Mastering emeasures - Charting a Course To Align Quality And Payment

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“Mastering eMeasures -

Charting a Course To Align

Quality And Payment”

a complimentary webinar from

healthsystemCIO.com,

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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,

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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

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Agenda

• eMeasures History

• Approach

• Tracking

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Quality Is Center Stage in the Road to Reimbursement

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Source: NQF Webinar “Implementing Electronic Measures 101: The What, Why, and How”; July 28,

2011

“Electronify”

A Measure =

EHR

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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?

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Sample - Data Input Supporting eMeasures

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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Risk Details by eMeasure

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Integrated Clinical BI Strategy Overview

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

• 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

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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

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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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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

3

 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

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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

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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 si o 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

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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)

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

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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

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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

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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

Capture EHR and demographic data in a secure discrete manner

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The CoreQUEST™ Solution

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

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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.