telligen quality innovation network-quality improvement ...€¦ · – hl7 ealthcare...

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Telligen Quality Innovation Network-Quality Improvement Organization (QIN-QIO) Igniting HIE Through Data Standardization Samm Anderegg, PharmD, MS, BCPS Health IT Consultant | Project Manager, Pharmacy HIT Collaborative April 12, 2018

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Telligen: Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for

Colorado, Iowa, and Illinois

Telligen QIN-QIO

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The Telligen QIN-QIO network offers expertise and support at local, regional and national levels

We believe the quality of healthcare can be transformed to better serve the people of all communities How we serve our participants:

• Assess and understand unique needs and opportunities • Provide opportunities to connect with • Align improvement efforts • Leverage expertise and relationships • Facilitate connections, sharing and learning • Bring you access to tools, resource, metrics, evidence based, collaboration, best practice,

peer support, education

Join the Telligen QIN-QIO Network

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1. Characterize the goals and mission of the Pharmacy HIT Collaborative

2. Describe methods for documenting pharmacy services using standard clinical terminologies

3. Examine strategies for normalizing data for exchange via Consolidated-Clinical Documentation Architecture (C-CDA)

Learning Objectives

Represents over 250,000+ members in all pharmacy practice settings

• AACP – ACCP – ACPE – AMCP – APhA – ASCP – ASHP – NASPA – NCPA

Founding Members

• Surescripts – NCPDP – Amgen – Pfizer – Cardinal Health/Fuse

Associate Members

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Pharmacy Health Information Technology Collaborative

Goals 1. Access – ensure HIT supports pharmacists in health

care service delivery 2. Connectivity – achieve pharmacists’ integration

within health information exchange 3. Quality – support national quality initiatives enabled

by HIT

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The Key to Pharmacy’s Future?

• Structured, discrete data documentation • Clinical reporting • Population health • Value-based care

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Clinical Documentation

• Purpose – not just billing! – Tracking productivity – Linking care to outcomes

– Communicate care plans – Pass-off to colleagues

• Limited by capabilities of software systems

Measuring Quality

Interoperability

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Free Text vs. Discrete Data

Free Text

• Typographical representation of care provided

• Traditional documentation method

• Transcended into age of electronic systems

Discrete Data

• Codified clinical information

• Structured documentation

• Commonly used for billing fee-for-service

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Progress Note

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Discrete Data

1. Comprehensive Medication Review (CMR) 2. Medication Reconciliation (Med Rec) 3. Medication Action Plan (MAP) 4. Medication Synchronization (Med Sync)

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Discrete Data Reporting

MRN Clinic Service Med Rec CMR MAP Doc Med Sync

0000001 CCTR Oncology Yes Yes Yes Yes

0000002 IM4 Transplant Yes Yes

0000003 IM2 Medicine Yes

0000004 CCTR BMT Yes Yes Yes Yes

0000005 IM3 Cardiology

0000006 IM4 Transplant Yes Yes Yes Yes

0000007 IM2 Medicine Yes

0000008 IM1 Medicine Yes Yes Yes

0000009 IM3 Cardiology Yes Yes

0000010 CCTR Oncology Yes Yes

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Quantifying Data

Metric Q3 CY2015

Q4 CY2015

Q1 CY2016

Q2 CY2016

Med Rec 19.2% 50.3% 89.9% 92.6% CMR 5.5% 44.2% 70.2% 88.5% MAP Doc 34.9% 35.6% 40.1% 43.5% Med Sync 25.4% 21.6% 24.1% 23.2%

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Benchmarking Data

Metric Q3 CY2015

Q4 CY2015

Q1 CY2016

Q2 CY2016

Med Rec 19.2% 50.3% 89.9% 92.6% CMR 5.5% 44.2% 70.2% 88.5% MAP Doc 34.9% 35.6% 40.1% 43.5% Med Sync 25.4% 21.6% 24.1% 23.2%

Below Threshold Above Threshold, Not at Goal At Goal

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Readmission vs Med Rec Rates

0102030405060708090100

0

5

10

15

20

25

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Q3 CY2014 Q4 CY2014 Q1 CY2015 Q2 CY2015Readmissions (All Cause) Readmissions (CHF)Readmissions (COPD) Admit Med RecDC Med Rec

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Meaningful Use

• Incentivizes hospitals and providers to adopt certified EHR systems

• Outlines capabilities/functions of EHRs required to meet MU standards ($$$) 1. Quality measure reporting 2. Interoperable exchange of health information

• Specifies technical requirements – SNOMED CT for clinical documentation – Value sets for implementation

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EHR Certification Program

• Health IT Certification Program – Administered by the Office of the National Coordinator

(ONC) – Certifies solutions that meet federal health IT

standards, implementation specifications, and other criteria promoting interoperability

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Interoperability-Health Information Exchange (HIE)

• Federal initiative to exchange patient information between EHR systems & report quality measures

• Pharmacy software vendors do not participate in Meaningful Use – No business incentive for pharmacy software vendors

to adopt technical requirements – No financial incentive for pharmacists to adopt

compliant software

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Goals

• Align pharmacy software systems functionality with EHR systems – Leverage interoperability to gain accountability – Maintain medication list, allergy list, ADRs – Manage treatment regimens, optimize outcomes

• Support exchange of standardized data between all providers and software vendors

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Goals

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Health IT Standards

• Standard Development Organizations (SDOs) – HL7 – healthcare communication – NCPDP – pharmacy communication

• Health Information Exchange (HIE) – Consolidated Clinical Document Architecture (C-CDA) – SCRIPT Standard – eRx, ePA

• Clinical Vocabularies (e.g. codes) – SNOMED CT – diagnoses/diseases, findings, procedures – RxNorm – medications – LOINC – laboratories – CVX – vaccines

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Standard Terminology

• SNOMED CT – Federally recognized standard for clinical

documentation – Detailed documentation of clinical information 19 hierarchies, 300K concepts, 1.5M relationships Diseases, findings, etiologies, living organisms,

procedures, outcomes – Common “language” that allows software systems to

talk to each other

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SNOMED CT for Pharmacy

SNOMED CT Concept SNOMED CT ID Referred by primary care physician 2021000124102 Patient unable to obtain medication 429611000124105 Medication dose too low 448152000 Hypertension medication review 473225006 Rheumatologic disorder education 413084000 Recommendation to increase dose 428811000124101 Medication reconciliation by pharmacist

428701000124107

Hemoglobin A1c <7% 165679005 Adverse reaction to drug 62014003

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SNOMED CT for Pharmacy

How do we implement SNOMED CT in electronic systems?

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Value Sets

• Set of codes deemed appropriate for documenting within a specific data field

• Guides vendors and implementers how to build documentation codes within solutions

Pharmacy SNOMED CT Codes

300-400 Codes

Pharmacy SNOMED

CT Value Sets Sets of 10-40

Codes 300,000+

Codes

SNOMED CT

Codes

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Value Sets

Codes

“Value Sets”

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Referral Source Value Set

Referral Source SNOMED CT ID Referred by health care professional 2011000124105 Referred by physician 309014007 Referred by primary care physician 2021000124102 Referred by specialist physician 2031000124104 Referred by nurse practitioner 2041000124109 Referred by self 1991000124105 Referred by payer 2001000124107

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Health Information Exchange

• National Vendors – CommonWell – SureScripts – Care Quality

• State Health Information Exchanges

Using HL7 standards, APIs for data exchange

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Exchanging Pharmacy Information

• Clinical Document Architecture (C-CDA) – Standard developed by Health Level 7 (HL7) – Provides a common framework for development of

electronic clinical documents – Capture, store, access, display, and transmit clinical

data elements

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Clinical Document Architecture

• C-CDA Clinical Document Templates 1. History & Physical (H&P) 2. Progress Note 3. Procedure Note 4. Consultation Note 5. Discharge Summary 6. Continuity of Care Document (CCD) 7. Pharmacist Care Plan (PhCP)

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Clinical Document Architecture

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Work with Vendors

• Map out patient care process • Codify clinical documentation, reference data

standards (e.g. value sets) • Make it easy for clinicians to document • Drive changes within your system; do not be confined

by current capabilities • Design to comply with C-CDA or other HIE

communication standards

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Medicaid Incentive Program

• Funding tied to the Health Information Technology for Economic and Clinical Health (HITECH) Act

• Allows 90% federal match for administrative costs related to health information exchange (HIE) promotion for Medicaid EPs

• As of Spring 2016, expanded to include non-EP providers, including pharmacies

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Online Resource Center

• Over 40 links; 13 documents authored by PHIT Collaborative workgroups and representatives

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Implementation Guide

• Beginner’s Guide published on PHIT Collaborative website

• Additional documents pending publication

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How to Access Value Sets

https://vsac.nlm.nih.gov/#

• Create a free UMLS login to access • Draft and finalized value sets published here • Search for Author/Steward = PharmacyHIT

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How to Access Value Sets

• Click on Search Value Sets tab

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SNOMED CT & Value Set Inquiries

http://pharmacyhit.org/

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Key Takeaways

• Pharmacy HIT Collaborative represents the profession of pharmacy in Health IT

• Terminologies like SNOMED CT and communication standards like HL7 C-CDA make health information exchange possible

• Standard data sets (e.g. value sets) allows all software vendors to exchange common data elements

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Questions?

Samm Anderegg, Pharm.D., MS, BCPS Health IT Consultant

sammuel.anderegg@gmail.com @anderegg14

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Telligen QIN-QIO Medication Safety Initiative Colorado | Illinois | Iowa

Katy Brown, PharmD Katy.Brown@area-d.hcqis.org

515-453-8124 | 712-299-6850 https://telligenqinqio.com/our-work/medication-safety/

Contact

This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QIN-C3.6-03/27/17-2059