emeasures: Everything You Want To Know

Transcription

1 emeasures: Everything You Want To Know Floyd Eisenberg iparsimony, LLC Rosemary Kennedy ecare Informatics, LLC February 20, 2014 Physician Webinar Series #3

2 Welcome to the Physician Community Webinar Series Sponsored by the HIMSS Physician Engagement Committee Complimentary virtual event that will be held monthly & offer continuing education hours Will cover a wide range of topics on Medical Informatics, HIEs (Health Information Exchange), Standards & Interoperability, emeasures & Quality Initiatives and more More information or contact Lauren Kaderabek lkaderabek@himss.org

3 Moderator & Speakers Lou Diamond, MD, MBChB, FCP(SA), FACP, FHIMSS President, Quality Health Care Advisory Group Chair, HIMSS Physician Engagement Committee Floyd Eisenberg, MD Rosemary Kennedy, PhD, RN, MBA, FAAN

4 Speaker Bio Floyd Eisenberg, MD, is a consultant in quality measurement and clinical decision support. An Infectious Diseases internist with clinical practice and managed care quality experience, Dr. Eisenberg served as a Senior Key Expert at Siemens Medical Solutions Health Services. At National Quality Forum, he led development of the Quality Data Model to enable electronic measurement from EHRs, coordinating measure conversion to enable the transition. He is currently a co-chair of the HL7 Clinical Quality Information Workgroup and a member of the Health IT Standards Committee (HITSC) and the HIMSS Quality Cost and Safety Committee and Quality Measurement Task Force.

5 Speaker Bio Rosemary Kennedy, PhD, RN, MBA, FAAN, is CEO of ecare Informatics, and also Faculty at The Thomas Jefferson University in Philadelphia. She is a member of the HIT Standards Committee Quality Workgroup and is currently working on the development and pilot testing of a denova emeasure. Most recently Dr. Kennedy was Vice President of Health Information of Technology at the National Quality Forum in Washington, DC. Prior to the role, she was the Chief Nursing Informatics Officer for Siemens. She has over 25 years of experience in the development and implementation of the electronic health record.

6 Agenda National Quality Strategy Priorities Quality Management Life-Cycle Converting Quality Measures into Action Quality Measurement Standards Update

7 National Quality Strategy: Aims and Priorities Better Care Healthy People / Healthy Communities Affordable Care 2011 Report to Congress: National Strategy for Quality Improvement in Health Care

8 National Quality Strategy: Public Private Input Better Care Healthy People / Healthy Communities Affordable Care 2011 Report to Congress: National Strategy for Quality Improvement in Health Care

9 National Quality Strategy: Priorities US Department of Health and Human Services Annual Progress Report to Congress: National Strategy for Quality Improvement in Health Care. July Available at: Accessed 25 January 2014.

10 National Quality Strategy: Priorities Center for Medicare and Medicaid Services. CMS Quality Strategy. November 18, Available at: Instruments/QualityInitiativesGenInfo/Downloads/CMS-Quality-Strategy.pdf. Accessed 25 January 2014.

11 National Quality Strategy: Infrastructure Health and Well Being Health Information Technology Affordable Care Prevention and Treatment Public Reporting Better Care Affordable Care Health People/Communities Measurement of Process and Outcomes Patient Safety Person Centered Care Rapid Cycle Learning & Innovation Care Coordinatio n Infrastructure Supports Payment Patient Safety Organizations Quality Improvement Organizations Certification Regulation Consumer Incentives Workforce Development 2011 Report to Congress: National Strategy for Quality Improvement in Health Care

12 National Quality Strategy: Goals Center for Medicare and Medicaid Services. CMS Quality Strategy. November 18, Available at: Instruments/QualityInitiativesGenInfo/Downloads/CMS-Quality-Strategy.pdf. Accessed 25 January 2014.

13 National Quality Strategy What s New this Year? Focus on collaboration between public and private payers, leading to adoption of a consensus set of core measures. Progress on reducing the burden of data collection for providers. Updates to all national tracking measures and targets for improvement. Private sector sharing best practices in each of the six priority areas. Focus on strategic opportunities, reflecting the breadth of activity to improve quality infrastructure across the country. Agency for Healthcare Research and Quality (AHRQ), 2013 Annual Report to Congress on the National Quality Strategy and Progress. Available at: Accessed 1 February 2014.

14 National Quality Strategy What s New this Year? Agency for Healthcare Research and Quality (AHRQ), 2013 Annual Report to Congress on the National Quality Strategy and Progress. Available at: Accessed 1 February 2014.

15 National Quality Strategy What s New this Year?

16 ONC s Federal Health IT Strategic Plan Clinical Quality Improvement Aligned with the National Quality Strategy and Meaningful Use (MU) Electronic clinical quality measures (ecqms) and clinical decision support (CDS) to deliver highquality care Efforts underway to harmonize quality measure (ecqm) data infrastructure (QDM and HQMF) with CDS (HeD and vmr) ONC and the National Library of Medicine (NLM) published Value Sets for ecqms Cypress, a tool to test EHRs ability to calculate MU ecqms. The Office of the National Coordination for Health Information Technology, Strategic Plan Available at: Accessed 3 February 2014.

17 eclinical Quality Measures (ecqms)

18 Electronic Quality Management Life Cycle

19 National Quality Strategy Implement through Measurement Eligible Provider Eligible Hospital

20 Quality Management Life Cycle

21 Quality Management Life Cycle Building a Solid Foundation

22 Incremental Growth Rooted in a Solid Foundation Measurement and Clinical Decision Support Data Needs Measure Structure Authoring Tool(s) Standard Terminology Clinical Decision Support Structure Harmonization of Concepts Currency of Evidence Reliability and Validity of Measures Structure for Reporting Feedback Mechanisms Update / Communication Methodology Collaboration for a Learning System

23 Past and Current Hospital Measures performed by chart abstraction by clinicians trained in the process Ambulatory Measures performed by evaluating claims data and non-reimbursable claim codes used to attest to clinical processes

24 Abstraction and claims-based entry of clinical data is overly cumbersome Expectations that exactly the same data are available in structured form in EHRs In some instances the data are available In other situations, data are not available A new process is needed

25 Common Issues with Current ecqms Processes not done for allowable reasons Exclusions Information about patients or events that should be removed from the emeasure population and denominator. E.g., exclude all patients with polycystic ovarian disease from all those taking medications for diabetes Exceptions Information that allows providers to exercise clinical judgment and make decisions about care individually for each patient in cases that do not meet the strict requirements of the guideline on which the measure is based. Exceptions are removed from the denominator only if the numerator criteria are not met.

26 Common Issues with Current ecqms Information about results or procedures performed in other settings Information documented only in narrative or inconsistent form: Care plans Patient preferences Reasons to perform a procedure Unfamiliar terminology (SNOMED-CT, LOINC, RxNorm, CVX) And then there is the complex logic is it really human readable?

27 Coordination: Multiple Measure Developers Clinical Decision Support (CDS) Developers Standardization Common general information (metadata) Common, readable, and usable expression language Common data description data model Common, reusable value sets (code lists)

28 Let s walk through an example: Tobacco Use Cessation Evidence* for specific interventions: Counseling Pharmacological treatment * National Cancer Institute: Cigarette Smoking: Health Risks and How to Quit. Available at:

29 Categories (QDM) Encounters Birth date Medications Procedures Observations Data Elements What do we want to know and how is the information captured? Who is my patient? What ages are important? What are the treatments: Pharmacologic Counseling What are reasons treatment isn t needed? Context (Timing, relationships) Specific Values (Value Set or Code List)

30 Categories (QDM) Data Elements Specific Values Encounters CPT SNOMED-CT Medications RxNorm Procedures SNOMED-CT Observations SNOMED-CT Labs - LOINC What do we want to know and how is the information captured? Who is my patient? What ages are important? What are the treatments: Pharmacologic Counseling What are reasons treatment isn t needed? Context (Every 2 Years)

31 Categories (QDM) Observations Data Elements Specific Values DEFINE TOBACCO USE MU 6 elements ecqm Larger value set more than smoking What do we want to know and how is the information captured? Who is my patient? What ages are important? What are the treatments: Pharmacologic Counseling What are reasons treatment isn t needed? Context (Every 2 Years)

32 First Release (HQMF R1) HL7 Health Quality Measure Format (HQMF) used to define electronic clinical quality measures (ecqms) for Meaningful Use 2011, 2014 QDM-based Implementation Guide (IG) HQMF Second Release (HQMF R2) QDM- Based IG

33 Virtual Medical Record (vmr) Health edecisions (HeD) Standards & Interoperability (S&I) Framework Uses Virtual Data Model (HL7) to describe data Bottom Line What can Decision Support do to improve and not be intrusive HeD S&I Framework Pilots

34 Monthly Report of Unscreened Patients Clinical Decision Support When status entered, what has been done before Health edecisions (HeD) Standards & Interoperability (S&I) Framework Uses Virtual Data Model (HL7) to describe data Bottom Line What can Decision Support do to improve and not be intrusive Enter Reasons for Not Counseling or Giving Pharmacologic Treatment

35 Value Sets NLM Value Set Authority Center CMS Measure Authoring Tool (MAT) Based on HQMF First Release MAT Measure Logic HQMF Output

36 Comments, Collaboration (Jira) New Measures HHS Contractor emeasure Implementation Group (emig) CMS / ONC Tools Comments, Review during development (Jira) Testing Logic (Bonnie) Testing Content (Cypress) Test the Logic (Bonnie) Test the Content (Cypress)

37 NQF Endorsement Validity Endorsement Reliability Feasibility

38 QDM-Based QRDA Guide HL7 Quality Reporting Document Architecture (QRDA) QRDA QRDA Category 1 (Single Patient Report) QRDA Category III (Aggregate Report)

39 Standard Method to Write Language [Quality Expression Language] Quality Information Data Model (QIDM) HQMF R2.1 TBD QRDA R2 Standard Header Information [Quality Metadata] QDM Updates MITRE Corporation HQMF Release 2.1 HL7 in progress Quality Information Data Model HL7 In progress to harmonize vmr and QDM Quality artifact expression language HL7 In progress for Quality Measures and Clinical Decision Support

40 ONC Clinical Quality Measure Issue Tracker HIMSS Quality Measurement Resource KLAS Software Research

41 emeasures: Everything You Want To Know Questions? Suggestions?

42 emeasures: Everything You Want To Know Floyd Eisenberg, MD, MPH, FACP iparsimony, LLC Rosemary Kennedy, PhD, RN, MBA, FAAN ecare Informatics, LLC

43 Continuing Education Credit This program has been designated for 1 hour of CAHIMS Credit This program has been designated for 1 hour of CPHIMS Credit Download forms at

44 HIMSS14 Physician Activities - Orlando, FL Physician IT Symposium: The Road to Quality-Enabled Health IT Sunday, February 23, 2014, 8:00am-4:00pm, Convention Center, Room 224A Physician Community Reception Sunday, February 23, 2014, 4:00pm-5:00pm, Convention Center, Room 224 Foyer Physician Community Networking Breakfast Monday, February 24, 2014, 7:00-7:45am ET, Convention Center, Room 209 A-C RSVP to lkaderabek@himss.org

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46 SAVE the Date: Physician Community Webinar Series Schedule: 3 rd Thursday of Every Month Mar 20, :00 pm central HIMSS14 Outcomes Apr 17, :00 pm central Standards & Interoperability-the Key to Data Exchange May 15, :00pm central Financial Quality Drivers-What s the Payer s Perspective? Register today!

47 Physician Community EHR Usability Pain Point Survey The HIMSS Physician Community is seeking working physicians who utilize EHR systems on a regular basis to give insight on EHR usability. Let your physician voice be heard on EHR usability by taking the survey today. The survey will close on March 30, Access the survey at:

48 EHR Usability Survey Preliminary Results Survey opened February 14 To date 117 number of responses received 70% of respondents belong to the hospital environment 25% of respondents belong to an ambulatory environment 83% of respondents say their EHR was NOT designed specifically for their specialty

49 EHR Usability Survey Preliminary Results Clinical Decision Support Top Pain Points Alerts inappropriate for clinical situation 24% Inability to filter alerts 17% Alert messages repeat 13% Alerts are disruptive 13% Lack of customization 11%

50 EHR Usability Survey Preliminary Results Med Rec and eprescribing Difficult to enter/reconcile comination meds 19% Absence or inaccurate filled rx data 19% Inability to electronically fill controlled substances 18% No side by side of pre and post dischage meds list 16%

51 Physician Community Website Please visit for more information on: Physician Community Activities How to Get Involved HIMSS14 Educational Sessions Networking