QUALITY REPORTING - Medisolvmedisolv.com/wp...Education-Summit-Oct-2010_01.pdf• Ischemic or hemorrhagic stroke –Stroke education • Ischemic or hemorrhagic stroke –Rehabilitation

©2007 Medisolv Inc.

Zahid Butt MD,FACGOctober 22, 2010

QUALITY REPORTING


The Quality Landscape

• 100+ Entities

• Data Sources

– Claims / Administrative

– Mandatory Submission

– “Voluntary Submission”

– Other Databases

Page 1

Source: Society of Actuaries 2009


Public Reporting / Ratings

Page 2



Accreditation/Certification

Page 3



Government Programs

Page 4



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

Page 6


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

Page 8


TJC Core Measures (Abstracted)

Page 9

©2007 Medisolv Inc. Page 10

Abstracted Measures Worksheet


Abstracted Measures Worksheet

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Clinical Documentation Sources Core Measures Data Elements

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


AMI – 6 Data Elements

Page 13

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

Page 15


Quality Data Set (QDS) - HITEP

Page 16


HITSP e-Measures Specification

Page 17


Define Stroke Population

Page 18


Ischemic Stroke Value Set

Page 19


Ischemic Stroke Value Set

Page 20


Stroke Denominator Exclusions

Page 21


Palliative Care Value Set

Page 22


Palliative Care Value Set

Page 23


Therapy Exclusion Reason

Page 24


Therapy Exclusion Reason

Page 25


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)

Page 26


SNOMED CT Data Structures

Page 27


SNOMED CT Top Level Hierarchies

Page 28


SNOMED DOMAIN ATTRIBUTES

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SNOMED TERM DESCRIPTIONS

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Clinical Observations Recording and Encoding (CORE Subset)

Page 31


e- Measures Data Element Sources & Code Sets

Page 32

MT Applications e-Measures Data Elements Code (Value)

Sets

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

NUBC

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

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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

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MEDITECH PCM Problem Lists

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©2007 Medisolv Inc. Page 36

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

Page 37


Best Practice Workflow Example

Page 38


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

Page 39


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

Page 42


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

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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

Page 44


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

Page 45


Thank You

Zahid Butt MD, FACG

CEO

Medisolv Inc,

443-539-0505 Ext 23

[email protected]

Page 46

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QUALITY REPORTING - Medisolvmedisolv.com/wp...Education-Summit-Oct-2010_01.pdf• Ischemic or hemorrhagic stroke –Stroke education • Ischemic or hemorrhagic stroke –Rehabilitation