IT Enabled Quality Measurement IOM Dec 2012 Kevin Larsen MD, FACP Medical Director of Meaningful Use, ONC December 6, 2012
Our National Quality Strategy Aims Better Health for the Population Better Care for Individuals Lower Cost Through Improvement
Vision for the Future Measures Drive Improvement Real-time Local ownership with benchmarking Linked to decision support and patient dashboards Measures Drive Value-Based Purchasing Reliable Accurate Outcomes-based Measures Inform Consumers Meaningful Transparent
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Meaningful Use 12/11/2012 Office of the National Coordinator for Health Information Technology 4
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Advanced clinical processes Improved outcomes Data capturing and sharing Stage 3 Stage 2 Stage 1 8
Quality Measurement Alignment MU, PQRS, IQR, ACO, VBP, HRSA,CDC Unified Measures current EHR Reporting
Research What s happening? Guidelines What SHOULD Happen CDS It will happen Quality Measures Did it happen?
Evolution Paper Chart EHR Optimization Future State Labor intensive chart review Historical data based on claims Time delayed, post visit data collection Voluntary reporting Data captured in structured fields Coded data - ICD, CPT erx Orders and some test results Real time decision support based on evidence-based protocols Interoperability (consistent and comparable data) Use of registries for patient & population management Collaborative, patient centered care Culture of quality improvement and use of HIT to enhance care Triple aim achievement 11
CQM Reality of Today CQM reporting requirement in Stage 1 gets providers comfortable with the process of reporting, and HIT vendor products capable of reporting Some providers are expected to report on measures unrelated to practice scope Duplicate data submitted by multiple providers for the same patients Data is not interoperable. Heart Attack to a family physician may not be the same as acute subendocardial left-anterior descending infarct to a cardiologist. Systems don t see these as the same thing (MI). 12
ECQM Infrastructure Modular measures Composed of standards based reusable components Attribution, disease definition, episode of care Components embedded in EHR and data warehouse Utilize clinical data standards SNOMED etc Richer clinical representation 12/11/2012 Office of the National Coordinator for Health Information Technology 13
ECQM Infrastructure Fully built out as software Testable, auditable Logic complete, transparent Standardized transmission formats XML standards HQMF- representation QRDA1- patient representation QRDA2- spreadsheet QRDA3- aggregate- numerator/denominator 12/11/2012 Office of the National Coordinator for Health Information Technology 14
Future State: HIT Enabled QI Toolkit Stakeholders Unambiguous human readable Value Set Authority Center Public Domain Unambiguous machine readable EHR Certification Tools Electronic Health Records Population Health Tool Clinical Registries Clinical Decision Support CMS Quality Reporting Other HIT Tools 15
Quality Ecosystem Local EHR Registry or data intermediary Benchmarking Coaching Technical support 12/11/2012 Office of the National Coordinator for Health Information Technology 16
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Point of Care Intervention Health Condition Chronic condition Acute problems Risk Factors Age, gender, race/ethnicity Surgical Hx, Family Hx Lifestyle (e.g. alcohol, smoke, diet, exercise) Decision Modifiers Readiness, values, wishes (AD) Status (functional, cognitive, symptoms) Access to care, support, resources Intolerances Goals Desired outcomes Evidenced based medicine Clinical practice guidelines CDS Intervention Medication changes Order/perform tests Lifestyle and behavior support Identify related conditions
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Point of Care Intervention Health Condition Patient Example Diabetes Hypertension 72 year old, white, male Family history of diabetes BMI 31 Everyday smoker BP 141/82 DNR Risk Factors Decision Modifiers Goals A1C < 7 LDL < 100 BP < 130/80 Exercise 3x per week Reduction in sodium intake CDS Intervention Metformin Walking DASH diet Testing blood sugars and BP Testing cholesterol Aspirin
Longitudinal Measurement HIT enables automated tracking of clinical data over time and setting Stage 2 CQMs Longitudinal Improvement in Blood Pressure Depression in Remission after 6 months Stage 3 CQM Concepts Longitudinal Improvement in HbA1c Longitudinal Improvement in Smoking status Longitudinal Improvement in BMI
I wouldn t give a fig for simplicity on this side of complexity but I d give my right arm for simplicity on the other side of complexity. Oliver Wendell Holmes
Questions? Kevin.larsen@hhs.gov For more information about ONC visit: healthit.gov 12/11/2012 Office of the National Coordinator for Health Information Technology 23