Quality Measures for
Meaningful Use and Beyond
Melissa Swanfeldt,
Associate Vice President, MEDITECH
Zahid W. Butt, MD, FACG,
CEO, Medisolv
• Stage 1 Clinical Quality Measures for Meaningful Use
• Quality Measure Trends Beyond MU
• What we know about Stage 2 CQMs
Stage 1 Clinical Quality Measures for Hospitals
15 e-Measures
• Stroke
• VTE
• ED Throughput
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
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
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
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)
All Measure Results in One Simple Screen
Page 8
Drilldown to Analyze Results
Page 9
Review Non-Compliant Cases
Page 10
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
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
Page 12
THE QUALITY “ENTERPRISE”
Quality e-Measures
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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
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, 2003. (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 2007. (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-00-11-35438; various reviews; expected issue
date: FY 2012; new start; Affordable Care Act)
http://oig.hhs.gov/reports-and-publications/archives/workplan/2012/Work-Plan-2012.pdf
Dual Environment Challenges
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Quality Measurement Governance
Data Collection Issues
Performance Rate Validation
Benchmarking Issues
Patient Level Data Submission Issues
Public Reporting Issues
Clinician Education
Measure Development
PCPI & Specialty Assoc.
NCQA/JC
CMS
Evidence and CPG
Generation
Measure Endorsement
NQF
Measure Implementation
AQA, HQA, QASC
Physician & Hospitals, etc.
Health Plans and CMS
HIT vendors
AQA-AQA
CME-Continued medical evaluation
CPG-Clinical practice guidelines
CPPD-Continued physician professional
development
HIT Support
CME/CPPD
Evaluation
HIT-Healthcare Information Technology
HQA-Hospital Quality Alliance
NCQA/JC-National Committee on Quality
Assurance/Joint Commission
QASC-Quality Alliance Steering Committee
VTE 1 Workflow Summary
Physician
Admission Order
VTE
Prophylaxis
Mechanical
Prophylaxis
Nursing
Documentation
SNOMED
Pharmacologic
Prophylaxis
EMAR/BMV
RXNORM
Physician Order
Contraindication
Clinical Trial /
Comfort
Measures
SNOMED
SNOMED
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
New Workflow Paradigms
Stage 2 Clinical Quality Measures
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113 NQF Endorsed Measures
• 39 Eligible Hospital Measures
• 83 Eligible Professional Measures
• Practice
• Radiology
• Oncology
MEDITECH Prepares for Stage 2
Quality Reports
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Specification Review
• Best Practice Workflows
• Focus Groups
• Nomenclature Mapping Tools
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
Current State Analysis