“Mastering eMeasures - Charting a Course To Align
Quality And Payment”
a complimentary webinar from
healthsystemCIO.com,
sponsored by Encore Health Resources
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Objectives
• To learn from those who – through trial and error – have found success
• To leave today’s presentation with specific, actionable advice which can immediately be put into practice
• To absorb the underlying principles which have made a “win” possible, so they may be applied in your facility
Agenda – Panelists
Liz Johnson, VP, Applied Clinical Informatics, Tenet Healthcare Corporation
Michael Nelson, VP, Information Services, Universal Health Services, Inc.
Agenda – Continued
A Word from our Sponsor – Linda Lockwood, Associate Partner, Encore Health Resources
Q&A With Panelists – Moderated by Anthony Guerra, founder/editor, healthsystemCIO.com
“Mastering eMeasures – Charting a Course
To Align Quality And Payment”
healthsystemCIO.com
Liz Johnson, MS, FHIMSS, CPHIMS, RN-BC VP of Applied Clinical Informatics
HHS Health Information Technology Standards Committee Member
Modern Healthcare 2010 Top 25 Clinical Informaticist
HIMSS 2010 Nursing Informatics Leadership Award & HIMSS50 in 50: Memorable Contributors in HIMSS’ 50 Year History
Agenda
8
• eMeasures History
• Approach
• Tracking
• Lesson Learned
Quality Is Center Stage in the Road to Reimbursement
9
Source: NQF Webinar “Implementing Electronic Measures 101: The What, Why, and How”; July 28,
2011
“Electronify”
A Measure =
EHR
National Quality Forum
10
Tenet’s Approach to “Electronify” a Measure
EDW
PBAR*
Cerner* EDW*
eMeasure Requirements
Content
Processes Workflows
Measuring Quality with eMeasures
Data Capture
MU Dashboard
Decision-making
• Capture the right data in the right
format enabled by workflow to
support Meaningful Use Stages
1-3 and other related initiatives
• Support Tenet’s overall BI
Objective, joining of Clinical and
Operational data in a common
repository
12
It Started with a Reference Library
• We created a reference library that contained the each measures definition, codes, data elements, derived data to support measure calculation
13
What Workflows, Content & Order Sets were used for each eMeasures?
*end user training
Sample - Data Input Supporting eMeasures
14
Discharge Inpatient Stay Admission
Admission History
Problem List
Medication Reconciliation
Vital Signs
Stroke Orders
Nursing
Physician
Problem List
Education
Education
Summary of
Care
Evidence based orders support Stroke Quality requirements for
Meaningful Use
We Track Design Decisions and Issues
15
Managing Risk
16
Risk Details by eMeasure
17
Integrated Clinical BI Strategy Overview
18
Clinical Analytics Strategy
Meaningful Use
Clinical Decision Support
Value Realization
Clinical Quality
• Power Insight
• Cerner ODS
Initial
Focus
EDW Meaningful Use Dashboard
19
Lesson Learned
20
• Make decisions now with the future in mind
– Stage 2 and 3 expected requirements – Accountable Care Organizations – Pay for performance (quality based)
• Overlap between CMS Core Measures and CMS EHR Clinical Quality Measure programs exists – These will not be 100% “harmonized” – Will require expansion of hospital quality programs
• The data matters, a lot – Summary analysis of the CMS regulations is not enough
- need to get to the data level (measure by measure) – Data must be discrete, at the lowest level – Can’t build for the future without the data in mind – Must be able to aggregate, calculate and report
• Workflows will have to be redesigned with specific training
Lesson Learned
• Communicate, communicate, communicate
– Help users understand what is coming
– Set expectations, things will change
• It is a journey that has many side trips and distractions – never forget it is about improving patient care
• Have a team dedicated to tracking, interpreting and attesting
• It’s a balancing act that requires effective governance to manage other priorities (e.g. 5010, ICD-10)
• Engage your clinicians, early, often and get their input
21
Michael Nelson,
VP, Information Services, Universal Health Services, Inc.
Building an eMeasure Foundation for the Future:
UHS and the Meaningful Use Journey
Today’s Objectives
eMeasures: Setting the Foundation for the Future of Healthcare
The UHS MU Journey – Getting to the details
Clinical IT History
Current State
How we approached MU
Our timeline
Building for the future
Where is my data? Defining a source of truth
Lessons Learned
New Care Models
24
Share Exchange
Data
Capture and Use EHR
Aggregate Calculate
Report
eMeasures
Meaningful Use
This is not only about
Meaningful Use…
…it’s about
creating an
eMeasure
foundation for the
future
Creating an eMeasure Foundation for the Future
UHS Information Technology - History
3
2007 focus on stabilizing Clinical Software applications 2008 upgraded existing applications to improve functionality 2009 developed a strategy and conducted Selection Project Cerner selected as primary vendor Scope includes ED, Nursing, Rx, Lab, Rad, OR, Med Recs, etc.
2010 conducted design, configuration and initial testing 2011 converted initial site and 2 additional facilities 2011 design and enhancements for MU compliance 2011 Inpatient CPOE and MU requirements targeted for go-live
Patient Registration
Scheduling
Interface Engine
Patient Accounting
Patient Accounting Doc Imaging
OR incl. Scheduling
Materials Management
Accounts Payable
General Ledger
Human Resources
Payroll
Lab
Pharmacy
Radiology
Medical Records
Transcription
Quality Management
Ancillary Systems
Emergency Dept
PACS
Order Management
Nursing Clinical Documentation
MD Data Viewer
Data Repository
“Core” Clinicals
Mobile Results PDA
No installed product for: -Computerized Physician Order Entry -Bedside Medication Administration (barcoding) -Medical Device Integration
UHS Replaced Clinical Systems in “Red” with Cerner Software-Enabling a Foundation for eMeasures
Revenue Cycle
UHS Milestone Timeline: Keeping our Eye on the Target
UHS MU Assessment Final Findings 27
Sept Oct Nov Dec Jan Mar
Phase 1 Phase 2
Sept. 18: Facility #4 Integrated Testing Fu
sio
n Oct. 1:
Facility 5-9 Activation of Database
Nov. 6: Facility #4 Integrated Testing
Dec. 7: Facility #1 Inpatient CPOE Live
Jan. 29: Facility #2 & 3 Inpatient CPOE Live
MU
Feb
Nov. 1-Dec. 15 MU CPOE Testing Additional Gap Items
March: Review compliance Optimize Prepare to attest
Sept. 1-Nov. 1: MU Design Decisions MU Build CPOE
Dec – Feb: Reporting Production Usage Education
Feb 12: Facility #4 Go-live
• Meaningful Use provided the incentive for UHS to accelerate our Cerner implementations
• UHS understood that this initiative must be grounded in improving clinical outcomes and patient care, while looking ahead to Stage 2
• We quickly realized that you have to be in “the details” to properly handle eMeasures
MU Setting a Platform for eMeasures
The MU Journey: Vendor Dashboards to eMeasure Reality
• UHS had received vendor dashboards-we knew we had gaps
• Significant work to get our hands around all the requirements
• As usual there are the People, Process and Technology components to meet the data capture and reporting for eMeasures
• Strong preference to get this right for MU asap and deploy an MU compliant new Clinical System as opposed to going back to multiple facilities for subsequent MU upgrades
• Requires a lot of work to address Stage 1 and planning for what is likely in Stage 2
Getting to the Data Level for VTE 1: Data Map Sample
(700+ Line Items Like This for MU eMeasures)
30
Measure
Number
Identifier
Measure
Title
DerivedDa
ta:Elemen
ts
Data
Elements
Value Set Numerator /
Denominator
Inclusion/
Exclusions
Module Table Field NameEvent Code/DTACode Set Data Element Defaulted/Value Data Element Requires Manual Entry
VTE-1 VTE
prophylaxi
s within 24
hours of
arrival
Clinical
Trial-VTE
Related
Clinical
Trial
Purpose
Joint
Commission
Clinical Trial
Value Set
Denominator Exclusion NHIQM Clinical
Events
LH_F_VTE_
METRICS
CLIN_TRIA
L_EXCL_FL
AG
Reg VTE Relevant Clinical Trial Code Set
93
Code set
72
YES/Defaulted value = "No" Manual intervention to change
clinical trial question = "yes" if
patient on clinical trial
Conduct a measure by measure review of data, workflow and content
Validate data elements against federal data eMeasure requirements
Populate the tool with design decisions, issues, risks & workflows
Conduct risk analysis and manage risks and issues
Coordinate with a multi-disciplinary team to reach consensus
Produce work plan with key tasks by functional area
*Make Meaningful Use modifications
*Current work
How We Did It: The UHS MU Approach to Date
Where is UHS Now? • We have completed our comprehensive Meaningful Use Assessment-and
have started our “Modification” phase, building to close gaps in system design, content, workflow and process
• We must execute this modification phase quickly while maintaining go-live schedule
• We have developed a comprehensive program management infrastructure-how we will manage attestation, communication and education with our hospitals
• Establishing focused project management, governance and decision making
– People, Process and Tools
• Incorporating lessons learned from initial go lives with clinical documentation and orders, identifying overlaps and efficiently making key organizational decisions (i.e., electronic medication reconciliation, CPOE adoption and roll out)
32
Where is My Data: Defining a “Source of Truth”
• Like most hospitals today we collect core measures by manual chart review, and enter them into our Core Measure system
• For eMeasure data capture we recognized the data must be in a new format, and eventually reported electronically
• However there are some overlaps and it is important to clearly define “what” data are being entered “where” and by “whom”
• For MU we needed to define a “source of truth”
• For UHS that is Cerner
• But it requires design, configuration, processes and proper deployment to work for MU
Lessons Learned
• Design and build with the future in mind: Must design for Stage 2, not just Stage 1
– Build all your data elements to support eMeasure capture
– Build and focus on implementing all Menu Set items
– Set your targets higher than national standards knowing they will increase
– Design your orders sets and content to capture all Core Measures for Quality
– Focus on sharing and exchanging data
• Messaging: Focus on improving quality of care and patient safety, not meeting the measures for payment
• Engage your clinicians: This is about using the system in a “meaningful way” design the system to support clinician workflow, bring your physicians to the table to participate when ever possible
Lessons Learned
• Truly understand the scope: the MU effort is tremendous
• You must get to the “details” of the data to capture eMeasures inclusive of processes, content and workflow
• You must track status and progress down to the detailed data element level
• Your team is critical: You must have enough of the right people available to administer the program and make the decisions required to complete the build.
Lessons Learned
• MU cannot be accomplished in a silo: This is NOT an IT effort alone, Quality, Compliance, Nursing, and Physicians must all be at the table making decisions together.
• Integrate, Integrate, Integrate: Your implementation team and MU team must be seamless, work plans need to be integrated, teams need to make design decisions together, and meet on a weekly basis. Everyone owns this process and success
Linda Lockwood,
Associate Partner, Encore Health Resources
eMeasures
Road to Reimbursement Reform
38
Integrate data to
display results and
provide capabilities
(referrals, e-Rx) for
individual pts
Aggregate, calculate
data for analysis
across populations for
cost, quality, risk and
chronic disease
Securely move and
exchange this data with
key stakeholders
39
Capture EHR and
demographic data in a
secure discrete manner
The Evolving Model of Care
The CoreQUEST™ Solution
40
CoreQUEST™ Our Method
CoreGPS™
Our Tool
CoreTEAM Our People
Encore Healthcare Reform Wiki and Knowledge Base
The CoreQUEST™ Solution
Encore’s CoreQUEST™ solution optimizes and accelerates the use of eMeasures
Based on OVER 1,700 pages of government rules & industry
specifications
The CoreGPS™ Data Tool
41
24 Eligible Hospital (EH) measure definitions as well as the 15 quality eMeasures deconstructed (39 total):
• 100+ individual data elements
• 700+ unique data element mappings
• 70+ value sets consisting of over 3,500 individual codes
25 Eligible Professional (EP) measure definitions as well as 44 quality eMeasures deconstructed (69 total)
• 200+ individual data elements
• 2200+ unique data element mappings
• 550+ value sets consisting of over 7,000 individual codes
Q&A
Liz Johnson, VP, Applied Clinical Informatics, Tenet Healthcare Corporation
Michael Nelson, VP, Information Services, Universal Health Services, Inc.
Anthony Guerra, editor, healthsystemCIO.com
Click the “Ask a Question” button located on the bottom of your screen, type in your
question and then click submit.
Closing
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Thank You!
We hope you will join us for more
healthsystemCIO.com Webinars in the future
Questions/Comments – Anthony Guerra
[email protected] 201-638-2727