1. Clinical Quality Measures (CQMs) CoP
This is an advance copy of the CQM presentation for your review only. This presentation is subject to change and should not be reproduced. The final version of the presentation will be posted to the Medicaid HITECH TA Web site at a later date.
September 11, 2014
2:00 PM Eastern Time
Medicaid Electronic Health Record (EHR) Team (MeT)
Centers for Medicare and Medicaid Services (CMS)

2. Today’s CMS & MeT Resources
David Koppel:
CMS, Health Information Technology for Economic and Clinical Health (HITECH) Coordinator
Phone: (410)
Izanne Leonard-Haak:
MeT, Team Member
Health Management Associates

3. PopHealth Guests Presenter: Jackie Mulhall, eHealthConnecticut
Resources:
John Rancourt, Office of the National Coordinator for Health Information Technology (ONC)
Linda Cramer, Wyoming Medicaid EHR program
Izanne to explain agenda
-Will cover four Topics today some more thoroughly than others
-Between each topic we will
-Topic #1 was just added in the last several days as we learned of a report that is now available

4. Agenda
Poll
popHealth Presentation
Q & As/Discussion
Next CQM CoP

5. Participant Poll #1 Please click all that apply: IT Policy
Operations/Audit
Clinical/Quality
Provider Training/Outreach

6. popHealth Overview for CQM CoP Jackie Mulhall, eHealthConnecticut

7. Acronyms HL7 - Health Level Seven International
CDA – Clinical Document Architecture (An architecture with templates for clinical documents e.g. CCDs)
CCDA – Consolidated Clinical Document Architecture (Similar to CDA)
CCD – Continuity of Care Document (A summary document for a single patient)
QRDA – Quality Reporting Document Architecture
HQMF - Health Quality Measure Format (eMeasure)
eCQM – Electronic Clinical Quality Measure
CIPCI – Connecticut Institute for Primary Care Innovation

8. popHealth Overview
popHealth is an Open-Source Clinical Quality Measure database and reporting engine presented through a web-based interface
Centralized repository of clinical data
Data is sent from EHRs via nationally recognized standards
Consolidated Clinical Data Architecture (C-CDA) Continuity of Care (CCD) Document
QRDA (Quality Reporting Data Architecture) Cat 1 or 3 Document
Clinical Quality Measures (CQMs) are calculated for providers and presented through a web-based interface
Drill down ability to the provider and patient-level data
Track trends in quality and health over time
Capture CQMs for Meaningful Use Reporting

9. History of popHealth
September popHealth started as a prototype, proof-of- concept for a Clinical Quality Measure (CQM) reporting module: popHealth v0.1
September popHealth formally supported by ONC as a MU Stage 1 reference implementation
2011 – popHealth certified
January 2012 – v1.4 support for multi-provider with enhanced functionality released
December v2.0 support for MU Stage 2 CQMs for EPs released
February 2013 – v2.1.2 with enhanced functionality released
June v3.0 with upgraded user interface (UI), enhanced technical architecture, support for QRDA import released
Spring v3 certified
Fall 2014 – transition to Open Source Community from ONC

10. Current Status Entities are using popHealth in a variety of ways
Active User Community
Monthly user group meetings
Includes active users and interested users
Currently Managed by ONC, Moving to Open Source Community
Open Source Electronic Health Record Alliance (OSEHRA) selected to manage Open Source Community
Process of moving to OSEHRA has begun, will take place over the next few months
EHR Upgrades to 2014 CEHRT impacting popHealth
QRDA Documents becoming available but issues due to being a new standard
CCD v1.1 not always working, additional testing required

11. Database Technology Stack popHealth Server CQM Calculation
Ruby (version 2.1.1) on Rails (version or higher)
Database
MongoDB (version 2.0.1) *depends on the host server
CQM Calculation
Leverages MapReduce framework in MongoDB
popHealth Internal Measure Representation
Uses JSON and JavaScript

12. Implementation Challenges
popHealth is Open Source prototype software that was developed by MITRE through a grant from ONC
Pros
No cost to purchase
Active Open Source Community
All users benefit from enhancements/contributions back to the Open Source Community
Cons
“Free like a puppy”
Documentation is lacking and support is voluntary through Open Source Community
Requires skill set that is unusual:
 HL7, QRDA standards  Mongo DB  Ruby on Rails  JSON 

13. Current popHealth Use Cases
CQM Reporting for Meaningful Use
Northwestern University Medical System
Feed data from various EHRs (through their data warehouse) to popHealth for CQM reporting for all entities in health system VA
MITRE working to connect popHealth to VA’s Corporate Data Warehouse (CDW) for CQM reporting
Wyoming Medicaid
Database for QRDA Cat 3 data (CQM data) that is entered by providers
Ability to rank providers into tiers for payment based on CQM rates
Future plans for eCQM submission by accepting QRDA Cat 3 documents

14. Current popHealth Use Cases
CQM Reporting for Other Purposes
eHealthConnecticut (CT Regional Extension Center)
FQHCs (CHCs) send CCD data to popHealth database
Centralized clinical database data from FHQCs
Use for CQMs and other clinical data reporting needs
Unexpected outcome is workflow improvement to resolve data issues
Used for CQM measurement for CT DPH SHAPE grant
IL DPH
Used for CQMs and popHealth dashboards to drive clinic improvements in hypertension management

15. Consolidated CDA
Output of the effort to create one guide that could be used for implementation and analysis of documents within the CDA standard
The Consolidated CDA solution is a library of reusable CDA templates 
Templates can be utilized at multiple levels within a CDA document:
Level 1: Document Level Templates, such as CCD or Discharge Summary, can be utilized to define a template for the document as a whole.
Level 2: Section Level Templates, such as Allergies or Medications, can be utilized to define what specific information will be included in each section.
Level 3: Entry Level Templates, such as specific Observations or Procedures, can be utilized to define how the information is encoded within each section.
Consolidated CDA has a document level template for CCD
QRDA uses parts of C-CDA framework but is not a template

16. Continuity of Care Document
Part of C-CDA Architecture
Extensive clinical data
Allergies: RxNorm*, Systematized Nomenclature of Medicine (SNOMED)-CT*
Care Goals, Social History, Medical Equipment: SNOMED-CT*
Conditions: SNOMED-CT*, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), ICD-10-CM
Encounters: Current Procedural Terminology (CPT)
Immunizations, Medications: RxNorm*, Codes for Vaccine Administered (CVX*)
Procedures: CPT, ICD-9-CM, ICD-10-CM, SNOMED-CT*
Vitals, Results, Assessments: Logical Observation Identifiers Names and Codes (LOINC*), SNOMED-CT*
Communications: SNOMED-CT
* preferred
All continuity of care entries are time-stamped
Results and vitals must be provided structured with units and values

17. QRDA Architecture
HL7 QRDA 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. QRDA reports are used for the exchange of eCQM data between systems for a variety of quality measurement and reporting initiatives.
QRDA makes use of CDA templates, which are business rules for representing clinical data consistently. Many QRDA templates are reused from the HL7 Consolidated CDA (C-CDA) standard.
Templates defined in the QRDA Category I and III enable consistent representations of quality reporting data to streamline implementations and promote interoperability.

18. QRDA Documents
A QRDA Category I report is an individual patient quality report. Each report contains quality data for one patient for one or more eCQMs, where the data elements in the report are defined by the particular measure(s) being reported. A QRDA Category I report contains raw applicable patient data (e.g., the specific dates of an encounter, the clinical condition) using standardized coded data (e.g., ICD-9-CM, SNOMED CT®). When pooled and analyzed, each report contributes the quality data.
A QRDA Category III report is a standard structure to use in reporting aggregate quality measure data. Each report contains aggregate quality data for one provider for one or more eCQMs necessary to calculate population measure metrics.

19. CCD vs. QRDA Cat I CCD/CCD 1.1
Clinical summary document for patient history of procedures, encounters, allergies, medications, etc.
Main body of data contains different sections for different clinical data components e.g. medical history, procedures, medications, etc.
The data sections are larger and have more general templates for procedures, encounters, etc.
QRDA Cat 1
QRDA reports are generated based on a CQM request. The data contained in the QRDA file is specific to certain CQMs.
Main body of data is divided into three segments: - reporting measure(s) - reporting parameters (rep period) - patient data
Templates are more specific and thorough, with smaller general sub groups.
Newer standard – less tested

20. CCD and QRDA Comparison

21. Data Flow for Population Health Management
Providers Collaborate on Patient Health
Population Health Reporting Tool
Electronic Medical Records Database for Practice
Clinicians Enter Patient Data into Electronic Medical Record (EMR)
Secure Transfer of Patient Data

22. popHealth Today for FQHCs in CT
popHealth Reporting Tool
CCD Data
Aggregate Data
popHealth Database
FQHC 1 Data
FQHC 2 Data
FQHC 3 Data
FQHC 4 Data
FQHC 1
EHR
FQHC 2
FQHC 3
FQHC 4
Role-based web access
MU Stage 1 and 2 Reports
Overall measures with ability to drill down
HIPAA compliant
Aggregated population health reports

23. popHealth Next Generation in CT
popHealth Reporting Tool
CCD via Batch
Aggregate Data
popHealth Database
Provider Data
Hospital Data
FQHC Data
Other Data
EHR 1
CCD via Direct
EHR 2
QRDA Cat 1
EHR 3
QRDA via Direct
EHR 4
Provider CQMs
DPH Reporting
DSS/Medicaid
Cat 3 Docs
Comparison to cohort
Grant CQMs
PCMH
ACO

24. Main Dashboard

25. Individual Provider Statistics

26. Individual Provider Dashboard

27. Measure Criteria

28. List of Applicable Patients for a Measure

29. Patient Summary

30. Jackie Mulhall, Director eHealthConnecticut
Contact Information
Jackie Mulhall, Director eHealthConnecticut
c/o SMC Partners LLC Hartford Square North 10 Columbus Boulevard, 9th Floor Hartford, CT 06106
Phone: s:

31. Question & Answers/ Discussion

32. Thursday, November 6, 2014 2:00 PM ET
Upcoming CQM CoP
Thursday, November 6, :00 PM ET

33. CMS, HITECH Coordinator
David Koppel
CMS, HITECH Coordinator
Phone:
Izanne Leonard-Haak
MeT Team
Here are the addresses for the team that supports the MuCoP
Izanne will close out thanking :
Participants
Ren??? For ?? Todays MU CoP