telligen quality innovation network-quality improvement ...€¦ · – hl7 ealthcare...
TRANSCRIPT
1
Telligen Quality Innovation Network-Quality Improvement Organization (QIN-QIO) Igniting HIE Through Data Standardization Samm Anderegg, PharmD, MS, BCPS Health IT Consultant | Project Manager, Pharmacy HIT Collaborative April 12, 2018
2
Telligen: Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for
Colorado, Iowa, and Illinois
Telligen QIN-QIO
3
The Telligen QIN-QIO network offers expertise and support at local, regional and national levels
We believe the quality of healthcare can be transformed to better serve the people of all communities How we serve our participants:
• Assess and understand unique needs and opportunities • Provide opportunities to connect with • Align improvement efforts • Leverage expertise and relationships • Facilitate connections, sharing and learning • Bring you access to tools, resource, metrics, evidence based, collaboration, best practice,
peer support, education
Join the Telligen QIN-QIO Network
4
1. Characterize the goals and mission of the Pharmacy HIT Collaborative
2. Describe methods for documenting pharmacy services using standard clinical terminologies
3. Examine strategies for normalizing data for exchange via Consolidated-Clinical Documentation Architecture (C-CDA)
Learning Objectives
Represents over 250,000+ members in all pharmacy practice settings
• AACP – ACCP – ACPE – AMCP – APhA – ASCP – ASHP – NASPA – NCPA
Founding Members
• Surescripts – NCPDP – Amgen – Pfizer – Cardinal Health/Fuse
Associate Members
6
Pharmacy Health Information Technology Collaborative
Goals 1. Access – ensure HIT supports pharmacists in health
care service delivery 2. Connectivity – achieve pharmacists’ integration
within health information exchange 3. Quality – support national quality initiatives enabled
by HIT
7
The Key to Pharmacy’s Future?
• Structured, discrete data documentation • Clinical reporting • Population health • Value-based care
8
Clinical Documentation
• Purpose – not just billing! – Tracking productivity – Linking care to outcomes
– Communicate care plans – Pass-off to colleagues
• Limited by capabilities of software systems
Measuring Quality
Interoperability
9
Free Text vs. Discrete Data
Free Text
• Typographical representation of care provided
• Traditional documentation method
• Transcended into age of electronic systems
Discrete Data
• Codified clinical information
• Structured documentation
• Commonly used for billing fee-for-service
10
Progress Note
11
Discrete Data
1. Comprehensive Medication Review (CMR) 2. Medication Reconciliation (Med Rec) 3. Medication Action Plan (MAP) 4. Medication Synchronization (Med Sync)
12
Discrete Data Reporting
MRN Clinic Service Med Rec CMR MAP Doc Med Sync
0000001 CCTR Oncology Yes Yes Yes Yes
0000002 IM4 Transplant Yes Yes
0000003 IM2 Medicine Yes
0000004 CCTR BMT Yes Yes Yes Yes
0000005 IM3 Cardiology
0000006 IM4 Transplant Yes Yes Yes Yes
0000007 IM2 Medicine Yes
0000008 IM1 Medicine Yes Yes Yes
0000009 IM3 Cardiology Yes Yes
0000010 CCTR Oncology Yes Yes
13
Quantifying Data
Metric Q3 CY2015
Q4 CY2015
Q1 CY2016
Q2 CY2016
Med Rec 19.2% 50.3% 89.9% 92.6% CMR 5.5% 44.2% 70.2% 88.5% MAP Doc 34.9% 35.6% 40.1% 43.5% Med Sync 25.4% 21.6% 24.1% 23.2%
14
Benchmarking Data
Metric Q3 CY2015
Q4 CY2015
Q1 CY2016
Q2 CY2016
Med Rec 19.2% 50.3% 89.9% 92.6% CMR 5.5% 44.2% 70.2% 88.5% MAP Doc 34.9% 35.6% 40.1% 43.5% Med Sync 25.4% 21.6% 24.1% 23.2%
Below Threshold Above Threshold, Not at Goal At Goal
15
Readmission vs Med Rec Rates
0102030405060708090100
0
5
10
15
20
25
30
Q3 CY2014 Q4 CY2014 Q1 CY2015 Q2 CY2015Readmissions (All Cause) Readmissions (CHF)Readmissions (COPD) Admit Med RecDC Med Rec
16
Meaningful Use
• Incentivizes hospitals and providers to adopt certified EHR systems
• Outlines capabilities/functions of EHRs required to meet MU standards ($$$) 1. Quality measure reporting 2. Interoperable exchange of health information
• Specifies technical requirements – SNOMED CT for clinical documentation – Value sets for implementation
17
EHR Certification Program
• Health IT Certification Program – Administered by the Office of the National Coordinator
(ONC) – Certifies solutions that meet federal health IT
standards, implementation specifications, and other criteria promoting interoperability
18
Interoperability-Health Information Exchange (HIE)
• Federal initiative to exchange patient information between EHR systems & report quality measures
• Pharmacy software vendors do not participate in Meaningful Use – No business incentive for pharmacy software vendors
to adopt technical requirements – No financial incentive for pharmacists to adopt
compliant software
19
Goals
• Align pharmacy software systems functionality with EHR systems – Leverage interoperability to gain accountability – Maintain medication list, allergy list, ADRs – Manage treatment regimens, optimize outcomes
• Support exchange of standardized data between all providers and software vendors
20
Goals
21
Health IT Standards
• Standard Development Organizations (SDOs) – HL7 – healthcare communication – NCPDP – pharmacy communication
• Health Information Exchange (HIE) – Consolidated Clinical Document Architecture (C-CDA) – SCRIPT Standard – eRx, ePA
• Clinical Vocabularies (e.g. codes) – SNOMED CT – diagnoses/diseases, findings, procedures – RxNorm – medications – LOINC – laboratories – CVX – vaccines
22
Standard Terminology
• SNOMED CT – Federally recognized standard for clinical
documentation – Detailed documentation of clinical information 19 hierarchies, 300K concepts, 1.5M relationships Diseases, findings, etiologies, living organisms,
procedures, outcomes – Common “language” that allows software systems to
talk to each other
23
SNOMED CT for Pharmacy
SNOMED CT Concept SNOMED CT ID Referred by primary care physician 2021000124102 Patient unable to obtain medication 429611000124105 Medication dose too low 448152000 Hypertension medication review 473225006 Rheumatologic disorder education 413084000 Recommendation to increase dose 428811000124101 Medication reconciliation by pharmacist
428701000124107
Hemoglobin A1c <7% 165679005 Adverse reaction to drug 62014003
24
SNOMED CT for Pharmacy
How do we implement SNOMED CT in electronic systems?
25
Value Sets
• Set of codes deemed appropriate for documenting within a specific data field
• Guides vendors and implementers how to build documentation codes within solutions
Pharmacy SNOMED CT Codes
300-400 Codes
Pharmacy SNOMED
CT Value Sets Sets of 10-40
Codes 300,000+
Codes
SNOMED CT
Codes
26
Value Sets
Codes
“Value Sets”
27
Referral Source Value Set
Referral Source SNOMED CT ID Referred by health care professional 2011000124105 Referred by physician 309014007 Referred by primary care physician 2021000124102 Referred by specialist physician 2031000124104 Referred by nurse practitioner 2041000124109 Referred by self 1991000124105 Referred by payer 2001000124107
28
Health Information Exchange
• National Vendors – CommonWell – SureScripts – Care Quality
• State Health Information Exchanges
Using HL7 standards, APIs for data exchange
29
Exchanging Pharmacy Information
• Clinical Document Architecture (C-CDA) – Standard developed by Health Level 7 (HL7) – Provides a common framework for development of
electronic clinical documents – Capture, store, access, display, and transmit clinical
data elements
30
Clinical Document Architecture
• C-CDA Clinical Document Templates 1. History & Physical (H&P) 2. Progress Note 3. Procedure Note 4. Consultation Note 5. Discharge Summary 6. Continuity of Care Document (CCD) 7. Pharmacist Care Plan (PhCP)
31
Clinical Document Architecture
32
Work with Vendors
• Map out patient care process • Codify clinical documentation, reference data
standards (e.g. value sets) • Make it easy for clinicians to document • Drive changes within your system; do not be confined
by current capabilities • Design to comply with C-CDA or other HIE
communication standards
33
Medicaid Incentive Program
• Funding tied to the Health Information Technology for Economic and Clinical Health (HITECH) Act
• Allows 90% federal match for administrative costs related to health information exchange (HIE) promotion for Medicaid EPs
• As of Spring 2016, expanded to include non-EP providers, including pharmacies
34
Online Resource Center
• Over 40 links; 13 documents authored by PHIT Collaborative workgroups and representatives
35
Implementation Guide
• Beginner’s Guide published on PHIT Collaborative website
• Additional documents pending publication
36
How to Access Value Sets
https://vsac.nlm.nih.gov/#
• Create a free UMLS login to access • Draft and finalized value sets published here • Search for Author/Steward = PharmacyHIT
37
How to Access Value Sets
• Click on Search Value Sets tab
39
Key Takeaways
• Pharmacy HIT Collaborative represents the profession of pharmacy in Health IT
• Terminologies like SNOMED CT and communication standards like HL7 C-CDA make health information exchange possible
• Standard data sets (e.g. value sets) allows all software vendors to exchange common data elements
41
Telligen QIN-QIO Medication Safety Initiative Colorado | Illinois | Iowa
Katy Brown, PharmD [email protected]
515-453-8124 | 712-299-6850 https://telligenqinqio.com/our-work/medication-safety/
Contact
This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QIN-C3.6-03/27/17-2059