Quality And Payment” - healthsystemcio.com · Lesson Learned • Communicate, communicate,...

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“Mastering eMeasures - Charting a Course To Align Quality And Payment” a complimentary webinar from healthsystemCIO.com, sponsored by Encore Health Resources

Transcript of Quality And Payment” - healthsystemcio.com · Lesson Learned • Communicate, communicate,...

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“Mastering eMeasures - Charting a Course To Align

Quality And Payment”

a complimentary webinar from

healthsystemCIO.com,

sponsored by Encore Health Resources

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Housekeeping

• To ensure you enjoy all the functionality of today’s event, please turn off your pop-up blocker

Internet Explorer I 1. Tools 2. Pop-Up Blocker 3. Turn off Pop-Up Blocker (If you are given the option to “Turn on Pop-Up Blocker” simply exit this dropdown menu)

Mozilla Firefox 1. Options 2. Options 3. Content 4. Uncheck “Block Pop-Up

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Housekeeping

• If you would like to submit a question at any time during the webcast, you may do so by utilizing the “Ask a Question” button located on the bottom of your screen. Click on the button, type in your question and then click submit.

• If you would like to download today’s presentation, please click through to the following URL: healthsystemcio.com/documents/EncoreWebinar.pptx This will be provided again at the conclusion of our event.

• An Archive will be available within 24 hours after the webcast has ended. You may access the Archive by using the same link you registered with.

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Objectives

• To learn from those who – through trial and error – have found success

• To leave today’s presentation with specific, actionable advice which can immediately be put into practice

• To absorb the underlying principles which have made a “win” possible, so they may be applied in your facility

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Agenda – Panelists

Liz Johnson, VP, Applied Clinical Informatics, Tenet Healthcare Corporation

Michael Nelson, VP, Information Services, Universal Health Services, Inc.

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Agenda – Continued

A Word from our Sponsor – Linda Lockwood, Associate Partner, Encore Health Resources

Q&A With Panelists – Moderated by Anthony Guerra, founder/editor, healthsystemCIO.com

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“Mastering eMeasures – Charting a Course

To Align Quality And Payment”

healthsystemCIO.com

Liz Johnson, MS, FHIMSS, CPHIMS, RN-BC VP of Applied Clinical Informatics

HHS Health Information Technology Standards Committee Member

Modern Healthcare 2010 Top 25 Clinical Informaticist

HIMSS 2010 Nursing Informatics Leadership Award & HIMSS50 in 50: Memorable Contributors in HIMSS’ 50 Year History

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Agenda

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• eMeasures History

• Approach

• Tracking

• Lesson Learned

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Quality Is Center Stage in the Road to Reimbursement

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Tenet’s Approach to “Electronify” a Measure

EDW

PBAR*

Cerner* EDW*

eMeasure Requirements

Content

Processes Workflows

Measuring Quality with eMeasures

Data Capture

MU Dashboard

Decision-making

• Capture the right data in the right

format enabled by workflow to

support Meaningful Use Stages

1-3 and other related initiatives

• Support Tenet’s overall BI

Objective, joining of Clinical and

Operational data in a common

repository

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It Started with a Reference Library

• We created a reference library that contained the each measures definition, codes, data elements, derived data to support measure calculation

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What Workflows, Content & Order Sets were used for each eMeasures?

*end user training

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Sample - Data Input Supporting eMeasures

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Discharge Inpatient Stay Admission

Admission History

Problem List

Medication Reconciliation

Vital Signs

Stroke Orders

Nursing

Physician

Problem List

Education

Education

Summary of

Care

Evidence based orders support Stroke Quality requirements for

Meaningful Use

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We Track Design Decisions and Issues

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Managing Risk

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Risk Details by eMeasure

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Integrated Clinical BI Strategy Overview

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Clinical Analytics Strategy

Meaningful Use

Clinical Decision Support

Value Realization

Clinical Quality

• Power Insight

• Cerner ODS

Initial

Focus

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EDW Meaningful Use Dashboard

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Lesson Learned

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• Make decisions now with the future in mind

– Stage 2 and 3 expected requirements – Accountable Care Organizations – Pay for performance (quality based)

• Overlap between CMS Core Measures and CMS EHR Clinical Quality Measure programs exists – These will not be 100% “harmonized” – Will require expansion of hospital quality programs

• The data matters, a lot – Summary analysis of the CMS regulations is not enough

- need to get to the data level (measure by measure) – Data must be discrete, at the lowest level – Can’t build for the future without the data in mind – Must be able to aggregate, calculate and report

• Workflows will have to be redesigned with specific training

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Lesson Learned

• Communicate, communicate, communicate

– Help users understand what is coming

– Set expectations, things will change

• It is a journey that has many side trips and distractions – never forget it is about improving patient care

• Have a team dedicated to tracking, interpreting and attesting

• It’s a balancing act that requires effective governance to manage other priorities (e.g. 5010, ICD-10)

• Engage your clinicians, early, often and get their input

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Michael Nelson,

VP, Information Services, Universal Health Services, Inc.

Building an eMeasure Foundation for the Future:

UHS and the Meaningful Use Journey

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Today’s Objectives

eMeasures: Setting the Foundation for the Future of Healthcare

The UHS MU Journey – Getting to the details

Clinical IT History

Current State

How we approached MU

Our timeline

Building for the future

Where is my data? Defining a source of truth

Lessons Learned

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New Care Models

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Share Exchange

Data

Capture and Use EHR

Aggregate Calculate

Report

eMeasures

Meaningful Use

This is not only about

Meaningful Use…

…it’s about

creating an

eMeasure

foundation for the

future

Creating an eMeasure Foundation for the Future

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UHS Information Technology - History

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2007 focus on stabilizing Clinical Software applications 2008 upgraded existing applications to improve functionality 2009 developed a strategy and conducted Selection Project Cerner selected as primary vendor Scope includes ED, Nursing, Rx, Lab, Rad, OR, Med Recs, etc.

2010 conducted design, configuration and initial testing 2011 converted initial site and 2 additional facilities 2011 design and enhancements for MU compliance 2011 Inpatient CPOE and MU requirements targeted for go-live

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Patient Registration

Scheduling

Interface Engine

Patient Accounting

Patient Accounting Doc Imaging

OR incl. Scheduling

Materials Management

Accounts Payable

General Ledger

Human Resources

Payroll

Lab

Pharmacy

Radiology

Medical Records

Transcription

Quality Management

Ancillary Systems

Emergency Dept

PACS

Order Management

Nursing Clinical Documentation

MD Data Viewer

Data Repository

“Core” Clinicals

Mobile Results PDA

No installed product for: -Computerized Physician Order Entry -Bedside Medication Administration (barcoding) -Medical Device Integration

UHS Replaced Clinical Systems in “Red” with Cerner Software-Enabling a Foundation for eMeasures

Revenue Cycle

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UHS Milestone Timeline: Keeping our Eye on the Target

UHS MU Assessment Final Findings 27

Sept Oct Nov Dec Jan Mar

Phase 1 Phase 2

Sept. 18: Facility #4 Integrated Testing Fu

sio

n Oct. 1:

Facility 5-9 Activation of Database

Nov. 6: Facility #4 Integrated Testing

Dec. 7: Facility #1 Inpatient CPOE Live

Jan. 29: Facility #2 & 3 Inpatient CPOE Live

MU

Feb

Nov. 1-Dec. 15 MU CPOE Testing Additional Gap Items

March: Review compliance Optimize Prepare to attest

Sept. 1-Nov. 1: MU Design Decisions MU Build CPOE

Dec – Feb: Reporting Production Usage Education

Feb 12: Facility #4 Go-live

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• Meaningful Use provided the incentive for UHS to accelerate our Cerner implementations

• UHS understood that this initiative must be grounded in improving clinical outcomes and patient care, while looking ahead to Stage 2

• We quickly realized that you have to be in “the details” to properly handle eMeasures

MU Setting a Platform for eMeasures

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The MU Journey: Vendor Dashboards to eMeasure Reality

• UHS had received vendor dashboards-we knew we had gaps

• Significant work to get our hands around all the requirements

• As usual there are the People, Process and Technology components to meet the data capture and reporting for eMeasures

• Strong preference to get this right for MU asap and deploy an MU compliant new Clinical System as opposed to going back to multiple facilities for subsequent MU upgrades

• Requires a lot of work to address Stage 1 and planning for what is likely in Stage 2

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Getting to the Data Level for VTE 1: Data Map Sample

(700+ Line Items Like This for MU eMeasures)

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Measure

Number

Identifier

Measure

Title

DerivedDa

ta:Elemen

ts

Data

Elements

Value Set Numerator /

Denominator

Inclusion/

Exclusions

Module Table Field NameEvent Code/DTACode Set Data Element Defaulted/Value Data Element Requires Manual Entry

VTE-1 VTE

prophylaxi

s within 24

hours of

arrival

Clinical

Trial-VTE

Related

Clinical

Trial

Purpose

Joint

Commission

Clinical Trial

Value Set

Denominator Exclusion NHIQM Clinical

Events

LH_F_VTE_

METRICS

CLIN_TRIA

L_EXCL_FL

AG

Reg VTE Relevant Clinical Trial Code Set

93

Code set

72

YES/Defaulted value = "No" Manual intervention to change

clinical trial question = "yes" if

patient on clinical trial

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Conduct a measure by measure review of data, workflow and content

Validate data elements against federal data eMeasure requirements

Populate the tool with design decisions, issues, risks & workflows

Conduct risk analysis and manage risks and issues

Coordinate with a multi-disciplinary team to reach consensus

Produce work plan with key tasks by functional area

*Make Meaningful Use modifications

*Current work

How We Did It: The UHS MU Approach to Date

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Where is UHS Now? • We have completed our comprehensive Meaningful Use Assessment-and

have started our “Modification” phase, building to close gaps in system design, content, workflow and process

• We must execute this modification phase quickly while maintaining go-live schedule

• We have developed a comprehensive program management infrastructure-how we will manage attestation, communication and education with our hospitals

• Establishing focused project management, governance and decision making

– People, Process and Tools

• Incorporating lessons learned from initial go lives with clinical documentation and orders, identifying overlaps and efficiently making key organizational decisions (i.e., electronic medication reconciliation, CPOE adoption and roll out)

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Where is My Data: Defining a “Source of Truth”

• Like most hospitals today we collect core measures by manual chart review, and enter them into our Core Measure system

• For eMeasure data capture we recognized the data must be in a new format, and eventually reported electronically

• However there are some overlaps and it is important to clearly define “what” data are being entered “where” and by “whom”

• For MU we needed to define a “source of truth”

• For UHS that is Cerner

• But it requires design, configuration, processes and proper deployment to work for MU

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Lessons Learned

• Design and build with the future in mind: Must design for Stage 2, not just Stage 1

– Build all your data elements to support eMeasure capture

– Build and focus on implementing all Menu Set items

– Set your targets higher than national standards knowing they will increase

– Design your orders sets and content to capture all Core Measures for Quality

– Focus on sharing and exchanging data

• Messaging: Focus on improving quality of care and patient safety, not meeting the measures for payment

• Engage your clinicians: This is about using the system in a “meaningful way” design the system to support clinician workflow, bring your physicians to the table to participate when ever possible

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Lessons Learned

• Truly understand the scope: the MU effort is tremendous

• You must get to the “details” of the data to capture eMeasures inclusive of processes, content and workflow

• You must track status and progress down to the detailed data element level

• Your team is critical: You must have enough of the right people available to administer the program and make the decisions required to complete the build.

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Lessons Learned

• MU cannot be accomplished in a silo: This is NOT an IT effort alone, Quality, Compliance, Nursing, and Physicians must all be at the table making decisions together.

• Integrate, Integrate, Integrate: Your implementation team and MU team must be seamless, work plans need to be integrated, teams need to make design decisions together, and meet on a weekly basis. Everyone owns this process and success

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Linda Lockwood,

Associate Partner, Encore Health Resources

eMeasures

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Road to Reimbursement Reform

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Integrate data to

display results and

provide capabilities

(referrals, e-Rx) for

individual pts

Aggregate, calculate

data for analysis

across populations for

cost, quality, risk and

chronic disease

Securely move and

exchange this data with

key stakeholders

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Capture EHR and

demographic data in a

secure discrete manner

The Evolving Model of Care

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The CoreQUEST™ Solution

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CoreQUEST™ Our Method

CoreGPS™

Our Tool

CoreTEAM Our People

Encore Healthcare Reform Wiki and Knowledge Base

The CoreQUEST™ Solution

Encore’s CoreQUEST™ solution optimizes and accelerates the use of eMeasures

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Based on OVER 1,700 pages of government rules & industry

specifications

The CoreGPS™ Data Tool

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24 Eligible Hospital (EH) measure definitions as well as the 15 quality eMeasures deconstructed (39 total):

• 100+ individual data elements

• 700+ unique data element mappings

• 70+ value sets consisting of over 3,500 individual codes

25 Eligible Professional (EP) measure definitions as well as 44 quality eMeasures deconstructed (69 total)

• 200+ individual data elements

• 2200+ unique data element mappings

• 550+ value sets consisting of over 7,000 individual codes

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Q&A

Liz Johnson, VP, Applied Clinical Informatics, Tenet Healthcare Corporation

Michael Nelson, VP, Information Services, Universal Health Services, Inc.

Anthony Guerra, editor, healthsystemCIO.com

Click the “Ask a Question” button located on the bottom of your screen, type in your

question and then click submit.

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Closing

• At this point, you will see a window open to our PowerPoint presentation, which you can then download. If not, go to healthsystemcio.com/documents/EncoreWebinar.pptx

• Within 24 hours, an archive of this event will be available for 3 months. It may be accessed by using the same link you registered with.

• For more information on Encore Health Resources, go to encorehealthresources.com or view the browser window which has opened on your computer.

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Thank You!

We hope you will join us for more

healthsystemCIO.com Webinars in the future

Questions/Comments – Anthony Guerra

[email protected] 201-638-2727