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Meaningful Use Reporting: Build or Buy? What is the Best Approach? By Steve Nitenson - RN, BSN, MS, MBA, Ph.D. Sr. Healthcare Solutions Architect, Perficient Oct 28th, 2011

Meaningful Use Reporting: Build or Buy?

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Page 1: Meaningful Use Reporting: Build or Buy?

Meaningful Use Reporting: Build or Buy?

What is the Best Approach?

By Steve Nitenson - RN, BSN, MS, MBA, Ph.D.

Sr. Healthcare Solutions Architect, Perficient

Oct 28th, 2011

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2011 Copyright

Build vs. Buy – Won’t my EHR vendor handle this for me?

What does it take to develop a single clinical quality measure and reporting requirements?

Review the current state of the market with respect to clinical quality measures

Understand the lifecycle of a clinical quality measure and measure processing challenges

What a pre-built clinical measure healthcare BI framework should have with a focus on “meaningful use” reporting

Q & A

2

Agenda Topics

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What are the Options?

Options Pros Cons

Do Nothing Low costLow disruption

Inability to meet reporting requirementsLack of information to make decisions

Internal Development Control of your dataControl of your timelineHighly customized to your organizationControl your success

Long time to bring to useCosts to fund effort is highRisk of minimal innovationYou bear the risk of failure

Rely on EMR vendor solution

Good for data acquisition Electronic submission

Creation of reporting and dashboards using vendor BI tools by your staffHidden costs of development

Buy a certified Meaningful Use solution

ONC certified solutionYearly updates on measure calculations/new measuresActionable information from dashboards/trends

Data quality challengesVariability in maturity of EMR implementations

Build

Buy

Buy

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EHR Vendors: Meaningful Use Reporting Requirements

170.304 (j) Calculate and submit clinical quality reports – Eligible Professionals

• 3 core and 3 alternate core quality measures• 3 measures out of additional 38 quality measures• Report submission using PQRI XML 2009 format

170.306 (i) Calculate and submit clinical quality reports – Eligible Hospitals

• 15 clinical quality measures• Report submission using PQRI XML 2009 format

170.302 (n) Automate measure calculation

• 16 EHR usage measures for Eligible Professionals• 14 EHR usage measures for Eligible Hospitals

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Clinical Quality Measure Challenges

Usability, flexibility, scalability as well as maintenance costs are some of the key concerns…

“Client measure applicability may be different from the

certified set” “We do not have in-house clinical expertise to validate

and manage measure definitions…”

“Our hardcoded approach is not a scalable solution – we have to revisit our strategy

very soon”

“Ongoing effort and cost of maintenance given the volatility in measures is one of our major

concerns”

“Our customers are asking for custom measures in addition to support on other quality

initiatives like PQRS”

!

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Is your EHR Vendor’s Efforts Enough

?While many EHRs have minimally completed the “meaningful use” certification for clinical quality measures, there are significant challenges ahead…

Challenges for EHR clients – Hospitals & Physician Practices

• Clinical quality measures relevant for many clients will be different from the small set of certified measures

• Clients may not be able to comply with the “meaningful use” requirements despite using a certified EHR

• Need for custom measure definitions for customer / regulatory needs

Challenges for EHR vendors themselves

• To add new clinical quality measures, vendors will need significant effort and cost for:

o CQM specs, software development and QA/testing

o ONC certification of additional measures

• Ongoing effort and cost in maintaining an increasing list of clinical quality measures

Minimal Certification Strategy Challenges

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Hospital Electronic Health Record

§170.306 (i) Calculate and submit clinical quality measures (EH)

NQF 0371 VTE prophylaxis within 24 hours of arrivalNQF 0372 ICU VTE prophylaxisNQF 0373 Anticoagulation overlap therapyNQF 0374 Platelet monitoring on unfractionated heparinNQF 0375 VTE discharge instructionsNQF 0376 Incidence of potentially preventable VTENQF 0435 Ischemic stroke—Discharge on anti-thromboticsNQF 0436 Ischemic stroke—Anticoagulation for A-fib/flutterNQF 0437 Ischemic stroke—Thrombolytic therapy for patients

arriving within 2 hours of symptom onsetNQF 0438 Ischemic or hemorrhagic stroke—Antithrombotic

therapy by day 2… ….… ….

Comply with Meaningful use

criteria

Report 15 clinical

quality measures

1

2

Clinical Quality Reporting Requirements

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§170.304 (j) Calculate and submit clinical quality measures (EP)

NQF 0013 Hypertension: Blood Pressure MeasurementNQF 0024 Weight Assessment and CounselingNQF 0028 Tobacco Use Assessment and CessationNQF 0038 Childhood Immunization StatusNQF 0041 Preventive Care and Screening: Influenza Immunization

…NQF 0421 Adult Weight Screening & Follow-Up

NQF 0001 Asthma AssessmentNQF 0002 Appropriate Testing for Children with PharyngitisNQF 0004 Initiation and Engagement of Alcohol and Other Drug

Dependence Treatment: (a) Initiation, (b) EngagementNQF 0012 Prenatal Care: Screening for HIV

… ….…. ….

Comply with NIST test

procedures

Report 6 core

measures

Report ANY 3 out of 38 additional measures

1

2

3

Clinical Quality Reporting Requirements

Ambulatory EHR

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NQF 0061: Measure Specification

NQF 0061: EP Measure SpecificationsSource: NQF_HQMF_HumanReadable_0061.pdf

NQF_Retooled_Measure_0061.xlsx

Measure Description

Denominator Selection

Numerator Processing

Relevant concept codes

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Clinical Quality Measure Implementation Life Cycle

Key Steps in Clinical Quality Measure Implementation

Use of appropriate clinical concepts at point of care - observations, clinical documentation, results, exclusions

Develop condition processing algorithm/ rules engine to distribute patients in various numerator buckets

Apply rules – including exclusion criteria – for identifying patients in the denominator

Measure status determination based QDC matrix

Denominator Selection

NumeratorGroup 1

Numerator Group n

Clinical Concepts at Point of Care

…. Measure Status

Clinical DataExtraction

Extract / standardize data using clinical terminologies

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True Assign (3075F)

Group 3 – Numerator processing

Group 2 – Numerator processing

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NQF 0061: Denominator Selection

True Assign (3074F)

FalseAssign (2000F) with 8P

True Assign (3079F)

FalseAssign (3080F)

If systolic less than 130

If systolic in 130-139

False

False

True Assign (3078F)

C1

C2

C3

C4

C5

Denominator (#Qualified Patients)

True

If blood pressure observation exists

If diastolic less than 80

If diastolic between 80-89

FalseAssign (3077F)

Group 1 – Numerator processing

Denominator Definition

Patient Demographic Filters• Age range: 18 to 75

(as on Date of Encounter)• Gender: Both

Condition Group

Are part of a visit in Entire reporting period with:

• Any of following ICD9 Codes:250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.00, 648.01, 648.02, 648.03, 648.04

AND• Any of following CPT/HCPCS codes:

97802, 97803, 97804, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0270, G0271

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NQF 0061: Measure Status Analysis

BI/Dashboardvisualization

Measure Status CPT-II Codes Patient Count (Numerator)

Meets Performance 3074F & 3078F, 3075F & 3078F 688

Medical PerformanceExclusion

Not applicable for this measure -

Patient Performance Exclusion

Not applicable for this measure -

System PerformanceExclusion

Not applicable for this measure -

Other Performance Exclusion

Not applicable for this measure -

Performance Not Met 3077F & 3078F, 3077F & 3079F, 3077F & 3080F, 3074F & 3079F, 3074F & 3080F, 3075F & 3079F, 3075F & 3080F, 2000F-8P

67

Denominator Count 755

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Clinical Quality Measures: Implementation Challenges

Clinical Data Capture & transformation• Building clinical concepts into clinical

applications e.g. EHR • Ability to use the concepts for mapping

relevant clinical data related to patients and encounters

• Data cleansing & terminology mapping for to ensure data consistency

Numerator Processing• Multiple condition flows & variables for

single measure• Measure-specific variances in condition

logic & measure status grouping• Extracting usable information from

clinical documentation and mapping clinical concepts

Denominator Selection• Mapping clinical concepts and

extracting qualified patient population• Variances in coding standards based on

source systems• Measure-specific variances in criteria

for diagnosis, procedures, etc.

Denominator Selection

NumeratorGroup 1

Numerator Group n

Clinical Conceptsat Point of Care

…. Measure Status

Clinical DataExtraction

Measure Status Analysis• Maintain status mapping for

multiple measures and condition groups

• Provide analysis capabilities around measure status for causal analysis, etc.

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Can you Buy a complete, certified Solution – It Depends…

The BI you may select should offer a simple and fundamentally new approach to Healthcare Business Intelligence (BI)

–More than 600 pre-built measures and Key Performance Indicators

–Accelerated compliance to Meaningful Use and ACO quality reporting requirements.

The BI should use state-of-the-art BI and analytics tools to enhance clinical decision support, performance benchmarking, and persona-based dashboards from data across a wide range of clinical and financial systems.

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Powerful Regulatory Compliance Tool

ONC-ATCB 2011/2012 certified for all 44 EP and all 15 EH Meaningful Use quality measuresGuaranteed support for 100% Meaningful Use Stage 2 and Stage 3 compliance100% PQRI measures coverage200+ inbuilt measures / KPIs for financial and operational reporting100% coverage of all 65 quality performance measures required by ACOs for the Shared Savings Program100% coverage of 88 JCAHO measures

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Sustainable Model for Healthcare BI

Powerful End User Capabilities: Real-time clinical alerts to enhance point-of-care decision support. Health BI supports both clinical and financial data, which provides a 360 degree view of population health management.

Quality Management: Health BI provides a comprehensive measure library based on specifications recommended by leading quality and regulatory organizations such as HEDIS, ADA, AHRQ and NCQA. With an extensive range of customizable persona-based dashboards, Health BI provides drill down capabilities for advanced analytics, decision support, performance benchmarking, and complete physician practice clinical quality reporting.

Utilization Management: Deployed by a leading MCO for effective utilization management through integrated clinical and financial reporting.

Extensible: Offering a Proprietary Clinical Measure Processing Framework to configure and deploy clinical rules for implementation of changing evidence-based guidelines and quality measures, Health BI offers multi-server architecture and cloud-based deployment options that provide easy and rapid scalability.

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• Comprehensive BI framework for healthcare providers – ONC-ATCB 2011/2012 Certified for Meaningful Use

• Disease registries for clinical reporting on both outcome and process measures

• Business reporting and financial management dashboards for reporting and improving key performance measures

• Robust integration framework - integration with leading financial & clinical applications

• Robust, flexible and cost-effective technology built on BI platform

• Rapid deployment time – providers can get started within a couple of months!!

• Highly cost-effective solution – 40%+ cost saving over other BI solutions

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Solution Highlights

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Key CapabilitiesMarket CoveragePhysician Practices, Hospitals, IDNs, MCOs, ACOs & HIEs

Regulatory Reporting and Compliance

Meaningful Use, HEDIS, PQRS, ACO, JCAHO

End User CapabilitiesActionable intelligence,

performance benchmarking, custom dashboards, clinical

decision support and integrated analytics

Clinical Measure Processing Framework Rule Based, Highly Flexible and Easily Configurable

Architecture and Deployment Modular, Scalable, Flexible & Interoperable

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Market Coverage

Market CoveragePhysician Practices, Hospitals, IDNs, MCOs, ACOs & HIEs

Health BI Market Coverage

Strong coverage of provider markets – across physician practices, hospitals, and IDNs

Integrated reporting for multiple hospitals facilities and associated physician practices – key success factor for MCOs and ACOs

Completely integrated approach to clinical quality reporting and financial & operational reporting

Extensive coverage of HIE reporting requirements

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Architecture and Deployment

Health BI – Architecture and Deployment

Modular and scalable architecture

Standards-based approach to healthcare business intelligence

Easy 4-step integration with a wide range of partner applications in less than 45 days

Incorporates Service Oriented Architecture and cloud-based deployment models

Easily customizable for specific partner and client requirements

Architecture and Deployment Modular, Scalable, Flexible & Interoperable

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Dimension AdvantageEasy to integrate

Flexible architecture designed to integrate effectively and rapidly with a wide range of partner applications

Comprehensive Supports both clinical & financial aspects of patient care for developing 360 degree view of Population Health Management Processes.

Extensible Proprietary rules-engine to configure and deploy clinical rules to support ever growing evidence-based guidelines and quality measures

Cloud-enabled Supports deployment on both private and public cloud infrastructure, with capability to provide CQM Framework as a service

Service-oriented

Highly flexible web-services based architecture for ease of integration and distributing information through various channels (devices, browser, thick-client, Apps)

Interoperable Supports multiple standards (e.g. XML, flat-files, HL7, CCR / CCD) and multiple clinical terminologies

Health BI’s modular, scalable and standards-based approach to healthcare BI/ Analytics has been very well received in the marketplace

Health BI can be integrated with a healthcare applications in less than 45 days

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Architectural Highlights

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Health BI is powered by BI-Clinical

BI-Clinical Datamarts & Cubes

BI-Clinical Measure Processing Framework

Partner App

Interface

On-demand

processing

Clinical Alerts

Partner App Adapter

Partner AppStaging

Database

BI-Clinical Audit

Database

BI-Clinical Data Submission

Ambulatory

Hospitals & IDNs

MCOs & HMOs

Partner Analytics User Interface

Analytics, Scorecard, Trends,

Benchmarking, Ad-hoc reporting & repot schedules

BI-Clinical Framework Modules

Application database(s)

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ayer

Ap

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Ap

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Application processing

logic

Partner App

Partner Analytics

UI Link

Partner Point of

Care Module

BI-Clinical Adaptor

Partner App UI Integra-

tion

Partner DB

Views

Step 4: Point-of-Care integration

(optional)

Step 1: BI-Clinical Views creation

Step 3: Reporting Configuration

Step 2: Scorecard integration

Health BI can be integrated with HIT Vendors in just 30-45 days!

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Clinical Measure Processing Framework

Health BI – CMP Framework

Highly flexible and configurable rules engine for measure definition and modification

User friendly interfaces that allow clinical experts to define custom measures

Powerful data abstraction module to support data capture by chart reviewers

Deep drill down capabilities to get extensive visibility into patient information

Clinical Measure Processing Framework Rule Based, Highly Flexible and Easily Configurable

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Clinical Measure Definition Capability

Health BI provides a user-friendly interface for clinical experts to define custom measures

Example: PQRI #1

Example: STK-1

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Regulatory Reporting and Compliance

Health BI – Reporting and Compliance

Only 3rd party reporting solution that is ONC-ATCB 2011/2012 certified for both EH and EP clinical quality measures

Comprehensive coverage of Meaningful Use, HEDIS, PQRS, ACO and JCAHO reporting requirements

600+ in-built measures and key performance indicators for comprehensive clinical, financial, operational and regulatory reporting

Pre-built disease registries for population care and chronic condition management

Regulatory Reporting and ComplianceMeaningful Use, HEDIS, PQRS, ACO,

JCAHO

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ACO Performance

Measures

Meaningful Use EH Measures

Meaningful Use EP Measures

PQRS 2011 Measures

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Regulatory Reporting

BI-Clinical 10.3 is the ONLY comprehensive ONC-ATCB 2011/2012 Certified BI solution:

• Certified for ALL 15 Meaningful Use Stage 1 criteria for Eligible Hospitals (EH)

• Certified for ALL 44 clinical quality measures in Stage 1 for Eligible Providers (EP)

BI-Clinical provides guaranteed coverage for current and future regulatory requirements, including

• Meaningful Use Stage 2 criteria

• 200+ PQRS measures

• ACO Performance guidelines

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End-User Capabilities

Health BI – End-User Capabilities

Leverages cutting-edge technologies to provide advanced analytics and reporting capabilities

Extensive drill-down and slice-and-dice capabilities to generate actionable intelligence

Integrated financial and operational analytics and reporting

Ability to provide Point-of-Care Decision Support and patient querying capabilities to partner applications

Certified for Meaningful Use report submission in prescribed format

End User Capabilities

Actionable intelligence, performance

benchmarking, custom dashboards, clinical

decision support and integrated analytics

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End User Capabilities (1/2)

KPI Scorecards & Trends Benchmarking & Drill-down Analytics

Clinical Decision Support at Point of CareMeaningful Use Submission Reports

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End User Capabilities (2/2)

Physician / Facility Scorecards Persona-based Dashboards

Integrated Operational AnalyticsIntegrated Financial Analytics

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Who We Are What We Do Our Work Our Approach Our Team

Thank you

Q&A

Steve Nitenson - RN, BSN, MS, MBA, Ph.D. Sr. Healthcare Solutions Architect 650-291-7792   [email protected]

www.healthcare.perficient.com/landingpages/HealthBIIndex.html

Here is a link to all Healthcare white papers: http://www.healthcare.perficient.com/RegulatoryCompliance.aspx

 

Demo Contact:Babita Patel - MBA713.554.4011   [email protected]