quality improvement and measurement with hit · population health tool other hit tools ehr...

Kevin Larsen MD Medical Director, Meaningful Use Office of the National Coordinator of Health IT

Quality Improvement and Measurement with HIT

March 7 2013

The only way you can achieve the triple aim is not to do one thing but to do everything.

Don Berwik

3/29/2013 Office of the National Coordinator for Health Information Technology

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It is winter, sometimes there

is snow. Be careful.

Press here to document you

read this.

Bathroom water

pressure is low

Scheduled

maintenance due in

2 months, mark

here to accept

Computer assisted flying as CDS

New Care Models

Health IT

National Quality Strategy

Medicare ACOs (CMMI)

Medicaid ACOs (SIM)

Standards

Commercial ACOs


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8

Data capturing

and sharing

Advanced clinical

processes

Improved outcomes

Stage 1

Stage 2

Stage 3

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“I am the expert about me.”

Hurricane

Sandy

INTEROPERABILITY

Complex Adaptive System

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Quality

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Quality Ecosystem

• Local EHR

• Registry or data intermediary

• Benchmarking

• Coaching

• Technical support


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Only those who provide care can improve care

HIT enable practice of the future 16

Vision for the Future

• Measures Drive Improvement

–Real-time –Local ownership with benchmarking –Linked to decision support and patient dashboards

• Measures Drive Value-Based Purchasing

–Reliable –Accurate –Outcomes-based

• Measures Inform Consumers

–Meaningful –Transparent

“Small Data is our short term focus”

Dr. Joe Kimura

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Small Data is our Short Term Focus. Dr. Joe Kimura

Source: CDC, July 2012

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HHS Core HIV Indicators

Measure Numerator Denominator

HIV positivity Number of HIV positive tests in the 12-month measurement period

Number of HIV tests conducted in the 12-month measurement period

Late HIV diagnosis Number of persons with a diagnosis of Stage 3 HIV infection (AIDS) within 3 months of diagnosis of HIV infection in the 12-month measurement period

Number of persons with an HIV diagnosis in the 12-month measurement period

Linkage to HIV Medical Care

Number of persons who attended a routine HIV medical care visit within 3 months of HIV diagnosis

Number of persons with an HIV diagnosis in 12-month measurement period

Retention in HIV Medical Care

Number of persons with an HIV diagnosis who had at least one HIV medical care visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between the first medical visit in the prior 6 month period and the last medical visit in the subsequent 6 month period

Number of persons with an HIV diagnosis with at least one HIV medical care visit in the first 6 months of the 24‐month measurement period

Antiretroviral Therapy (ART) Among Persons in HIV Medical Care

Number of persons with an HIV diagnosis who are prescribed ART in the 12-month measurement period

Number of persons with an HIV diagnosis and who had at least one HIV medical care visit in the 12-month measurement period

Viral Load Suppression Among Persons in HIV Medical Care

Number of persons with an HIV diagnosis with a viral load <200 copies/mL at last test in the 12–month measurement period

Number of persons with an HIV diagnosis and who had at least one HIV medical care visit in the 12-month measurement period

Housing Status Number of persons with an HIV diagnosis who were homeless or unstably housed in the 12-month measurement period

Number of persons with an HIV diagnosis receiving HIV services in the last 12 months

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Research • What’s happening?

Guidelines • What

SHOULD Happen

Quality Measures

• Did it happen?

CDS • It will

happen

Quality Measurement Alignment

MU, PQRS, IQR, ACO, VBP, HRSA,CDC

current

Unified Measures

EHR Reporting

Medicare Data Sharing for Performance Measurement

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Qualified

Entity

INSURANCE COMPANIES MEDICARE?

NOW FUTURE

COMPREHENSIVE

CONSISTENT

FAIR

ACTIONABLE

INSURANCE COMPANIES MEDICARE?

eMeasures

• eMeasures are software queries

• Need to find space for clinical judgment

• Easy and broad dissemination

• Innovation model from the start- continue to innovate

• Tools for local use and for accountablity

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Future State: HIT Enabled QI Toolkit

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Value Set Authority

Center

Public Domain

Electronic Health Records

Population Health Tool

Other HIT Tools

EHR Certification Tools Unambiguous machine

readable

Unambiguous human readable

Clinical Decision Support

Clinical Registries

CMS Quality Reporting

Stakeholder

s

Development Time Current Process Jan 2013

Electronic Clinical Quality Measure Development Kaizen Future & Current States

Development Time Future Process

3-5 years

1 year

Major Changes Future vs. Current: -Single Piece Flow vs. Batch Flow Processing -Upfront vs. During Stakeholder Engagement -Streamlined vs. Redundant Approval Loops -QA throughout the process vs. only the end

= Measure in Development

Rework Loop

Measure Development “Ecosystem”

VSAC

cEHRT

eCQMs QDM MAT NQF ? MAP? Rule ?

Cypress PopHealth

SEVT (reporting to CMS)

CDA RIM

HQMF

QRDA

STANDARDS

vMR HeD

CDS

USHIK

popHealth

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HHS Post Kaizen Event – Notional Future State Clinical Quality Measure Testing Process Flow

Title

5.

Imple

menta

tion

Fie

ld T

esting

4. D

ata

Ele

ment

QA

and e

-Sp

ec

3. M

easure

Concept

Researc

h

2.

Exte

rnal

Sta

keho

lders

1. H

HS

Contr

acts

6. R

elia

bili

ty &

Va

lidity F

ield

Testing

Identify Measure

Concept

Submit IRB

Application

Vet Prospective

Testing Entities

Approved Test Bed

Vendors Hosps Beacons HIEs EPs

National

IRB/HIPAA

Waiver

Testing Templates

(Plan, SOW, DUA)National

Test Tools

National

Test Bed

Criteria

Proposed National Testing Development Efforts

Add Task Cross-

Stakeholder

Innovation

Measure Related Contract Modifications

Incorporate

Agile/Lean

Modify

Deliverables

Schedule

Allocate

New Task

Funding

Potential Testing Entities

Vendors Hosps Beacons HIEs EPs

SOW/DUA

Paperwork

Select SME

Panel

HL7/Standards Organizations

Clinicians

Methodologists

EHR Data

Experts

Standards

Experts

Preliminary Data Element

Assess (see sub-flow 1)Review Materials

Preliminary Face

Validity Assess

Data Element

Repo

National

Fail Early?

1 Measure

NarrativeN

Update National

Templates

Allocate

Test Bed

Funding

Draft HQMF MAT Entry VSAC /

NLM

VS Repo

National Draft Measure

Require. Tool

Measure

Developer

Create Test Cases

Vetting Process

Cypress &

Bonnie ETL

Answer

Key Test Cases

Simulated

Modifications

Updated HQMF

Fail Early?N

2

Update AMA National

Template Data Element

Table Tool (DET) ®

Update National

Template Query

Vendor

Review Fail Early?

Completed

DET

Data Warehouse

Vendor Query

CountsFeasibility

Analysis

Vendor

Implementation

3

N

ETL

Measure Calc

Performance

Report

Answer Key

Comparison

Fail Early?4

N

Data Collection

Form (DCF)

Binomial

Analysis Code

Approved IRB/

HIPAA WaiverExecuted

Contract/DUA

Determine R&V Testing

Approach

Does DB Volume/Struct.

Support Binomial Analysis?

Perform Binomial

R&V Analysis

Binomial R&V

Analysis Results

Perform On-Site

Validity Against

Gold Standard

R&V Compare

ResultsEHR System

Production

N

Fail Early?

5a

Fail Early?

5b

Y

B o o z | A l l e n | H a m i l t o n F e b r u a r y 2 4 , 2 0 1 3P o s t - K a i z e n M e a s u r e T e s t i n g a n d C e r t i f i c a t i o n W o r k g r o u p P a g e 1

Health eDecisions

•http://wiki.siframework.org/Health+eDecisions+Homepage


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http://wiki.siframework.org/Health+eDecisions+Homepage







“I wouldn’t give a fig for simplicity on this side of complexity but I’d give my right arm for simplicity on the other side of complexity.”

Oliver Wendell Holmes

Questions?

[email protected]

For more information about ONC visit: healthIT.gov


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quality improvement and measurement with hit · population health tool other hit tools ehr...

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