Clinical Decision Support symposium€¦ · Interoperability Stage 3 Improved outcomes Electronically capturing health information in a standardized format Communicating clinical

Clinical Decision Support

Product Enhancements

Jim KirkendallVice President, Clinical Decision Support Services

2013 Midas+ User Symposium - 2 -

Product Enhancements Topics

Midas+ Live - Meaningful Use DataVision & CPMS - Web Application Update DataVision & CPMS - Cost of Care Analytics Statit PPR & PiMD – 2012 Release

Meaningful Use – Midas+ Live


Focus of Meaningful Use by StageStage 1

Data Capture and Sharing

Stage 2 Advance clinical processes and Interoperability

Stage 3 Improved outcomes

Electronically capturing health information in a standardized format

Communicating clinical summaries upon transitions of care

Improving quality, safety, and efficiency, leading to improved health outcomes

Using that information to track key clinical conditions

Secure electronic messaging between the provider and the consumer

Decision support for national high-priority conditions

Initiating the reporting of clinical quality measures and public health information

Using information to engage patients and their families in their care

Improving Population Health



QDM Example


MU Stage 2 – Product Changes



Certification CriteriaCQMs 170.314(c)

(1) Clinical Quality Measures – capture and export (29 measures).

(2) Clinical quality measures - import and calculate (29 measures).

(3) Clinical quality measures - electronic submission. Enable a user to electronically create a data file for transmission of clinical quality measurement data (29 measures).

Security 170.314(d)

(1) Authentication, access control, and authorization.

(2) Auditable events and tamper-resistance.

(3) Audit report(s). Enable a user to create an audit report for a specific time period and to sort entries in the audit log according to each of the data specified in the standards at § 170.210(e).


Certification CriteriaSecurity 170.314(d) (cont)

(5) Automatic log-off. Prevent a user from gaining further access to an electronic session after a predetermined time of inactivity.

(6) Emergency access. Permit an identified set of users to access electronic health information during an emergency.

(7) End-user device encryption. Paragraph (d)(7)(i) or (ii) of this section must be met to satisfy this certification criterion.

(8) Integrity.

170.314(g)

(4) Quality management system. For each capability that an EHR technology includes and for which that capability’s certification is sought, the use of a Quality Management System (QMS) in the development, testing, implementation and maintenance of that capability must be identified.


Certification Criteria (cont.)Security 170.314(d)

(5) Automatic log-off. Prevent a user from gaining further access to an electronic session after a predetermined time of inactivity.

(6) Emergency access. Permit an identified set of users to access electronic health information during an emergency.

(7) End-user device encryption. Paragraph (d)(7)(i) or (ii) of this section must be met to satisfy this certification criterion.

(8) Integrity.

170.314(g)

(4) Quality management system. For each capability that an EHR technology includes and for which that capability’s certification is sought, the use of a Quality Management System (QMS) in the development, testing, implementation and maintenance of that capability must be identified.

New - QDM based database

Brand new database has been created which adheres to the

structure contained within the QDM.

• In alignment with the Categories (i.e. Encounter, laboratory Test, Interventions, Medications, etc.).

• Stores required category attributes (i.e. start datetime, stop datetime, negation rationale, etc.).

• Allows for structured data for categories and attributes (LOINC, SNOMED‐CTTM , RxNorm, HL7 value sets).


InRule® Rule Engine

Advantages:• Highly scalable

• Rules can be authored and maintained by clinical staff that best understand the measure logic.

• Long term platform component that will allow us to respond quickly to measure changes and to a measurement expansion


InRule®


MU Stage 2


Interoperability


• Data Integration (HL7 v2.x, v3.x, v3 CDA, or .csv files)

• Terminology capture options1. Include terminologies (RxNorm, SNOMED CT, and LOINC codes)

within HL7 segments.2. Provide terminologies via file load3. Hospital maps terminologies within Midas+ Live. Mapping

leveraged for future encounters.4. Fee-based integration with 3M HDD (Health Data Dictionary) –

Pending Agreement

Administrative Mapping Function



No matches foundRefine search terms

Save


• Look-up button available when search terms are refined• Click Look-Up to display RxNorm List


• Highlighted term displays in acceptance box• Clicking “SAVE” updates RxNorm code to list



Interoperability Dataflow


Option 1 Option 2

Rule Engine

MU Stage 2


UI Changes


• Administrator Mapping function

• New patient views

• Updated CQM Surveys• User can provide terminologies associated with discrete data• User cannot enter new discrete data concepts directly




Click on “Yes” hyperlink to drill down on calculation

Challenges with MU Stage 2

• HL7 v3.0 CDA files used for certification can contain information covering multiple encounters for a patient with no clear delineation

• Lots of logic errors found in measure algorithms (Midas+ has submitted approximately 75 errors to CMS).

• “Scoop and filter” or “specific occurrences” requirement.


More Information?


After lunch today – June 4th

DataVision & CPMS

Web Application Update


Thanks for your input!


Comparative Data Dashboard (DataVision)

Updated look and feel (DataVision and CPMS)

Updated Navigation (DataVision and CPMS)

Configurable SmartReport (DataVision)

Update SmartReport Monthly (DataVision)

Increased focus on 3M APR DRGs (DataVision)

DataVision Update - Summer 2013


SoonRetiring

Role based initial setup


**Creates widget configuration for Dashboard and SmartReport.

Beta in July

What is a widget?

• DataVision contains approximately 25 widgets.

• Some widgets can be added to the Dashboard.

• Up to 15 widgets can be added to the Smartreport.

• Each widget contains a pre-defined set of measures that can be selected for that widget.

• Role configures which widgets appear on your smartreportand dashboard. It also determines which measures for each widget are tracked.

• Each user can customize which widgets are activated for the Dashboard and Smartreport and the user can modify which measures are tracked within each active widget.


New Comparative Data Dashboard


Dashboard

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Widget title and the date range for the data

Performance percentile

Performance score (represented by gold stars)

Performance trend compared with the previous period

Performance values

Link to top and bottom performers

Widget configuration tool

2013 Midas+ User Symposium

Dashboard - top and bottom performers

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Top and Bottom Performers• APR DRGs

– Green flag a indicates top performer

– Red flag indicates a bottom performer

– Ranked by delta value– Delta value is the

observed value minus the expected value

– View by APR DRG, provider, or Service Line


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Measure Selection• Drag a measure to or from the Active list.• Active measures contribute to your facility’s performance score.• Once widget is updated, your performance is recalculated based

on changes to measure tracking.

Widget Configuration


Dashboard – Report Parameters

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• Parameter options– Most recent 3 months– Most recent harvested quarter– Year to date– Previous year


Dashboard

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APR DRG Performance– Drag the period slide bar to view APR DRG mortality, LOS,

and PPR performance for up to 8 periods. – Hover cursor over a bubble to see the observed/expected

ratio.– Based on active measures in the widget

x-axis – Percentiley-axis – O/E Ratioz-axis – case volume


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SmartReport


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Title

Date range for the data

Measure selection tool – add or remove a measure

SmartReport Widgets

Comparative Performance Score for widget

Alert performance history chart2013 Midas+ User Symposium

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A measure is displayed on the SmartReport if performance is:

Below average or poor in the current 3-month period and in at least two of the three preceding periods.

Below average or poor in the current 3-month period and above average or excellent in at least one of the three preceding periods

Poor in the current 3-month period and in at least one of the three preceding periods.

SmartReport Widgets


SmartReport Widgets

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Rare/Serious Reportable Events icon• Displays the number of rare events in the current

period (or >9 if more than nine)

SmartReport Widgets

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MS-DRG Coding Analysis icon• High – performance is in the 90th percentile or

higher for the period • Low – performance is in the 10th percentile or lower

for the period


SmartReport Tab Configuration

• Five configurable tabs

• Three configurable widgets on each tab

• Tab configuration is accessible through the Options bar

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SmartReport Tab Configuration

• Tab names can be customized

• Widgets can be added, removed, repositioned


Navigation

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• Click the Navigation tab to display the menus.

• Left menu– Navigate to the Dashboard,

Platinum Quality Scorecard, or SmartReport

– Search with optional filters

• Right menu– Navigation tree


Options

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Navigate to:-Parameters-Measure Definitions-Related Reports


Training Sessions• Midas+ will provide a large number of Webex and

recorded sessions

• Look for an announcement at the end of June

More information? After lunch today – 1:00PM


DataVision & CPMS

Cost of Care Analytics

Add-on

Growing Emphasis on Cost

• Growing pressures to manage costs

• Information needs to be disseminated

• Need to manage costs by clinical populations

• Understanding physician costs differences is key

• Need comparative data to identify target populations

• Risk-adjusted data is critical to analysis

• Lower costs, but maintain quality!!!


Distributed Focus Study

Single data repository eases integration


Data Integration

File loads also required:

• Charge Master Detail with Revenue Codes

• Cost Center Codes and Descriptions 2013 Midas+ User Symposium

Midas+ Cost Category

Each patient will have a series of charges. We need each charge, number of units, cost of unit, number of units, by day of service.

Revenue Code will be inferred from file load

Using the CMS revenue code, Midas+ maps each charge to a “Midas+ Mapped Category”.

Midas+ Mapped Categories are used in indicators and Cost of Care toolpack.


Geometric Mean Cost of Care Indicators for 78 clinical populations in DV


Integration with Statit PPR and PiMD

Similar to our Core Measure provider attribution results, cost data will be available in Statit PPR.

Statit PPR will track provider performance for each clinical population and mapped category with drill down into cost detail.

PiMD can be used to store results in dashboard SBC charts.


Cost of Care Standard Report


Cost of Care Toolpack Will be available in July (currently in final Development)

13 worksheets help you understand cost trends– Cost by Midas+ Cost Category– Cost Category Detail– Average cost by day of stay and APR DRG RW– Average cost by LOS and APR DRG RW– Average cost by Category and day of stay– Total and average cost by payer– Cost and reimbursement by MS-DRG– Cost by Discharge Disposition– Total and average cost by MS-DRG– Cost by Principal Diagnosis and Principal Procedure– Patient Variance– Attending Provider Variance– Procedure Provider Variance– Cost by Severity of Illness


Cost of Care Toolpack






Harvest and Normalize Cost Data

• Begin harvesting cost detail in September harvest.

• Perform regional and cost of living adjustments using CMS’ MSPB - Medicare Spending per Beneficiary methodology.

The MSPB measure was developed by Centers for Medicare & Medicaid Services (CMS) in conjunction with a team of clinical and statistical experts from Acumen LLC and Vangent.


Comparative Cost Data

• Geometric mean cost indicators by clinical population and Midas+ cost categories will use normalized costs.

• We will link normalize cost data to APR DRGs for DataVision clients to build severity adjusted cost data (observed costs vs expected costs) by provider, service line, and specialty.

• We will add cost data to new SmartReport and Dashboards (including APR DRG bubble graph).

• We will plant back to your server expected costs for enhanced reporting.


Cost of Care Evaluation?

- We need participants to build the DataVision and CPMS Comparative Data- First 50 CPMS or DV clients that sign their Cost of Care Analytic Addendum will receive: Free Cost Integration Free Evaluation of software through 12/31 discharges Can Evaluate solution until June 2014 Hospitals that continue with solution will receive 40%

discount for the first three years of contract.

- Remaining evaluation opportunities exist.


More Information?

New! DataVision/CPMS Cost of Care Analytics In this 22nd Annual Midas+ User Symposium bonus session, you will learn about the new Cost of Care Analytics option for CPMS and DataVision clients. This licensed package brings patient‐level cost and charge data into Midas+, providing cost category mapping and prebuilt cost‐of‐care Indictors for selected clinical populations. The package also includes an Excel Toolpack that can be generated for any CPMS, DataVision, or client‐created Indicator. Join us for this informal presentation and Q & A session.


Today at 4:30 at Tucson East.Hosted by Dr. Johnson

Statit piMD Enhancement

Highlights

Cumulative columns in ScorecardYour choices are:• Year To Date

• Fiscal Year to Date

• Last N Months


Control Indicator Order in a Folder


Trend Multiple IndicatorsYou can now plot multiple indicators on the same chart. They

all need to have the same period size and you can have up to 5 indicators on the chart.


DataVision Benchmarks customizable for each Indicator


Dynamic Drill Down is now displayed in a pop up window


Login Assistance screenUsers can now easily get some help if they are unable to

login into Statit (e.g. forget their password)


Access Indicator Admin form from Indicator Output


Edit Data Source from Ind Admin


Statit PPR Enhancements

Highlights

Allow order of indicators to be controlled within a folder


Provider Facility Grid SupportStatit now supports the Midas+ facility grid in the Midas+

Providers table. Used when you have a Provider that practices at multiple facilities with different specialties.


Peer Score for Cumulative Section


New User Type: Power UserA Power User has view only access by default to all Profiles just like a System Administrator does. But they are a user with no administrative capabilities.

Power Users can be granted Edit Only or Full access to Profiles as well.


Find all docs that are red for any indicator in a profile


Using Find Unusual Provider Performance you can now see all indicators for providers that are currently red for the most recent period.

Can now select multiple sections in Compare Providers for Indicators


Control whether Provider Email Notifications contain their Profile

There is now a global property which controls whether or not the user notifications to Providers include the provider’s profile, or just a link for the provider to login to PPR.


Providers can now accept the data in their Profile

You can now keep track of when the profile was last viewed by a Provider and whether they accepted it or not.


View all indicators in a profile and keep header row displayed


Documents

Clinical Decision Support symposium€¦ · Interoperability Stage 3 Improved outcomes Electronically capturing health information in a standardized format Communicating clinical