Are You Ready for CMS Interoperability?
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The document discusses healthcare's need for master data management (MDM) to create a single trusted source of reference data across disparate systems. It notes that MDM hubs can standardize data to common governance rules, define common reference data, and avoid redundant data entry. The document also provides examples of common healthcare domains that can benefit from MDM like providers, facilities, patients, reference codes. Finally, it summarizes one healthcare organization's experience deploying MDM starting with provider and location domains to consolidate inconsistent data across various systems and enable more accurate reporting.
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Are You Ready for CMS Interoperability?
- 1. 05_01_1805_01_18 Martin Boyd VP of Product Marketing, Profisee Jenny Hyun Director of Enterprise Data Analytics, Vituity Tyler Graham Director of Emerging Technologies, Profisee CMS INTEROPERABILITY AND MDM Strictly Confidential © 2019 Profisee Group, Inc. 1
- 2. 05_01_18 WHY DOES HEALTHCARE NEED MDM? Requires authoritative, reliable TRUSTED data foundation Trusted Master Data Facility/LocationProvider Data Interoperability Mandates Supplies Reference DataTreatmentPatient Reporting and Operational Efficiency
- 3. 05_01_18 WHY DO HEALTHCARE PROVIDERS NEED MDM? Requires authoritative, reliable TRUSTED data foundation Facility/LocationProvider Supplies Reference DataTreatmentPatient MDM Hubs – Build and maintain trusted data for a ‘domain’ • Share trusted data • Validate, store and manage incoming information • Synchronize data across internal systems • Standardize all data to YOUR Governance and DQ standards • Define commonly used reference data • Avoid redundant effort • Enable cross- system reporting • Meet compliance requirements
- 4. 05_01_18 “ROSETTA STONE” – TYPICAL DATA EXAMPLES • Data created in different silos ‘speaks’ in different ‘languages’ • MDM is a Rosetta Stone to translate between source and target so they can ‘understand’ each other • Between internal systems • Interoperation with external systems University Uni Univ University-Campus *University Anesthesia Anesthes Anes EP2 Anesthesiology AN ARNP ARNP. A.R.N.P ANP-R AP-RN APRN Gender Gender - Source Gender - CMS Std M M F F H U MB4O M MPO M Unknown U Standard term Variations Address Verification Address Verified Address type AV11 Y Physical AV12 Y POBox AV13 Y Both AV14 N Unknown AV15 Y Both AV21 Y Physical AV22 Y Both AV23 Y POBox AV24 N Unknown AV25 Y Physical
- 5. 05_01_18 5 Consolidated Single Trusted Source Of Truth PROVIDER HUB MDM EMR 1 EMR 2 Credential System 1 Credential System 2 EMR 3 CMS Directory EMR (Partner) Name: Deborah Smith Practice: Westside Family Care NPI: 655890321 EMR (Secondary) Name: Deborah Varchey Practice: Eastside Pediatrics Type: Designated Practitioner Provider Listing Name: Deborah A Varchie Practice: Eastside Pediatrics Privileges: Admit, Discharge NPI: 302840392 Credentialing Name: Debora Varchy NPI: 699890321 Degree: Pediatrics …… …… Composite Record NPI Primary: 655890321 Practice NPI 302840392 Gender: Female Degrees: Primary: Pediatrics Secondary1: Family Medicine Secondary2: Masters, Public Health eMail: dvarchy@ccc.com Phone: 232-803-8233 DEA#: xxxxxx3312 SPI#: xxxxxx4322 Staff Status: Admit, Discharge Staff Type: Managed Practitioner Practice Organizations: Eastside Pediatrics, Westside Pediatrics, Central Pediatric Clinic
- 6. 05_01_18 6 Provider Hub is core to many operational processes PROVIDER HUB MDM EMR 1 EMR 2 Credential System 1 Credential System 2 Medical Staff Office CMS Directory Utilization Web directory (and API) Specialty coverage Physician recruitment Referral management Patient Scheduling Identity/access management Regulatory Reporting CMS compliance
- 7. 05_01_18 BEYOND PROVIDER MASTER – MANY DOMAINS/USE CASES 7 • Event management • Fire monitoring • Call management, etc. • Access management • Employee directory • Emergency notification, etc. • Study inclusion • Address verification • Clinical contact only flags • Charity donor list • Householding • Do not contact suppression • Supply reconciliation • Price benchmarking • Chargeback classification • Standard codes • Definitions • Medical vocabularies • Crosswalking/mappings Facility/ Location Patient Supplies Reference Data Management Employee Donor
- 8. 05_01_18 TAXONOMY GOVERNANCE – COVID-19 AND CANCER Standardized, Searchable Data • Easy to search for researchers • Foundation for AI/ML analysis Disease Treatment Outcome Electronic Medical Record Profisee: Domain glossaries Terminology crosswalks Patient Medical Ontologists Symptoms Markers DIagnoses ‘Raw’ Clinical Data Profisee “Context Engine” Profisee manages all ‘context’ • Specialists manage governance & DQ rules for each data domain • Profisee enforces standards and manages issue resolution
- 9. 05_01_1805_01_18 VITUITY STORY Strictly Confidential © 2019 Profisee Group, Inc. 9
- 10. 05_01_12 Strictly Confidential © 2019 Profisee Group, Inc. 10
- 11. 05_01_12 • Most data is siloed • Poor overall data governance • Inconsistent data that is hard to integrate VITUITY – “MASTER DATA JOURNEY” 11 • Redundant effort (common data being maintained in several locations) • Poor visibility – difficult to manage the business and make strategic decisions • Operational errors & inefficiency – inconsistent data can cause billing and other interoperability errors and consequent rework Unacceptable roadblocks for a fast-growing business! Data Challenges Business Impacts
- 12. 05_01_12 Approaches considered: 1. Use existing systems as ‘master data sources’ • Existing systems are not designed for this task • Fundamentally does not work if data is in multiple systems 2. Custom coding of Data Warehouse to ‘master’ data • Hard to maintain • No transparency • Lot of effort 3. Master Data Management platform • Phase 1 deployment – Provider and Site domains (in Azure cloud) • Future planned domains – Patient, Payer Contracts, Reference Data 4. Data Governance • Clearly needed and initial steps taken to drive governance maturity • MDM implements governance rules VITUITY – “MASTER DATA JOURNEY” 12 Not viable Not viable Phase 1 live, more to go Starting the journey…
- 13. 05_01_12 VITUITY – MANY DOMAINS AND USE CASES • Drive consistent names/spellings and related information • Eliminates redundant effort • Enables accurate reporting (and trust in data) • Consolidate information from EHR, Credentialling, Billing and Legal • Eliminate errors/inconsistencies • Avoid redundant maintenance effort • Solid foundation for reporting and capturing additional information • Enable patient tracking through whole care experience for • Better care • Better tracking and metrics • Avoid redundant data entry (basic info, insurance, etc.) • Standard codes & definitions • Standardize mapping & crosswalks • CPT codes • ICD9/10 codes • CCS Diagnostics, etc. Facility/ Location Patient Reference Data Management Provider • Standardize payer names • Enrich with roll-up hierarchies “Start with 1 domain for simplicity BUT there is no chance there is a business out there that only has one domain to be mastered”, Jenny Hyun, Vituity Payer Contracts
- 14. 05_01_1805_01_18 MDM DEMONSTRATION Strictly Confidential © 2019 Profisee Group, Inc. 14
- 15. 05_01_18 • Data standardization, mapping & crosswalk • Match/merge from multiple sources (CMS, EHR, Credentialling) • Data steward notifications • Lookup before create to maintain data integrity DEMO FLOW 15Strictly Confidential © 2019 Profisee Group, Inc.
- 16. 05_01_12 Strictly Confidential © 2019 Profisee Group, Inc. 17
Editor's Notes
- There are 2 important pressures that are reshaping healthcare today. The first are the mandates for data interoperability being imposed by the Government and CMS as part of the Cures Act that state that there must be public APIs for provider and patient information. The APIs themselves are not really the issue though, it’s the need for well managed, complete and trusted data that is good enough to be shared, and that incoming information that may be in a variety of forms, can be understood and combined with existing information. Second is the ongoing for insight into the business through various forms of reporting and then the agility to be able to respond to those insights to drive more operational efficiency – whether that in clinical outcomes, managing utilization, procurement or some other aspect of the business – we all know that all organizationa are increasingly run through data. So it follows that bother these critical activities must be backed by ‘trusted master data’ – that is, the relatively slow moving data that forms the pillars of the business. Some of those what we call ‘domains’ are listed at the bottom of the slide. These and more can be ‘master data’ and aligning and synchronizing this data across and between systems is key to integratin gnad interoperating between those systems
- There are 2 important pressures that are reshaping healthcare today. The first are the mandates for data interoperability being imposed by the Government and CMS as part of the Cures Act that state that there must be public APIs for provider and patient information. The APIs themselves are not really the issue though, it’s the need for well managed, complete and trusted data that is good enough to be shared, and that incoming information that may be in a variety of forms, can be understood and combined with existing information. Second is the ongoing for insight into the business through various forms of reporting and then the agility to be able to respond to those insights to drive more operational efficiency – whether that in clinical outcomes, managing utilization, procurement or some other aspect of the business – we all know that all organizationa are increasingly run through data. So it follows that bother these critical activities must be backed by ‘trusted master data’ – that is, the relatively slow moving data that forms the pillars of the business. Some of those what we call ‘domains’ are listed at the bottom of the slide. These and more can be ‘master data’ and aligning and synchronizing this data across and between systems is key to integratin gnad interoperating between those systems
- A talk though on this slide In reality, the way master data is captured and updated across most organizations is fragmented and discontinuous. It’s MDM’s job to listen for new and updated information, link the correct information together, and assemble the puzzle pieces incrementally. Complicating this process is the fact that information is often incomplete and inconsistent. It would be like trying to assemble a jig saw puzzle where the picture side of the pieces had been damaged, and only part of the picture were visible. First build: In this scenario, the first piece of information available might be from an external source, such as a marketing lead file or in this case, Dun & Bradstreet. Here we capture information about Debora Varchy with Crete Carrier Corporation Second build: The next interaction might be with the parts department, when Debora orders a replacement part. In this case, the parts representative captures her name as “Deb Varchie” and abbreviates the company name to “Crete Carrier Corp.” MDM figures out that this is the same person, with the same company, and aggregates the information together. Third build: The next interaction might be with the service department, when the new part doesn’t work properly. In this case, the service representative captures her name as “Debby Varchy” and abbreviates the company name to “CCC”. Again, MDM recognizes that this is the same person and the same company, and continues to aggregate the information we know about Debora and Create Carrier Corporation. Fourth build: The next interaction might be with the warranty division, as the replacement part is clearly defective.….same story. Fifth build: MDM has taken these fragments of master data, correctly reconciled them, and used them to assemble an aggregate composite record that is the most complete, most up to date information available on Debora Varchy and Crete Carrier Corporation. As part of this process, MDM captures each contributing system and the primary keys for the data from each contributing record. This cross reference information is a gold-mine for analytics, allowing transactions from multiple systems to be correctly aggregated, even when the information in those systems is inconsistent or incomplete. Furthermore, the best, most complete composite data set can be shared back to operating systems, ensuring that invoices are sent to the most current and accurate billing address, or orders shipped to the best, most current delivery address, etc. What MDM is doing, really, is collecting updates and changes to key master data as they are captured across multiple systems. The real magic is two-fold. MDM will link up information fragments to build out the complete, composite picture, even when the information is not 100% accurate and consistent, and MDM will apply rules to assemble the best, most complete composite record – e.i. identify the best address, the best email, the best company name, etc.
- Chargeback – industry average is 4-5% comes from chargeable supplies; their average was 1% as some items were misclassified for chargeback – so 3-4% underbilling Undercharging by 3-4% = $20mm/year
- About 6.4M patient lives annually Business units – Providers, Practice Management, and RCM/Billing