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Meaningful Use Reporting: Build or Buy?


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Meaningful Use Reporting: Build or Buy?

  1. 1. Meaningful Use Reporting: Build or Buy?What is the Best Approach?BySteve Nitenson - RN, BSN, MS, MBA, Ph.D.Sr. Healthcare Solutions Architect, PerficientOct 28th, 2011
  2. 2. Agenda Topics Build vs. Buy – Won’t my EHR vendor handle this for me? What does it take to develop a single clinical quality measure and reporting requirements? Review the current state of the market with respect to clinical quality measures Understand the lifecycle of a clinical quality measure and measure processing challenges What a pre-built clinical measure healthcare BI framework should have with a focus on “meaningful use” reporting Q&A 2 2011 Copyright
  3. 3. What are the Options? Options Pros Cons Do Nothing Low cost Inability to meet reporting Low disruption requirements Lack of information to make decisions Internal Development Control of your data Long time to bring to use Control of your timeline Costs to fund effort is high Highly customized to your Risk of minimal innovation organization You bear the risk of failure Control your success Rely on EMR vendor Good for data acquisition Creation of reporting and solution Electronic submission dashboards using vendor BI tools by your staff Hidden costs of development Buy a certified Meaningful ONC certified solution Data quality challenges Use solution Yearly updates on measure Variability in maturity of EMR calculations/new measures implementations Actionable information from dashboards/trends 3 2011 Copyright
  4. 4. EHR Vendors: Meaningful Use Reporting Requirements 170.304 (j) Calculate and submit clinical quality reports – Eligible Professionals • 3 core and 3 alternate core quality measures • 3 measures out of additional 38 quality measures • Report submission using PQRI XML 2009 format 170.306 (i) Calculate and submit clinical quality reports – Eligible Hospitals • 15 clinical quality measures • Report submission using PQRI XML 2009 format 170.302 (n) Automate measure calculation • 16 EHR usage measures for Eligible Professionals • 14 EHR usage measures for Eligible Hospitals 4 2011 Copyright
  5. 5. Clinical Quality Measure Challenges “Client measure applicability may be different from the certified set” “We do not have in-house clinical expertise to validate “Our hardcoded approach is and manage measure not a scalable solution – we definitions…” have to revisit our strategy very soon” ! “Our customers are asking for “Ongoing effort and cost of custom measures in addition maintenance given the volatility to support on other quality in measures is one of our major initiatives like PQRS” concerns” Usability, flexibility, scalability as well as maintenance costs are some of the key concerns… 5 2011 Copyright
  6. 6. Is your EHR Vendor’s Efforts Enough Minimal Certification Strategy Challenges ? While many EHRs have minimally completed the “meaningful use” certification for clinical quality measures, there are significant challenges ahead… Challenges for EHR clients – Hospitals Challenges for EHR vendors & Physician Practices themselves • Clinical quality measures relevant for • To add new clinical quality measures, many clients will be different from the vendors will need significant effort and small set of certified measures cost for: • Clients may not be able to comply with o CQM specs, software development the “meaningful use” requirements and QA/testing despite using a certified EHR o ONC certification of additional • Need for custom measure definitions measures for customer / regulatory needs • Ongoing effort and cost in maintaining an increasing list of clinical quality measures 6 2011 Copyright
  7. 7. Hospital Electronic Health Record Clinical Quality Reporting Requirements Comply with 1 Meaningful use §170.306 (i) Calculate and submit clinical quality measures (EH) criteria NQF 0371 VTE prophylaxis within 24 hours of arrival NQF 0372 ICU VTE prophylaxis Report NQF 0373 Anticoagulation overlap therapy 2 15 clinical NQF 0374 Platelet monitoring on unfractionated heparin quality NQF 0375 VTE discharge instructions measures NQF 0376 Incidence of potentially preventable VTE NQF 0435 Ischemic stroke—Discharge on anti-thrombotics NQF 0436 Ischemic stroke—Anticoagulation for A-fib/flutter NQF 0437 Ischemic stroke—Thrombolytic therapy for patients arriving within 2 hours of symptom onset NQF 0438 Ischemic or hemorrhagic stroke—Antithrombotic therapy by day 2 … …. … …. 7 2011 Copyright
  8. 8. Ambulatory EHR Clinical Quality Reporting Requirements Comply with §170.304 (j) Calculate and submit clinical quality measures (EP) 1 NIST test procedures NQF 0013 Hypertension: Blood Pressure Measurement NQF 0024 Weight Assessment and Counseling Report NQF 0028 Tobacco Use Assessment and Cessation 2 6 core NQF 0038 Childhood Immunization Status measures NQF 0041 Preventive Care and Screening: Influenza Immunization … NQF 0421 Adult Weight Screening & Follow-Up NQF 0001 Asthma Assessment Report ANY NQF 0002 Appropriate Testing for Children with Pharyngitis 3 3 out of 38 NQF 0004 Initiation and Engagement of Alcohol and Other Drug additional Dependence Treatment: (a) Initiation, (b) Engagement measures NQF 0012 Prenatal Care: Screening for HIV … …. …. …. 8 2011 Copyright
  9. 9. NQF 0061: Measure Specification Measure Description Denominator Selection Numerator Processing Relevant concept codes NQF 0061: EP Measure Specifications Source: NQF_HQMF_HumanReadable_0061.pdf NQF_Retooled_Measure_0061.xlsx 9 2011 Copyright
  10. 10. Clinical Quality Measure Implementation Life Cycle Key Steps in Clinical Quality Measure Implementation Clinical Concepts Clinical Data Denominator Numerator …. Numerator Measure at Point of Care Extraction Selection Group 1 Group n Status Extract / standardize data Develop condition processing using clinical terminologies algorithm/ rules engine to distribute patients in various numerator bucketsUse of appropriate clinical Apply rules – including Measure status determinationconcepts at point of care - exclusion criteria – for based QDC matrixobservations, clinical identifying patients in thedocumentation, results, exclusions denominator 10 2011 Copyright
  11. 11. NQF 0061: Denominator Selection Denominator Denominator Definition (#Qualified Patients) Patient Demographic FiltersIf blood pressure • Age range: 18 to 75observation C1 False Group 1 – Numerator (as on Date of Encounter)exists Assign processing (2000F) • Gender: Both True with 8P Condition Group Are part of a visit in Entire reportingIf diastolic less True period with:than 80 C2 Assign (3078F) • Any of following ICD9 Codes: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, False If systolic less 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, than 130 True Group 2 – Numerator 250.40, 250.41, 250.42, 250.43, 250.50, 250.32, 250.33, C4 Assign (3074F) 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, processing 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, False 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, True 648.00, 648.01, 648.02, 648.03, 648.04If diastolic C3 Assign (3079F)between 80-89 AND If systolic in • Any of following CPT/HCPCS codes: False 97802, 97803, 97804, 99201, 99202, 99203, 99204, Assign (3080F) 130-139 True Group 3 – Numerator 99213, 99214, 99215, 99304, 99305, 99205, 99212, C5 Assign (3075F) processing 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, False 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0270, G0271 Assign (3077F) 11 11 2011 Copyright
  12. 12. NQF 0061: Measure Status Analysis BI/Dashboard visualization Measure Status CPT-II Codes Patient Count (Numerator) Meets Performance 3074F & 3078F, 3075F & 3078F 688 Medical Performance Not applicable for this measure - Exclusion Patient Performance Not applicable for this measure - Exclusion System Performance Not applicable for this measure - Exclusion Other Performance Not applicable for this measure - Exclusion Performance Not Met 3077F & 3078F, 3077F & 3079F, 67 3077F & 3080F, 3074F & 3079F, 3074F & 3080F, 3075F & 3079F, 3075F & 3080F, 2000F-8P Denominator Count 755 12 2011 Copyright
  13. 13. Clinical Quality Measures: Implementation ChallengesClinical Data Capture & transformation Numerator Processing• Building clinical concepts into clinical • Multiple condition flows & variables for applications e.g. EHR single measure• Ability to use the concepts for mapping • Measure-specific variances in condition relevant clinical data related to patients logic & measure status grouping and encounters • Extracting usable information from• Data cleansing & terminology mapping for clinical documentation and mapping to ensure data consistency clinical concepts Clinical Concepts Clinical Data Denominator Numerator …. Numerator Measure at Point of Care Extraction Selection Group 1 Group n Status Denominator Selection Measure Status Analysis • Mapping clinical concepts and • Maintain status mapping for extracting qualified patient population multiple measures and • Variances in coding standards based on condition groups source systems • Provide analysis capabilities • Measure-specific variances in criteria around measure status for for diagnosis, procedures, etc. causal analysis, etc. 13 2011 Copyright
  14. 14. Can you Buy a complete, certified Solution – It Depends…The BI you may select should offer a simple and fundamentally newapproach to Healthcare Business Intelligence (BI) –More than 600 pre-built measures and Key Performance Indicators –Accelerated compliance to Meaningful Use and ACO quality reporting requirements.The BI should use state-of-the-art BI and analytics tools to enhanceclinical decision support, performance benchmarking, and persona-based dashboards from data across a wide range of clinical andfinancial systems. 14 2011 Copyright
  15. 15. Powerful Regulatory Compliance Tool ONC-ATCB 2011/2012 certified for all 44 EP and all 15 EH Meaningful Use quality measures Guaranteed support for 100% Meaningful Use Stage 2 and Stage 3 compliance 100% PQRI measures coverage 200+ inbuilt measures / KPIs for financial and operational reporting 100% coverage of all 65 quality performance measures required by ACOs for the Shared Savings Program 100% coverage of 88 JCAHO measures 15 2011 Copyright
  16. 16. Sustainable Model for Healthcare BI Powerful End User Capabilities: Real-time clinical alerts to enhance point-of-care decision support. Health BI supports both clinical and financial data, which provides a 360 degree view of population health management. Quality Management: Health BI provides a comprehensive measure library based on specifications recommended by leading quality and regulatory organizations such as HEDIS, ADA, AHRQ and NCQA. With an extensive range of customizable persona-based dashboards, Health BI provides drill down capabilities for advanced analytics, decision support, performance benchmarking, and complete physician practice clinical quality reporting. Utilization Management: Deployed by a leading MCO for effective utilization management through integrated clinical and financial reporting. Extensible: Offering a Proprietary Clinical Measure Processing Framework to configure and deploy clinical rules for implementation of changing evidence-based guidelines and quality measures, Health BI offers multi-server architecture and cloud-based deployment options that provide easy and rapid scalability. 16 2011 Copyright
  17. 17. Solution Highlights• Comprehensive BI framework for healthcare providers – ONC-ATCB 2011/2012 Certified for Meaningful Use• Disease registries for clinical reporting on both outcome and process measures• Business reporting and financial management dashboards for reporting and improving key performance measures• Robust integration framework - integration with leading financial & clinical applications• Robust, flexible and cost-effective technology built on BI platform• Rapid deployment time – providers can get started within a couple of months!!• Highly cost-effective solution – 40%+ cost saving over other BI solutions 17 2011 Copyright
  18. 18. Key Capabilities Market Coverage Physician Practices, Hospitals, IDNs, MCOs, ACOs & HIEs End User Capabilities Actionable intelligence, performance benchmarking, custom dashboards, clinical decision support and integrated analytics Architecture and Deployment Modular, Scalable, Flexible & Interoperable Clinical Measure Processing Framework Regulatory Reporting and Rule Based, Highly Flexible Compliance and Easily Configurable Meaningful Use, HEDIS, PQRS, ACO, JCAHO 18 2011 Copyright
  19. 19. Market Coverage Health BI Market Coverage Market Coverage Physician Practices, Hospitals,  Strong coverage of provider IDNs, MCOs, ACOs & HIEs markets – across physician practices, hospitals, and IDNs  Integrated reporting for multiple hospitals facilities and associated physician practices – key success factor for MCOs and ACOs  Completely integrated approach to clinical quality reporting and financial & operational reporting  Extensive coverage of HIE reporting requirements 19 2011 Copyright
  20. 20. Architecture and Deployment Health BI – Architecture and Architecture and Deployment Deployment Modular, Scalable, Flexible & Interoperable  Modular and scalable architecture  Standards-based approach to healthcare business intelligence  Easy 4-step integration with a wide range of partner applications in less than 45 days  Incorporates Service Oriented Architecture and cloud-based deployment models  Easily customizable for specific partner and client requirements 20 2011 Copyright
  21. 21. Architectural Highlights Dimension Advantage Easy to Flexible architecture designed to integrate effectively and integrate rapidly with a wide range of partner applications Comprehensive Supports both clinical & financial aspects of patient care for developing 360 degree view of Population Health Management Processes. Health BI’s modular, Extensible Proprietary rules-engine to configure and deploy clinical scalable and rules to support ever growing evidence-based guidelines standards-based and quality measures approach to Cloud-enabled Supports deployment on both private and public cloud healthcare BI/ infrastructure, with capability to provide CQM Framework Analytics has as a service been very well received in the Service- Highly flexible web-services based architecture for ease of marketplace oriented integration and distributing information through various channels (devices, browser, thick-client, Apps) Health BI can be Interoperable Supports multiple standards (e.g. XML, flat-files, HL7, CCR integrated with a / CCD) and multiple clinical terminologies healthcare applications in less than 45 days 21 2011 Copyright
  22. 22. Health BI is powered by BI-Clinical Step 2: Scorecard Partner Analytics Ambulatory Partner integration User InterfaceApplication Analytics Hospitals & IDNs UI Layer UI Link Analytics, Scorecard, Trends, MCOs & HMOs Partner Benchmarking, Ad- Point of Care Step 3: Reporting hoc reporting & BI-Clinical Data repot schedules Submission Module Configuration Partner BI-Clinical Datamarts & On-Applicatio App UI Step 4: Point-of- demand n Layer Integra- Partner Cubes Application tion Care integration App processing processing Interface BI-Clinical Measure Clinical logic BI- (optional) Processing Framework Alerts Clinical Adaptor Partner App BI-Clinical Staging Audit Step 1: BI-Clinical Database DatabaseApplicatioDatabase Partner Views creation Application n DB database(s) Partner App Adapter Views Partner App BI-Clinical Framework Modules Health BI can be integrated with HIT Vendors in just 30-45 days! 22 2011 Copyright
  23. 23. Clinical Measure Processing Framework Health BI – CMP Framework  Highly flexible and configurable rules engine for measure definition and modification  User friendly interfaces that allow clinical experts to define custom measures  Powerful data abstraction module to support data capture by chart reviewers Clinical Measure Processing Framework  Deep drill down capabilities to get Rule Based, Highly Flexible and Easily Configurable extensive visibility into patient information 23 2011 Copyright
  24. 24. Clinical Measure Definition Capability Example: STK-1 Example: PQRI #1Health BI provides a user-friendly interface for clinical experts to define custom measures 24 2011 Copyright
  25. 25. Regulatory Reporting and Compliance Health BI – Reporting and Compliance  Only 3rd party reporting solution that is ONC-ATCB 2011/2012 certified for both EH and EP clinical quality measures  Comprehensive coverage of Meaningful Use, HEDIS, PQRS, ACO and JCAHO reporting requirements  600+ in-built measures and key performance indicators for comprehensive clinical, financial,Regulatory Reporting and Compliance operational and regulatory reporting Meaningful Use, HEDIS, PQRS, ACO, JCAHO  Pre-built disease registries for population care and chronic condition management 25 2011 Copyright
  26. 26. Regulatory ReportingBI-Clinical 10.3 is the ONLY comprehensiveONC-ATCB 2011/2012 Certified BI solution:• Certified for ALL 15 Meaningful Use Stage 1 criteria for Eligible Hospitals (EH)• Certified for ALL 44 clinical quality measures in Meaningful Use Meaningful Use Stage 1 for Eligible Providers (EP) EP Measures EH MeasuresBI-Clinical provides guaranteed coverage forcurrent and future regulatory requirements,including• Meaningful Use Stage 2 criteria• 200+ PQRS measures• ACO Performance guidelines ACO Performance PQRS 2011 Measures Measures 26 2011 Copyright
  27. 27. End-User Capabilities Health BI – End-User Capabilities Leverages cutting-edge technologies to provide advanced analytics and reporting capabilities Extensive drill-down and slice-and-dice capabilities to generate actionable intelligence Integrated financial and operational analytics and reporting End User Capabilities Ability to provide Point-of-CareActionable intelligence, performance Decision Support and patient queryingbenchmarking, custom capabilities to partner applications dashboards, clinical decision support and integrated analytics Certified for Meaningful Use report submission in prescribed format 27 2011 Copyright
  28. 28. End User Capabilities (1/2) KPI Scorecards & Trends Benchmarking & Drill-down Analytics Meaningful Use Submission Reports Clinical Decision Support at Point of Care 28 2011 Copyright
  29. 29. End User Capabilities (2/2)Physician / Facility Scorecards Persona-based DashboardsIntegrated Financial Analytics Integrated Operational Analytics 29 2011 Copyright
  30. 30. Who We Are What We Do Our Work Our Approach Our Team Thank youSteve Nitenson - RN, BSN, MS, MBA, Ph.D. Demo Contact:Sr. Healthcare Solutions Architect Babita Patel - MBA650-291-7792 mobile 713.554.4011 is a link to all Healthcare white papers: