possible performance (Centers for Medicare & Medicaid Services, n.d.). In case the organization is showing poor performance than other, it should consider defining it sources of failures and use others as their example to make improvements.


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