QUALITY REPORTING - Medisolvmedisolv.com/wp...Education-Summit-Oct-2010_01.pdf• Ischemic or...

Zahid Butt MD,FACGOctober 22, 2010

QUALITY REPORTING

The Quality Landscape

• 100+ Entities

• Data Sources

– Claims / Administrative

– Mandatory Submission

– “Voluntary Submission”

– Other Databases

Source: Society of Actuaries 2009

Public Reporting / Ratings

Accreditation/Certification

Government Programs

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

Certified EHR TechnologyEligible 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

TJC Core Measures (Abstracted)

Abstracted Measures Worksheet

Clinical Documentation Sources Core Measures Data Elements

Core Measures Its All About Data: Jane Metzger et. al

AMI – 6 Data Elements

Core Measures Its All About Data: Jane Metzger et. al

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

Quality Data Set (QDS) - HITEP

HITSP e-Measures Specification

Define Stroke Population

Ischemic Stroke Value Set

Stroke Denominator Exclusions

Palliative Care Value Set

Therapy Exclusion Reason

Systematized Nomenclature OfMedicine – 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)

SNOMED CT Data Structures

SNOMED CT Top Level Hierarchies

SNOMED DOMAIN ATTRIBUTES

SNOMED TERM DESCRIPTIONS

Clinical Observations Recording and Encoding (CORE Subset)

e- Measures Data Element Sources & Code Sets

MT Applications e-Measures Data Elements Code (Value)

Registration / ADT A/D/T & Demographics UB 04

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

Maintain Problem List –Final Rule

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.

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

“Abstracted” Problem List

MEDITECH PCM Problem Lists

Problem List Dictionary

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

Best Practice Workflow Example

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

Meaningful Use Measures Medisolv Dashboard

Eligible HospitalsReporting 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

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

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

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

Thank You

Zahid Butt MD, FACG

Medisolv Inc,

443-539-0505 Ext 23

zbutt@medisolv.com

QUALITY REPORTING - Medisolvmedisolv.com/wp...Education-Summit-Oct-2010_01.pdf• Ischemic or...

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