Technical Discussion State eCQM Models Data Types and Formats Data Intermediary Services and Data Quality supporting priority uses of eCQM information Agenda Introductions Context ID: 731256
Download Presentation The PPT/PDF document "eCQM Affinity Group Session #2" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
eCQM Affinity GroupSession #2
Technical Discussion
–
State
eCQM
Models, Data Types and Formats,
Data Intermediary Services, and Data Quality
supporting priority uses of
eCQM
informationSlide2
AgendaIntroductions
Context
Technical models
State
eCQM
Technical Models
Data types
Shared services through data intermediaries and governance
QRDA / C-CDA
Next stepsSlide3
ContextONC is convening the
eCQM
Affinity
Group as collaborative peer sharing providing assistance for
eCQM
strategy development.
The
eCQM
Affinity Group will discuss an end-to-end framework and state/regional examples discussing strategic planning, technical models, and implementation best practices.
Federal trajectory for quality measurement to support Alternative Payment Models
ONC Learning Event –
eCQMS
– National and State Usage and Issues in Support of Value-Based Payments
eCQM
Affinity Group #1 - Building Clinical Quality Measure Capacity Framework
ONC Health IT Stack for Value-Based Payment Models Slide4
Context: eCQM FrameworkSlide5
Context: Affinity Group ObjectivesDiscuss CQM framework supporting: Strategic planning for innovation and value based payment models;
Discussing governance and policy to support building measurement capacity;
Understanding technical models
a
nd considerations for choosing appropriate technical model for your state; and
Supporting quality improvement activities improving health, quality of care, and reducing costs.Slide6
Context: eCQM Uses and Benefits
Uses
Benefits
Clinical Quality Calculation
and Measurement
i
mproving quality
of care delivery
Produces better value through higher quality and lower cost of care
Measure for Payment – Pay for Value
financial incentives for health care providers
Rewards providers for lower cost and better outcomes
Public Reporting
for
cost and quality transparency
Provides transparency
on quality of care supporting
supports better decisions by consumers and purchasers
Reuse
collected dat
a for
clinical
action and population health measurement
Collect
data once and reuse for clinical quality measurement and clinical action, such as
Clinical Decision Support (CDS)
and provider s
elf-monitor progress
Payment
reform
design,
implementation
, program
monitoring and evaluation
Builds more effective programs using
available
quality measures
Assesses impact of payment reform programs on value
Decision support and gap analysis
of
patient
cohort
Cohort identification and understanding of controlled and uncontrolled patient cohortsSlide7
State eCQM Technical Models
Oregon
CQMR
Michigan
CQMRR at HIE
Connecticut
Indexing (Edge servers)
MyHealth
Access Network
Tulsa, OK
The Health Collaborative Cincinnati, OH
Utah
UHIN
Medicaid EHR Incentive Program attestationSlide8
For discussionHow do states identify end state goals and path to get there? Are there models missing? States using data intermediaries
What were steps taken to implement your model?
What were challenges?
Are you planning on scaling to other uses of the
eCQM
information? Slide9
Data type and sources supporting eCQMs
Claims only, Clinical only, Integrated (Clinical and Claims)
Figure source: Catalyst for Payment Reform. “CPR Employer-Purchaser Guide to Quality Measure Selection.” http://
www.catalyzepaymentreform.org
/how-we-catalyze/purchaser-strategy-and-tools/quality-measures October 2015 Slide10
System
Individual Organization
Individual Practice
Provider
Patient
Population
Clinical
Coordinated
Central
Decentralized
Central/shared
1
3
Data Type
Identity Management
Unit of Measurement
Claims
Independent
2
4
eCQMs
– Use Case #1 – Claims Only
Governance
Advantages
Disadvantages
Data easy to access
No use for clinical quality measurement
Value
of data for c
linical
a
ction
goes down
No comparison across organizations
Uses
Clinical Quality
Measurement
Pay for Value
Clinical
action and population health measurement
Pt
Cohort Decision support & management
Program requirements
and evaluation
Cost and quality transparency public reportingSlide11
System
Cross Organization
Cross
Practice
Provider
Patient
Population
Clinical
Coordinated
Central
Decentralized
Central/shared
1
3
Data Type
Identity Management
Unit of Measurement
Claims
Independent
2
4
eCQMs
– Use Case #2 – Claims Only & Shared Identifier
Governance
Advantages
Disadvantages
Data easy to access
Measurement
/comparison across organizations and practices
No use for clinical quality measurement
Value
of data for c
linical
a
ction
goes down
Uses
Clinical Quality
Measurement
Pay for Value
Clinical
action and population health measurement
Pt
Cohort Decision support & management
Program requirements
and evaluation
Cost and quality transparency public reportingSlide12
System
Cross Organization
Cross
Practice
Provider
Patient
Population
Clinical
Coordinated
Central
Decentralized
Central/shared
1
3
Data Type
Identity Management
Unit of Measurement
Claims
Independent
2
4
eCQMs
– Use Case #3 – Clinical Only & Shared Identifier
Governance
Advantages
Considerations
CMS program quality measurement requirements
Need
for central or coordinated governance
Need to pool information and analyze for population health measurement
Uses
Clinical Quality
Measurement
Pay for Value
Clinical
action and population health measurement
Pt
Cohort Decision support & management
Program requirements
and evaluation
Cost and quality transparency public reportingSlide13
Considerations for data intermediary services
Identity Management
supporting cross organization and provider calculation
Data quality
improvement services supporting practices with data capture may be professional services or technical solutions
Data completeness and consistency
– address data gaps and missing data elements
Central reporting
–support reporting to payers
Governance options
Decentralized – services provided separately and by separate organizations
Central – one data intermediary providing services (e.g., SDE, HIE, state)
Coordinated – one or more data intermediaries with virtual trust community and technical services
Data Aggregation
Reporting Services
Notification Services
Consumer Tools
Analytic
Services
Provider
Portal
Data
Quality
Pt.
Prov
/Attribution
Data Transport and Load
(
Warehouse/Repository)
Data Extraction
Identity Management
Provider Directory/Registry
Security Mechanisms
Consent Management
Governance
Financing
Policy/Legal
Business OperationsSlide14
Data qualitySlide15
Patients with >1 clinical data sourcesSlide16
DiscussionWhat are dependencies to getting to patient level data? How do you plan for gaps in EHR data and eCQM capabilities?
How are states planning data quality improvement strategies? Slide17
QRDA Cat 1 and C-CDA for Quality Reporting
QRDA Cat I
C-CDA
Intent
for use
Developed
for collecting data
required to calculate
the
93 e-specified measures
required for MU2
Developed to
provide
a
longitudinal view of patient’s
health information
to support
care coordination
Perspective
Ambulatory
/hospital
oriented:
A
ims
to capture information on provider/hospital behaviors and processes and their impact on patient care and outcomes
Patient
oriented:
Aims to capture information to provide a
longitudinal view of a patient’s health and healthcare history
Function
Used for the exchange of
eCQM
data between systems for
quality measuremen
t and
reporting initiative
Primary
function is to support
care coordination
but can be used for
quality reporting
Available Data
QRDA I Is limited to data required for eCQM calculation
C-CDA Includes additional
data components
t
hat can support multiple functions
Structured data and data quality
Enforces structured data
capture improving interoperability and comparisons
Does
not enforce the capture of structured data and may require additional data quality efforts (professional and technical) to ensure quality reporting
Discussion Slide18
Clinical Data Format Discussion
What
are opportunities and limitations to data
types and data
formats?
Are states planning for QRDA and/or C-CDA for
eCQM
? Or other data formats (e.g., ADTs, Lab results)
What challenges are states facing with QRDA and/or C-CDA?
Can
states get to additional
eCQM
uses using C-CDA?
Slide19
Next StepsSession #3 – Thursday, 12/17 – 11 am ETSession #4 – Thursday, 1/7 – 11 am ET
Specific questions contact ONC Resource Center or submit TA requestSlide20
Clinical Quality Measures (CQM) - Tools that help measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.1
Electronic
CQM (
eCQM
)
-
CQMs
that are specified in a standard electronic format and are designed to use data from Health IT systems for measurement
.
Common Definitions
Sources:
1
http://
www.cms.gov
/Medicare/Quality-Initiatives- Patient-Assessment-Instruments/
QualityMeasures
/ index.html 2. Office of the National Coordinator, “ Health IT Enabled Quality: A Vision to Achieve Better Health and Health Care”, *
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.htmlSlide21
Common DefinitionsQRDA is a standard document format for the exchange of electronic clinical quality measure (eCQM) data. QRDA reports contain data extracted from electronic health records (EHRs) and other information technology systems. The reports are used for the exchange of
eCQM
data between systems for quality measurement and reporting
initiatives
QRDA Category I report contains raw applicable patient data. When pooled and analyzed, each report contributes the quality data necessary to calculate population measure metrics.
QRDA
-III report is an aggregate quality report using data collected in patient-level QRDA-I reports. Each QRDA-III report contains calculated summary data for one or more measures for a specified population of patients within a particular health system over a specific period of time.
21
https://
www.cms.gov
/regulations-and-guidance/legislation/
ehrincentiveprograms
/downloads/qrda_ep_hqr_guide_2015.pdfSlide22
Clinical Decision Support (CDS) - A key functionality of health IT and certified EHRs that provides health care providers and patients with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.
Common Data Element (CDE)
-
Clinical
concepts that contain standardized and structured metadata, have unambiguous intent, and a clearly delineated value domain. These CDEs, such as “systolic blood pressure,” would define a curated, universal specification for each clinical or administrative concept, optimizing the data to be reused across the QI ecosystem.
Common Definitions
Sources:
1
http://
www.cms.gov
/Medicare/Quality-Initiatives- Patient-Assessment-Instruments/
QualityMeasures
/
index.html
2.
Office of the National Coordinator, “ Health IT Enabled Quality: A Vision to Achieve Better Health and Health Care”, * http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures
/index.htmlSlide23
Additional ResourcesNRHI - Center for Healthcare Transparency Innovation PilotsIntegrating claims and clinical information
Health Collaborative White Paper
Pilot Summary: The Health Collaborative – Document
Pilot Summary: The Health Collaborative – Presentation
Pilot Summary: Utah Health Information Network (UHIN) – Document
Pilot Summary: UHIN – Presentation
Webinar Recording: Overview of Both Pilots
Patient experience survey pilots
Pilot Summary: Patient Experience – Presentation
Pilot Summary: Patient Experience – Document
Pilot Research Findings Report
Fielding Guide
Literature Review
Webinar Recording: Overview of Patient Experience
PilotSlide24
Appendix: Regional case study – The Health Collaborative
Clinical data
Claims data
Central CQM Processing
eCQM
+ Cost Combining Process
Source
Health System utilizing Epic
Self-insured health system
Open Source / Freely Available Tools
Measure Authoring Tool
– author
eCQM
to produce HQMF
Value Set Authority Center
– official vocabulary sets
BONNIE
–
eCQM testing tool
Cypress – MU testing toolpopHealth – eCQM engine
Generate the measureLocate the Enterprise Patient ID in numerator and denominatorLocate EID from Cost data set
Include cost in measure
Data Format
Approximately 6,000 CCD’s
Custom flat files for
Member file
Claims files
Shared
Services
CCDs processed against MPI and stored for later use
Files processed against MPI and stored for later use
Transport
Daily CCD
extract
-
DIRECT method utilizing existing
MirthMail
sFTP
collection