BETH ISRAEL DEACONNESS DATA WAREHOUSE PROJECT February 27, 2009

BETH ISRAEL DEACONNESS DATA WAREHOUSE PROJECT

February 27, 2009

- -Massachusetts eHealth Collaborative

Slide title © MAeHC. All rights reserved.

BACKGROUND

BIDPO/BIDMC would like to engage MAeHC to provide a quality data warehouse service to:

• Enable automated extraction and aggregation of selected clinical data from member physicians’ eCW and WebOMR EHR systems

• Develop selected clinical quality measures for BIDPO internal benchmarking, reporting to health plans and case management

• Create a demonstration of emerging HITEP II quality data set standards

MAeHC quality data center (QDC) currently aggregates clinical data from participants in MAeHC pilot projects

• Automated, longitudinal, and patient-centric

• 20 core measures

Current project will require

• Measure definition and specification according to BIDPO requirements

• Creation of HITSP-compliant CCD interfaces from eCW and WebOMR to MAeHC QDC



AGENDAAGENDA

MAeHC QDC current status

BIDMC/BIDPO goals

Accomplishing our goals

Roles and Responsibilities

Timeline

Next Steps



MAeHC ARCHITECTURE AND DATA FLOWS

Brockton Newburyport North Adams

Community-level:HIE

Outcomes analysis

BenchmarkingMAeHC-level:Analysis

Provider-level: EHR

MAeHC-level:QDC



QDC Reporting

Server(Data Mart)

QDC Database Server (Data Warehouse)

eClinicalWorksWellogic

HL7 Messages

Patient encounter message extraction

Patient encounter message transformation

Patient encounter message load

Message data

ETL audit data

Staging source data

Normalized message

data

Internet

Physician feedback reporting

HL7 Messages

Quality measure calculation

QDC Web

Server

Portal authentication and security

Report downloadPhysician feedback reports

Physician feedback reports

Patient Encounter Message Interface (from HIE vendor)

Web browser

Legend

= EHR/HIE vendors / CSC

= CSC

= MHQP

= MHQP / MAeHC

= Existing

= Drill down option

Patient encounter messages originating from the participating providers’ EHR systems and routed by the HIE systems are collected and uploaded real time

Physician feedback reports are published quarterly for Web access and download.

HL7 Messages

Patient Encounter Message Interface (from HIE vendor)

Calculated measure

data

HL7-based visit, procedure,

diagnosis, patient medication, vaccination,

lab

CURRENT ARCHITECTURE



DATA BEING SENT TO THE MAEHC QDC TODAY

• QDC went into production in summer 2008

- Over 200,000 records collected to date across all three communities

• Clinical data being collected

- Problems

- Procedures

- Allergies

- Medications

- Demographics (encrypted identifiers)

- Smoking status

- Visits

- Diagnosis

- Lab results

- Rad results

- Future -- inpatient data to include surgical history



CURRENT MEASURE DESCRIPTIONS

Coronary Artery Disease (CAD)

• CAD: LDL-Cholesterol Test Performed

- The percentage of adults, ages 18 to75, who had evidence of a hospital discharge for an acute cardiovascular event during the first 10 months prior to the measurement year (acute myocardial infarction (AMI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty), or who had a diagnosis of ischemic vascular disease (IVD) in both the measurement year and the previous year and received an LDL-C screening test in the measurement year.

• CAD: LDL-Cholesterol in Good Control(<100 mg/dL)

- The percentage of adults, ages 18 to 75, who had evidence of a hospital discharge for an acute cardiovascular event during first 10 months prior to the measurement year (acute myocardial infarction (AMI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty), or who had a diagnosis of ischemic vascular disease (IVD) in both the measurement year and the previous year and whose LDL-C was screened and controlled to less than 100 mg/dl for the most recent LDL-C result in the measurement year.

• CAD: Drug Therapy for Lowering LDL Cholesterol

- The percentage of adults, ages 18 to 75, with coronary artery disease (CAD) who were prescribed a lipid-lowering therapy (based on current ACC/AHA guidelines) anytime in the 12-month measurement period as of the last day of the measurement year.

• CAD: Antiplatelet Therapy

- The percentage of adults, ages 18 to 75, who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty during the first 10 months prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the previous year and were prescribed antiplatelet therapy. Note: Antiplatelet therapy is considered any one of the following: aspirin, clopidogrel, or a combination of aspirin and dipyridamole.



CURRENT MEASURE DESCRIPTIONS (II) Diabetes

• DM: HbA1c Test Performed

- The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes who had a hemoglobin A1c (HbA1c) test during the measurement year.

• DM: HbA1c in Poor Control(>9% or Not Tested)

- The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes who had poorly controlled HbA1c (level > 9.0%) during the measurement year. Note: For this measure, a lower rate indicates better performance (i.e., a low rate of poor control indicates better care). Eligible adults who did not receive an HbA1c test during the measurement year will be considered in poor control.

• DM: Blood Pressure in Good Control(<140/80 mmHg)

- The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes whose most recent blood pressure measurement during the measurement period was <140/80 mmHg.

• DM: LDL-Cholesterol Test Performed

- The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes who had a serum cholesterol level (LDL-C) screening during the measurement year.

• DM: LDL Cholesterol in Good Control(<100 mg/dL)

- The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes whose most recent cholesterol level (LDL-C) measurement during the measurement year was < 100 mg/dL.

• DM: Retinal Eye Exam Performed

- The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes who had an eye exam (retinal or dilated) performed during the measurement year (or during the previous year if the patient is at low risk for retinopathy). Note: A patient is considered low risk if the following three criteria are met: (1) the patient is not taking insulin; (2) the patient has an A1c < 8.0%; and (3) the patient showed no evidence of retinopathy during the year prior to the measurement year and within six months after the last eye exam during that year.



CURRENT MEASURE DESCRIPTIONS (III)

Asthma

• Asthma: Appropriate Medications Prescribed

- Part A: The percentage of children, ages 5 to 17, identified as having persistent asthma who were prescribed acceptable medication for long-term control of asthma during the measurement year. Part B: The percentage of adults, ages 18 to 56, identified as having persistent asthma who were prescribed acceptable medication for long-term control of asthma during the measurement year.

Hypertension

• HTN: Blood Pressure in Good Control(<140/90 mmHg)

- The percentage of adults, ages 18 to 85, with diagnosed hypertension whose most recent blood pressure measurement during the measurement year was 140/90 mmHg or lower. Note: Both the systolic pressure and diastolic pressure must have been at or under these thresholds for blood pressure to be considered controlled.

Pediatric

• Appropriate testing for Pharyngitis

- The percentage of children, ages 2 to 18, who were diagnosed with pharyngitis, prescribed an antibiotic, and received a group A streptococcus test at the same outpatient visit during the measurement year. Note: This measure assesses the adequacy of clinical management of pharyngitis episodes for patients who receive an antibiotic prescription.

• Appropriate treatment for Upper Respiratory Infection (URI)

- The percentage of children, ages 3 months to 18 years, who, during the measurement year, were diagnosed with URI and were not dispensed an antibiotic prescription on or within three days after the episode start date.



CURRENT MEASURE DESCRIPTIONS (IV)

Prevention

• PREV: Influenza Vaccination(>=50yrs)

- The percentage of adults, 50 years or older at the beginning of a flu season, who received an influenza vaccination during the one-year measurement period.

• PREV: Pneumonia Vaccination(>=65 yrs)

- The percentage of adults, 65 years or older, who have ever received a pneumococcal vaccination.

• PREV: Colorectal Cancer Screening(50-80 yrs)

- The percentage of adults, ages 50 to 80, who had an

- appropriate screening for colorectal cancer. Appropriate screening is considered one or more of the following:

· Fecal occult blood test (FOBT) during measurement year;

· Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year;

· Double contrast barium enema (DCBE) during the measurement year or the four years prior; or

· Colonoscopy during the measurement or the nine years prior.

• PREV: Breast Cancer Screening(42-69 yrs)

- The percentage of women, ages 42 to 69, who received a mammogram during the measurement year or the previous year.

• PREV: Documentation of Smoking Status

- The percentage of adults, 18 years or older at the start of the two-year measurement period, who were asked about their tobacco use one or more times during the two-year measurement period.



PEER COMPARISON REPORT (I)



PEER COMPARISON REPORT (II)



DRILL-DOWN REPORT



BENCHMARK SUMMARY



AGENDAAGENDA


BIDMC/BIDPO goals



Timeline

Next Steps



BIDPO/BIDMC GOALS

Clinical source systems

• eCW through eHX

• WebOMR

Data measures

• BID Clinical Standards Group approved measures

• HITEP II measures

Access and reporting

• BIDPO-defined enterprise-level and physician-level reports, as required

• BIDPO enterprise-level access, query, reporting, exporting



BID CLINICAL STANDARDS GROUP MEASURES



BID CLINICAL STANDARDS GROUP MEASURES (II)



HITEP OBJECTIVES

HITEP Goals

• The intent is to provide a method to encode clinical data obtained during the routine practice of medicine that would then be available to match against the encoded quality measure to determine if the patient or population of patients met any of these specified quality criteria. In so doing, the hope is to provide feedback to clinicians, administrators, policy makers and public health authorities for the purpose of improving the quality of healthcare provided to U.S. patients.

HITEP Measures

1. Controlling high BP (logic: could bring in VSs from EHR)

2. Colon cancer screening (logic: complex measure due to multiple modalities and currently requires hybrid review)

3. Overuse measures for adults and children - (logic: requires meds and diagnoses and gets to overuse)

a. Avoid antibiotics for child with URI

b. Avoid antibiotic use for adult with bronchitis



AGENDAAGENDA


BIDMC/BIDPO goals



Timeline

Next Steps



ACCOMPLISHING OUR GOALS

Gap analysis from existing MAeHC core measures

• BIDPO measures

• HITEP II measures

HITSP/HITEP Specification Review

• Measure definition and specification

• Transport specification -- upgrade from HL7 2.x to CCD, in conformance with HITSP specifications

Reporting

• Report requirements/specifications

• Access

• Authentication

• Authorization (User roles)



BIDPO-QDC DATA FLOWS



CAN WE LEVERAGE MA-SHARE WORK ON CCD-EXCHANGE TO FACILITATE WEBOMR INTEGRATION?



AGENDAAGENDA


BIDMC/BIDPO goals



Timeline

Next Steps



ROLES AND RESPONSIBILITIES

ACTIVITYMAeHC(CSC,

MHQP)BIDMC/BIDPO MA-Share

Program/Project

Management

Measure Gap Analysis/Spec

Report Design

App/dB Dev

Interface/Connectivity

Testing/Validation

Communication

Training/Optimization



AGENDAAGENDA


BIDMC/BIDPO goals



Timeline

Next Steps



HIGH-LEVEL SCHEDULE

Develop

TEST

Implement

Measure Spec/Analysis

Update Database Design/Schema

Design

I

II

III

IV

DEV/TEST SYS Prep

Upgrade Data Transport Method

Internal Testing

PROD SYS Prep First Pilot

Project phases Month

0

Month

3

Month

6

Month

9

Month

12

Key dates Project Kickoff

Measure Acceptance

Go-Live Signoff

Application/Reports Design

Development Completed

Enable Live Data Feed

Data Validation

Modify APP/dB

Install dB/App



AGENDAAGENDA

Current status

Goals



Budget

Timeline

Next Steps



NEXT STEPS

Confirm measures

• TCNY, HITEP, etc.

• Detailed gap analysis

• Prioritization

HITSP Specification/Requirements

• Detailed Gap analysis

• Roadmap for implementation

Determine access and reporting requirements

Confirm roles & responsibilities

MAeHC Statement Of Work

Legal Framework

Documents

BETH ISRAEL DEACONNESS DATA WAREHOUSE PROJECT February 27, 2009