ecqm implementation: a provider’s...
TRANSCRIPT
eCQM Implementation: A Provider’s Perspective
April 12, 2015
Michael Zaroukian, MD, PhD, MACP, FHIMSS VP & CMIO – Sparrow Health System
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Conflict of Interest Michael Zaroukian, MD, PhD, MACP, FHIMSS Has no real or apparent conflicts of interest to report.
© HIMSS 2015 2
Learning Objectives – Provider focus • Describe the quality eMeasures implementation process,
along with some of the challenges…
• Employ strategies to best engage with your vendor for updating measure specifications.
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Provider Goals for Quality Reporting
• Make sure the CQMs…
– are clear, understandable, consistent, stable
– matter to my patients and me (Triple Aim +)
– are fairly attributed to me
– fit into efficient EHR workflows
– yield reports I agree with, can act on
– are easy to calculate and submit • CEHRT does it for me
– can be implemented at reasonable cost
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Providers Will Support eCQMs if…
• There is a value proposition • Their staffs support, recommend eCQM submission • Burden low – benefit high
– Reading, writing, thinking, navigating, reporting • Staff and vendor will make sure reports are right • I can see how I’m doing and have tools to improve • Anything reported publically will accurate reflect care
delivered
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Provider Perspective: Keep it Simple
Measure Developers
• Develop measures that make sense, are feasible, will work in real world
Vendors • Build functionality into EHR to
support measures (capture, EHR reporting, e-submission)
Providers • Align workflows and
EHR functionalities • Provide appropriate
care, EHR to do the rest
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Provider Concerns
• Reports don’t look right need to research
• Rules & regs are hard to find, understand, reconcile, connect to EHR tasks
• Alphabet soup of obscure terms and relationships – QRDA I/III, IQR, HQMF, LOINC, RxNorm, NQF, IPFQR, ICD,
SNOMED CT, CVX, ISO, CPT/HCPCS…
• Vendor access, responsiveness, capacity to support
• Staff resources needed to manage reporting
• Added work to prove you met a measure
• Process vs. outcome measures
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Some Feedback from Our Front Lines…
• Ambulatory eCQM submission – YES • Providers on EHR for full reporting year
– EHR-generated QRDA-III (aggregate) data file QualityNet portal (MU and PQRS)
• Providers on EMR for partial year – Manual entry of MU CQM data, claims-based data for PQRS
• Struggles with subtle or minor program differences – State (Medicaid) vs. Federal (Medicare) measure logic
– Payer-based incentive programs with similar measures requiring custom reports and reporting methods
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Some Feedback from Our Front Lines…
• Inpatient eCQM submission – NO
• Not ready for IP QRDA I eMeasure reporting
– Too many files (per patient; no aggregate option)
– Staff resources to complete terminology mappings
– Major EHR workflow changes required
• Data entry in specific locations & time frames
• Lower performance vs. abstraction until adopted
• Negation documentation complexity
– Concern CMS will publically report performance early
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Strategies to Engage with Your Vendor
• Commit to mutual purpose, shared success – Vendor commits to supporting your eCQM success
– Providers/staff commit to learning, workflow changes
• Assigned customer and vendor leads to coordinate quality, eMeasure reporting progress
• Study vendor quality reporting documents, project management, terminology mapping, crosswalks (measures workflows reporting)
• Promote synergy, not defensiveness
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Top Priorities for Progress
• Collaboration of all key stakeholders is paramount – Mutual purpose, shared goals, clear roles – Actors, not victims – Clear communication
• Technical, clinical, and operational expert participation is essential
• Keep focus on whether data collection & reporting will result in better health, better care, lower costs
• Align rewards and accountability around “who benefits” and “who pays”
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Quality
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Remember Why We Are Doing This…
Contact Information • Email: [email protected]
• Twitter: @mzaroukian
• LinkedIn: https://www.linkedin.com/pub/michael-
zaroukian-md-phd-macp-fhimss/1/39/471
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eMeasures: Specification April 12, 2015
Sharon Giarrizzo-Wilson, MS, RN-BC, CNOR
SymQuality Consulting, LLC
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Conflict of Interest Sharon Giarrizzo-Wilson, MS, RN-BC, CNOR Has no real or apparent conflicts of interest to report.
© HIMSS 2015
Learning Objectives • Identify the technical standards used to define, manage, and report electronic
clinical quality measures (eMeasures) • Review the eMeasure specification process
• Discuss current considerations for eMeasure development
National HIT Agenda
Local EHR
Secondary use
Decision support
Quality reporting
Reuse
Quality Data Model Data Element
HL7 Version 3 Implementation Guide: Quality Data Model – based Health Quality Measures Format Release 1 – US Realm February 2014
Standards: QDM, eMeasures, QRDA, CDA
HL7 Version 3 Implementation Guide: Quality Data Model – based Health Quality Measures Format Release 1 – US Realm February 2014
Health Quality Measure Format (eMeasure)
HQMF Header <QualityMeasureDocument> HQMF Body <section> <title>Population criteria</title> <text> <entry>Initial Patient Population</entry> <entry>Denominator</entry> <entry>Numerator</entry> <entry>Exclusions</entry> … </section> <section> <title>Data criteria</title> <text> <entry> … </section> … </QualityMeasureDocument>
End-to-End Reporting Process
CMS Quality Reporting Document Architecture: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Guide_QRDA_2014eCQM.pdf
DW eMeasure Application
Quality Measure
Identification eMeasure
Specification eMeasure
Testing eMeasure
Implementation eMeasure Use,
Evaluation, Maintenance
Feasibility Evaluation
Month 1 Month 5 Month 12 Month 21 Month 27
eMeasure Lifecycle
eMeasure Lifecycle - Identification
Quality Measure
Identification
Concept list generated
Stakeholders
Tools
TEP/SME Patients/ Caregivers
CMS Measure Manger
NLM Value Set Authority
Center
USHIK Draft Measures
CMS/HHS Inventory
USHIK Clinical Quality
Measures
CMS eCQM Library
NQF Quality Positioning
System
CMS MMS Blueprint
Months 1 - 5
eMeasure Lifecycle - Specification
eMeasure Specification
Draft specifications,
initial feasibility
Stakeholders
Tools
TEP/SME HL7 eMIG
Cypress
Bonnie Tool
QDM
HQMF
MAT
VSAC & Value Set Authoring
Tool
CMS MMS Blueprint
Months 4 - 12
NLM
JIRA
CMS MMS Blueprint
• Standardized system for developing and maintaining quality measures
• Measure developers should follow core set of business processes and decision criteria
• Two volumes: – Measure Development – Measure Maintenance
• Download:
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MeasuresManagementSystemBlueprint.html
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ONC JIRA Issue Tracking System • Feedback from public comments • Updates may impact clinical intent, logic or value set • Identification of implementation challenges and harmonization
opportunities – Initiation of multi-stakeholder consensus discussions
• eMIG, eMeasures Governance • NLM data element consults • Logic Harmonization workgroup
• Link: https://jira.oncprojectracking.org/secure/Dashboard.jspa
NLM Value Set Authority Center (VSAC)
• Services – Value Set: Search, Retrieval, Download – Authoring and validation tool for creating new and revising published
value sets – Reduces quality assurance tasks – Standard vocabularies used to define clinical concepts in CQMs
• SNOMED CT®
• ICD-10 CM/PCS • RxNorm®
• LOINC®
The Measure Authoring Tool (MAT)
• Developer – The National Quality Forum
• Ownership – Centers for Medicare and Medicaid
• Supported by – Health Care Innovation Services, Telligen/Net, Net Integrated
Consulting • Publicly-available, web-based tool • Exports eMeasure as human-readable, Simple XML, and HQMF XML
Bonnie Testing Tool - Test Case
eMeasure Lifecycle - Testing
eMeasure Testing
Develop, implement
comprehensive testing plan
Stakeholders
Tools
Formative testing
feedback recourses
Testing partners
(e.g., test sites)
TEP/SME
Cypress (implantation
testing) Bonnie Tool
Months 5 - 21
eMeasure - Testing • Types
– Feasibility • Data availability, accuracy, standards, workflow
– Validity • Face validity, logic validity, data element validity, measure
score validity – Reliability
• Clarity (“ace reliability”), logic ambiguity (logic reliability), data elements conformance to standard
• Phases – Alpha: internal testing – Beta: field testing
* No national test bed available *
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Cypress – Implementation Testing
ONC Cypress: Meaningful Use State 2 Testing and Certification Tool, http://projectcypress.org/faq.html#whatIsCypress
eMeasure Lifecycle - Implementation
eMeasure Implementation
Support eCQM rollout: Federal rulemaking, business process, NQF endorsement,
education & outreach
Stakeholders
Tools
CMS Federal Regulations
The Public
CMS eCQM Library JIRA
Months 21 - 27
USHIK
NQF Measures
Application Partnership
eMeasure Lifecycle – MAINTENANCE
eMeasure Use, Evaluation,
Maintenance Stakeholders
CMS Measure Management Contractor
The Public
From Month 27
CMS
TEP/SME NQF
Assess measure performance in field, conduct maintenance
eMeasure Considerations
• Changes for 2015 – More efficient tools – Aligning Eligible Provider and Eligible Hospital eMeasures
• Challenges – Risk adjusted and composite measures – Tool limitations – Unable to test full range of use cases/scenarios – Value sets updated annually – Lack of national test bed – Maintaining eMeasures of ‘topped-out” paper-measures
Questions
Sharon Giarrizzo-Wilson, MS, RN-BC, CNOR [email protected]
Measure Development, Specifications & Implementation
April 12, 2015 Zahid Butt MD,FACG
CEO Medisolv Inc.
Chair HIMSS Performance Measurement Taskforce
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Conflict of Interest
CEO of Medisolv; Quality Measurement Software Vendor Do not speak for nor refer to any specific EHR product Has no other real or apparent conflicts of interest to report.
© HIMSS 2015
Learning Objectives
• Discuss eCQM (eMeasures) implementation: A Software Vendor Perspective
eCQM Implementation/Update Life Cycle
• Final Rules • Specifications
Annual Update
eCQM
• Build • Test
Software • Clinician
Workflows • Data
Capture
Data
• Validation
Results • Test • Final
Submission
eCQM Implementation/Update Life Cycle
• Final Rules • Specifications
Annual Update
eCQM
• Build • Test
Software • Clinician
Workflows • Data
Capture
Data
• Validation
Results • Test • Final
Submission
9 – 18 Months
Specification Changes / Issues
Specification Changes / Issues
• Value set changes; Impact on clinician workflow – Major – Minor – None
• Logic changes; Impact on results – Yes – No
• Value set & logic changes outcomes – Routine “Maintenance” – Errors fixed – New errors introduced
Specification Changes / Issues
Quality Data Model & EHR Data
EHR Data Issues in eCQMs
• Not captured as structured data • Structured but not coded or mapped • Missing / ambiguous meta data • Null vs. Negation documentation • Same element – variable / multiple locations in physical
database • Multiple code systems for same element (e.g. Diagnosis)
Thank you !!
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[email protected] 443-539-0505 Ext 223
410-925-7005 (cell) Linked In: Zahid Butt MD, FACG
Twitter:@zbytes