QUALITY REPORTING Zahid Butt MD,FACG October 22, 2010
The Quality Landscape 100+ Entities Data Sources Claims / Administrative Mandatory Submission Voluntary Submission Other Databases Source: Society of Actuaries 2009 Page 1
Public Reporting / Ratings Source: Society of Actuaries 2009 Page 2
Accreditation/Certification Source: Society of Actuaries 2009 Page 3
Government Programs Source: Society of Actuaries 2009 Page 4
ARRA / HITECH Meaningful Use Use Certified EHR Technology Meet Minimum Performance Thresholds of Specified Functionality Measures Generate Specified Quality e-measures Enhance Patient Security and Confidentiality Report to CMS Functional Measures Performance Quality e-measures Reporting Function
ARRA / HITECH Meaningful Use Page 6
Certified EHR Technology Eligible MEDITECH Hospitals Complete EHR Certification* MEDITECH Versions Magic & C/S 5.64 with ARRA Priority Pack 6.0x with ARRA Priority Pack Modular EHR Certification* Other Vendors Meaningful Use EHR Functionality Quality Reporting Vendors *Projected
Stage I CQM e-measures (15) Eligible Hospitals (TJC Retooled) Emergency Department Throughput admitted patients Median time from ED arrival to ED departure for admitted patients. Stratify by Psychiatric Diagnosis Emergency Department Throughput admitted patients Admission decision time to ED departure time for admitted patients. Stratify by Psychiatric Diagnosis Ischemic stroke Discharge on anti-thrombotics Ischemic stroke Anticoagulation for A-fib/flutter Ischemic stroke Thrombolytic therapy for patients arriving within 2 hours of symptom onset Ischemic or hemorrhagic stroke Antithrombotic therapy by day 2 Ischemic stroke Discharge on statins Ischemic or hemorrhagic stroke Stroke education Ischemic or hemorrhagic stroke Rehabilitation assessment VTE prophylaxis within 24 hours of arrival Intensive Care Unit VTE prophylaxis Anticoagulation overlap therapy Platelet monitoring on unfractionated heparin VTE discharge instructions Incidence of potentially preventable VTE Page 8
TJC Core Measures (Abstracted) Page 9
Abstracted Measures Worksheet Page 10
Abstracted Measures Worksheet Page 11
Clinical Documentation Sources Core Measures Data Elements Core Measures Its All About Data: Jane Metzger et. al Page 12
AMI 6 Data Elements Core Measures Its All About Data: Jane Metzger et. al Page 13
Clinical Quality e-measures e- Measures Specifications Development Retooling of Existing Measure Sets New Measure Sets Data Captured / Mapped With Standards based Nomenclature & Codification Abstraction Burden Shifts to Documentation Burden Computer Programming Substitutes for Human Cognition in Some Instances Page 15
Quality Data Set (QDS) - HITEP Page 16
HITSP e-measures Specification Page 17
Define Stroke Population Page 18
Ischemic Stroke Value Set Page 19
Ischemic Stroke Value Set Page 20
Stroke Denominator Exclusions Page 21
Palliative Care Value Set Page 22
Palliative Care Value Set Page 23
Therapy Exclusion Reason Page 24
Therapy Exclusion Reason Page 25
Systematized Nomenclature Of Medicine Clinical Terms Developed by CAP as SNOMED RT Merged with NHS CT (Read Codes) Currently maintained by IHTSDO 311,000 Active Unique Concepts 800,000 Unique Descriptions 1,360,000 Links / Semantic Relationships 5000 CORE Problem List Subset Formal Processes: Cross Maps / Extensibility / New concepts (terms) Page 26
SNOMED CT Data Structures Page 27
SNOMED CT Top Level Hierarchies Page 28
SNOMED DOMAIN ATTRIBUTES Page 29
SNOMED TERM DESCRIPTIONS Page 30
Clinical Observations Recording and Encoding (CORE Subset) Page 31
e- Measures Data Element Sources & Code Sets MT Applications e-measures Data Elements Code (Value) Sets Registration / ADT A/D/T & Demographics UB 04 NUBC Lab Information System Selected Lab Result Values LOINC PCM (CPOE) / RxM Inpatient Orders Discharge Medication Orders Rx Norm SNOMED Pharmacy Medications Administered Rx Norm Problem List Inclusions & Exclusions SNOMED Medication Allergy List Exclusion Medications SNOMED Physician Notes Exclusion Reasons Discharge Instructions SNOMED Nursing Notes Interventions Performed SNOMED Page 32
Maintain Problem List Final Rule The measure associated with this objective requires that entries be recorded in structured data and in this context we adopted ICD 9 or SNOMED CT to provide that structure. As a result, Certified EHR Technology must be capable of using ICD 9 or SNOMED CT when an eligible professional or eligible hospital seeks to maintain an up-to-date problem list. 45 CFR Part 170 We did not and do not intend that coding of the diagnosis be done at the point of care. This coding could be done later and by individuals other than the diagnosing provider. 42 CFR Parts 412, 413, 422 et al. Page 33
Abstracted Problem List Page 34
MEDITECH PCM Problem Lists Page 35
Problem List Dictionary Page 36
Current e- Measures Issues with Use of Problem Lists Problem Lists are Patient Centric & Current Quality Measures are Encounter Centric Problem Lists Do Not Support Encounter Coding Concepts Principal Diagnosis Discharge Diagnosis ICD 9 allowed in Functional Requirements but not in e-measures- Need to Maintain Mapping if ICD 9 is used in Problem List Page 37
Best Practice Workflow Example Page 38
Medisolv Meaningful Use Module Data Import (? Data Mapping) Support both Functional and Quality Measures Generate Measure Results Create PQRI Registry 2009 XML Files with Aggregate Results for Quality Measures Create Attestation Ready Reports in 2011 e-submission of Quality Measures Aggregate results in 2012 and beyond Modular EHR Reporting Certification Page 39
Meaningful Use Measures Medisolv Dashboard
Eligible Hospitals Reporting Periods & Payments Stage I Yr 1 90 Continuous Days by Sept 30, 2011 for EH 90 Continuous Days by December 31,2011 for EP Stage I Yr 2 365 Continuous Days by Sept 30, 2012 for EH 365 Continuous Days by December 31, 2012 for EP Earliest Report Submission April 2011 Earliest Payments Start May 2011 Page 42
CMS National Data Repository for Meaningful Use Payments Northrop Gruman awarded $ 34 Million Contract to Build and Manage Receive Data from Provider & Hospitals for Meaningful Use Reporting Determine Meaningful Use Compliance Determine Amount & Accuracy of Payment Avoid Duplication of Payments Page 43
Prepare & Plan Now Establish Leadership/Workgroup Team(s) Educate Team Members/Executives Detailed Gap Analysis Software Applications with Certified Versions Standards Based Data Capture Detailed Implementation Plan Design/Redesign Documentation Work Flows Incorporate MEDITECH Best Practices Develop Reporting Strategy Page 44
Summary Opportunity to Design (Re-design) EHR e-measures CQM & Functional Measures Have Important Dependencies Plan Ahead for Stage II & III Point of Care Problem Lists Implement CPOE / PCM / BMV / EMAR / Med Rec. Clinical Documentation with Selected Structured / Coded Data Elements Abstraction Burden Maybe Reduced but will not be Eliminated Page 45
Thank You Zahid Butt MD, FACG CEO Medisolv Inc, 443-539-0505 Ext 23 zbutt@medisolv.com Page 46