Post on 03-Sep-2020
Clinical Quality and PolicyA DEEP DIVE BEFORE AN AERIAL VIEW
Our Mission
1. Understand the technical framework
2. Testing
3. Programs and performance
4. Governance
5. Data- and Workflow
6. Integration and Interoperability
7. Making Quality Meaningful
Understanding the Technical Framework
1. QDM to CQL
2. CDA to FHIR, Smart on FHIR apps
3. Terminology
4. VSAC
5. Cimi on FHIR
Understanding a Measure: (Example title and number)
eMeasure (or eCQM)
The electronic format for quality measures using:
• the Quality Data Model to define clinical concepts (Lego brick specifications) and
• the Healthcare Quality Measure Format to define quality measures (instructions constraining the use of Lego blocks to create meaningful structures).
8Barnes I. Making the Move to Electronic Clinical Quality Measurement. Epic 2015 Expert User Group Meeting. Verona, WI. March 17, 2015
The Quality Data ModelAn information model intended to clearly and consistently define concepts used in quality measures in a standardized format.
The QDM includes:
➢ criteria for data elements,
➢ relationships for relating data element criteria to each other, and
➢ functions for filtering criteria to the subset of data elements that are of interest.
Quality Data Model (QDM)
9Barnes I. Making the Move to Electronic Clinical Quality Measurement. Epic 2015 Expert User Group Meeting. Verona, WI. March 17, 2015
HOW DO WE DESCRIBE A PROBLEM FOR ELECTRONIC QUALITY MEASUREMENT?
QUALITY DATA ELEMENT Category: consists of a single clinical concept identified by a value set
‘Medication’, ‘Laboratory Test’
Data Type: The context in which each category is used to describe a part of the clinical care process
‘Laboratory Test, Order’ ‘Laboratory Test, Performed’
Attribute: provides specific detail about a QDM element
‘Laboratory Test, Performed: (result)’
Value Set: used to define the set of codes that can possibly be found in a patient record for a particular concept.
Barnes I. Making the Move to Electronic Clinical Quality Measurement. Epic 2015 Expert User Group Meeting. Verona, WI. March 17, 2015
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Health Quality Measures Format (HQMF)
A Health Level Seven International (HL7) standard for documenting the content and structure of a quality measure.
It includes:
• Metadata
describing the
quality measure
• Human readable
narrative
description, data
criteria, and
measure
population
• Machine readable
translation of the
measure.
Barnes I. Making the Move to Electronic Clinical Quality Measurement. Epic 2015 Expert User Group Meeting. Verona, WI. March 17, 2015
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2018 Standards Evolution for CMS eCQM Specifications
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Public comment on eCQMs open until Nov. 10!
Expression Logical Model (ELM)
Clinical Quality Language (CQL)
NativeJava
ScriptDrools SQL
Authors use CQL to produce libraries containing human-readable yet precise logic.
ELM XML documents contain machine-friendly rendering of the CQL logic. This is the intended mechanism for distribution of libraries.
Implementation environments will either directly execute the ELM, or perform translation from ELM to their target environment language.
Future Standards Need to be Interoperable Across Each Other to Allow Flexibility
Evolving eCQM Standards
Now
Definitions:
HQMF – Health Quality Measure Format
CQL – Clinical Quality Language QDM – Quality Data Model
Near Term
HQMF (Metadata, Population Structure
QDM (Logic)
QDM (Data
Model)
HQMF (Metadata, Population Structure)
CQL (Logic)
QDM (Data Model)
Differences Between the Quality Data Model (QDM) Now and When using Clinical Quality Language (CQL)
QDM Now
• Data Model and Logic are both in the QDM
QDM with CQL
• The Data Model will continue to exist as the QDM
• CQL will provide the logic expressions and will replace that function currently in the QDM
Clinical Quality LanguageOriginated from need to harmonize decision support and quality measurement
Author-friendly and human-readable language
Computable and implementable
Standard for Trial Use (STU)
CQL provides the ability to express logic that is human readable yet structured enough for processing a query electronically
Limitations of a QDM Logic Model QDM can’t express comparisons needed to evaluate outcomes of care
◦ e.g., change in depression scale (PHQ-9) results over time for a single patient, or for each patient in a cohort
QDM can’t use mathematical expressions to derive results◦ e.g., patients who have a PHQ-9 Follow-Up Score = ½(Baseline PHQ-9 Score)
QDM can’t identify components of an assessment, examination or test procedure
◦ e.g., assure the systolic and diastolic blood pressure results are from the same blood pressure reading
QDM logic model only works with QDM data model
Benefits of CQL
**
Measure Authoring Tool
Narrative Measure Specification
Measure Authoring Tool Measure Package
MAT Measure Package Export
1. Human Readable HTML
2. CQL Library information
3. ELM (machine-friendly representation of XML)
4. HQMF XML file consumable by an EHR
Measures encoded and packaged in the MAT output 4 measure artifacts
Measure Authoring Tool: Clause Library
Standards Improvement and Harmonization:Clinical Quality Measurement and Clinical Decision Support
CQM
Specific
Standards
HQMF
QRDA
Category-1
QRDA
Category-3
QDM
CDS
Specific
Standards
HeD
vMR
Common
Metadata
Standard
Common Data
Model Standard
(QI
Core/FHIR)*
Common
Expression
Logic Standard
(CQL)**
* Quality Improvement and Clinical Knowledge
** Clinical Quality Language
Common
Expression
Logic Standard
(CQL)**
Common
Clinical Data
Elements
(CIMI/FHIR)
Advanced Next Generation Standards for Clinical Quality Improvement
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Allowed in QPP now– proposed support in future QPP reporting API
Next Generation Standards for Clinical Quality: FHIR Clinical Reasoning: FHIRhttps://hl7-fhir.github.io/clinicalreasoning-module.html
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HSPC: Healthcare Services Platform Consortium“The iPhone Approach”
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Terminology
The problem
• Huge amounts of clinical data being generated both within and outside clinical care settings
• Tremendous potential• Primary use – i.e., clinical care
• Secondary use – e.g., quality measures, public health, rare diseases research
• But potential can only be realized if the data are stored and exchanged using common data and messaging standards
Data versus messaging standards
• Data standards – provide a consistent definition for a given concept across systems
• Messaging standards – provide a common structure by which to exchange data between systems
Data vs messaging standards
• Need both common data and messaging standards for successful interoperability
iOS AndroidiOS Messaging standardMessaging standard
Data standard
Data standards
• LOINC – laboratory and clinical observations• Urine sodium, Systolic blood pressure, Ankle MRI
• SNOMED CT – findings/values• Hypernatremia, Hypotension, Streptococcus pneumoniae bacteremia
• RxNORM – clinical drugs• Penicillin, Infliximab
• IEEE – observables for medical devices• Ventilator breath rate setting, EEG burst rate
• ICD-10-CM – diagnoses (for billing)
• CPT – procedures (for billing)
Messaging standards
• HL7 (Health Level 7)• Version 2
• Version 3/CDA
• FHIR
• DICOM (Digital Imaging and Communications in Medicine)
LOINC in an HL7 message
MSH|^~\&|||||19981105131523||ORU^R01|
PID|||100928782^9^M11||Smith^John^J|
OBR||||55417-0^Blood pressure panel^LN|
OBX||CE|8361-8^Body position^LN| |33586001^Sitting^SCT|
OBX||NM|8479-8^Systolic blood pressure^LN||138|mmHg|
OBX||NM|8462-4^Diastolic blood pressure^LN||85|mmHg|
LOINC in XML message (e.g., HL7 CDA)
<Observation> ...
<component> <code>
<coding> <system value="http://loinc.org" /> <code value= "1975-2" /> <display value="Bilirubin.total [Mass/volume] in Serum or Plasma" />
</coding> </code> <valueQuantity>
<value value="0.8" /> <unit value="mg/dL" /> <system value="http://unitsofmeasure.org" /> <code value="mg/dL" />
</valueQuantity> </component>
Data vs messaging standards
• Need both common data and messaging standards for successful interoperability
Hospital
EHRCMS
Personal
health
record
Messaging standard
OBX|1|Data type|Test code||Result|Units|…
Messaging standard
OBX|1|Data type|Test code||Result|Units|…
8479-8 Systolic blood pressure 138 mmHg18816-9 Medication name + identifier 2193 Ceftriaxone RxCUI8361-8 Body position with respect to gravity 33586001 Sitting SNOMED CT
Data standards
LOINC basics
Logical Observation Identifiers Names and Codes
• Standard terminology to identify lab tests, clinical measurements, documents, surveys, and more
• Used in 170+ countries, mandated in nearly 30
• Maintained by Regenstrief Institute, Inc.
• Supported by the National Library of Medicine
And it’s free!
Brief history of LOINC
• Organized in 1994 by Clement McDonald, MD
• Needed a universal language for observation identifiers
• Began with laboratory observations
• Expanded to clinical observations in 1996
• Currently includes 4 major categories• Laboratory LOINC
• Clinical LOINC
• HIPAA attachments
• Standardized survey instruments
LOINC grows because you ask
How to access LOINC
• Twice-yearly releases in June and December
• June 2017 (v2.61) release had >85,000 terms
• Find codes using• Regenstrief LOINC mapping assistant (RELMA) – desktop application
• https://search.loinc.org
• Multiple download formats
• New files in v2.61, including LOINC Parts, Answers, and Groups
Value Set Authority Center (VSAC)
The Value Set Authority Center (VSAC) publishes updated eCQM value sets annually.
The Downloadable Resource Table provides prepackaged downloads for the most recently updated and released eCQM value sets, as well as for previously released versions.
Where can I find value sets?
https://vsac.nlm.nih.gov
Download value sets by measure, value
set name, or quality data model category
VSAC Value Sets: Downloadables
Value Set Authority Center (VSAC)
Clinical Information Interoperability Council
CIIC is a broad stakeholder-based group of clinical and technical stakeholder organizations who are seeking to fill in the gaps needed to reach a shared set of interoperability data elements for clinical care
Has adopted the CIMI detailed clinical model approach with the physical CDEs translated to FHIR
Targets gaps including: clinician organization engagement and education, governance processes, resourcing, and tooling
https://healthservices.atlassian.net/wiki/spaces/CIIC/overview
Graphic of a CIMI Detailed Clinical Model
data 138 mmHg
SystolicBPSystolicBPObs
quals
data Right Arm
BodyLocationBodyLocation
data Sitting
PatientPositionPatientPositionSNOMED CT
LOINC
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FHIR Data Element Resourcehttps://www.hl7.org/fhir/dataelement.html
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Discussion: Standards
Why MACRA?Medicare Access and CHIP Reauthorization Act of 2015
Beginning in 2019, all current Medicare payment, including incentive programs, will be combined into one Merit-Based Incentive Payment System (MIPS), replacing all Medicare reimbursement for eligible professionals.
The MIPS program will use four performance measures to determine reimbursement, which will begin in 2019:
Quality;
Resource use;
Clinical practice improvement activities; and
Meaningful use of certified EHR technology (Advancing Care Information)
Privacy and security including HIPAA are also requirements and failure to adhere to required standards results in penalties
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Now just “Improvement Activities (IA)”
CMS prefers term “QPP”
Program started 2017, timelines continue to shift and payment adjustments lag by 2 years
Still on hold
QPP Builds on Prior Existing CMS Programs and Requirements
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• Many providers say that the expansion of quality programs has distracted from, rather than added to the focus on providing quality care
• Need for alignment with non-federal programs has been recognized but not addressed
APMs & MIPSPaying for Performance
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Clinicians who receive a substantial portion of their revenues (at least 25% of Medicare
revenue in 2018-2019 but threshold will increase over time) from qualifying
alternative payment mechanisms will not be subject to MIPS.
While the definition of a qualifying APM has yet to be determined, MACRA outlines
criteria which includes but is not limited to:
Alternative Payment Model
(APM)
Merit-Based Incentive Payment System (MIPS)
Quality
(60% of MIPS score 1st year)
Clinical Practice Improvement
Activities(15%)
Resource Use
(0% 1st year)
Advancing Care Information
(25%)
Quality Measures
Advancing Care Information
Risk-sharing
Adjustments based on the composite performance score of each eligible physician or other health professional on a 0-100 point scale based on the following performance measures. All scores noted below are for the first MIPS year and are subject to adjustment. Additional positive adjustment available for exceptional performance.
MIPS/QPP Weighting: 2017 and 2018
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Majority of program weight lies on quality measures with contributions from Improvement Activities and Advancing Care Information; aligning all three of these activities allows a reporter to maximize value and staff engagement while minimizing investment.
In 2018, the proposed rule does not change the mix of weighted activities. Cost will be measured and feedback will be provided in 2018; however, it will not be used to calculate performance. Therefore, considering cost starting in 2018 will position reporters ideally for future years in which cost will begin to take on greater weight for scoring.
Cost (AKA ”Resource Use”)
50
• CMS will calculate the Medicare Spending Per Beneficiary (MSPB) and total per capita cost measures for feedback purposes.
• Do not include previous episode-based measures but new ones are in development.
• Improvement scoring will be based on statistically significant changes at the measure level.
Why think about cost now?• Improvement scoring with CMS • Future episode-based cost measures• Move to APM or other cost-sharing arrangement (not
just with CMS)• Your own bottom line (+ making the C-suite happy)
More on QPP Scoring…
51SOURCE: CMS, HTTPS://QPP.CMS.GOV/DOCS/QPP_PROPOSED_RULE_SLIDE_PRESENTATION.PDF
More on QPP Scoring…
52SOURCE: CMS, HTTPS://QPP.CMS.GOV/DOCS/QPP_PROPOSED_RULE_SLIDE_PRESENTATION.PDF
Really,
0-14?
HEDIS
About HEDIS It all starts with HEDIS®
Health care’s
most-used tool
for improving
performance
Asks how often
insurers provide
evidence-based
care to support
more than 70
aspects of health
54
H
E
D
I
S
ealthcare
ffectiveness
ata
nformation
et
55
184 million 57% of population
HEDIS shines a light on health plans' quality
About HEDISIt all starts with HEDIS®
Administrative/Claims
Data
57
About HEDIS
Medical Record
Data
Survey
Data
HEDIS in LOINC
• Since 2009, NCQA and Regenstrief have worked together to maintain HEDIS value sets in LOINC
• Updated every fall for the following year
• For value sets that have not changed, dates are updated
• Otherwise new panels are created
TJC
2017/2018 ORYX Performance Measurement Reporting Requirements Updated: 8/15/2017
2017/2018 ORYX Performance Measurement Reporting Requirements Updated: 8/15/2017
Discussion
LUNCH
Understanding the Big Picture
Governance and Strategy• Start by aligning your quality strategy to your business goals• Build a team of multidisciplinary experts and thought leaders• Create an overview of all your programmatic and regulatory requirements• Develop a coherent approach that minimizes rework, mapping, and validation• Automate and test test test• Celebrate your successes and build on them
Infrastructure for Successful eCQM Implementation
Successful eCQMs
Health IT/Data
Governance
Team Effort
Quality
http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/
Gap
analysis
Data capture
and workflow
design
Data extraction
and eCQM
calculation
Validation
Downstream
uses of
eCQM
results
Get
content
Overview: eCQM Implementation Process
A Study of the Impact of Meaningful Use Clinical Quality Measures. Eisenberg et al., 2013. http://www.aha.org/content/13/13ehrchallenges-report.pdf
eCQM Implementation is Iterative and Collaborative
A Study of the Impact of Meaningful Use Clinical Quality Measures. Eisenberg et al., 2013. http://www.aha.org/content/13/13ehrchallenges-report.pdf
Workflow Analysis
Definitions of workflow vary:◦ The flow of work through space and time, where work is comprised
of three components: inputs are transformed into outputs.[1]
◦ The activities, tools, and processes needed to produce or modify work, products, or services. More specifically, clinical workflow encompasses all of the 1) activities, 2) technologies, 3) environments, 4) people, and 5) organizations engaged in providing and promoting health care.[2]
1. Carayon P, Karsh, BT. Workflow toolkit and lessons in user-centered design. Paper presented at the AHRQ Annual Health IT Grantee and Contractor Meeting; 2010 June 2-4; Washington, DC.
2. Niazkhani Z, van der Sijs H, Pirnejad H, Redekop W, Aarts J. Same system, different outcomes: Comparing the transitions from two paper-based systems to the same computerized physician order entry system. International Journal of Medical Informatics 2009; 78(3): 170-181.
Agency for Healthcare Research and Quality. What Is Workflow. Rockville MD. October 2010.http://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/presentations
Dataflow: What is it?
Dataflow and Workflow Redesign
Data Capture◦ New query build
◦ Interface to bring data from disparate application into certified electronic health record technology (CEHRT)
◦ Deploy alerts, reminders, and order sets judiciously
Workflow redesign◦ Work with subject matter experts to determine where/how data should be captured
(e.g., cardiovascular services)
◦ Evaluate aspects of care coordination or transitions of care
Step 1: Decide what processes to examine
Step 2: Create a preliminary flowchart
Step 3: Add detail to the flowchart
Step 4: Determine who you need to observe and interview
Step 5: Do the observations and interviews
Workflow Analysis Process
Is workflow just the sequence of steps of a process?
Not exactly
Workflow is the sequence of physical and mental tasks performed by various people over time and through space
◦ It can occur at different and/or multiple levels (e.g., one person, between people, or across organizations)
◦ It can occur sequentially or simultaneously
Agency for Healthcare Research and Quality. What Is Workflow. Rockville MD. October 2010.http://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/presentations
Shows how processes really happen, as opposed to how they are supposed to happen or how we expect they will happen
Allows a better understanding of what contributes to different types of flows for the same processes
Helps to identify ways to improve the flows
Can illustrate ways that health IT will affect workflows
Goals of a flowchart
Agency for Healthcare Research and Quality. What Is Workflow. Rockville MD. October 2010.http://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/presentations
Both flowcharts show the workflow of “patient check-in”
Both are accurate descriptions of the same process at a particular clinic, but only the figure on the right (#2) shows the details of what the workflow really is
The details of the workflow will change when you implement health IT
◦ If you don’t understand the details, you cannot plan for the changes that will come.
Example: Detailed Flowcharts
Agency for Healthcare Research and Quality. What Is Workflow. Rockville MD. October 2010.http://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/presentations
Implementing Shared Formulary and E-based Medication Order Review to Create "Closed Loop" Medication Process in Critical Access Hospitals (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD.
http://archive.ahrq.gov/news/events/conference/2009/wakefield/index.html
Example: Swim Lane Diagram, Before Population
Example: Swim Lane Diagram, After Population
Implementing Shared Formulary and E-based Medication Order Review to Create "Closed Loop" Medication Process in Critical Access Hospitals (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/news/events/conference/2009/wakefield/index.html
Clinic-level workflow: the flow of information, in paper or electronic formats, among people at a practice or clinic.
Intra-visit workflow: workflow during a patient visit
Inter-organizational workflow: workflow between healthcare organizations
Cognitive workflow: the workflow in the mind
The Layers of Workflow Interactions
Agency for Healthcare Research and Quality. What Is Workflow. Rockville MD. October 2010.http://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/presentations
Compare measures
Consider reporting modification or quality improvement
Challenges to data identification and collection:
◦ Unstructured data
◦ Data latency
◦ Discordant data
Data and Workflow Process for Updates
Data Extraction and eCQM Calculation
Once data are available, move forward with data extraction and calculation
Continue iterative process of validation
Additional tweaks to data capture and/or workflow may be necessary after validation
Remember to modify tracking documentation
http://blog.bersin.com/mit-symposium-focuses-on-data-quality/
Workflow Assessment:
Capturing Data as Part of WorkflowDepression Care Example
Patient with DepressionHas current depression diagnosis
Taking antidepressant
Receiving psychotherapy
Care team includes PCP, nurse case manager, consulting psychiatrist, pharmacist
Symptoms routinely assessed using PHQ-9 Health Questionnaire (recent score indicates moderate depression)
Goes to visit with PCP
Historical Data
◦ Patient history in PCP’s EHR◦ Diagnoses
◦ Visits
◦ Referrals
◦ Medications
◦ Patient completes PHQ-9 on patient portal mobile app and at visits
Workflow for Patient Visit
• Updates personal info
• Completes PHQ-9 on tablet
Patient Check-in
• RN assessment
• Weight
• Blood PressureRooming
• PCP assessment
• Adjusts treatment
• Follow-up with RN Case Manager
PCP Exam
Data Capture in Real Time
• Updates personal info
• Completes PHQ-9 on tablet
Patient Check-in
• RN assessment
• Weight
• Blood PressureRooming
• PCP assessment
• Adjusts treatment
• Follow-up with RN Case Manager
PCP Exam
Data for Quality MeasurementStructured
By-product of workflow
Captured and used in real time (supports measurement-based care)
In this example:
Denominator = Patient with active depression diagnosis and visit
Numerator = PHQ-9 administered to monitor symptoms
Common Clinical DataSet (CCDS)Required for transitions of care in 2014 and 2015 Editions of Certification
Describes a minimum set of data with variable level of specification– generally minimum requirement is a terminology binding
Alone does not guarantee interoperability because metadata and other form and manner vary
However, it is a good starting place to look for requirements that will be widely available
Common Clinical Data Set
Renamed the “Common MU Data Set.” This does not impact 2014 Edition certification.Includes key health data that should be accessible and available for exchange.Data must conform with specified vocabulary standards and code sets, as applicable.
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Patient name Lab tests
Sex Lab values/results
Date of birth Vital signs (changed from proposed rule)
Race Procedures
Ethnicity Care team members
Preferred language Immunizations
Problems Unique device identifiers for implantabledevices
Smoking Status Assessment and plan of treatment
Medications Goals
Medication allergies Health concerns
2015-2017
Send, receive, find and use priority data domains to improve health and health quality
ONC Interoperability Roadmap Goal
Red = New data added to data set (+ standards for immunizations)Blue = Only new standards for data
Data Mapping:
Mapping
• Mapping is the process of matching a concept in one system to the equivalent concept in another system
• For example, laboratory code to LOINC
• ICD-10-CM code to SNOMED CT
• NDC code to RxNorm
• Best to assign the standard code as close to the origin of the data as possible to prevent loss of information
• The more times the data is mapped from one system to another, the higher the chance for errors
Mapping principles
• Map to the most specific code based on the available information
• Do not overspecify, i.e., do not map to a concept that has more information than what you have available by making assumptions about your data
Choose codes to fit your purpose
• Laboratory – in most cases a single LOINC represents a single assay
• Acute clinical care – need granular codes that accurately reflect what is being measured
• 76215-3 Invasive Systolic blood pressure
• 76534-7 Noninvasive Systolic blood pressure
Choose codes to fit your purpose (cont.)
• If comparing two methodologies for measuring an analyte, need to find the exact LOINC codes that represent those two assays
• Example – comparing Zika IgM immunoassay to Zika IgM immunofluorescence assay
80824-6 Zika virus IgM Ab [Presence] in Serum by Immunoassay
82731-1 Zika virus IgM Ab [Presence] in Serum by Immunofluorescence
• If doing a study on how many pregnant women were tested for Zikavirus infection over a certain time period, need to use all Zika LOINC codes to find the correct data
Searching principles
• Searches should be tailored for the purpose – i.e., looking for very specific data (Zika IgM by IF or IA) versus broader use
• For specific searches, use all available information to narrow down the results
• Searching for Zika IgM IF returns 1 LOINC code
• Searching for Zika CSF returns 8 codes
• For broad use, keep the search broad• Searching for Zika returns 30 records
Mapping examples
• Major laboratories have LOINC mappings published on their websites• https://www.labcorp.com/test-menu/30451/lipid-panel-with-total-
cholesterolhdl-ratio
Mapping examples
• https://www.mayomedicallaboratories.com/test-catalog/Fees+and+Coding/82047
Mapping examples
• http://www.questdiagnostics.com/testcenter/eGFR
Customizing a HIT Installation: Impacts
Often EHR and HIT systems will allow the implementer to make many customizations to the system being implemented
The level of effectiveness of a customization varies based on the:◦ Guidance offered by the developer
◦ Knowledge of the informatics team involved in the implementation
◦ Data already available in the system
◦ Knowledge and alignment of the existing system database
◦ Knowledge and alignment of export requirements for reporting and exchange
The Impact of Customization: Pro/Con
Pros:Allows the system to reflect specialized requirements
Gives local terms and providers a place in the system
Cons:Generally the more customization the bigger the barrier to interoperability
The more customization the more the cost of mapping and maintenance
The more customization the more likely things are to break
How to Position Yourself on the Leading Edge: Clinical Quality Programs:
1. Look at scoring and bonus point opportunities
2. Consider reorienting your practice into groups. Or “practice groups”
3. Consider creating or using measures that are more meaningful:1. Outcomes and risk adjustment2. Special populations*, specialty measures3. Multidimensional interventions
4. Integrating workflow and process changes– thinking about cost1. Care plans and coordination (count for IA)2. Sophisticated risk assessment* and targeted intervention
5. Evaluate changes in reporting options
6. New standards and technology
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Discussion