MN Community Measurement February 2019 Reducing the Burden of Data Reporting: Introduction to PIPE (Process Intelligence Performance Engine) MN Community Measurement February 2019

PIPE Project Background Problem Statement: Measuring quality of health care is an essential component to improving care received by patients and ultimately to managing the total cost of care. Current methods for the collection and submission of data to support these important ends, however do pose some challenges: Collecting data requires time, attention to detail, and investment of providers Annual submission limits opportunity to identify quality issues as they happen Complexity of data reconciliation from multiple sources requires manual interventions and integrations for measurement

PIPE Project Goals PIPE seeks to increase benefits and lessen burden for our data-contributing medical groups – while delivering more timely information to inform quality improvement. PIPE Focus Develop new data application that will enhance user experience, streamline submission process, and facilitate better communication between MNCM and providers Enable portal to have multiple approaches for data submission and reduce duplication of effort by central application of measure specifications by MNCM Provide data submitters the ability to contribute data more frequently to facilitate delivery of timely feedback reports and improve timeliness of data files Reduce provider burden by deploying technical mechanism within data application to automate data retrieval, extraction, and analysis of quality measurement data

Approach to achieve our goals June 2018 2nd Quarter 2019 Phase I Evaluate Phase II Develop Phase III Build Phase IV Implement Evaluate current state Business requirements Work plan Procurement App dev Infrastructure build Testing User Group Start Learn

A Search for a Solution MNCM considered many different approaches to alleviate the burden on providers while ensuring system scalability and flexibility to work with all EHRs Technology Reviewed Enhanced DDS: This approach was focused on enhancing our existing portal by improving user navigation, measurement upload process, and expanding user roles. While some of these enhancements will be added to the existing portal, it would not have alleviated the current burden on providers. Interoperability Vendors: MNCM reviewed multiple interoperability vendors and discussed the ability to adapt quality measurement to common HL7 transactions. Ultimately it was determined that utilizing today’s healthcare interoperability technology would increase the burden on clinics. Analytics Vendors: MNCM reviewed multiple analytic vendors in the healthcare space. While each brought a unique perspective, it was determined that MNCM would develop our own in-house engine that would be capable of calculating, measuring, and delivering reports back to participating providers. Software Robotics: Software robotics are widely used around the nation by configuring computer software or a “software robot” to capture and interpret existing applications for processing a transaction, manipulating data, triggering responses and communicating with other digital systems. Software robotics is used in healthcare, banking, manufacturing, and many other industries. MNCM reviewed multiple software robotics vendors.

Process Intelligence Performance Engine (PIPE) Once the data has been extracted, the information is moved into the MNCM Performance Engine (PE). The PE is able to quickly analyze the data and provide real-time denominator and numerator reporting back to the clinic group. Unlike the current DDS process, PIPE can retrieve clinic data monthly and report back to each clinic group on a monthly and quarterly schedule. These reports will be accessible via MNCM Portal and/or API back into the EHR. Through the use of software robotics, PIPE can integrate applications that weren’t built to be connected and automate processes across such heterogenous systems; cloud/SaaS applications with premise systems, legacy systems with modern web applications, and back office systems. PIPE utilizes this technology to automate the clinical extraction process from clinic EHRs. This aspect of the software suite is known as the Process Intelligence (PI).

Process Intelligence (Software Robotics) Front end user simulation Securely implement EHR extraction in days, not weeks/months Automatically extract patient data or documents into a patient record, create reminders, alerts, or tasks Eliminate the need for interfaces (HL7 or API) Bypass EHR vendor involvement Health IT Extraction

Software Robotics Robotic Process Automation (RPA) is a technology that involves applying software robotics (software algorithms) to perform repetitive rules-based knowledge work across an organization as a substitute for, or aide to, human workers. RPA can be thought of as a virtual employee. RPA works with existing applications and carry out structured processes automatically. No changes have to be made to existing systems – RPA does the job just like employees. Thus RPA can automate a variety of processes, including report generation, credentialing, manufacturing, and employee onboarding. With Robotic Process Automation, business processes are carried out quickly, without errors and fully automatically.

Difference in Extraction Approach “Backend” Database Interfaces & Integrations Process Intelligence Approach Time Months Days Cost Low High Accelerated Flexibility To Expand Supported Data Types Linear, Limited Flexible, Customizable Ability to Extract and Insert Data into EHR No Yes EHR Vendor Involvement Required Little to None Various 100% Audit Trail High Minimal to None Technical Burden on Clinic

Performance Engine Health IT Extraction Ability to analyze clinical data to determine denominator and numerator Provide monthly reports via the portal or API to participating organizations Receive notifications when new reports become available Utilize SFTP and other secure mechanisms for data transmission Allow MNCM to aggregate encounter data for year end reporting and facilitate audit review by participating organizations Health IT Extraction

PIPE Security/Compliance Process Intelligence Credentials stored as an input to a schedule are encrypted using AES-256 encryption Roboservers access limited to authorized MNCM staff Audit logs accessible to medical group Performance Engine SFTP and DSM used for file delivery Data encrypted at rest Data segmentation and integrity enforced Role based access provided to each medical group

Software Development Timeline

Submissions Tiers Submission Tiers Tier 1: Clinic submits denominator per the existing specification standard; clinic receives cycle numerator per existing standard (uses existing portal application). No change in process. Tier 2: Clinic submits broader encounter data (problems, procedure, medication, etc.) monthly and MNCM applies measurement specification to determine denominator and numerator. Clinic receives access to monthly and annual results. Utilizes PI technology. Tier 3: Full PIPE uses clinic EHR credentials which are governed by clinic/group privacy and security standards to extract encounter data; MNCM extracts denominator and numerator; clinic receives on-going monthly analytics via either the portal or API back into the EHR.