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Meaningful Use Reporting: Build or Buy?
What is the Best Approach?
By Steve Nitenson - RN, BSN, MS, MBA, Ph.D.
Sr. Healthcare Solutions Architect, Perficient
Oct 28th, 2011
2011 Copyright
Build vs. Buy – Won’t my EHR vendor handle this for me?
What does it take to develop a single clinical quality measure and reporting requirements?
Review the current state of the market with respect to clinical quality measures
Understand the lifecycle of a clinical quality measure and measure processing challenges
What a pre-built clinical measure healthcare BI framework should have with a focus on “meaningful use” reporting
Q & A
2
Agenda Topics
2011 Copyright
3
What are the Options?
Options Pros Cons
Do Nothing Low costLow disruption
Inability to meet reporting requirementsLack of information to make decisions
Internal Development Control of your dataControl of your timelineHighly customized to your organizationControl your success
Long time to bring to useCosts to fund effort is highRisk of minimal innovationYou bear the risk of failure
Rely on EMR vendor solution
Good for data acquisition Electronic submission
Creation of reporting and dashboards using vendor BI tools by your staffHidden costs of development
Buy a certified Meaningful Use solution
ONC certified solutionYearly updates on measure calculations/new measuresActionable information from dashboards/trends
Data quality challengesVariability in maturity of EMR implementations
Build
Buy
Buy
2011 Copyright
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EHR Vendors: Meaningful Use Reporting Requirements
170.304 (j) Calculate and submit clinical quality reports – Eligible Professionals
• 3 core and 3 alternate core quality measures• 3 measures out of additional 38 quality measures• Report submission using PQRI XML 2009 format
170.306 (i) Calculate and submit clinical quality reports – Eligible Hospitals
• 15 clinical quality measures• Report submission using PQRI XML 2009 format
170.302 (n) Automate measure calculation
• 16 EHR usage measures for Eligible Professionals• 14 EHR usage measures for Eligible Hospitals
2011 Copyright
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Clinical Quality Measure Challenges
Usability, flexibility, scalability as well as maintenance costs are some of the key concerns…
“Client measure applicability may be different from the
certified set” “We do not have in-house clinical expertise to validate
and manage measure definitions…”
“Our hardcoded approach is not a scalable solution – we have to revisit our strategy
very soon”
“Ongoing effort and cost of maintenance given the volatility in measures is one of our major
concerns”
“Our customers are asking for custom measures in addition to support on other quality
initiatives like PQRS”
!
2011 Copyright
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Is your EHR Vendor’s Efforts Enough
?While many EHRs have minimally completed the “meaningful use” certification for clinical quality measures, there are significant challenges ahead…
Challenges for EHR clients – Hospitals & Physician Practices
• Clinical quality measures relevant for many clients will be different from the small set of certified measures
• Clients may not be able to comply with the “meaningful use” requirements despite using a certified EHR
• Need for custom measure definitions for customer / regulatory needs
Challenges for EHR vendors themselves
• To add new clinical quality measures, vendors will need significant effort and cost for:
o CQM specs, software development and QA/testing
o ONC certification of additional measures
• Ongoing effort and cost in maintaining an increasing list of clinical quality measures
Minimal Certification Strategy Challenges
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Hospital Electronic Health Record
§170.306 (i) Calculate and submit clinical quality measures (EH)
NQF 0371 VTE prophylaxis within 24 hours of arrivalNQF 0372 ICU VTE prophylaxisNQF 0373 Anticoagulation overlap therapyNQF 0374 Platelet monitoring on unfractionated heparinNQF 0375 VTE discharge instructionsNQF 0376 Incidence of potentially preventable VTENQF 0435 Ischemic stroke—Discharge on anti-thromboticsNQF 0436 Ischemic stroke—Anticoagulation for A-fib/flutterNQF 0437 Ischemic stroke—Thrombolytic therapy for patients
arriving within 2 hours of symptom onsetNQF 0438 Ischemic or hemorrhagic stroke—Antithrombotic
therapy by day 2… ….… ….
Comply with Meaningful use
criteria
Report 15 clinical
quality measures
1
2
Clinical Quality Reporting Requirements
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§170.304 (j) Calculate and submit clinical quality measures (EP)
NQF 0013 Hypertension: Blood Pressure MeasurementNQF 0024 Weight Assessment and CounselingNQF 0028 Tobacco Use Assessment and CessationNQF 0038 Childhood Immunization StatusNQF 0041 Preventive Care and Screening: Influenza Immunization
…NQF 0421 Adult Weight Screening & Follow-Up
NQF 0001 Asthma AssessmentNQF 0002 Appropriate Testing for Children with PharyngitisNQF 0004 Initiation and Engagement of Alcohol and Other Drug
Dependence Treatment: (a) Initiation, (b) EngagementNQF 0012 Prenatal Care: Screening for HIV
… ….…. ….
Comply with NIST test
procedures
Report 6 core
measures
Report ANY 3 out of 38 additional measures
1
2
3
Clinical Quality Reporting Requirements
Ambulatory EHR
2011 Copyright
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NQF 0061: Measure Specification
NQF 0061: EP Measure SpecificationsSource: NQF_HQMF_HumanReadable_0061.pdf
NQF_Retooled_Measure_0061.xlsx
Measure Description
Denominator Selection
Numerator Processing
Relevant concept codes
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Clinical Quality Measure Implementation Life Cycle
Key Steps in Clinical Quality Measure Implementation
Use of appropriate clinical concepts at point of care - observations, clinical documentation, results, exclusions
Develop condition processing algorithm/ rules engine to distribute patients in various numerator buckets
Apply rules – including exclusion criteria – for identifying patients in the denominator
Measure status determination based QDC matrix
Denominator Selection
NumeratorGroup 1
Numerator Group n
Clinical Concepts at Point of Care
…. Measure Status
Clinical DataExtraction
Extract / standardize data using clinical terminologies
2011 Copyright
True Assign (3075F)
Group 3 – Numerator processing
Group 2 – Numerator processing
11
NQF 0061: Denominator Selection
True Assign (3074F)
FalseAssign (2000F) with 8P
True Assign (3079F)
FalseAssign (3080F)
If systolic less than 130
If systolic in 130-139
False
False
True Assign (3078F)
C1
C2
C3
C4
C5
Denominator (#Qualified Patients)
True
If blood pressure observation exists
If diastolic less than 80
If diastolic between 80-89
FalseAssign (3077F)
Group 1 – Numerator processing
Denominator Definition
Patient Demographic Filters• Age range: 18 to 75
(as on Date of Encounter)• Gender: Both
Condition Group
Are part of a visit in Entire reporting period with:
• Any of following ICD9 Codes:250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.00, 648.01, 648.02, 648.03, 648.04
AND• Any of following CPT/HCPCS codes:
97802, 97803, 97804, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0270, G0271
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2011 Copyright
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NQF 0061: Measure Status Analysis
BI/Dashboardvisualization
Measure Status CPT-II Codes Patient Count (Numerator)
Meets Performance 3074F & 3078F, 3075F & 3078F 688
Medical PerformanceExclusion
Not applicable for this measure -
Patient Performance Exclusion
Not applicable for this measure -
System PerformanceExclusion
Not applicable for this measure -
Other Performance Exclusion
Not applicable for this measure -
Performance Not Met 3077F & 3078F, 3077F & 3079F, 3077F & 3080F, 3074F & 3079F, 3074F & 3080F, 3075F & 3079F, 3075F & 3080F, 2000F-8P
67
Denominator Count 755
2011 Copyright
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Clinical Quality Measures: Implementation Challenges
Clinical Data Capture & transformation• Building clinical concepts into clinical
applications e.g. EHR • Ability to use the concepts for mapping
relevant clinical data related to patients and encounters
• Data cleansing & terminology mapping for to ensure data consistency
Numerator Processing• Multiple condition flows & variables for
single measure• Measure-specific variances in condition
logic & measure status grouping• Extracting usable information from
clinical documentation and mapping clinical concepts
Denominator Selection• Mapping clinical concepts and
extracting qualified patient population• Variances in coding standards based on
source systems• Measure-specific variances in criteria
for diagnosis, procedures, etc.
Denominator Selection
NumeratorGroup 1
Numerator Group n
Clinical Conceptsat Point of Care
…. Measure Status
Clinical DataExtraction
Measure Status Analysis• Maintain status mapping for
multiple measures and condition groups
• Provide analysis capabilities around measure status for causal analysis, etc.
2011 Copyright
Can you Buy a complete, certified Solution – It Depends…
The BI you may select should offer a simple and fundamentally new approach to Healthcare Business Intelligence (BI)
–More than 600 pre-built measures and Key Performance Indicators
–Accelerated compliance to Meaningful Use and ACO quality reporting requirements.
The BI should use state-of-the-art BI and analytics tools to enhance clinical decision support, performance benchmarking, and persona-based dashboards from data across a wide range of clinical and financial systems.
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2011 Copyright
Powerful Regulatory Compliance Tool
ONC-ATCB 2011/2012 certified for all 44 EP and all 15 EH Meaningful Use quality measuresGuaranteed support for 100% Meaningful Use Stage 2 and Stage 3 compliance100% PQRI measures coverage200+ inbuilt measures / KPIs for financial and operational reporting100% coverage of all 65 quality performance measures required by ACOs for the Shared Savings Program100% coverage of 88 JCAHO measures
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2011 Copyright
Sustainable Model for Healthcare BI
Powerful End User Capabilities: Real-time clinical alerts to enhance point-of-care decision support. Health BI supports both clinical and financial data, which provides a 360 degree view of population health management.
Quality Management: Health BI provides a comprehensive measure library based on specifications recommended by leading quality and regulatory organizations such as HEDIS, ADA, AHRQ and NCQA. With an extensive range of customizable persona-based dashboards, Health BI provides drill down capabilities for advanced analytics, decision support, performance benchmarking, and complete physician practice clinical quality reporting.
Utilization Management: Deployed by a leading MCO for effective utilization management through integrated clinical and financial reporting.
Extensible: Offering a Proprietary Clinical Measure Processing Framework to configure and deploy clinical rules for implementation of changing evidence-based guidelines and quality measures, Health BI offers multi-server architecture and cloud-based deployment options that provide easy and rapid scalability.
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2011 Copyright
• Comprehensive BI framework for healthcare providers – ONC-ATCB 2011/2012 Certified for Meaningful Use
• Disease registries for clinical reporting on both outcome and process measures
• Business reporting and financial management dashboards for reporting and improving key performance measures
• Robust integration framework - integration with leading financial & clinical applications
• Robust, flexible and cost-effective technology built on BI platform
• Rapid deployment time – providers can get started within a couple of months!!
• Highly cost-effective solution – 40%+ cost saving over other BI solutions
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Solution Highlights
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Key CapabilitiesMarket CoveragePhysician Practices, Hospitals, IDNs, MCOs, ACOs & HIEs
Regulatory Reporting and Compliance
Meaningful Use, HEDIS, PQRS, ACO, JCAHO
End User CapabilitiesActionable intelligence,
performance benchmarking, custom dashboards, clinical
decision support and integrated analytics
Clinical Measure Processing Framework Rule Based, Highly Flexible and Easily Configurable
Architecture and Deployment Modular, Scalable, Flexible & Interoperable
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Market Coverage
Market CoveragePhysician Practices, Hospitals, IDNs, MCOs, ACOs & HIEs
Health BI Market Coverage
Strong coverage of provider markets – across physician practices, hospitals, and IDNs
Integrated reporting for multiple hospitals facilities and associated physician practices – key success factor for MCOs and ACOs
Completely integrated approach to clinical quality reporting and financial & operational reporting
Extensive coverage of HIE reporting requirements
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Architecture and Deployment
Health BI – Architecture and Deployment
Modular and scalable architecture
Standards-based approach to healthcare business intelligence
Easy 4-step integration with a wide range of partner applications in less than 45 days
Incorporates Service Oriented Architecture and cloud-based deployment models
Easily customizable for specific partner and client requirements
Architecture and Deployment Modular, Scalable, Flexible & Interoperable
2011 Copyright
Dimension AdvantageEasy to integrate
Flexible architecture designed to integrate effectively and rapidly with a wide range of partner applications
Comprehensive Supports both clinical & financial aspects of patient care for developing 360 degree view of Population Health Management Processes.
Extensible Proprietary rules-engine to configure and deploy clinical rules to support ever growing evidence-based guidelines and quality measures
Cloud-enabled Supports deployment on both private and public cloud infrastructure, with capability to provide CQM Framework as a service
Service-oriented
Highly flexible web-services based architecture for ease of integration and distributing information through various channels (devices, browser, thick-client, Apps)
Interoperable Supports multiple standards (e.g. XML, flat-files, HL7, CCR / CCD) and multiple clinical terminologies
Health BI’s modular, scalable and standards-based approach to healthcare BI/ Analytics has been very well received in the marketplace
Health BI can be integrated with a healthcare applications in less than 45 days
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Architectural Highlights
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Health BI is powered by BI-Clinical
BI-Clinical Datamarts & Cubes
BI-Clinical Measure Processing Framework
Partner App
Interface
On-demand
processing
Clinical Alerts
Partner App Adapter
Partner AppStaging
Database
BI-Clinical Audit
Database
BI-Clinical Data Submission
Ambulatory
Hospitals & IDNs
MCOs & HMOs
Partner Analytics User Interface
Analytics, Scorecard, Trends,
Benchmarking, Ad-hoc reporting & repot schedules
BI-Clinical Framework Modules
Application database(s)
A
pp
lica
tio
n U
I L
ayer
Ap
pli
cati
on
D
atab
ase
Ap
pli
cati
on
La
yer
Application processing
logic
Partner App
Partner Analytics
UI Link
Partner Point of
Care Module
BI-Clinical Adaptor
Partner App UI Integra-
tion
Partner DB
Views
Step 4: Point-of-Care integration
(optional)
Step 1: BI-Clinical Views creation
Step 3: Reporting Configuration
Step 2: Scorecard integration
Health BI can be integrated with HIT Vendors in just 30-45 days!
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Clinical Measure Processing Framework
Health BI – CMP Framework
Highly flexible and configurable rules engine for measure definition and modification
User friendly interfaces that allow clinical experts to define custom measures
Powerful data abstraction module to support data capture by chart reviewers
Deep drill down capabilities to get extensive visibility into patient information
Clinical Measure Processing Framework Rule Based, Highly Flexible and Easily Configurable
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Clinical Measure Definition Capability
Health BI provides a user-friendly interface for clinical experts to define custom measures
Example: PQRI #1
Example: STK-1
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Regulatory Reporting and Compliance
Health BI – Reporting and Compliance
Only 3rd party reporting solution that is ONC-ATCB 2011/2012 certified for both EH and EP clinical quality measures
Comprehensive coverage of Meaningful Use, HEDIS, PQRS, ACO and JCAHO reporting requirements
600+ in-built measures and key performance indicators for comprehensive clinical, financial, operational and regulatory reporting
Pre-built disease registries for population care and chronic condition management
Regulatory Reporting and ComplianceMeaningful Use, HEDIS, PQRS, ACO,
JCAHO
2011 Copyright
ACO Performance
Measures
Meaningful Use EH Measures
Meaningful Use EP Measures
PQRS 2011 Measures
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Regulatory Reporting
BI-Clinical 10.3 is the ONLY comprehensive ONC-ATCB 2011/2012 Certified BI solution:
• Certified for ALL 15 Meaningful Use Stage 1 criteria for Eligible Hospitals (EH)
• Certified for ALL 44 clinical quality measures in Stage 1 for Eligible Providers (EP)
BI-Clinical provides guaranteed coverage for current and future regulatory requirements, including
• Meaningful Use Stage 2 criteria
• 200+ PQRS measures
• ACO Performance guidelines
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End-User Capabilities
Health BI – End-User Capabilities
Leverages cutting-edge technologies to provide advanced analytics and reporting capabilities
Extensive drill-down and slice-and-dice capabilities to generate actionable intelligence
Integrated financial and operational analytics and reporting
Ability to provide Point-of-Care Decision Support and patient querying capabilities to partner applications
Certified for Meaningful Use report submission in prescribed format
End User Capabilities
Actionable intelligence, performance
benchmarking, custom dashboards, clinical
decision support and integrated analytics
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End User Capabilities (1/2)
KPI Scorecards & Trends Benchmarking & Drill-down Analytics
Clinical Decision Support at Point of CareMeaningful Use Submission Reports
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End User Capabilities (2/2)
Physician / Facility Scorecards Persona-based Dashboards
Integrated Operational AnalyticsIntegrated Financial Analytics
Who We Are What We Do Our Work Our Approach Our Team
Thank you
Q&A
Steve Nitenson - RN, BSN, MS, MBA, Ph.D. Sr. Healthcare Solutions Architect 650-291-7792 [email protected]
www.healthcare.perficient.com/landingpages/HealthBIIndex.html
Here is a link to all Healthcare white papers: http://www.healthcare.perficient.com/RegulatoryCompliance.aspx
Demo Contact:Babita Patel - MBA713.554.4011 [email protected]