# Presentation: 198602

## Critical Next Steps for Automating Quality Reporting Vendor PerspectiveFloyd Eisenberg, MD MPHManaging Director, Clinical Informatics Secondary Data Use, SiemensCo-Chair, HITSP Biosurveillance Technical CommitteeAHIC Quality Workgroup11 October 2006

## Agenda

- Problem Space / Market Demand
- Lack of Standard Reporting
- Essential Factors for Achieving Quality / P4P
- Parallel Industry Efforts
- Interoperability – NHIN

## Problem Space:Market Demand

- Customer Investment Priority
- Customers do not place a high priority on quality improvement tools; the focus is more on return on investment and increased efficiency in documentation.
- Workflow Intrusion
- Capturing guideline compliance often adds more data capture and lengthens the time needed to document care without increased reimbursement.

## Lack of Standard Reporting

- There are no standardized methods to report quality measures to payers/QI organizations and different payers require different information.
- Current government initiatives (PVRP) do not allow physicians who are early adopters the option of reporting quality data electronically.

## Standardize Clinical Performance Measures 
Independent of care setting 
Coordinate terminologies – billing, clinical
Process specific, not practitioner specific
Free of charge
Show clear relationship to highly prevalent, high incidence, high impact (cost/services) entities

- Independent of care setting
- Coordinate terminologies – billing, clinical
- Process specific, not practitioner specific
- Free of charge
- Show clear relationship to highly prevalent, high incidence, high impact (cost/services) entities

**Essential Factors ****to Achieving Quality / P4P**

## Create specifications enabling electronic health record system (EHRs) vendors to integrate clinical performance measures into their products. 
Provide clear relationship to atomic level terminology codes to enhance data collection and/or data management within electronic records
Provide clear, terminology-based standardization of population (denominator)
Provide clear, terminology-based exclusion criteria
Avoid proscriptive system methodology; encourage marketplace competition regarding collection and management within established standards and guidelines

- Provide clear relationship to atomic level terminology codes to enhance data collection and/or data management within electronic records
- Provide clear, terminology-based standardization of population (denominator)
- Provide clear, terminology-based exclusion criteria
- Avoid proscriptive system methodology; encourage marketplace competition regarding collection and management within established standards and guidelines

**Essential Factors ****to Achieving Quality / P4P**

## Essential Factors to Achieving Quality / P4P

- Adopt interoperability standards for guidelines and clinical performance measures.
- Enable incremental terminology-based standardization to build semantic interoperability beginning with performance / secondary use requirements
- Avoid overwhelming the industry with too many measures at once
- Align multiple measurement organizations
- Allow time for testing to appropriately modify / time deployment based on effectiveness, feasibility

## Parallel Industry Efforts

- Collaboration for Performance Measure Integration into EHR Systems – AMA, CMS, NCQA, JCAHO, EHRVA
- Conference 22 June 2006 – Next meeting 17 Nov 2006
- Standardization of performance measures
- Technical barriers to adding performance measure functionality
- Vendor participation in performance measure development process
- Data aggregation
- Two Working Groups
- Data Capture and Internal Reporting
- Data Extraction and External Reporting

## Interoperability Where EHRVA is HeadedDifferent types of information exchange services

**Interoperability Where EHRVA is Headed*****Different types of information exchange services***

**Edge HIT to Edge HIT System**
**communication**

**Edge HIT Systems**
**to NHIN Sub-network Communication**

**Internet**

**Document Sharing**

**Dynamic Information **

**Management**

**Transactions**

***Clinical Content***

***Resource Locator Services***

**Security and **
**Identity**

**Persistent**
**Info**
**Documents**

**Dynamic**
**Information**
**Access**

**Workflow**

**Quality**

- Patient
- and
- Provider
- ID Mgmt

- Access
- Control

- Medical Summaries

- Lab Results

- Radiology

- Medications

- Allergies

- Problems

- Requests
- ResponsesNotifications
- (ePrescribing,
- Lab Ordering
- etc.)

- Quality &
- Public
- Health
- Reporting

- Lab Results

## The “Truly Valuable” Electronic Health Record

**The “Truly Valuable” Electronic Health Record**

**Standardized Clinical Quality Measures**

**Quality Measures**
**Interoperable**

**EHR**

**         ****Data Driven Quality Improvement**

**Notes:**
To more operationalize the strategic framework....let’s take a look at what we’re trying to get to.

We need to have providers utilizing ehrs.  
Automate direct care activities and processes while optimizing clinical workflow.   
Support non-direct care processes.
Operate as a collection of interlocking solutions in hospitals, IDNs, physician practices, and/or in local, regional, or national health information networks
Serve as enablers for population health and personalized care, as well as an element of the national healthinformation infrastructure.

Operationalize Standards  - In order to have interoperability, we need standardization of these ehrs and the way they will communicate with each other.

Once the standards are determined, you can begin to implement interoperability among  the various providers utilizing the ehrs.  This will be done through community connectivity projects and/or RHIOS and the National Health Information Infrastructure or NHII or com.

This roadmap lowers the risk and improves the benefits significantly thus helping to spur adoption and allowing everyone to reap the benefits.