1. Meaningful Use and Beyond
Quality Measures for
Meaningful Use and Beyond
Melissa Swanfeldt,
Associate Vice President, MEDITECH
Zahid W. Butt, MD, FACG,
CEO, Medisolv

2. Quality Measure Trends Beyond MU What we know about Stage 2 CQMs
Stage 1 Clinical Quality Measures for Meaningful Use
Quality Measure Trends Beyond MU
What we know about Stage 2 CQMs

3. Stage 1 Clinical Quality Measures for Hospitals
15 e-Measures
Stroke
VTE
ED Throughput

4. Challenges Value sets use vocabularies not used widely
in EHRs (SNOMED CT, RxNorm)
e-Measure specifications contain multiple
errors and inconsistencies
HITSP Specification TN906 has over 500 data
elements in the 15 measures
Data capture must be in discrete fields
Impact on workflow for clinicians

5. Best Practice Guidance for Data Capture
Nomenclature Mapping
LOINC
SNOMED CT and ICD-9 for problems
RxNorm
Exclusions
Contraindications
Clinical trials
ARRA Quality Reporting Page

6. Stage 1 CQM’s for Eligible Professionals
44 Ambulatory Clinical Quality Measures
3 Core/3 Alternate Core
3 Additional Measures
Use of MPM Clinical Reporting Tool for Stage 1
Performance and Outcomes are not measured

7. Stage I MU Quality Reporting Prepare or Procrastinate
Clinician Education is Essential
Sustainable Workflow Design/Redesign
Minimize Data Capture Burden
Leverage Clinical Decision Support - CPOE
“Problem Lists” Reconciliation
Performance Rate Analysis
(Errors vs. Low Performance)

8. All Measure Results in One Simple Screen
Page 8 8

9. Drilldown to Analyze Results
Page 9 9

10. Review Non-Compliant Cases
Page 10 10

11. Why have 50+ Hospitals Chosen Medisolv for Meaningful Use Reporting?
“Medisolv team was outstanding. They offered clinical as well as programming resources. They are VERY knowledgeable about the measure requirements, clinical processes as well as reporting details. We began building for the quality measures in May and our 90 day period began June 1. The Medisolv team was very engaged and responsive. …we would likely not be attesting for stage I this year without their help.” From the MUSE List Server
Pamela Feeler, Director of Nursing Informatics - Phelps County Regional Medical Center

12. Quality Measurement Trends
Quality Reporting is Central to Healthcare
CMS Programs: IQR,OQR,PQRS,VBP
Accreditation (The Joint Commission)
ARRA Meaningful Use
ACA & National Quality Strategy
NHSN & State Initiative
Performance Matters
Pay for Performance
Public Perception/Reporting

13. THE QUALITY “ENTERPRISE”

16. Quality e-Measures E-Measures Replace Abstracted/Paper Measures
“Dual Measures Environment” Will Persist for Many Years
Patient Level Data Submission
Certification will Include Algorithm Validation
New Auditing Methods and Criteria

17. OIG 2012 Work Plan Priorities
Reliability of Hospital-Reported Quality Measure Data We will review hospitals’ controls for ensuring the accuracy and validity of data related to quality of care that they submit to CMS for Medicare reimbursement. Hospitals must report quality measures for a set of 10 indicators established by the Secretary as of November 1, (The Social Security Act, § 1886(b)(3)(B)(vii).) A reduction in payments of 0.4 percent to hospitals that did not report quality measures to CMS was established by the MMA, § 501(b). The reduction was increased to 2 percent effective at the beginning of FY (Social Security Act, § 1886(b)(3)(viii), as added by the Deficit Reduction Act of 2005 (DRA), § 5001(a).) We note that the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) also expands the existing quality initiative. (OAS;W ; various reviews; expected issue date: FY 2012; new start; Affordable Care Act)

18. Dual Environment Challenges
Quality Measurement Governance
Data Collection Issues
Performance Rate Validation
Benchmarking Issues
Patient Level Data Submission Issues
Public Reporting Issues

19. Measure Implementation Evidence and CPG Generation
Clinician Education
Measure Endorsement
NQF
Measure Implementation
AQA, HQA, QASC
Physician & Hospitals, etc.
Health Plans and CMS
HIT vendors
Evidence and CPG Generation
HIT Support
CME/CPPD
Evaluation
Measure Development
PCPI & Specialty Assoc.
NCQA/JC
CMS
AQA-AQA HIT-Healthcare Information Technology CME-Continued medical evaluation HQA-Hospital Quality Alliance CPG-Clinical practice guidelines NCQA/JC-National Committee on Quality CPPD-Continued physician professional Assurance/Joint Commission development QASC-Quality Alliance Steering Committee

20. VTE 1 Workflow Summary Physician Order Physician Admission Order
VTE Prophylaxis
Contraindication
Clinical Trial / Comfort Measures
Mechanical Prophylaxis
Pharmacologic Prophylaxis
SNOMED
SNOMED
Nursing Documentation
EMAR/BMV
SNOMED
RXNORM

21. The Tale of Two Problem Lists
Problem List in Patient Summary Panel (Clinical Review)
ICD 9 or SNOMED linked to Mnemonic
Current vs. Historical
Attribute Selection
Active vs. Resolved
Ordinality (Reason For Admission always first)
Coded Visit Abstract
ICD 9 with Mapping to SNOMED

22. New Workflow Paradigms

23. Stage 2 Clinical Quality Measures
113 NQF Endorsed Measures
39 Eligible Hospital Measures
83 Eligible Professional Measures
Practice
Radiology
Oncology

24. MEDITECH Prepares for Stage 2 Quality Reports
Specification Review
Best Practice Workflows
Focus Groups
Nomenclature Mapping Tools

27. Medisolv Quality Expertise
The Joint Commission
ORYX® vendor for reporting Core Measures
1 of only 14 ORYX Vendors Piloting e-Measures
CMS
Q-Net vendor for Quality reporting
Fully Engaged in the Quality Enterprise
Voting Member of the National Quality Forum
Chair HIMSS NQF Taskforce (Patient Safety
and Quality Committee)
Member CMS Meaningful Use CQM Technical Expert Panel

28. Current State Analysis