Improving Outcomes with HIT Kevin Larsen MD Medical Director, Meaningful Use Office of the National Coordinator of Health IT Connecting Michigan for Health, June 5, 2014 Objectives • Understand the rationale for migration to electronic quality measures • Describe the attributes of the future state of a quality ecosystem • Understand certification of electronic quality measures • Understand opportunities for registry integration with EHRs 3 4 CHANGE IS NOT COMING CHANGE IS HERE ALREADY 5 Advanced clinical processes Data capturing and sharing Improved outcomes Stage 3 Stage 2 Stage 1 6 Only those who provide care can improve care Barriers to widespread adoption Quality Measurement Enterprise EVIDENCE DEVELOPMENT GUIDELINE DEVELOPMENT MEASURE DEVELOPMENT MEASURE ENDORSEMENT MEASURE IMPLEMENTATION Create the evidence base for what is effective treatment Use evidence to create guidelines for providers Use guidelines to create performance measures of adherence to guidelines Provide assurance that performance measures are evidencebased, methodologically sound Implement/use measures to understand and improve quality QM Spectrum Comparisons Public Health Surveillance Local Quality Improvement Projects Pay for Performance OVERALL MEASURES Measurement Framework Intermediate Outcomes 6/18/2014 Expenditures Healthcare Expenditures Public Health Expenditures Patient Expenditures Enabling Service Expenditures Experience Patient Activation Access to Care and Information Communication with Healthcare Shared Decision-making Access to Enabling Services Office of the National Coordinator for Health Outcomes Functional Health Health Risk Disease/condition Site of Care 11 Why electronic quality measures? • Claims measures only capture activity, not quality – e.g. how many visits for blood pressure- not what is the blood pressure • Paper abstraction measures are expensive• Hospital Core measures- very expensive to run • Claims + chart abstraction (ala HEDIS+) are also expensive- (estimate $75 per chart) 12 How much cheaper? • Kaiser study showed that using stage 1 MU measures the cost was 50% reduced- even with the issues need to resolve the measures • Outpatient care showing similar cost savings 13 EHRs can measure new types of care • Patient reported outcomes • Functional status • Clinical outcomes- such as blood pressure at goal, diabetes controlled, asthma controlled, pain controlled etc. • Data is “cheap”- e.g. can build measures of repeated variables 14 HHS Measurement Alignment MU, PQRS, IQR, ACO, VBP, HRSA,CDC current Unified Outcome Measures EHR as primary reporting platform, with secondary reporting from registry, claims Car with no dashboard 16 “Small Data is our short term focus” Small Data is our Short Term Focus. Dr. Joe Kimura Dr. Joe Kimura 17 Intermountain Physician Compact • Demand that providers vary from standard clinical processes • Build a feedback loop- take variances – feedback to the providers based on feedback – Good protocols tend to change monthly 18 MU2 eCQM Certification Policy through 2017 Modular- choose which measures you want Validate to QRDA standard (schematron) Capture • Data > QRDA1 Calculate • QRDA3 Report • QRDA1, QRDA3 19 How a registry can do this now EHR EHR additional data • eCQM certified data Registry Other measures, other data uses • Import, calculate and report certified eCQMs CMS Submit for PQRS • Submit to CMS for credit for MU and PQRS 20 Can do this with open source software • Pophealth is certified to “import, calculate and report eCQMs” for MU2 • Pophealth is open source- therefore free! • Cost to a registry is the cost to connecting this in • Contains the standardized measure “engine” for all 93 eCQMs in MU2 21 Future: Linking Measurement & Improvement Clinical Data Value Based Purchasing Claims 22 Future State: HIT Enabled QI Toolkit Stakeholder s Unambiguous human readable Value Set Authority Center Public Domain Unambiguous machine readable EHR Certification Tools Population Health Tool Electronic Health Records Clinical Registries Clinical Decision Support CMS Quality Reporting Other HIT Tools 23 Barriers to widespread adoption Use Standards and Tools for Interoperability • Create and use standards based exchange of information for quality improvement • Can now create a measure (query) using federal tools- free and open source – Measure authority tool – Value Set Authority Center – Cypress/Pophealth/Bonnie – PROMIS 25 Measure Development “Ecosystem” STANDARDS HQMF CDA QRDA RIM USHIK VSAC QDM MAT eCQMs NQF ? MAP? Rule ? CDS vMR PopHealth HeD SEVT (reporting to CMS) cEHRT Cypress Value Set Authority Center http://vsac.nlm.nih.gov/ 27 Value Set Authority Center http://vsac.nlm.nih.gov/ 28 Measure Authoring Tool 29 30 • Cypress is an open source tool that can test and verify the accurate calculation of Stage 1 and stage 2 Meaningful Use Clinical Quality Measures reported by Electronic Health Record (EHR) software systems or modules • Users of Cypress : 1. EHR software vendors 2. The EHR testing community • Used for Certification 31 BONNIE Testing Tool 32 Pophealth Page 33 popHealth/cypress 34 popHealth Open Source Community Publicly available demonstration via the popHealth website or http://demo.projectpopheal th.org Open Source Development Occurring Including: 1. Popeye 2. Viral Hepatitis Page 35 Click to edit Master title style Jira Issue Tracking for eCQMs http://jira.oncprojectracking.org/ 37 Future Orientated Data Architecture Problem Statement: Need to describe a set of capabilities to allows HIT applications and architecture to better manage disparate data with an ecosystem of players beyond just EHRs to enable performance reporting to public and private payers and actionable, timely feedback to providers on quality, efficiency and cost of care. Qualified Entities HIE Data Repositories EHR Clinical Data Population Health Vendors Medicare Claims Data How to further integrate data across the ecosystem? Clinical Data Intermediary Repositories Clinical Data Registries Other Data Repositories Private Payer Claims Data 38 Complex Adaptive System 39 Medicare Data Sharing for Performance Measurement NOW INSURANCE COMPANIES FUTURE MEDICARE? INSURANCE COMPANIES MEDICARE? Qualified Entity COMPREHENSIVE CONSISTENT FAIR ACTIONABLE 40 “I am the expert about me.” 41 INTEROPERABILITY Standard Interoperability “Building Blocks” How should well-defined values be coded so that they are universally understood? Semantic Interoperability Content Structure How should the message be formatted so that it is computable? Syntactic Interoperability Transport How does the message move from A to B? Vocabulary & Code Sets Security How do we ensure that messages are secure and private? Services How do health information exchange participants find each other? Common Data Elements- the future A terminology based metadata solution frees data consumers from data interpretation Data Access Framework The scope of the Targeted Data Access Use Case is to define the requirements for interorganizational access to individual patient data. The requirements in this use case will focus on the interchange between applications across two trusted healthcare organizations willing to exchange data. The diagram below illustrates the scope within the larger workflow of a user (e.g. Healthcare Professional) accessing patient data from a trusted external healthcare organization. http://wiki.siframework.org/Data+Access+Framework+Homepage 45 Structured Documents http://wiki.siframework.org/Structured+Data+Capture+Initiative 46 Future Opportunities • Create standard exchange from EHRs to Registries and from registries to EHRs • Help create common data elements • Use federal tools to make registries use standardized measures and queries • Patient reported outcomes • Build feedback loops- ideally realtime- to providers 47 “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 6/18/2014 Office of the National Coordinator for Health 49
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