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©2007 Medisolv Inc.
Zahid Butt MD,FACGOctober 22, 2010
QUALITY REPORTING
©2007 Medisolv Inc.
The Quality Landscape
• 100+ Entities
• Data Sources
– Claims / Administrative
– Mandatory Submission
– “Voluntary Submission”
– Other Databases
Page 1
Source: Society of Actuaries 2009
©2007 Medisolv Inc.
Public Reporting / Ratings
Page 2
Source: Society of Actuaries 2009
©2007 Medisolv Inc.
Accreditation/Certification
Page 3
Source: Society of Actuaries 2009
©2007 Medisolv Inc.
Government Programs
Page 4
Source: Society of Actuaries 2009
©2007 Medisolv Inc.
ARRA / HITECH Meaningful Use
• Use Certified EHR Technology
– Meet Minimum Performance Thresholds of
Specified Functionality Measures
– Generate Specified Quality e-Measures
– Enhance Patient Security and Confidentiality
• Report to CMS
– Functional Measures Performance
– Quality e-Measures Reporting Function
©2007 Medisolv Inc.
ARRA / HITECH Meaningful Use
Page 6
©2007 Medisolv Inc.
Certified EHR TechnologyEligible MEDITECH Hospitals
• Complete EHR Certification*
– MEDITECH Versions
• Magic & C/S 5.64 with ARRA Priority Pack
• 6.0x with ARRA Priority Pack
• Modular EHR Certification*
– Other Vendors
• Meaningful Use EHR Functionality
• Quality Reporting Vendors
*Projected
©2007 Medisolv Inc.
Stage I CQM e-Measures (15)Eligible Hospitals (TJC Retooled)
• Emergency Department Throughput –admitted patients Median time from ED arrival to ED
departure for admitted patients. Stratify by Psychiatric Diagnosis
• Emergency Department Throughput –admitted patients –Admission decision time to ED
departure time for admitted patients. Stratify by Psychiatric Diagnosis
• Ischemic stroke –Discharge on anti-thrombotics
• Ischemic stroke –Anticoagulation for A-fib/flutter
• Ischemic stroke –Thrombolytic therapy for patients arriving within 2 hours of symptom onset
• Ischemic or hemorrhagic stroke –Antithrombotic therapy by day 2
• Ischemic stroke –Discharge on “statins”
• Ischemic or hemorrhagic stroke –Stroke education
• Ischemic or hemorrhagic stroke –Rehabilitation assessment
• VTE prophylaxis within 24 hours of arrival
• Intensive Care Unit VTE prophylaxis
• Anticoagulation overlap therapy
• Platelet monitoring on unfractionated heparin
• VTE discharge instructions
• Incidence of potentially preventable VTE
Page 8
©2007 Medisolv Inc.
TJC Core Measures (Abstracted)
Page 9
©2007 Medisolv Inc. Page 10
Abstracted Measures Worksheet
©2007 Medisolv Inc.
Abstracted Measures Worksheet
Page 11
©2007 Medisolv Inc.
Clinical Documentation Sources Core Measures Data Elements
Page 12
Core Measures Its All About Data: Jane Metzger et. al
©2007 Medisolv Inc.
AMI – 6 Data Elements
Page 13
Core Measures Its All About Data: Jane Metzger et. al
©2007 Medisolv Inc.
©2007 Medisolv Inc.
Clinical Quality e-Measures
• e- Measures Specifications Development
– “Retooling” of Existing Measure Sets
– New Measure Sets
• Data Captured / Mapped With Standards
based Nomenclature & Codification
• “Abstraction Burden” Shifts to
“Documentation Burden”
• Computer Programming Substitutes for
Human Cognition in Some Instances
Page 15
©2007 Medisolv Inc.
Quality Data Set (QDS) - HITEP
Page 16
©2007 Medisolv Inc.
HITSP e-Measures Specification
Page 17
©2007 Medisolv Inc.
Define Stroke Population
Page 18
©2007 Medisolv Inc.
Ischemic Stroke Value Set
Page 19
©2007 Medisolv Inc.
Ischemic Stroke Value Set
Page 20
©2007 Medisolv Inc.
Stroke Denominator Exclusions
Page 21
©2007 Medisolv Inc.
Palliative Care Value Set
Page 22
©2007 Medisolv Inc.
Palliative Care Value Set
Page 23
©2007 Medisolv Inc.
Therapy Exclusion Reason
Page 24
©2007 Medisolv Inc.
Therapy Exclusion Reason
Page 25
©2007 Medisolv Inc.
Systematized Nomenclature OfMedicine – Clinical Terms
• Developed by CAP as SNOMED RT
• Merged with NHS CT (Read Codes)
• Currently maintained by IHTSDO
• 311,000 Active “Unique Concepts”
• 800,000 Unique Descriptions
• 1,360,000 Links / Semantic Relationships
• 5000 “CORE Problem List” Subset
• Formal Processes:
– Cross Maps / Extensibility / New concepts (terms)
Page 26
©2007 Medisolv Inc.
SNOMED CT Data Structures
Page 27
©2007 Medisolv Inc.
SNOMED CT Top Level Hierarchies
Page 28
©2007 Medisolv Inc.
SNOMED DOMAIN ATTRIBUTES
Page 29
©2007 Medisolv Inc.
SNOMED TERM DESCRIPTIONS
Page 30
©2007 Medisolv Inc.
Clinical Observations Recording and Encoding (CORE Subset)
Page 31
©2007 Medisolv Inc.
e- Measures Data Element Sources & Code Sets
Page 32
MT Applications e-Measures Data Elements Code (Value)
Sets
Registration / ADT A/D/T & Demographics UB 04
NUBC
Lab Information System Selected Lab Result Values LOINC
PCM (CPOE) / RxM Inpatient Orders
Discharge Medication Orders
Rx Norm
SNOMED
Pharmacy Medications Administered Rx Norm
Problem List Inclusions & Exclusions SNOMED
Medication Allergy List Exclusion Medications SNOMED
Physician Notes Exclusion Reasons
Discharge Instructions
SNOMED
Nursing Notes Interventions Performed SNOMED
©2007 Medisolv Inc.
Maintain Problem List –Final Rule
Page 33
We did not and do not intend that coding of the diagnosis be done at the point of care.
This coding could be done later and by individuals other than the diagnosing provider.
42 CFR Parts 412, 413, 422 et al.
The measure associated with this objective requires that entries be recorded in
„„structured data‟‟ and in this context we adopted ICD–9 or SNOMED CT to provide
that structure. As a result, Certified EHR Technology must be capable of using ICD–9
or SNOMED–CT when an eligible professional or eligible hospital seeks to maintain
an up-to-date problem list. 45 CFR Part 170
©2007 Medisolv Inc.
“Abstracted” Problem List
Page 34
©2007 Medisolv Inc.
MEDITECH PCM Problem Lists
Page 35
©2007 Medisolv Inc. Page 36
Problem List Dictionary
©2007 Medisolv Inc.
Current e- Measures Issues with Use of Problem Lists
• Problem Lists are Patient Centric & Current
Quality Measures are Encounter Centric
• Problem Lists Do Not Support Encounter
Coding Concepts
– Principal Diagnosis
– Discharge Diagnosis
• ICD 9 allowed in Functional Requirements
but not in e-Measures- Need to Maintain
Mapping if ICD 9 is used in Problem List
Page 37
©2007 Medisolv Inc.
Best Practice Workflow Example
Page 38
©2007 Medisolv Inc.
Medisolv Meaningful Use Module
• Data Import (? Data Mapping)
• Support both Functional and Quality Measures
• Generate Measure Results
• Create PQRI Registry 2009 XML Files with
Aggregate Results for Quality Measures
• Create “Attestation Ready” Reports in 2011
• e-Submission of Quality Measures Aggregate
results in 2012 and beyond
• Modular EHR Reporting Certification
Page 39
©2007 Medisolv Inc.
Meaningful Use Measures Medisolv Dashboard
©2007 Medisolv Inc.
Eligible HospitalsReporting Periods & Payments
• Stage I Yr 1
– 90 Continuous Days by Sept 30, 2011 for EH
– 90 Continuous Days by December 31,2011 for EP
• Stage I Yr 2
– 365 Continuous Days by Sept 30, 2012 for EH
– 365 Continuous Days by December 31, 2012 for EP
• Earliest Report Submission April 2011
• Earliest Payments Start May 2011
Page 42
©2007 Medisolv Inc.
CMS National Data Repository for Meaningful Use Payments
• Northrop Gruman awarded $ 34 Million
Contract to Build and Manage
– Receive Data from Provider & Hospitals for
Meaningful Use Reporting
– Determine Meaningful Use “Compliance”
– Determine Amount & Accuracy of Payment
– Avoid Duplication of Payments
Page 43
©2007 Medisolv Inc.
Prepare & Plan Now
• Establish Leadership/Workgroup Team(s)
• Educate Team Members/Executives
• Detailed Gap Analysis
– Software Applications with Certified Versions
– Standards Based Data Capture
• Detailed Implementation Plan
– Design/Redesign Documentation Work Flows
– Incorporate MEDITECH Best Practices
• Develop Reporting Strategy
Page 44
©2007 Medisolv Inc.
Summary
• Opportunity to Design (Re-design) EHR
• e-Measures CQM & Functional Measures Have
Important Dependencies
• Plan Ahead for Stage II & III
– Point of Care Problem Lists
– Implement CPOE / PCM / BMV / EMAR / Med Rec.
– Clinical Documentation with Selected Structured / Coded
Data Elements
• “Abstraction Burden” Maybe Reduced but will
not be Eliminated
Page 45
©2007 Medisolv Inc.
Thank You
Zahid Butt MD, FACG
CEO
Medisolv Inc,
443-539-0505 Ext 23
Page 46