eCQM Implementation: A Provider’s Perspective

April 12, 2015

Michael Zaroukian, MD, PhD, MACP, FHIMSS VP & CMIO – Sparrow Health System

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Michael Zaroukian, MD, PhD, MACP, FHIMSS Has no real or apparent conflicts of interest to report.

© HIMSS 2015 2

Learning Objectives – Provider focus • Describe the quality eMeasures implementation process,

along with some of the challenges…

• Employ strategies to best engage with your vendor for updating measure specifications.

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Provider Goals for Quality Reporting

• Make sure the CQMs…

– are clear, understandable, consistent, stable

– matter to my patients and me (Triple Aim +)

– are fairly attributed to me

– fit into efficient EHR workflows

– yield reports I agree with, can act on

– are easy to calculate and submit • CEHRT does it for me

– can be implemented at reasonable cost

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Providers Will Support eCQMs if…

• There is a value proposition • Their staffs support, recommend eCQM submission • Burden low – benefit high

– Reading, writing, thinking, navigating, reporting • Staff and vendor will make sure reports are right • I can see how I’m doing and have tools to improve • Anything reported publically will accurate reflect care

delivered

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Provider Perspective: Keep it Simple

Measure Developers

• Develop measures that make sense, are feasible, will work in real world

Vendors • Build functionality into EHR to

support measures (capture, EHR reporting, e-submission)

Providers • Align workflows and

EHR functionalities • Provide appropriate

care, EHR to do the rest

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Provider Concerns

• Reports don’t look right need to research

• Rules & regs are hard to find, understand, reconcile, connect to EHR tasks

• Alphabet soup of obscure terms and relationships – QRDA I/III, IQR, HQMF, LOINC, RxNorm, NQF, IPFQR, ICD,

SNOMED CT, CVX, ISO, CPT/HCPCS…

• Vendor access, responsiveness, capacity to support

• Staff resources needed to manage reporting

• Added work to prove you met a measure

• Process vs. outcome measures

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Some Feedback from Our Front Lines…

• Ambulatory eCQM submission – YES • Providers on EHR for full reporting year

– EHR-generated QRDA-III (aggregate) data file QualityNet portal (MU and PQRS)

• Providers on EMR for partial year – Manual entry of MU CQM data, claims-based data for PQRS

• Struggles with subtle or minor program differences – State (Medicaid) vs. Federal (Medicare) measure logic

– Payer-based incentive programs with similar measures requiring custom reports and reporting methods

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Some Feedback from Our Front Lines…

• Inpatient eCQM submission – NO

• Not ready for IP QRDA I eMeasure reporting

– Too many files (per patient; no aggregate option)

– Staff resources to complete terminology mappings

– Major EHR workflow changes required

• Data entry in specific locations & time frames

• Lower performance vs. abstraction until adopted

• Negation documentation complexity

– Concern CMS will publically report performance early

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Strategies to Engage with Your Vendor

• Commit to mutual purpose, shared success – Vendor commits to supporting your eCQM success

– Providers/staff commit to learning, workflow changes

• Assigned customer and vendor leads to coordinate quality, eMeasure reporting progress

• Study vendor quality reporting documents, project management, terminology mapping, crosswalks (measures workflows reporting)

• Promote synergy, not defensiveness

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Top Priorities for Progress

• Collaboration of all key stakeholders is paramount – Mutual purpose, shared goals, clear roles – Actors, not victims – Clear communication

• Technical, clinical, and operational expert participation is essential

• Keep focus on whether data collection & reporting will result in better health, better care, lower costs

• Align rewards and accountability around “who benefits” and “who pays”

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Quality

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Remember Why We Are Doing This…

Contact Information • Email: michael.zaroukian@sparrow.org

• Twitter: @mzaroukian

• LinkedIn: https://www.linkedin.com/pub/michael-

zaroukian-md-phd-macp-fhimss/1/39/471

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eMeasures: Specification April 12, 2015

Sharon Giarrizzo-Wilson, MS, RN-BC, CNOR

SymQuality Consulting, LLC

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Sharon Giarrizzo-Wilson, MS, RN-BC, CNOR Has no real or apparent conflicts of interest to report.

© HIMSS 2015

Learning Objectives • Identify the technical standards used to define, manage, and report electronic

clinical quality measures (eMeasures) • Review the eMeasure specification process

• Discuss current considerations for eMeasure development

National HIT Agenda

Local EHR

Secondary use

Decision support

Quality reporting

Reuse

Quality Data Model Data Element

HL7 Version 3 Implementation Guide: Quality Data Model – based Health Quality Measures Format Release 1 – US Realm February 2014

Standards: QDM, eMeasures, QRDA, CDA

HL7 Version 3 Implementation Guide: Quality Data Model – based Health Quality Measures Format Release 1 – US Realm February 2014

Health Quality Measure Format (eMeasure)

HQMF Header <QualityMeasureDocument> HQMF Body <section> <title>Population criteria</title> <text> <entry>Initial Patient Population</entry> <entry>Denominator</entry> <entry>Numerator</entry> <entry>Exclusions</entry> … </section> <section> <title>Data criteria</title> <text> <entry> … </section> … </QualityMeasureDocument>

End-to-End Reporting Process

CMS Quality Reporting Document Architecture: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Guide_QRDA_2014eCQM.pdf

DW eMeasure Application

Quality Measure

Identification eMeasure

Specification eMeasure

Testing eMeasure

Implementation eMeasure Use,

Evaluation, Maintenance

Feasibility Evaluation

Month 1 Month 5 Month 12 Month 21 Month 27

eMeasure Lifecycle

eMeasure Lifecycle - Identification

Quality Measure

Identification

Concept list generated

Stakeholders

Tools

TEP/SME Patients/ Caregivers

CMS Measure Manger

NLM Value Set Authority

Center

USHIK Draft Measures

CMS/HHS Inventory

USHIK Clinical Quality

Measures

CMS eCQM Library

NQF Quality Positioning

System

CMS MMS Blueprint

Months 1 - 5

eMeasure Lifecycle - Specification

eMeasure Specification

Draft specifications,

initial feasibility

Stakeholders

Tools

TEP/SME HL7 eMIG

Cypress

Bonnie Tool

QDM

HQMF

MAT

VSAC & Value Set Authoring

Tool

CMS MMS Blueprint

Months 4 - 12

NLM

JIRA

CMS MMS Blueprint

• Standardized system for developing and maintaining quality measures

• Measure developers should follow core set of business processes and decision criteria

• Two volumes: – Measure Development – Measure Maintenance

• Download:

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MeasuresManagementSystemBlueprint.html

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ONC JIRA Issue Tracking System • Feedback from public comments • Updates may impact clinical intent, logic or value set • Identification of implementation challenges and harmonization

opportunities – Initiation of multi-stakeholder consensus discussions

• eMIG, eMeasures Governance • NLM data element consults • Logic Harmonization workgroup

• Link: https://jira.oncprojectracking.org/secure/Dashboard.jspa

NLM Value Set Authority Center (VSAC)

• Services – Value Set: Search, Retrieval, Download – Authoring and validation tool for creating new and revising published

value sets – Reduces quality assurance tasks – Standard vocabularies used to define clinical concepts in CQMs

• SNOMED CT®

• ICD-10 CM/PCS • RxNorm®

• LOINC®

The Measure Authoring Tool (MAT)

• Developer – The National Quality Forum

• Ownership – Centers for Medicare and Medicaid

• Supported by – Health Care Innovation Services, Telligen/Net, Net Integrated

Consulting • Publicly-available, web-based tool • Exports eMeasure as human-readable, Simple XML, and HQMF XML

Bonnie Testing Tool - Test Case

eMeasure Lifecycle - Testing

eMeasure Testing

Develop, implement

comprehensive testing plan

Stakeholders

Tools

Formative testing

feedback recourses

Testing partners

(e.g., test sites)

TEP/SME

Cypress (implantation

testing) Bonnie Tool

Months 5 - 21

eMeasure - Testing • Types

– Feasibility • Data availability, accuracy, standards, workflow

– Validity • Face validity, logic validity, data element validity, measure

score validity – Reliability

• Clarity (“ace reliability”), logic ambiguity (logic reliability), data elements conformance to standard

• Phases – Alpha: internal testing – Beta: field testing

* No national test bed available *

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Cypress – Implementation Testing

ONC Cypress: Meaningful Use State 2 Testing and Certification Tool, http://projectcypress.org/faq.html#whatIsCypress

eMeasure Lifecycle - Implementation

eMeasure Implementation

Support eCQM rollout: Federal rulemaking, business process, NQF endorsement,

education & outreach

Stakeholders

Tools

CMS Federal Regulations

The Public

CMS eCQM Library JIRA

Months 21 - 27

USHIK

NQF Measures

Application Partnership

eMeasure Lifecycle – MAINTENANCE

eMeasure Use, Evaluation,

Maintenance Stakeholders

CMS Measure Management Contractor

The Public

From Month 27

CMS

TEP/SME NQF

Assess measure performance in field, conduct maintenance

eMeasure Considerations

• Changes for 2015 – More efficient tools – Aligning Eligible Provider and Eligible Hospital eMeasures

• Challenges – Risk adjusted and composite measures – Tool limitations – Unable to test full range of use cases/scenarios – Value sets updated annually – Lack of national test bed – Maintaining eMeasures of ‘topped-out” paper-measures

Questions

Sharon Giarrizzo-Wilson, MS, RN-BC, CNOR sgiarrizzowilson@SymQuality.com

Measure Development, Specifications & Implementation

April 12, 2015 Zahid Butt MD,FACG

CEO Medisolv Inc.

Chair HIMSS Performance Measurement Taskforce

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest

CEO of Medisolv; Quality Measurement Software Vendor Do not speak for nor refer to any specific EHR product Has no other real or apparent conflicts of interest to report.

© HIMSS 2015

Learning Objectives

• Discuss eCQM (eMeasures) implementation: A Software Vendor Perspective

eCQM Implementation/Update Life Cycle

• Final Rules • Specifications

Annual Update

eCQM

• Build • Test

Software • Clinician

Workflows • Data

Capture

Data

• Validation

Results • Test • Final

Submission

eCQM Implementation/Update Life Cycle

• Final Rules • Specifications

Annual Update

eCQM

• Build • Test

Software • Clinician

Workflows • Data

Capture

Data

• Validation

Results • Test • Final

Submission

9 – 18 Months

Specification Changes / Issues

Specification Changes / Issues

• Value set changes; Impact on clinician workflow – Major – Minor – None

• Logic changes; Impact on results – Yes – No

• Value set & logic changes outcomes – Routine “Maintenance” – Errors fixed – New errors introduced

Specification Changes / Issues

Quality Data Model & EHR Data

EHR Data Issues in eCQMs

• Not captured as structured data • Structured but not coded or mapped • Missing / ambiguous meta data • Null vs. Negation documentation • Same element – variable / multiple locations in physical

database • Multiple code systems for same element (e.g. Diagnosis)

Thank you !!

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zbutt@medisolv.com 443-539-0505 Ext 223

410-925-7005 (cell) Linked In: Zahid Butt MD, FACG

Twitter:@zbytes