State Health Information Exchange
Cooperative Agreement Program
Clinical Quality Measurement Recovery
and Repository
November 20, 2013
Agenda
Introduction
John Rancourt
Jason Werner
Clinical Quality Measurement Recovery
and Repository Discussion
Jeff Livesay
Q&A Session
All
2
Presentation to ONC Grantees
November 20, 2013
Clinical Quality Measurement
Recovery and Repository (CQMRR)
“skimmer”
Jeff Livesay
Associate Director
Copyright 2013 Michigan Health Information Network
3
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
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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 reused 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 (!!)
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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
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SOM Data Warehouse
CQMRR
Direct
emails
(or other
transport)
CQM
Data Mart
(Final)
MiHIN ESB
Reports,
Dashboards,
Comparisons,
Mining,
Valid QRDA
Valid QRDA
VPN to SOM
Michigan
Department of
Community
Health (MDCH)
Data Hub
VXU’s
QRDA
CAT I & III
Cypress/DQA
EH
Data Peeler
EP
valid
QRDA
CAH
MDSS
Health
Provider
Directory
NPI lookup
Copyright 2013 Michigan Health Information Network
MCIR
MSSS
Meaningful Use Database
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SOM Data Warehouse
CQMRR
CQM
Data Mart
(Final)
Eligible
Providers
Q
R
D
A
Reports,
Dashboards,
Comparisons,
Mining,
Eligible
QRDA
Hospitals (CAT I & III)
Q
R
D
A
Data Peeler
Cypress/DQA
Q
R
D
A
Q
Q
R
R
D
D
A
A
Valid QRDA
VPN to SOM
State of Michigan
Data Hub
QRDA
(CAT I & III)
Valid QRDA
VXU’s
CA
Hospitals
valid
QRDA
(CAT I & III)
Q
R
D
A
MDSS
MCIR
MSSS
cqms@direct.mihin.org
Health
Provider
Directory
NPI lookup
Copyright 2013 Michigan Health Information Network
Meaningful Use Database
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Reports and Data Analysis:
Cross Clinical Quality Comparison
• 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
Copyright 2013 Michigan Health Information Network
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.
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state maps can show aspects of medical care and organize it by region
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Project Status
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
Copyright 2013 Michigan Health Information Network
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Project Status (Con’d)
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
Copyright 2013 Michigan Health Information Network
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Project Status (Con’d)
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
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Transitions of Care (ADT) Service
Alerts &
Notification
Animation
Qualified
Sub-state HIE
or VQO
Qualified
Sub-state HIE
or VQO
Delivery
Preference
Lookup
Specialist
Primary Care
Patient to Provider
Attribution
Care
Coordinator
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
Copyright 2013 - Michigan Health Information Network
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Project Status (Con’d)
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
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Resources
Link to CMS on CQM MU2 Requirements:
http://www.cms.gov/Regulations-andGuidance/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_Development”
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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
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Questions / Comments