Clinical Quality Measures Lessons Learned and a Look Forward to Stage 3

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1 Clinical Quality Measures 2014 Lessons Learned and a Look Forward to Stage 3

2 Assumptions Attendees are Knowledgeable of Meaningful Use stages Familiar with 2014 Clinical Quality Measures

3 Objectives Recognize common issues that may be encountered when preparing interface files for 2014 Clinical Quality Measures Discuss methods to improve the efficiency of building data interfaces for 2014 Clinical Quality Measures Summarize anticipated changes for Meaningful Use Stage 3 and how to prepare

4 Lessons Learned 2014 Clinical Quality Measures

5 Haeffele, Drew (2010) The Long and Winding Road [Graphite and Prisma Color Pencil]

6 Then & Now Stage 1 15 measures Standard industry codes NOT required Allowed manual data entry measures 16 measures 3 domains Standard industry codes required No manual data entry

7 CQM Requirements Exceed CEHRT requirements Import Calculate Export High effort High cost

8 Technical and Clinical Validation Technical Clinical

9 Demographics Smoking Assessment Admission Documentation Teaching Active Medication List Med Reconcilliation Allergies VSS Assessment Physician Family Patient Nurse Discharge Management Lab Imaging Problem List Tests, Procedures Discharge Summary Discharge Instructions Ancillary Staff Interventions Patient History

10 Collaboration Health IT Clinical Staff Quality Staff Physician Staff

11 PLAN Who Team Staff buy-in What Measures? When Pace Where Internal and external deadlines How Technical needs

12 DOCUMENT. Every. Detail. Measure set selection Data used EHR report printouts Anything else that you may not recall later!

13 A Look Forward Stage 3 Meaningful Use

14 Primary Stage 3 Goal Stage 1: Data capture and patient access Stage 2: Information exchange and care coordination Stage 3: Improved outcomes

15 Stage 3 Goals Improving quality, safety, and efficiency, leading to improved health outcomes Decision support for national high-priority conditions Patient access to self-management tools Access to comprehensive patient data through patient-centered HIE Improving population health

16 Improving Quality, Safety & Efficiency Stage 2 CPOE > 60% of medication, lab, and radiology orders Stage 3 Proposed CPOE > 60% of medication, lab, and radiology orders Transition of Care Use CPOE for >20% of TOC/referral orders Transition document available within 4 calendar days

17 Improving Quality, Safety & Efficiency Stage 2 erx > 10% of discharge prescriptions transmitted electronically Demographics Preferred language Gender Race Ethnicity Date of Birth Stage 3 Proposed erx > 30% of discharge prescriptions transmitted electronically Demographics Add Occupation and industry codes Sexual orientation Gender identity Disability status

18 Improving Quality, Safety & Efficiency Stage 2 Clinical Decision Support 5 interventions related to 5 or more CQMs Drug-drug/Drug-allergy interactions Ability to perform Stage 3 Proposed Clinical Decision Support 15 interventions related to 5 or more CQMs Incorporate drugdrug/drug-allergy interaction checks Drug-drug/Drug-allergy interactions Ability to consume external lists

19 Improving Quality, Safety & Efficiency Stage 2 Lab results > 55% incorporated as structured data emar Track > 10% from order to administration Family history Record high priority family history on 20% Stage 3 Proposed Lab results > 80% incorporated as structured data Send > 70% to ordering provider emar Track > 10% from order to administration Track and act upon mismatches Family history Record high priority family history on 40%

20 Engage Patients & Families in Care Stage 2 View, Download, Transmit > 50% have care information within 36 hrs of discharge Provide 10% with ability to view, download, and transmit to a third party Stage 3 Proposed View, Download, Transmit > 50% provided ability to designate when and to whom summary of care is sent Ability for providers to review/accept updates Provide 10% with ability to submit information Provide 10% with ability to update/correct info

21 Engage Patients & Families in Care Stage 2 Provide patient-specific education resources > 10% of patients Stage 3 Proposed Provide patient-specific education resources Add language support Option 1: For top 5 nationally prevalent languages, 80% of materials provided in patient s preferred language Option 2: For 1 non-english speaking population, provide educational materials in that language

22 Improve Care Coordination Stage 2 Medication reconciliation Performed for > 65% of care transitions Summary of Care Provide for >65% of care transitions >10% electronically transmitted Stage 3 Proposed Medication reconciliation Performed for > 50% of care transitions Include medication allergies and problems for > 10% Summary of Care Provide for >65% of care transitions > 30% electronically transmitted Must include Concise narrative of reason Setting-specific goals Care for transition through 48 hrs Care team members with contact information

23 Improve Care Coordination Stage 2 NEW for Stage 3 Stage 3 Proposed Care plan information Electronically transmitted for >10% of transitions/referrals Must include Medical dx and Cross-setting care stages team members with Functional status, contact information including ADL s Patient s long-term Relevant social and goals for care, financial information including timeframe Relevant Specific advance environmental factors care plan (POLST) Most likely course of illness or condition

24 Improve Population & Public Health Stage 2 Immunizations Successful ongoing submission of immunization data to registry Stage 3 Proposed Immunizations Receive immunization history for 30% Implement immunization recommendation system Establishes baseline recommendations Allows for local/state variations 20% receive recommendation prior to immunization

25 Improve Population & Public Health Stage 2 NEW for Stage 3 Stage 3 Proposed Submission to jurisdictional registry Attest to submission for at least 20% of qualifying patients Additional measure for comment Submission to jurisdictional, professional, or aggregating resource Submission to HAI and Adverse Events Documentation of successful submission of total numeric count for 20% of reports

26

27 Unification Alignment Validation Employ into Care Delivery

28 CQMs Submitted for Comment Influenza Immunization Appropriate Use of Dual-energy X-ray Absorptionmetry (DXA) Scans in Women under 65 Overuse of Diagnostic Imaging for Uncomplicated Headache

29 How many measures?

30 I wouldn t give a fig for simplicity this side of complexity, but I d give my life for simplicity on the far side of complexity. Oliver Wendell Holmes, Sr.

31 Thanks for attending. Are there any questions? Carla McCorkle, Product Lead, Midas+ Live

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