Webinar #2 Data Capture: Meaningful Use Core Measures 6-12

Transcription

1 New York State-Health Centered Controlled Network (NYS HCCN) Webinar #2 Data Capture: Meaningful Use Core Measures 6-12 June 18, 2013 Ekem Merchant-Bleiberg, Clinical Implementation Specialist

2 Welcome & Introductions Participants Presenters How to Participate Learning Objectives

3 How to Participate Today Open and close your Panel View, Select, and Test your audio Submit text questions Raise your hand Q&A addressed throughout the session

4 Learning Objectives Review and define Stage One/ Stage Two MU Core Measures 6-12 How to capture and collect data for Stage One/Stage Two MU 6-12 Data Review Demonstration: Center for Primary Care Informatics (CPCI) /Arcadia

5 Phasing of requirements Slide adapted from HIT Policy Committee, Workgroup on Meaningful Use. June 16, 2009

6 Meaningful Use Criteria (Measures) For Eligible Professionals, there are a total of 25 meaningful use objectives of which 20 must be completed to qualify for an incentive payment. 15 are core objectives that are required, The remaining 5 objectives may be chosen from the list of 10 menu set objectives In the first year, and EP is required only to acquire, implement/upgrade a certified EMR with e-prescribing; Meaningful use criteria reporting is required in Year 2 (90 consecutive days) Meaningful use criteria reporting is required in Year 3 (365 consecutive days)

7 Core Measures Review 1. Stage 1 Core Measures Define the objective 3. Review the measurement 4. Discuss where this can be captured in CPS. Stage One 7. Record Vital Signs 8. Record Smoking Status 9. Implement one clinical decision support rule and ability to track compliance with rule. 10. On request provide patients with an electronic copy of their health information 11. Clinical Summaries for patients 12. Implement systems to protect privacy and security of patient data in the EHR

8 Stage One Measure 7:Vitals Documentation Core Objective Record and chart changes in vital signs: Height Weight Blood pressure (age 3 and over) Calculate and display BMI Plot and display growth charts for patients 0-20 years, including BMI Measure More than 80% of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data

9 Denominator Denominator/Numerator: Vitals Count 1 for every patient that meets the qualifying age and is seen by the eligible provider. Numerator Of the patients in the denominator, count 1 for every patient for whom all required vitals are recorded at least once in the patient's chart recorded - The required vitals entry date must be on or before the last day of the measure reporting period. required vitals - Includes height, weight, and blood pressure only as specified in the CMS measure.

10 Measure 7:Vitals

11 Stage Two Measure 8: Smoking Status Core Objective Record smoking status for patients 13 years old or older Measure More than 80% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data

12 Denominator/Numerator: Smoking Status Denominator Count 1 for every patient that meets the qualifying age and is seen by the eligible provider. Numerator Of the patients in the denominator, count 1 for every patient for whom a smoke status was recorded and signed in the patient's chart using smoke status observation terms with ONC-specified values. recorded - the smoking status entry date is on or before the last day of the measure reporting period. smoke status - searches for the observations Cigaret smkg, SMOK STATUS, smokes, smoking hx, HX CIGARETTE, SMKSTATOVR13.

13 Measure 8: Smoking Status

14 Core Objective Stage One Measure 9: Clinical Decision Support Use clinical decision support to improve performance on high-priority health conditions Measure Implement 5 clinical decision support interventions related to 4 or more clinical quality measures, if applicable, at a relevant point in patient care for the entire EHR reporting period.

15 Measure 9: Clinical Decision Support Providers have considerable flexibility in meeting this measure. They need only attest they are using a clinical decision support rule. For example, anything that provides a notification will be counted, including a pop-up alert that requires a response or an indicator on a form showing an immunization, exam, or test due.

16 Measure9: Clinical Decision Support Example

17 Core Objective Stage One Measure 10: Provide copy Electronic On request* provide patients with an electronic copy of their health information Health Information* Measure >50% of requesting patients receive electronic copy within 3 business days

18 Denominator/Numerator: Electronic Denominator Health Information Count 1 for each recorded qualifying request to which the eligible provider is linked. Numerator Of the qualifying requests in the denominator, count 1 for each request that was fulfilled in the required time frame.

19 Measure 10: Electronic Health Information

20 Core Objective Stage One Measure 11: Clinical Summaries Provide patients with clinical summaries Measure Clinical summaries provided for >50% of patients within 3 business days

21 Denominator Denominator/Numerator: Clinical Summaries Count 1 for every qualifying office visit linked to the eligible provider. Note : for this measure the Patient Encounter (MU) document view is not used to filter documents because it includes more document types than those used for an office visit. For the document to be counted in the denominator, the document needs to be signed AFTER the Clinical Summary has been printed and BEFORE the end of the reporting period. (Workflow dependent) Numerator For qualifying office visits in the denominator, count 1 where at least one qualifying visit summary audit event is logged or if a patient has the qualifying portal access during the required time frame.

22 Workflow Suggestion: Clinical Summaries Print Handout Important. The handout must be printed BEFORE the chart document is signed, otherwise visit-specific content is not included. The handout must be printed from an IN-PROGRESS update. If you attempt to print the handout outside an update, you cannot include visit information, and you will see MEL errors for some sections. 1. In the application, start an update of any type and document the patient encounter, but do not SIGN the update document. (Clinical List updates, including Problems and Medications, can be signed prior to printing.) 2. In the Chart menu, click Handouts. 3. Find and select the Clinical Visit Summary handout (or *Patient Instructions handout associated with the Patient Instructions-CCC form), and then click Print. 4. Important: The asterisk (*) must precede Patient Instructions in the name of the handout. 5. On the Print Patient Education Handout window, select Record handout printing in Chart before clicking Print. This workflow can be simplified when using handout custom lists and placing the Clinical Visit Summary in the appropriate handout custom list. 6. Give the handout to the patient or mail within 3 business days.

23 Workflow Suggestion: Clinical Summaries Generate CCD 1. In the application, go the patient s chart and in the main menu click Actions > Generate Chart Summary. 2. Set export, security, and clinical list options. 3. Export to preferred destination.

24 Measure 11: Clinical Summaries

25 Measure 11: Clinical Summaries

26 Measure 11: Summary Event Audit Log Setting Make sure that the Print a report option is under the Log Audit Events column.

27 Stage One Measure 12: Systems to Protect Patients Core Objective Implement systems to protect privacy and security of patient data in the EHR Measure Conduct or review security risk analysis, implement security updates as necessary, and correct identified security deficiencies. ; Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

28 Measure 12: Patient Support Systems Your organization must implement and maintain an internal security risk analysis or contract with another third party to analyze and maintain the security of your Centricity Practice Solution network, clients and database Determine a plan to conduct your health center s Security & Privacy Analysis.

29 MU Reporting tools

30 Reporting Tools MQIC Center for Primary Care Informatics (CPCI)Azara Health Care Review reporting capabilities available in CPS 10.0 MQIC Integration Crystal Reports Review CPCI

31 MQIC

32 MQIC Tool for Improvement GE s Clinical Data Warehouse Canned/Factory Reports Custom Reports from MU data cubes, DOQ-IT cubes, and other sources Export Report data to tracking system, custom dashboards, or reporting tools

33 MU Reports Nearly all functional and quality measures will be available in MQIC and as CPS integrated Crystal Reports. The reports can be used for more than just MU. You have access to build reports from the data cubes currently available in MQIC.

34 Quality Reports Not Available NQF (Additional) Appropriate Testing for Children with Pharyngitis NQF 0004 (Additional): Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (a) Initiation, (b) Engagement NQF 0012 (Additional): Prenatal Care - Screening for Human Immunodeficiency Virus (HIV) NQF 0014 (Additional): Prenatal Care - Anti-D Immune Globulin

35 Reports Not Available in MQIC NQF 0032 (Additional): Cervical Cancer Screening NQF 0034 (Additional): Colorectal Cancer Screening NQF 0083 (Additional) Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) [Also Not in Crystal Reports]

36 GE MQIC Warehouse Running Reports

37 MU Reports Tab

38 Running Reports Click on desired report Alliance primarily uses the DOQ-IT measures for the dashboard reports

39 Sample Factory MQIC Report

40 Exporting to MS-Excel Right-click on open space

41 Re-identifying (Re-ID) Patients and Providers Patients and Providers are encrypted Need to use a (free) Excel macro that GE provides to re-identify true patient and provider names and IDs Integrated into CPS 10

42 What About Crystal Reports? All factory reports are converted to Crystal Reports, Professional XI R2. Understand the definition of seen by for Crystal Reports and MQIC. The definition is located on page 7 of the GE Meaningful Use Reports manual.

43 Three Types of Providers Applies to MU Functional and Quality Reports " " = Responsible provider of a document generated from a qualifying visit " " = Signing provider of a document generated from a qualifying visit " " = Responsible provider for the patient's overall chart as indicated in Registration

44 Visit Provider

45 Signing Provider

46 Signing Provider

47 Chart Provider

48 Crystal Reports Embedded in CPS 10.0

49 Chart Reports Module Definition of seen by provider differs from MQIC. Reports may or may NOT match MQIC.

50 Full Use of Custom Parameters

51 Preview of MU Crystal Report

52 MQIC Embedded in CPS 10.0

53 More Info Button

54 MQIC Report Help

55 Show Patient List Button

56 Go To Chart and Convert To Inquiry Buttons Could also go to Reports and generate letters.

57 CPCI/Azara

58 LOC Breakdown

59 LOC Granularity

60 Measure Validation

61 Validation Process Select Measure(s) to validate Observe True Performance Generate the Measure(s) Manually Audit their Record Create a list of patients that failed the measure

62 Step 1: Select Measure(s) Select measure(s) that demonstrate: High Priority Performance Areas Unexplained performance variation or indicate significant gaps in quality of care Be certain to gain clinician buy in

63 Step 2: Generate the Measure In C-EMR there are two ways to access vendor provided quality measures: C-EMR Quality and Reports Module Reports Icon Quality Icon (these are MQIC Reports which are accessed through C-EMR) MQIC (GE hosted clinical data warehouse) Confirm with CPCI/Azara Note that some of the same measures are available in both modules

64 Step 3: Generate a List of Failures Identify a list of patients that apparently failed the quality measure(s)

65 Step 4: Manually Audit the Chart From the Inquiry Window select the patient (double click) Review the chart, particularly to find documentation that actually indicates that the patient met the measure Document your findings from the chart audit on an audit tool Use more than one person to conduct the validation on the same patient list (creates inter-rater reliability)

66 Step 5: Recalculate Performance Create a table to document performance statistic of each measure based on the two methods (auto generated vs manual review) Compare performance and document reasons for differences Develop an action plan to mitigate the most common reasons Implement the plan Regenerate the measures and compare baseline rates to the newly gathered rates

67 Measure Wrap Up

68 Measure Reliability and Validity Reliability is the extent to which a measures accurately and consistently assess the performance of clinician providing care Validity is the extent to which a measure truly measures that which it is intended and designed to measure

69 Challenges with Reliability & Validity Specificity of measure definitions including exceptions Documentation optimization putting key information in the right field Lack of use of standardized coding Mapping of data from outside sources (eg, lab interfaces) with structured fields in EHR

70 Tools to Support Measure Implementation Measure specifications EMR/HIT systems data dictionary Access to clinician/user knowledge related to system use and workflows Access to an ad hoc reporting tool Access to an advanced reporting tool Some calculations too complex to run inside EMR, may need a data warehouse

71 Questions & Thoughts

72 Upcoming Dates Friday,June 21 st 1-2pm: CPS Data & Reporting Office Hours August 16, 2013: Data Capture for Menu Objective 1-5