Clinical Quality Measures - Medisolvmedisolv.com/wp-content/uploads/MUSE-Presentation-Slides.pdf · Clinical Quality Measures: Now and Future ... -IMO Integration Required for 2014

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Clinical Quality Measures:Now and Future

MUSE InternationalGaylord National Harbor

May 28, 2013 Zahid Butt MD, FACG

© 2011 Medisolv, Inc. All Rights Reserved

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Conflict of Interest Disclosure

• Medisolv CEO – Healthcare Business Intelligence & Clinical Quality Reporting Software Vendor

• Represent myself as an Individual in this presentation

• No financial compensation


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eCQM / eMeasures Definitions

• CQM - Clinical Quality Measures

• eCQM - Electronic Clinical Quality Measures (aka..eMeasures)

• eSpecs - Electronic Specifications

• QDM - Quality Data Model

• HQMF - Health Quality Measure Format

• QRDA - Quality Reporting Data Architecture

Change is Here…………….


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The Change Agent !

“Transform this program

(Medicare) as we said time and

time again from being nothing

more than a passive payer to an

active purchaser of high quality

healthcare for Medicare

beneficiaries. We call this Value

Based Purchasing.”

Herb Kuhn

Deputy Administrator CMS

Circa 2006

Exhibit 4. Projected U.S. National Health Expenditures (NHE) by Source, 2013–2023

28% 26%26%

26%25%

24%18%

18%

18%

28%

31%

32%

0

1000

2000

3000

4000

5000

6000

2013 2018 2023

Federal government

State and localgovernment

Private employers(including "otherprivate revenue")

Households

$2.9 trillion

$4.0 trillion

$5.5 trillion

Note: GDP = gross domestic product.

Source: Estimates by Actuarial Research Corporation for The Commonwealth Fund.

NHE in $ billions

% GDP: 17.9% 18.7% 20.5%


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Quantify Value ?

Page 6

Quality

Value =

Cost (Revenue)


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Measurement Drives Triple Aim


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Quality Measures Growth

Page 9

CMS Quality Reporting Programs

Hospital Quality PhysicianQuality

“Payment Model” Quality

“Population”Quality *

IQR / OQR

ASC

Inpatient Psychiatric & PPS-Exempt Cancer

PQRS Medicare Shared Savings Program

Medicaid Adult& CHIPRA Quality Reporting

HAC / Readmission eRx Quality Reporting

Hospital Value based Purchasing (VBP)

Health Information Exchange Reporting

EHR Incentive Program - EH/CAH

EHR Incentive Program - EP

MedicarePart C & D

* Future

CMS Quality Reporting AlignmentRoadmap

2013 2014 2015 and beyond

EH/CAH - Align HVBP & IQR on Hospital Compare

- Implement EHR Reporting Pilot

- Introduce eCQM Reporting in IQR

- Transition to fully eCQM reporting in IQR and other reporting programs

EP-Individuals - Implement PQRS-EHR Incentive Pilot

- Align PQRS EHR reporting options with Stage II rules

EP- Groups - Align PQRS GPRO web interface with ACO &VBM GPRO Measure Sets

GPRO Reporting for ACO&VBM using CEHRT fulfills MU eCQM reporting

2012 Medicare EH/CAH Pilot: Participation

• 4 Hospitals submitted successfully!

• All 15 CQMs finalized in Stage 1 ruleo ED Throughput

o Stroke

o VTE

• Submission Vendor: Medisolv

2012-13 Medicare EH/CAH Pilot: Key Points

• Voluntary participation

• May continue to attest

• Requirements1. Submit 15 Stage 1 CQMs: ED, Stroke, VTE

o In 2013 CMS will accept 2014 e-Specifications

2. Patient level data

3. Medicare patients only

4. 1 full year reporting period

o Federal fiscal year (FFY) – October 1 – September 30

o Same reporting period regardless of program year participation

5. Transmission format: QRDA Category-I

6. CMS portal for data submission: QualityNet

eCQM Reporting in Meaningful UseEH & CAH

CEHRT 2011 Edition CEHRT 2014 Edition

MU Requirement One of the Core ObjectivesStage I

Incorporated in MU definitionStages I & II

Time Frame FY 2011 - 2013 From FY 2014 (October 1 2013)

Number 15 out of 15 16 out of 29. 3 NQS Domains

Specifications HITSP 1.1 and 1.2 2014 Edition eCQM (April 2013)

Certification Minimal Testing. Measure Algorithm & Logic Testing Excluded

2 Base EHR Criteria1 Criteria to Test Measure Logic in Quality Module

Method Attestation (Aggregate) Attestation (Aggregate) orEHR Incentive Pilot (QRDA)


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National Quality Strategy Domains

• Patient and Family Engagement

• Patient Safety

• Care Coordination

• Population and Public Health

• Efficient Use of Healthcare Resources

• Clinical Processes/Effectiveness


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Meaningful Use; Means to an End !

16

Data capturing

and sharing

Advanced clinical

processes

Improved outcomes

Stage 1

Stage 2

Stage 3


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MEDITECH MU eCQM Reporting Options

• MEDITECH Best Practices

• MEDITECH DR SQL Queries- IMO Integration Required for 2014 edition

• MEDITECH Alliance Partners- Medisolv (DR Supported)

- IHM


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Quality Measurement Lifecycle

Evidence

Specifications

Data Collection

Calculation

Reporting

Page 18


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VTE 1 – VTE Prophylaxis

• This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission

Page 19


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VTE 1 – VTE Prophylaxis

• Patient Population Criteria- All Patients

• Denominator Data Elements- Comfort Measures- Clinical Trial - Denominator Exclusions

• Numerator Data Elements- Mechanical or Pharmacologic Prophylaxis- Contraindications- End of Surgery Date/time

Page 20


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VTE 1: Manual Abstraction Specification


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VTE 1: Manual Abstraction Specification


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VTE 1: Abstraction Worksheet Example


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VTE 1: Human Readable eSpecification


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VTE 1: Human Readable eSpecification


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VTE 1: HQMF eSpecification

VTE 1: Data Capture/CDS Workflow

Physician Admission Orders

Contraindication

Physician Order

Mechanical Prophylaxis

Pharmacologic Prophylaxis

VTE Prophylaxis

Nursing Documentation

EMAR/BMV

RXNORMSNOMED

SNOMED

Clinical Trial / Comfort Measures

SNOMED


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eCQM Future – Stage 3 and beyond

• Better “Retooled” Measures

• Develop “de novo” eCQM (CMS TEPs)- Outcomes Measures; Including Patient Reported

Outcomes

- Fill NQS Gaps; E.g. Care Coordination

- eMeasures Risk Adjustment

• Leverage CDS linked to eCQM for CQI

• ? Creation of eMeasures Incubator

• Streamline eMeasures Development Process

eMeasures Development “Ecosystem”

VSAC

cEHRT

eCQMsQDM MATNQF MAPRules

CypressPopHealth

SEVT(reportingto CMS)

CDARIM

HQMF

QRDA

STANDARDS

vMR HeD

CDS

USHIK

Page 30

31

HHS Post Kaizen Event – Notional Future State Clinical Quality Measure Testing Process Flow

Title

5.

Imple

me

nta

tion

Fie

ld T

esting

4. D

ata

Ele

ment

QA

and e

-Sp

ec

3.

Measure

Concept

Researc

h

2.

Exte

rnal

Sta

keho

lders

1. H

HS

Contr

acts

6. R

elia

bili

ty &

Va

lidity F

ield

Testing

Identify Measure

Concept

Submit IRB

Application

Vet Prospective

Testing Entities

Approved Test Bed

Vendors Hosps Beacons HIEs EPs

National

IRB/HIPAA

Waiver

Testing Templates

(Plan, SOW, DUA)National

Test Tools

National

Test Bed

Criteria

Proposed National Testing Development Efforts

Add Task Cross-

Stakeholder

Innovation

Measure Related Contract Modifications

Incorporate

Agile/Lean

Modify

Deliverables

Schedule

Allocate

New Task

Funding

Potential Testing Entities

Vendors Hosps Beacons HIEs EPs

SOW/DUA

Paperwork

Select SME

Panel

HL7/Standards Organizations

Clinicians

Methodologists

EHR Data

Experts

Standards

Experts

Preliminary Data Element

Assess (see sub-flow 1)Review Materials

Preliminary Face

Validity Assess

Data Element

Repo

National

Fail Early?

1 Measure

NarrativeN

Update National

Templates

Allocate

Test Bed

Funding

Draft HQMF MAT Entry VSAC /

NLM

VS Repo

National Draft Measure

Require. Tool

Measure

Developer

Create Test Cases

Vetting Process

Cypress &

Bonnie ETL

Answer

Key Test Cases

Simulated

Modifications

Updated HQMF

Fail Early?N

2

Update AMA National

Template Data Element

Table Tool (DET) ®

Update National

Template Query

Vendor

Review Fail Early?

Completed

DET

Data Warehouse

Vendor Query

CountsFeasibility

Analysis

Vendor

Implementation

3

N

ETL

Measure Calc

Performance

Report

Answer Key

Comparison

Fail Early?4

N

Data Collection

Form (DCF)

Binomial

Analysis Code

Approved IRB/

HIPAA WaiverExecuted

Contract/DUA

Determine R&V Testing

Approach

Does DB Volume/Struct.

Support Binomial Analysis?

Perform Binomial

R&V Analysis

Binomial R&V

Analysis Results

Perform On-Site

Validity Against

Gold Standard

R&V Compare

ResultsEHR System

Production

N

Fail Early?

5a

Fail Early?

5b

Y

B o o z | A l l e n | H a m i l t o n F e b r u a r y 2 4 , 2 0 1 3P o s t - K a i z e n M e a s u r e T e s t i n g a n d C e r t i f i c a t i o n W o r k g r o u p P a g e 1


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"Americans can always be counted on to do the right thing......after they have exhausted all other possibilities."

-- Winston Churchill


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eMeasures Implementation:Key Success Factors

• Organizational Leadership

• Teamwork is Essential- IT/Quality/Clinicians/Vendors/SME’s

• Smart Data Capture / Clinical Workflow Design/Re-design

• Standards & Terminology Capability

• Integrate CDS & CQM in CQI

• Create a Learning Health System

Page 33


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Data Capture/Workflow Principles

Reduce data capture burden for quality reporting only; Avoid “Death by a thousand clicks”

Make clinical data capture sharable;

Routine patient care / Clinical decision support/ eMeasures

Anticipate & Incorporate “downstream needs” for standardized data early during data capture screen/form builds

Develop working knowledge of Key Standards SNOMED / RxNorm / LOINC

Involve Clinicians early; Find Champions

Dedicate resources for education in quality measurement

Communicate often & Celebrate successes

Leverage MEDITECH “Best Practices” where possible


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Handle with Care!!


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If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money.

If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off.

— Code of Hammurabi, c. 1750 B.C.


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Thank you !!

Page 37

Zahid Butt MD,FACG

[email protected]

443-539-0505 Ext 223

410-925-7005 (cell)

Twitter:@zbytes

mailto:[email protected]

Clinical Quality Measures - Medisolvmedisolv.com/wp-content/uploads/MUSE-Presentation-Slides.pdf · Clinical Quality Measures: Now and Future ... -IMO Integration Required for 2014

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