Implementation of a Population Health and Quality Reporting System for FQHCs

Implementation of a Population Health and Quality Reporting System for FQHCs

FQHC pophealth Pool Project pophealth is an Open-Source Clinical Quality Measure database and reporting engine presented through a web-based interface Centralized repository of clinical data Data is sent from EHRs via nationally recognized standards Consolidated Clinical Data Architecture (C-CDA) Architecture Continuity of Care (CCD)Document Clinical Quality Measures (CQMs) are calculated for providers and presented through a web-based interface Drill down ability to the provider and patient-level data Ability to compare a provider to the aggregate Track trends in quality and health over time Identify areas for improvement in workflow and data capture

FQHC pophealth Status All 14 FQHCS in CT participating 4 currently sending live data 2 testing process Remaining FQHCs upgrading their EHR first Contracted with EHR vendors to create CCD batch extracts pophealth is hosted centrally and data is sent via SFTP from each FQHC Potential to move to Direct Mail transport in the future ehct enhanced pophealth Role-based access Comparison to aggregate FQHCs send Continuity of Care (CCD) data to pophealth Currently used for MU CQMs Working with other public entities in CT to use data for grant reporting

pophealth Implementation Challenges pophealth is Open Source prototype software that was developed by MITRE through a grant from ONC Pros No cost to purchase Active Open Source Community All users benefit from enhancements/contributions back to the Open Source Community Cons Free like a puppy Documentation is lacking and support is voluntary through Open Source Community Requires skill set that is unusual: HL7, QRDA standards Mongo DB Ruby on Rails JSON

Data Flow for Population Health Management Clinicians Enter Patient Data into EMR Providers Collaborate on Patient Health Secure Transfer of Patient Data Electronic Medical Records Database for Practice Population Health Reporting Tool

pophealth Today for FQHCs pophealth Database pophealth Reporting Tool FQHC 1 EHR CCD Data FQHC 1 Data FQHC 2 EHR CCD Data FQHC 2 Data FQHC 3 EHR FQHC 4 EHR CCD Data CCD Data FQHC 3 Data FQHC 4 Data Aggregate Data Role-based web access MU Stage 1 and 2 Reports Overall measures with ability to drill down HIPAA compliant Aggregated population health reports

pophealth Next Generation pophealth Database pophealth Reporting Tool EHR 1 CCD via Batch Provider Data EHR 2 CCD via Direct Hospital Data EHR 3 EHR 4 QRDA Cat 1 QRDA via Direct FQHC Data Other Data Aggregate Data Provider CQMs DPH Reporting DSS/Medicaid Cat 3 Docs Comparison to cohort Grant CQMs PCMH ACO

Continuity of Care Data Requirements Extensive clinical data is needed to be present in Continuity of Care Documents (CCDs) for automating the generation of Meaningful Use Clinical Quality Measures in pophealth Allergies: RxNorm*, SNOMED-CT* Care Goals, Social History, Medical Equipment: SNOMED-CT* Conditions: SNOMED-CT*, ICD-9-CM, ICD-10-CM Encounters: CPT Immunizations, Medications: RxNorm*, CVX* Procedures: CPT, ICD-9-CM, ICD-10-CM, SNOMED-CT* Vitals, Results, Assessments: LOINC*, SNOMED-CT* Communications: SNOMED-CT * preferred Requires that all continuity of care entries are time-stamped Requires that results and vitals must be provided structured with units and values

CDA and QRDA Comparison CCD Continuity of Care Document (A summary document for a single patient) CDA Clinical Document Architecture (An architecture with templates for clinical documents e.g. CCDs) CCDA Consolidated Clinical Document Architecture (Similar to CDA) QRDA Quality Reporting Document Architecture (An architecture with templates for measure reports) CCD (CDA) CCD 1.1 (CCDA) QRDA Cat 1 Header (template IDs) Header (template IDs) Header (template IDs) Author, Custodian, Informant, etc Author, Custodian, Legal Authenticator, etc. Author, Custodian, Legal Authenticator, etc Patient Information Patient Information Patient Information Provider Information Provider Information Provider Information Structured sections - Procedures - Medications - Problems/Allergies - Encounters - Results Etc. Structured sections: - Procedures - Medications - Problems - Allergies - Encounters - Results Etc. Three 'components' - Measures - Reporting parameters - Patient Data (aggregate of entries for various sections)