AV: We’re at the nexus of the health care system. Just in the same way as when we work a shift, we’re the one place that is talking to providers in the hospital and outside the hospital. We see what happens when patients do not have access to effective heath care. We see so much of the cost levers at different places. The same is true on the policy side. So far on the policy side, that’s given us a lot of monikers that we don’t particularly care for and don’t reflect our care, such as the unnecessary ED visit or the costly price tag. The only way to get above the fray when it comes to all of those stories is to have data.

AV: It really helped me to achieve two aims. It was first a way to really embed myself in federal quality measurement policy; I had the opportunity to serve on several national quality forums, technical expert panels, and advisory committees. I had the opportunity to participate as both an emergency clinician as well as a health services researcher in the conversations about how measures get endorsed. At the same time, I also had the chance through our Center for Outcomes Research & Evaluation at Yale to work on several projects for CMS and their development of measures of hospital quality and hospital efficiency. I had completed the Robert Wood Johnson Clinical Scholars Program, so I had great research training. What you need is a little bit of help and support to get your first project up and off the ground. In my year, I had the chance to work with a big national data set that has a lot of detailed clinical and cost data. I studied variation between EDs and the use of observation services and how that variation may impact our measurement of their admission rates as well as their total cost of care.

AV: It’s a particularly great time for it because of ACEP’s launch of CEDR, the Clinical Emergency Data Registry. Now, all of a sudden, you have an infrastructure in place where thousands of EDs around the country are going to be coming into the CEDR to fulfill their quality reporting requirements for CMS. I think that emergency medicine has a lot of opportunity in the coming years to develop the next generation of quality measures. No longer measuring things that are simple process of care, like “Did you do an NIH stroke scale for a patient with a stroke?,” but rather getting to the next level. What does a patient-reported outcome measure look like for emergency medicine? Can we develop the science to say that we can effectively measure differences in headache treatment? Can we do a better job of actually measuring cost?