1. State Health Information Exchange Cooperative Agreement Program November 20, 2013 Clinical Quality Measurement Recovery and Repository

2. Agenda 2 Introduction John Rancourt Jason Werner Clinical Quality Measurement Recovery and Repository Discussion Jeff Livesay Q&A SessionAll

3. Presentation to ONC Grantees November 20, 2013 Clinical Quality Measurement Recovery and Repository (CQMRR) “skimmer” Copyright 2013 Michigan Health Information Network 3 Jeff Livesay Associate Director

4. Problem Statement Meaningful Use (MU) Stage 2 requires Clinical Quality Measurement (CQM) reporting CAT III QRDAs (aggregate statistics for a provider) CAT I QRDAs (individual measurements for a patient) Note: no CAT II’s… (this will come up again shortly!) Status quo is very basic: no standard way for providers to submit CQMs to state agencies providers must manually request MU credit limited ability to compare quality data within single clinics, within hospitals, across clinics Copyright 2013 Michigan Health Information Network 4

5. What We Will Show You Today How our eCQM pilot for receiving CAT III QRDA files for MU2 credit works today How our approach uses Direct and could be easily re- used by any other HIE, HIN, or SDE How the CAT III portion of the eCQM pilot will go into production soon under our CQMRR project What our additional plans are for piloting receipt of CAT I QRDAs using a very similar approach Some new ideas for validation, testing, and for CAT II’s as they pertain to Transitions of Care (!!) Copyright 2013 Michigan Health Information Network 5

6. Value Proposition shared service – uses Direct secure email QRDA files sent attached to Direct messages sent from within EHR workflow (automatic) manual attach/send via Direct client also sent to common Direct inbox at MiHIN detached, validated, stored in datamart allows easy submission of QRDA files records MU credit via our Provider Directory enables cross-clinical comparisons can lead to unlimited “mining” and analysis Copyright 2013 Michigan Health Information Network 6

7. 7 CQMRR EP EH CAH Data Peeler Cypress/DQA Michigan Department of Community Health (MDCH) Data Hub MiHIN ESB SOM Data Warehouse CQM Data Mart (Final) MDSSMCIRMSSS QRDA CAT I & III ELR’s Syndromics VXU’s Direct emails (or other transport) Valid QRDA VPN to SOM valid QRDA Health Provider Directory Meaningful Use Database Reports, Dashboards, Comparisons, Mining, Valid QRDA NPI lookup QRDA CAT I & III QRDA CAT I & III

8. Copyright 2013 Michigan Health Information Network 8 Eligible Providers Eligible Hospitals CA Hospitals Data Peeler Cypress/DQA SOM Data Warehouse CQM Data Mart (Final) MDSSMCIR MSSS ELR’s Syndromics VXU’s cqms@direct.mihin.org Valid QRDA VPN to SOM valid QRDA (CAT I & III) Health Provider Directory Meaningful Use Database Reports, Dashboards, Comparisons, Mining, NPI lookup State of Michigan Data Hub Valid QRDA CQMRR QRDA (CAT I & III) QRDA (CAT I & III)

9. Reports and Data Analysis: Cross Clinical Quality Comparison Copyright 2013 Michigan Health Information Network 9 skimming ‘la crème de la crème’ standard report generation cross clinical comparisons can identify best (and worst) clinics graphical dashboards using Tableau advanced data manipulation (e.g. SAS) data mining capabilities statistical analysis

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12. state maps can show aspects of medical care and organize it by region Copyright 2013 Michigan Health Information Network 12

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14. Project Status Copyright 2013 Michigan Health Information Network 14 Phase 1 – FY 2013 eCQM Pilot: inbound Direct accounts for CAT III files data “peeler” in production pilot “alpha” participant identified* & enabled test data sent; production data flowing select additional pilot contributors* build CAT III format validation (“Cypress-like”) refine CAT III data-mart (“PopHealth-like”) design sample reports using Tableau on-board additional participants *hardest steps

15. Project Status (Con’d) Copyright 2013 Michigan Health Information Network 15 Phase 2 – FY 2014 – Pilot to Production: integrate reporting tools (Tableau) design additional CQMRR reports  finalize data mart for MDCH*  select additional participants  conduct final testing  integrate with MDCH data hub/warehouse  migrate data mart from MiHIN to MDCH  enter production for CAT III’s  review results of Phase 2 *Michigan Department of Community Health

16. Project Status (Con’d) Copyright 2013 Michigan Health Information Network 16 Phase 3 - CAT I Pilot – FY14-15:  create datamart for CAT I files  utilize popHealth as much as possible  continue dialog with Connecticut  re-use existing components if possible  implement validation of CAT I  pilot CAT I QRDA file submission  utilize popHealth and Tableau reporting  evaluate success of Phase 3 Pilot

17. Qualified Sub-state HIE or VQO Transitions of Care (ADT) Service Copyright 2013 - Michigan Health Information Network Patient to Provider Attribution Delivery Preference Lookup 1) Patient goes to the hospital, hospital sends an ADT message to MiHIN 2) MiHIN checks Patient Attribution Lists and identifies three providers 3) Using the HPD, MiHIN identifies a Delivery Preference for each provider 4) Notification is routed to the providers based on their preference Primary Care Specialist Care Coordinator Alerts & Notification 17 Animation

18. Project Status (Con’d) Copyright 2013 Michigan Health Information Network 18 Phase 4 - CAT II and Validation Pilot:  design rule-based validation for all CATs  create large patient/clinic test databases  “PatientSim” large CAT I test database  “ClinicSim” large CAT III test database  create CAT II tag set from TOC/ACRS  create CAT II database from ACRS* files  pilot CAT II QRDA submission with ACRS  pilot/test rule-based validation for all CATs  implement validation for all CATs  evaluate success of Phase 4 Pilot *Active Care Relationship Service

19. Resources Copyright 2013 Michigan Health Information Network 19 Link to CMS on CQM MU2 Requirements: http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/VendorWorkgroup Call_April16.pdf Link to status of CAT II File standard development: http://wiki.hl7.org/index.php?title=Quality_Reporting_Document_Architecture #Standards_Under_Developmenthttp://wiki.hl7.org/index.php?title=Quality_Reporting_Document_Architecture #Standards_Under_Development”

20. Questions? Jeff Livesay Associate Director livesay@mihin.org Bill Doty Project Manager doty@mihin.org Michael Taylor Lead Intern taylor@mihin.org Copyright 2013 Michigan Health Information Network 20

21. Questions / Comments