vitl\blueprint for health
DESCRIPTION
VITL\Blueprint for Health. Quality Data, Quality Patients. Reasons for Good Data. “Without good data, healthcare systems simply cannot accurately measure and assess performance. …the practice of continuous measurement and public reporting creates a feedback loop that improves patient care .” - PowerPoint PPT PresentationTRANSCRIPT
Slide 1“Without good data, healthcare systems simply cannot
accurately measure and assess performance. …the practice of
continuous measurement and public reporting creates a feedback loop
that improves patient care.”
- National Quality Forum, The ABCs of Measurement
Data Quality Facts
4
The quality of the data in your source system affects the information sent to the reporting entities.
Quality data can reduce duplicative effort and enhance reporting and outreach.
Data Quality Facts
Increase costs
6
Objectively see where care deviates from clinicians’ intentions
Collect data at the point of care in the EMR
Feed data into statewide registry so practices can benchmark against peers
Identify who is doing well so organizations can share best practices
The overall goal is to improve the health outcomes by providing the highest quality care. In order to improve we need objectively be able to see where care deviates from what the clinician hopes they are doing for all of their patients.
The data that is used to create these performance reports is collected at the point of care in the EMR, minimizing duplication. When fed into a statewide registry it gives practices the opportunity to benchmark against their peers locally, at the state, and eventually the national level.
Furthermore it identifies who is doing well so organizations can share best practices.
As stated by Dr. Kevin Larsen….
6
7
How do we know that care is improving, and that health is getting better?
We need to measure it. Measurement isn’t the goal; better health is.
- Dr. Kevin Larsen, HHS
The overall goal is to improve the health outcomes by providing the highest quality care. In order to improve we need objectively be able to see where care deviates from what the clinician hopes they are doing for all of their patients.
The data that is used to create these performance reports is collected at the point of care in the EMR, minimizing duplication. When fed into a statewide registry it gives practices the opportunity to benchmark against their peers locally, at the state, and eventually the national level.
Furthermore it identifies who is doing well so organizations can share best practices.
As stated by Dr. Kevin Larsen….
7
Registries and External Reporting
The Health Information Technology structure in Vermont is designed to help practices with reports for:
8
Meaningful Use Measurement/Reporting
ACO Patient Records
Uniform Data System
Public Health Reporting
9
VITL - Vermont Health Information Exchange (VHIE)
Medicity
ADT
CCD
Covisint
VXU*
In Vermont practices enter information into their electronic health record, that information is fed up to the health information exchanged and merged with patient data coming from hospitals and other health systems. Within the health information exchange is a comprehensive health record for individual patients including clinical documents, labs, and some scanned notes. These are all valuable tools that can be used at the Point of Care. The Health Information Exchange feeds information to two additional sources, the Department of Health Immunization Registry and DocSite, a statewide patient registry. A specific discrete set of patient information is sent from the exchange to the statewide registry where again it is merged with information from sources such as the Supports and Services at Home (SASH), community health teams, and tobacco treatment specialists. Within the registry clinicians are able to generate complex multi-variable reports on their patient population and benchmark their reports against other practices within their local area and statewide. Furthermore the registry creates an integrated health record, for each patient including information from a variety of sources including laboratories, primary care practices, SASH, community health teams, and potentially other community based providers.
In order for reports and patient care to be accurate the data coming from the EMR or source system has to be accurate, up-to-date, complete and of the highest quality.
9
10
ADT
CCD
Accurate
Up-to-date
Complete
Highest Quality
In Vermont practices enter information into their electronic health record, that information is fed up to the health information exchanged and merged with patient data coming from hospitals and other health systems. Within the health information exchange is a comprehensive health record for individual patients including clinical documents, labs, and some scanned notes. These are all valuable tools that can be used at the Point of Care. The Health Information Exchange feeds information to two additional sources, the Department of Health Immunization Registry and DocSite, a statewide patient registry. A specific discrete set of patient information is sent from the exchange to the statewide registry where again it is merged with information from sources such as the Supports and Services at Home (SASH), community health teams, and tobacco treatment specialists. Within the registry clinicians are able to generate complex multi-variable reports on their patient population and benchmark their reports against other practices within their local area and statewide. Furthermore the registry creates an integrated health record, for each patient including information from a variety of sources including laboratories, primary care practices, SASH, community health teams, and potentially other community based providers.
In order for reports and patient care to be accurate the data coming from the EMR or source system has to be accurate, up-to-date, complete and of the highest quality.
10
Achieve Meaningful Use
Ensure accuracy within patient charts
Improve outreach
11
Patient Matching
Provider Panel – when the list of providers for an organization are incorrect or out of date
Patient attribution – when the patients aren’t assigned to the correct providers
Active/Inactive patients – when the list of active patients in a practices is incorrect or out of date
Deceased management - When deceased patients are left active in the health record.
Clinical data – when clinical data isn’t populating in the EMR correctly or in the right place for a variety of reasons we will review
Patient matching – when a patients health information isn’t matched to the correct patient
12
Inactive providers are still ACTIVE in source system.
Downstream systems do not know that providers are not inactive or that new providers have been assigned.
NPI is not exported with Provider information, causing incomplete data.
Fake providers are created for Out-of-Town patients and then exported cause confusion.
Workflow or system does not allow the practice to deactivate a provider or add a new provider.
Review panel and remove inactive providers.
Notify downstream systems of new or inactive providers.
Verify with VITL/vendor that NPI is exported in interface.
Determine how a fake provider is affecting the downstream system. Replace it with a standardized provider type.
Workflow or system does not allow the practice to deactivate a provider or add a new provider.
Ensures that practices are paid for active providers, and do not receive payment for inactive providers.
Allows there to be a synchronous accounting of providers.
Facilitate the transition of patients to the correct provider, ensuring that patient panel reports are accurate and actionable within the practice.
Patient Attribution Challenges
specific provider within a practice.
Patient Attribution Challenges
Patients no longer actively receiving care are not marked Inactive
Vacationers only seen once are marked Active
Patients are not assigned to a PCP
Patients are attributed to providers who are no longer with the practice
System has attribution besides PCP, such as Other Responsible Provider
Patient Attribution Challenges
16
Mark patients who have not been seen for 3 years Inactive
Develop a system to mark patients who are temporary as Inactive
Assign all patients a PCP and ensure that field is included in exports
Ensure that the Patient and Provider panels in the EMR are correct
Ensure export fields and mapping in the interface are correct
Patient Attribution Challenges
Accurate panel management reports and quality improvement measurements for the practices
Properly assigned patients and providers in patient attributions
Practices receive entire and correct payments
Active and Inactive Patient Status
18
Different rules apply to Active patient status.
Sites that provide both primary and specialty care may have patients who are Inactive within a practice and Active in the organization.
A patient is marked Inactive in the source system, but the EHR does not transfer an inactive flag.
Understand requirements in both source and downstream systems for Activating / Inactivating patients and synchronize.
Check with your organization regarding how to Inactivate a patient in one practice without doing so in other practices.
Ensure that status flag on your system is passing onto the next system.
Deceased Patient Status
Practices are not aware of patient’s death.
The Vermont death registry can supply a monthly list of people who die. Covisint can supply this information to practices in an Excel spreadsheet to be sorted by location.
Providers are not pulling panels containing deceased patients, thus avoiding the very unfortunate situation where they are contacting the families of the deceased.
Many practices rely on obituaries for death information.
Multi-practice sites need to mark deceased at parent source system or the data may be over-written in the organization.
Exports do not always support deceased indicator.
Work with VITL to determine if your export supports a deceased indicator. If not supported, report to down-stream systems.
Also essential for proper measurement, evaluation, and payment purposes.
Clinical Data Challenges
The EHR treats discrete numeric fields as text.
Ensures that reports and exported information is actionable by providers.
Some free text, delimiters, and combination fields in are not exportable.
Customized EHR fields are producing non-standard results.
Auto-fill used where more or different detail is needed.
Use discrete fields or drop-down menus whenever possible. Free text fields do not capture discreet data.
Ensures that the best quality care can be provided.
Limit the use of customized fields.
Customized data often do not pass in exports.
Ensure that numeric values are used in discrete fields where calculations may be required.
Essential for analysis and evaluation of the program and practice.
Patient Matching Challenges
Middle initial inconsistently provided
Invalid city-state-zip combination used
Establish a process to ensure proper data collection
Establish a policy of intermediate naming
Establish a process for proper phone # collection
Use drop-down menus for location information
Force numeric values where calculations may be required
Informed, impactful decisions at the point of care
Panel management reports have all information for patient outreach
Patient’s comprehensive medical history and set of conditions
Data Quality Sprints
22
Data quality sprints are used to clean up data within the host EMR or in the process of transmitting data to the Vermont Health Information Exchange or statewide registry.
All involved parties commit to working together and attending weekly meetings to review progress.
Participation from the practice or health system, VITL, Covisint/DocSite are essential to promote real time problem solving and immediate action.
The end result is better quality data in the EMR and registry, which leads to accurate actionable reports coming from either system.
Who Can Help?
Sprint Teams
Contact the BP Project Manager/Practice facilitator or call the BP office
e-Health Specialist
Contact VITL
Registry Managers
Contact the specific registry coordinator. If you do not have this information, contact VITL.
24
- National Quality Forum, The ABCs of Measurement
Data Quality Facts
4
The quality of the data in your source system affects the information sent to the reporting entities.
Quality data can reduce duplicative effort and enhance reporting and outreach.
Data Quality Facts
Increase costs
6
Objectively see where care deviates from clinicians’ intentions
Collect data at the point of care in the EMR
Feed data into statewide registry so practices can benchmark against peers
Identify who is doing well so organizations can share best practices
The overall goal is to improve the health outcomes by providing the highest quality care. In order to improve we need objectively be able to see where care deviates from what the clinician hopes they are doing for all of their patients.
The data that is used to create these performance reports is collected at the point of care in the EMR, minimizing duplication. When fed into a statewide registry it gives practices the opportunity to benchmark against their peers locally, at the state, and eventually the national level.
Furthermore it identifies who is doing well so organizations can share best practices.
As stated by Dr. Kevin Larsen….
6
7
How do we know that care is improving, and that health is getting better?
We need to measure it. Measurement isn’t the goal; better health is.
- Dr. Kevin Larsen, HHS
The overall goal is to improve the health outcomes by providing the highest quality care. In order to improve we need objectively be able to see where care deviates from what the clinician hopes they are doing for all of their patients.
The data that is used to create these performance reports is collected at the point of care in the EMR, minimizing duplication. When fed into a statewide registry it gives practices the opportunity to benchmark against their peers locally, at the state, and eventually the national level.
Furthermore it identifies who is doing well so organizations can share best practices.
As stated by Dr. Kevin Larsen….
7
Registries and External Reporting
The Health Information Technology structure in Vermont is designed to help practices with reports for:
8
Meaningful Use Measurement/Reporting
ACO Patient Records
Uniform Data System
Public Health Reporting
9
VITL - Vermont Health Information Exchange (VHIE)
Medicity
ADT
CCD
Covisint
VXU*
In Vermont practices enter information into their electronic health record, that information is fed up to the health information exchanged and merged with patient data coming from hospitals and other health systems. Within the health information exchange is a comprehensive health record for individual patients including clinical documents, labs, and some scanned notes. These are all valuable tools that can be used at the Point of Care. The Health Information Exchange feeds information to two additional sources, the Department of Health Immunization Registry and DocSite, a statewide patient registry. A specific discrete set of patient information is sent from the exchange to the statewide registry where again it is merged with information from sources such as the Supports and Services at Home (SASH), community health teams, and tobacco treatment specialists. Within the registry clinicians are able to generate complex multi-variable reports on their patient population and benchmark their reports against other practices within their local area and statewide. Furthermore the registry creates an integrated health record, for each patient including information from a variety of sources including laboratories, primary care practices, SASH, community health teams, and potentially other community based providers.
In order for reports and patient care to be accurate the data coming from the EMR or source system has to be accurate, up-to-date, complete and of the highest quality.
9
10
ADT
CCD
Accurate
Up-to-date
Complete
Highest Quality
In Vermont practices enter information into their electronic health record, that information is fed up to the health information exchanged and merged with patient data coming from hospitals and other health systems. Within the health information exchange is a comprehensive health record for individual patients including clinical documents, labs, and some scanned notes. These are all valuable tools that can be used at the Point of Care. The Health Information Exchange feeds information to two additional sources, the Department of Health Immunization Registry and DocSite, a statewide patient registry. A specific discrete set of patient information is sent from the exchange to the statewide registry where again it is merged with information from sources such as the Supports and Services at Home (SASH), community health teams, and tobacco treatment specialists. Within the registry clinicians are able to generate complex multi-variable reports on their patient population and benchmark their reports against other practices within their local area and statewide. Furthermore the registry creates an integrated health record, for each patient including information from a variety of sources including laboratories, primary care practices, SASH, community health teams, and potentially other community based providers.
In order for reports and patient care to be accurate the data coming from the EMR or source system has to be accurate, up-to-date, complete and of the highest quality.
10
Achieve Meaningful Use
Ensure accuracy within patient charts
Improve outreach
11
Patient Matching
Provider Panel – when the list of providers for an organization are incorrect or out of date
Patient attribution – when the patients aren’t assigned to the correct providers
Active/Inactive patients – when the list of active patients in a practices is incorrect or out of date
Deceased management - When deceased patients are left active in the health record.
Clinical data – when clinical data isn’t populating in the EMR correctly or in the right place for a variety of reasons we will review
Patient matching – when a patients health information isn’t matched to the correct patient
12
Inactive providers are still ACTIVE in source system.
Downstream systems do not know that providers are not inactive or that new providers have been assigned.
NPI is not exported with Provider information, causing incomplete data.
Fake providers are created for Out-of-Town patients and then exported cause confusion.
Workflow or system does not allow the practice to deactivate a provider or add a new provider.
Review panel and remove inactive providers.
Notify downstream systems of new or inactive providers.
Verify with VITL/vendor that NPI is exported in interface.
Determine how a fake provider is affecting the downstream system. Replace it with a standardized provider type.
Workflow or system does not allow the practice to deactivate a provider or add a new provider.
Ensures that practices are paid for active providers, and do not receive payment for inactive providers.
Allows there to be a synchronous accounting of providers.
Facilitate the transition of patients to the correct provider, ensuring that patient panel reports are accurate and actionable within the practice.
Patient Attribution Challenges
specific provider within a practice.
Patient Attribution Challenges
Patients no longer actively receiving care are not marked Inactive
Vacationers only seen once are marked Active
Patients are not assigned to a PCP
Patients are attributed to providers who are no longer with the practice
System has attribution besides PCP, such as Other Responsible Provider
Patient Attribution Challenges
16
Mark patients who have not been seen for 3 years Inactive
Develop a system to mark patients who are temporary as Inactive
Assign all patients a PCP and ensure that field is included in exports
Ensure that the Patient and Provider panels in the EMR are correct
Ensure export fields and mapping in the interface are correct
Patient Attribution Challenges
Accurate panel management reports and quality improvement measurements for the practices
Properly assigned patients and providers in patient attributions
Practices receive entire and correct payments
Active and Inactive Patient Status
18
Different rules apply to Active patient status.
Sites that provide both primary and specialty care may have patients who are Inactive within a practice and Active in the organization.
A patient is marked Inactive in the source system, but the EHR does not transfer an inactive flag.
Understand requirements in both source and downstream systems for Activating / Inactivating patients and synchronize.
Check with your organization regarding how to Inactivate a patient in one practice without doing so in other practices.
Ensure that status flag on your system is passing onto the next system.
Deceased Patient Status
Practices are not aware of patient’s death.
The Vermont death registry can supply a monthly list of people who die. Covisint can supply this information to practices in an Excel spreadsheet to be sorted by location.
Providers are not pulling panels containing deceased patients, thus avoiding the very unfortunate situation where they are contacting the families of the deceased.
Many practices rely on obituaries for death information.
Multi-practice sites need to mark deceased at parent source system or the data may be over-written in the organization.
Exports do not always support deceased indicator.
Work with VITL to determine if your export supports a deceased indicator. If not supported, report to down-stream systems.
Also essential for proper measurement, evaluation, and payment purposes.
Clinical Data Challenges
The EHR treats discrete numeric fields as text.
Ensures that reports and exported information is actionable by providers.
Some free text, delimiters, and combination fields in are not exportable.
Customized EHR fields are producing non-standard results.
Auto-fill used where more or different detail is needed.
Use discrete fields or drop-down menus whenever possible. Free text fields do not capture discreet data.
Ensures that the best quality care can be provided.
Limit the use of customized fields.
Customized data often do not pass in exports.
Ensure that numeric values are used in discrete fields where calculations may be required.
Essential for analysis and evaluation of the program and practice.
Patient Matching Challenges
Middle initial inconsistently provided
Invalid city-state-zip combination used
Establish a process to ensure proper data collection
Establish a policy of intermediate naming
Establish a process for proper phone # collection
Use drop-down menus for location information
Force numeric values where calculations may be required
Informed, impactful decisions at the point of care
Panel management reports have all information for patient outreach
Patient’s comprehensive medical history and set of conditions
Data Quality Sprints
22
Data quality sprints are used to clean up data within the host EMR or in the process of transmitting data to the Vermont Health Information Exchange or statewide registry.
All involved parties commit to working together and attending weekly meetings to review progress.
Participation from the practice or health system, VITL, Covisint/DocSite are essential to promote real time problem solving and immediate action.
The end result is better quality data in the EMR and registry, which leads to accurate actionable reports coming from either system.
Who Can Help?
Sprint Teams
Contact the BP Project Manager/Practice facilitator or call the BP office
e-Health Specialist
Contact VITL
Registry Managers
Contact the specific registry coordinator. If you do not have this information, contact VITL.
24