VITL\Blueprint for Health

Quality Data, Quality Patients

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Reasons for Good Data

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“Without good data, healthcare systems simply cannot accurately measure and assess performance. …the practice of continuous measurement and public reporting creates a feedback loop that improves patient care.”

- National Quality Forum, The ABCs of Measurement

Data Quality Facts

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Quality data is:

Accurate

Complete

Timely

Actionable

Data Quality Facts

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The quality of the data in your source system

affects the information sent to the reporting

entities.

Quality data can reduce duplicative effort and

enhance reporting and outreach.

Data Quality Facts

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Bad data:

Can affect quality of care

Increase costs

Put organizations in liability risk

Better Health is the Goal

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Improve health outcomes by providing the highest quality care

Objectively see where care deviates from clinicians’ intentions

Collect data at the point of care in the EMR

Feed data into statewide registry so practices can benchmark

against peers

Identify who is doing well so organizations can share best

practices

Better Health is the Goal

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How do we know that care is improving, and that health is getting better?

We need to measure it. Measurement isn’t the goal; better health is.

- Dr. Kevin Larsen, HHS

Registries and External Reporting

The Health Information Technology structure in Vermont is designed to help practices with reports for:

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The Vermont Blueprint for Health

Meaningful Use Measurement/Reporting

ACO Patient Records

Uniform Data System

Physician Quality Reporting System

National Committee for Quality Assurance

The Birth, Death, & Immunization Registry

Public Health Reporting

Data flow from Data flow from Practice to RegistryPractice to Registry

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Practice enters patient data into EHR/PM

System

VITL - Vermont Health Information Exchange (VHIE)

Medicity

ADTCCD

Vermont Blueprint for

Health

Blueprint Registry

ADTCCD

Practice views reports in DocSite

Covisint

Vermont Department of

Health

Immunizations Registry

VXU*

VXU*: Future Data Flow

VXU*

Data flow from Data flow from Practice to RegistryPractice to Registry

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Practice enters patient data into EHR/PM System

ADTCCD

Accurate

Up-to-date

Complete

Highest Quality

Benefits of Clean Data

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IMPROVE PATIENT CARE

Expedite clinical decision making

Prevent duplication of patient records

Achieve Meaningful Use

Enhance efficiency

Reduce costs

Heighten accuracy of reports

Increase amount of information transferrable to other systems

Ensure accuracy within patient charts

Improve outreach

Enhance the use of patient portal and consumer access

Common Data Quality Challenges

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Patient AttributionPatient Attribution

Active/Inactive StatusActive/Inactive Status Deceased Management Deceased Management

Clinical Data IssuesClinical Data Issues Patient MatchingPatient Matching

Provider Panel Challenges

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• Inactive providers are still ACTIVE in source system.

• Downstream systems do not know that providers are not inactive or that new providers have been assigned.

• NPI is not exported with Provider information, causing incomplete data.

• Fake providers are created for Out-of-Town patients and then exported cause confusion.

• Workflow or system does not allow the practice to deactivate a provider or add a new provider.

• Review panel and remove inactive providers.

• Notify downstream systems of new or inactive providers.

• Verify with VITL/vendor that NPI is exported in interface.

• Determine how a fake provider is affecting the downstream system. Replace it with a standardized provider type.

• Workflow or system does not allow the practice to deactivate a provider or add a new provider.

• Ensures that practices are paid for active providers, and do not receive payment for inactive providers.

• Allows there to be a synchronous accounting of providers.

• Facilitate the transition of patients to the correct provider, ensuring that patient panel reports are accurate and actionable within the practice.

Patient Attribution Challenges

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Patient Attribution Challenges

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Patients no longer actively receiving care are not marked Inactive

Vacationers only seen once are marked Active

Patients are not assigned to a PCP

Patients are attributed to providers who are no longer with the practice

System has attribution besides PCP, such as Other Responsible Provider

Patient Attribution Challenges

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Mark patients who have not been seen for 3 years Inactive

Develop a system to mark patients who are temporary as Inactive

Assign all patients a PCP and ensure that field is included in exports

Ensure that the Patient and Provider panels in the EMR are correct

Ensure export fields and mapping in the interface are correct

Patient Attribution Challenges

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Accurate panel management reports and quality improvement measurements for the practices

Properly assigned patients and providers in patient attributions

Practices receive entire and correct payments

Active and Inactive Patient Status

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PROBLEM REMEDIATION

Different rules apply to Active patient status.

Sites that provide both primary and specialty care may have patients who are Inactive within a practice and Active in the organization.

A patient is marked Inactive in the source system, but the EHR does not transfer an inactive flag.

Understand requirements in both source and downstream systems for Activating / Inactivating patients and synchronize.

Check with your organization regarding how to Inactivate a patient in one practice without doing so in other practices.

Ensure that status flag on your system is passing onto the next system.

Problem Remediation Outcomes

• Providers are not pulling panels containing deceased patients, thus avoiding the very unfortunate situation where they are contacting the families of the deceased. Also essential for

Deceased Patient Status

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• Practices are not aware of patient’s death.

• The Vermont death registry can supply a monthly list of people who die. Covisint can supply this information to practices in an Excel spreadsheet to be sorted by location.

• Providers are not pulling panels containing deceased patients, thus avoiding the very unfortunate situation where they are contacting the families of the deceased.

• Many practices rely on obituaries for death information.

• Multi-practice sites need to mark deceased at parent source system or the data may be over-written in the organization.

• Exports do not always support deceased indicator.

• Work with VITL to determine if your export supports a deceased indicator. If not supported, report to down-stream systems.

• Also essential for proper measurement, evaluation, and payment purposes.

Problem Remediation Outcomes

• Providers are not pulling panels containing deceased patients, thus avoiding the very unfortunate situation where they are contacting the families of the deceased. Also essential for

Clinical Data Challenges

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• EHR, labs, and other external sources use different codes.

• The EHR treats discrete numeric fields as text.

• Ensures that reports and exported information is actionable by providers.

• Some free text, delimiters, and combination fields in are not exportable.

• Customized EHR fields are producing non-standard results.

• Auto-fill used where more or different detail is needed.

• Use discrete fields or drop-down menus whenever possible. Free text fields do not capture discreet data.

• Ensures that the best quality care can be provided.

• Limit the use of customized fields.

• Customized data often do not pass in exports.

• Ensure that numeric values are used in discrete fields where calculations may be required.

• Essential for analysis and evaluation of the program and practice.

Patient Matching Challenges

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Data Quality Sprints

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Data quality sprints are used to clean up data within the host EMR or in the process of transmitting data to the Vermont Health Information Exchange or statewide registry.

All involved parties commit to working together and attending weekly meetings to review progress.

Participation from the practice or health system, VITL, Covisint/DocSite are essential to promote real time problem solving and immediate action.

The end result is better quality data in the EMR and registry, which leads to accurate actionable reports coming from either system.

Who Can Help?

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