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Page 1: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Making Meaningful Use Reports Meaningful

October 14 th, 2011

Making Meaningful Use Reports Meaningful

- 0 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Page 2: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Agenda

MAeHC experience

Why we measureWhy we measure

HIT and CQM

Using CQM data

What is the future of CQMWhat is the future of CQM

Changing healthcare landscape

National Quality Strategy

Questions, comments, discussion

- 1 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Questions, comments, discussion

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MAEHC Mission: Facilitate universal EHR adoption

• Company launched September 2004

–Non-profit registered in the –Non-profit registered in the Commonwealth of Massachusetts

• CEO on board January 2005

• Backed by broad array of 34 non-• Backed by broad array of 34 non-profit MA health care stakeholders

- 2 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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MAeHC Selected three pilot sites from 35 Applicants : Brockton, Newburyport, North Adams

• Provided EHRs to ~600 clinicians practicing in over 200 office locations

• Created health information exchanges connecting the physicians with each other and with the hospitals

• Created a quality data center to extract clinical data

- 3 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

from EHRs to evaluate effectiveness and measure performance

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MAeHC architecture and data flows

Outcomes analysis

BenchmarkingAnalysis and Reporting

Reporting to plans, others?

Quality Data Center

Community-level: HIE

Brockton Newburyport North Adams

Community-level: HIE

Provider-level: EHR

- 4 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Provider-level: EHR

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Since the pilot program, MAeHC has expanded its exp erience base and involvement in a variety of projects

300 Physician EHR implementation – Beth Israel Deaconess Physician Organization (BIDPO)

Community-wide EHR Implementation and HIE planning project – Large Healthcare Foundation

HEAL 5 New York – New York State Department of Health and New York eHealth HEAL 5 New York – New York State Department of Health and New York eHealth Collaborative (NYeC)

HEAL 10 New York – Adirondack Region Patient Centered Medical Home Pilot

State-level HIE technical services vendor procurement – Missouri , North Carolina

State Level Health Information Exchange Strategic and Operational Plan Development – New Hampshire– New Hampshire

Regional Extension Center planning, deployment, and operations – New York, Massachusetts, Rhode Island, New Hampshire

- 5 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Page 7: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Agenda

MAeHC experience

Why we measureWhy we measure

HIT and CQM

Using CQM data

What is the future of CQMWhat is the future of CQM

Changing healthcare landscape

National Quality Strategy

Questions, comments, discussion

- 6 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Questions, comments, discussion

Page 8: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

What is a measure?

Meas•ure n. A standard: a basis for comparison; a reference

point against which other things can be evaluated; “they set the point against which other things can be evaluated; “they set the

measure for all subsequent work.” v. To bring into comparison

against a standard.

- 7 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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We know we can’t measure everything

Not everything that counts can be counted, and not everything that can be counted counts.

~Albert Einstein

But…

You can’t improve what you don’t measure

- 8 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

You can’t improve what you don’t measure

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Why measure?

Measures drive improvement. Teams of healthcare providers who review their performance measures are able to make adjustments in care, share successes, and probe for causes when progress comes up short — all on the road to improved patient probe for causes when progress comes up short — all on the road to improved patient outcomes.

Measures inform consumers. As a growing number of measures are publicly reported, Measures inform consumers. As a growing number of measures are publicly reported, consumers are better able to assess quality for themselves, and then use the results to make choices, ask questions, and advocate for good healthcare. Some providers now post performance measures on their websites, and consumers can consult national sources such as www.HospitalCompare.hhs.gov and www.Medicare.gov/NHComparesources such as www.HospitalCompare.hhs.gov and www.Medicare.gov/NHCompare

Measures influence payment . Increasingly, private and public payers use measures as preconditions for payment and targets for bonuses, whether it is paying providers for performance or instituting nonpayment for complications associated with NQF’s list of “Serious Reportable Events.”

Source: NQF 2011

- 9 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Page 11: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Agenda

MAeHC experience

Why we measureWhy we measure

HIT and CQM

Using CQM data

What is the future of CQM

Changing healthcare landscape

National Quality Strategy

Questions, comments, discussion

- 10 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Page 12: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Linkage of Health IT and measurement

• Capture the right data, in the right format (CPT, ICD, LOINC)Data Sources ICD, LOINC)Data Sources

• Calculate the performance measureCQM • Calculate the performance measureCQM

• Provide real-time information to the clinician with • Provide real-time information to the clinician with decision supportEHR and HIT Tools

• Publicly report for accountability, payment, public health, and comparative effectivenessE-Infrastructure

Source: NQF 2011

- 11 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Source: NQF 2011

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Meaningful Use CQM objective

Improve quality, safety, efficiency and reduce health disparitiesImprove quality, safety, efficiency and reduce health disparitiesImprove quality, safety, efficiency and reduce health disparitiesImprove quality, safety, efficiency and reduce health disparities

Ob

ject

ive Report ambulatory clinical quality

measures to CMS or the States: Core: Hypertension, Tobacco Use

Sta

nd

ard For 2011, provide aggregate

numerator, denominator, and exclusions through attestation as

Ob

ject

ive

Core: Hypertension, Tobacco Use Assessment & Cessation Intervention, Adult Weight Screening (NQF 13, 28, 421 or PQRI 128) Menu: Must choose 3

Sta

nd

ard

exclusions through attestation as discussed in section II(A)(3) of this final rule. For 2012, electronically submit the clinical quality measures.PQRI 128) Menu: Must choose 3

measures to reportquality measures.

Requires only Yes / No Attestation Exclusion CriteriaRequires only Yes / No Attestation Exclusion Criteria

X None

http://healthcare.nist.gov/docs/170.304.j_CalcSubmitClinQualityMeasures_v1.0.pdf

http://healthcare.nist.gov/docs/170.306.i_CalcSubmitClinQualityMeasures_v1.0.pdf

- 12 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

http://healthcare.nist.gov/docs/170.306.i_CalcSubmitClinQualityMeasures_v1.0.pdf

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CQM is based on current standards – NQF, PQRI

http://www.ama -assn.org/ama1/pub/upload/mm/399/ehr -clinical -quality -measures.pdf

Population may be all patients, patients seen, or unique patients

- 13 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

http://www.ama -assn.org/ama1/pub/upload/mm/399/ehr -clinical -quality -measures.pdf

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Key to CQM success

Keep required data in reportable fields

Code and document completely; missing values or missing information = lower Code and document completely; missing values or missing information = lower performance

Information should be kept as structured data in searchable/sortable fields rather Information should be kept as structured data in searchable/sortable fields rather than free-text

Establish workflows and maximize staff capabilities to enter data elements, i.e. support staff can enter problems, medications, allergies and history

Patient/Medical/System reasons for exclusions should be documented and coded; helps to improve scores by legitimately reducing the denominatorhelps to improve scores by legitimately reducing the denominator

- 14 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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Meaningful Use CQM issues

Must select 3 additional CQMs that your EHR is certified to submit

Centricity meets the following clinical quality measures: NQF 0013, NQF 0024, NQF 0028, NQF 0038, NQF 0041, NQF 0059, NQF 0061, NQF 0064, NQF 0421.

CQM reporting tool must be certified if it is outside your EHR (MQIC)

Use “bundled” EHR when registering using additional software packagesUse “bundled” EHR when registering using additional software packages

Incorrect data mapping by vendor – understanding triggers for calculations

Submission can be “0/0”Submission can be “0/0”

- 15 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Page 17: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Agenda

MAeHC experience

Why we measure

HIT and CQM

Using CQM data

What is the future of CQM

Changing healthcare landscape

National Quality StrategyNational Quality Strategy

Questions, comments, discussion

- 16 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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CQM data must be relevant, timely and actionable

What you did What you are doing What you should do

Historical data based on claims

collected post visit with time delay

Current data incorporating eRX, orders and some

test results

CDS based on real time ICD/CPT data, eRX, results, and

approved protocols

EHR Implementation and Adoption

- 17 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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CQM data must be relevant, timely and actionable

CMS has acknowledged that the CQM reporting requirement in Stage 1 is no more than that—a reporting requirement meant to get physicians comfortable with the process of that—a reporting requirement meant to get physicians comfortable with the process of reporting.

CMS is under no illusions that the data collected will be meaningful as a measure of the level or quality of care being provided. level or quality of care being provided.

Many physicians will be reporting on problems for which they are not treating the patients, which means that measure numerators will be zero (or very low) and that duplicate data will be submitted by different physicians for the same patients for the duplicate data will be submitted by different physicians for the same patients for the same conditions, which will result in an underestimation of the true care being delivered.

- 18 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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Individual scores

Source:MAeHC QDC

- 19 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

MAeHC QDC

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Peer-to-Peer comparison

Source:MAeHC QDC

- 20 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

MAeHC QDC

Page 22: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Benchmark against standards

- 21 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Source:MAeHC QDC

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Other ways your data warehouse can present data?

Longitudinal scorecards to show variation over timeLongitudinal scorecards to show variation over time

Scorecards by payer to facilitate Quality Contracts (PFP)

Scorecards by CQM for treatment comparison

Local, regional and national benchmarksLocal, regional and national benchmarks

- 22 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Page 24: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Agenda

MAeHC experience

Why we measure

HIT and CQM

Using CQM data

What is the future of CQM

Changing healthcare landscape

National Quality StrategyNational Quality Strategy

Questions, comments, discussion

- 23 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Page 25: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Measures are getting better defined, but measure proliferation is a growing concern but measure proliferation is a growing concern

Meaningful Use Stage 1

44 measures

PQRS

187 measures

NCQA HEDIS /PCMH

Numerous measure choices

NQF

730+ Measures

+choices

+ +

Intent of measures often are very similar, but very few if any Intent of measures often are very similar, but very few if any measures have same definitions across categories

- 24 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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What the future holds for MU – Stage 2 and Stage 3

- 25 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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Future framework for the reporting of CQM

The Stage 2 recommendations for CQM reporting that the HIT Policy Committee has forwarded to CMS significantly expand on the Stage 1 Committee has forwarded to CMS significantly expand on the Stage 1 measures in an attempt to address a broader set of factors that affect quality, as well as to be relevant to a wider set of physicians, including specialists.

Providers would report on some number of the core measures, (between 5 and all 8 or 9 is the recommendation), and at least one measure from each of the 6 menu “domains”.

The core quality measure set would include all of the core and alternate core measures from Stage 1 and an additional 2 measures related to care coordination.

The intention is that all providers (including specialists) will find measures relevant to their specialty in the core set as well as in each of the domains

- 26 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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Future framework for the reporting of CQM

The intention is to broaden the scope of reporting to address a wider spectrum of factors affecting care and to accommodate all types of physicians. All providers will find measures relevant to their specialty in the core set as well as in each of the domains

- 27 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

relevant to their specialty in the core set as well as in each of the domains

Page 29: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Agenda

MAeHC experience

Why we measureWhy we measure

HIT and CQM

Using CQM data

What is the future of CQM

Changing healthcare landscape

National Quality Strategy

Questions, comments, discussion

- 28 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Page 30: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

The health reform law included a section that direc ted the HHS Secretary to establish a “Shared Savings Program”Secretary to establish a “Shared Savings Program”

“Not later than January 1, 2012, the Secretary shall establish a shared savings program “Not later than January 1, 2012, the Secretary shall establish a shared savings program that promotes accountability for a patient population and coordinates items under parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery”

Allows groups of providers of services and supplier s to manage and coordinate care for Medicare fee -for -services beneficiaries through an “Accountable Care care for Medicare fee -for -services beneficiaries through an “Accountable Care Organization” or ACO

- 29 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Source: Social Security Act Sec. 1899

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A shift to ACOs will increase demand for informatio n

Clinical information to support:

�Care coordination

�Evidence Based Medicine (EBM)

Immature In early use Mature

�Risk adjustment for patient population

Quality information to support:

�Reporting on clinical processes and outcomes

�Reporting on patient/caregiver experience of care

�Reporting on utilization (e.g., Preventable hospital admissions)

�Referral decisions (e.g., quality score for a lab, specialist practice, or provider)specialist practice, or provider)

Administrative/financial information to support:

�Payment – FFS

�Payment – Capitation, bundled payment, P4P

�Payment – Shared savings

�Referral decisions (e.g., rate cards for a lab, specialist practice, or provider)

- 30 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

�Assignment of patients to ACO

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A shift to ACOs will increase demand for integratio n

Enterprise

Meaningful Use capability

Clinical integration capability

Accountable care capability

Population, Risk, and Financial Management

Population, Risk, and Financial Management

Enterprise Integration & Management

• Business alignment

• Business integration

Measurement &

Case management & longitudinal

viewing

Measurement &

Management

Case management & longitudinal

viewing

Measurement &

Management

• Performance mgmt

• Team-based care

• Patient engagement

Measurement & Reporting

Registries & Repositories

Measurement & Reporting

Registries & Repositories

Measurement & Reporting • Population mgmt

• Utilization mgmt

• Case facilitationRegistries & Repositories

EHR functions

Clinical messaging

EHR functions

Clinical messaging

EHR functions

Clinical messaging

EHR functions

Clinical messaging • Become electronic

• Fill in gaps in care transitions

- 31 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Independent actors

IDNACOIPA/PHO

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EHR penetration will lead to proliferation of inter facing requirements

Clinicians will soon face too many measure

ehr ehr ehr ehr

definitions and too many proprietary reporting methods to respond to

Both sides will be exposed to ongoing technology and

Measure recipients will face too many disparate systems, incomplete

technology and market changes

systems, incomplete implementations, and inaccurate measure reports

PayorContracts

CMS MU CMS PQRS Public health

Others?

- 32 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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Is there a better way?

ehr ehr ehr ehr

Data Warehouse

Payers

CMS MU

CMS PQRS

Public health

Others

- 33 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

CMS MU Public health

Page 35: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Agenda

MAeHC experience

Why we measure

HIT and CQM

Using CQM data

What is the future of CQM

Changing healthcare landscape

National Quality StrategyNational Quality Strategy

Questions, comments, discussion

- 34 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Page 36: Making Meaningful Use Reports Meaningful - SNHAHEC Meaningful Use Reports Meaningful.pdfMeaningful Use CQM objective Improve quality, ... Assessment & Cessation Intervention, Adult

Federal Health IT Strategic Plan 2011-2015

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Interoperability Goals Drive RoadmapInteroperability Goals Drive Roadmap

Facilitate Information Exchange to support Meaningful Use of EHRs (Goal 1,

Objective B)

WHAT we want to do

Objective B)

Ensure that HIE takes place across individual exchange models, and

advance health systems and data interoperability interoperability (Strategy 1.B.3)advance health systems and data interoperability interoperability (Strategy 1.B.3)

� Improved care coordination

�Patient access and engagement�Patient access and engagement

� Improved decision-making

�Population health / learning health care system

WHY?INTEROPERABILITY GOALS

�Population health / learning health care system

HOW we will do it

STANDARDS

� Standards &

Interoperability Framework

SERVICES

� State HIE Cooperative

Agreement

POLICIES

� Governance regulations

� MU regulations

36

HOW we will do it Interoperability Framework Agreement

� Direct Project

� NwHIN Infrastructure

� MU regulations

� S&C regulations

� State policy levers

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Eyes on the Prize: National Quality StrategyEyes on the Prize: National Quality Strategy

� Aims� Aims– Better Care: Improve quality, by making health care more patient-centered,

reliable, accessible, and safe

– Healthy People and Communities: Improve health of population – Healthy People and Communities: Improve health of population

– Affordable Care: Reduce cost of quality health care

� Six Priorities and Goals to help focus public and private efforts:– Safer Care: eliminate preventable health care-acquired conditions– Safer Care: eliminate preventable health care-acquired conditions

– Effective Care Coordination

– Person- and Family-Centered Care

– Prevention and Treatment of Leading Causes of Mortality: prevent and reduce – Prevention and Treatment of Leading Causes of Mortality: prevent and reduce

harm caused by cardiovascular disease

– Support Better Health in Communities

– Make Care More Affordable– Make Care More Affordable

National Quality Strategyhttp://www.healthcare.gov/center/reports/quality03212011a.html#append

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Agenda

MAeHC experience

Why we measure

HIT and CQM

Using CQM data

What is the future of CQM

Changing healthcare landscape

National Quality StrategyNational Quality Strategy

Questions, comments, discussion

- 38 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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How Measures Will Serve Our Future

“Measures are becoming both more precise and more complex. The next generation of

measures will span healthcare settings and episodes of care to present a more

complete picture of care. In the public arena, reporting of measures will become clearer

and easier for patients and their families to understand and use. Wider adoption of

electronic health records (EHRs) can spur measure use enormously. A tremendous

boom for patient care and patient experience, EHRs put all the relevant information,

including a patient’s medical history, at a provider’s fingertips. Patients can avoid including a patient’s medical history, at a provider’s fingertips. Patients can avoid

duplicate tests or imaging. EHRs will also make measurement and performance data

available on a real-time basis, making healthcare much more responsive to patient

needs. Without good data, healthcare systems simply cannot accurately measure and needs. Without good data, healthcare systems simply cannot accurately measure and

assess performance.”

Source: NQF 2011

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Source: NQF 2011

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Jeff Loughlin Jen Monahan Leo McNamaraJeff Loughlin Jen Monahan Leo McNamaraExecutive Director Program Coordinator Project Manager(508) 326-3944 (603) 717-5420 (781) 434-7755

[email protected] [email protected] [email protected]

Nancy Fennell Jaime Dupuis Dave Delano Practice Consulting Practice Consulting CAH Consultant(603) 717-5021 (603) 717-5225 (339) 222-4036

[email protected] [email protected] [email protected]@maehc.org [email protected] [email protected]

Regional Extension Center of New Hampshirec/o New Hampshire Medical Society

7 North State Street7 North State StreetConcord, NH 03301Tel: 603.717.5420Fax: [email protected]

- 40 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

[email protected]

Massachusetts eHealth Collaborative © MAeHC. All rights reserved.