# Presentation: 243832

## AHIC “Prototype”

**AHIC “Prototype”**
**Quality Use Case - 2007**
**Office of the National Coordinator**
**March 27, 2007**

## AHIC Priorities and Analysis Activities To-date

***Use case options for AHIC prioritization ***

***AHIC workgroup recommendations for priorities and issues***

***Work group areas were clustered for cross-workgroup coordination and synergy***

- AHIC Priorities

***Prototype Use Cases***

## Providers would benefit from the collection and dissemination of healthcare quality data such as HQA quality indicators for inpatient care and AQA quality indicators for ambulatory care, particularly if this information can be integrated into EHR systems within the provider's workflows. Clinicians could benefit from receiving realtime or near-realtime feedback regarding relevant quality indicators and contra-indications for specific patients.  Additionally, quality data across multiple providers and entities could be aggregated for the purpose of public reporting.

**Providers would benefit from the collection and dissemination of healthcare quality data such as HQA quality indicators for inpatient care and AQA quality indicators for ambulatory care, particularly if this information can be integrated into EHR systems within the provider's workflows. Clinicians could benefit from receiving realtime or near-realtime feedback regarding relevant quality indicators and contra-indications for specific patients.  Additionally, quality data across multiple providers and entities could be aggregated for the purpose of public reporting.**

***AHIC Priority Areas***
**Q 1.0 Inpatient Quality Measures (core set)**
**Q 2.0 Ambulatory measures (core set)**
**Q 3.0 Clinicians have access to feedback (self-assessment)**
**Q 4.0 Public reporting**

***Workgroup Issues***
**Q 8.0 Lack of data and technical standards and clinical documentation**
**Q 9.0 Data sharing rights and responsibilities**
**Q 10.0 Data security and privacy – policies for secondary use**

## Quality and public health initiatives would benefit from the availability of a comprehensive data source which spans the continuum of care, providing the ability to combine electronic data from a variety of sources including laboratories, pharmacies, claims, EHRs, etc.

**Quality and public health initiatives would benefit from the availability of a comprehensive data source which spans the continuum of care, providing the ability to combine electronic data from a variety of sources including laboratories, pharmacies, claims, EHRs, etc.**

***AHIC Priority Areas***
**Q 4.1 Data aggregation**

***Workgroup Issues***
**Q 8.0 Lack of data and technical standards and clinical documentation**
**Q 9.0 Data sharing rights and responsibilities**
**Q 10.0 Data security and privacy – policies for secondary use**
**BIO 7.0 Storage, retrieval and management concerns of large amounts of data**

## Quality and public health reports frequently include pre-existing clinical data, as well as, additional information supplied the provider ((or designee)) in order to more fully describe the circumstances of the occurrence.  Both providers and recipients of these reports would benefit from the ability to have electronic prompts or data collection aids to facilitate reporting the additional information needed based on the specific type of report being made by the provider

**Quality and public health reports frequently include pre-existing clinical data, as well as, additional information supplied the provider ((or designee)) in order to more fully describe the circumstances of the occurrence.  Both providers and recipients of these reports would benefit from the ability to have electronic prompts or data collection aids to facilitate reporting the additional information needed based on the specific type of report being made by the provider**

***AHIC Priority Areas***
**BIO 1.0 Case reporting**
**Q 1.0 Inpatient quality measures (core set)**
**Q 2.0 Ambulatory measures (core set)**

***Workgroup Issues***
**BIO 6.0 Lack of EHR case reporting, adverse events, and electronic lab reporting (ELR) integration**
**BIO 8.0 Lack of central dissemination process for public health IT standards**
**BIO 13.0 Privacy/Security Concerns**
**BIO 9.0 Lack of interoperable bi-directional communications**

## Quality Use Case Scope

- Information flows needed to support the collection and reporting of a core set of HQA and AQA quality measures using EHR systems in hospital care and ambulatory care settings
- Presentation of information to clinicians and issues around sequence of data aggregation and reporting** **
- Like other use cases, models some aspects of the “to-be” future environment as well as the current “as-is” environment
- Can provide a context for policy decisions, but does not provide policy guidance

## Quality Scenarios

**Hospital-based care**
- covers the documentation, collection and transmission of patient information relevant to the calculation of an established quality measure, when care is provided to a patient within a hospital setting.
**Clinicians**
- covers the documentation, collection and transmission of patient information relevant to the calculation of an established quality measure for clinician quality, when care is provided to a patient within an ambulatory or inpatient care setting, but where a specific clinician can be identified as responsible for ensuring adherence to best practice.
**	**

## Quality Perspectives and Roles

- The use case describes Quality measurement and reporting scenarios from the roles of:
- Hospital-based care
- Hospital-level measurement and feedback
- Multi-hospital measurement and reporting
- Clinicians
- Multi-entity measurement and reporting

## Quality Perspectives and Roles

- Hospital-based care
- HQA measures
- Flow of quality information through an EHR at acute or specialty hospitals
- Hospital-level measurement and feedback
- Collection and validation of patient-level quality data
- Internal reporting (feedback) of quality data at patient, provider, hospital levels
- Reporting to external entities
- Examples could include services performed by a contracted performance measurement vendor, by CMS or by the hospitals themselves
- Multi-hospital measurement and reporting
- Aggregation and reporting of multi-hospital data
- Examples could include services performed by the Joint Commission, by CMS or organizations providing health information exchange services

## Hospital-based Care Quality Information Collection and Feedback Flow

- Health Researchers

- Public Health Monitoring Systems

- Consumers

- 6.1.4 Filter EHR data for information matching inclusion/ exclusion factors

-  6.1.2 Document patient care

- 6.2.2 Receive and analyze data for quality measure

- 6.1.1 Evaluate and treat patient

-  6.2.6 Transmit quality information

- 6.1.7 Format and transmit patient information & admin data sets

- 6.1.6 Augment EHR data with manual extraction of patient data

**Perspectives/Roles**

**Information Sources & Recipients**

- 6.1.3 Receive listing of defined measures & abstraction guidelines

- 6.3.1 Collect
- Information

- 6.1.5  Discharge patient

**1**

**2**

**3**

**5**

**6**

**7**

| Scenario Flows |  |
| --- | --- |
|  | Defined quality measurements to be reported are sent to hospitals & Hospital-level Measurement & Feedback |
|  | Notice is given to HIS to support clinical decisions and augment recorded data |
|  | Quality info is sent to Hospital-level Measurement and Feedback |
|  | Initial report is sent for validation and/or correction |
|  | Corrected initial report is sent to Hospital-level Measurement and Feedback |
|  | Revised preview report is sent to hospital for validation and/or correction |
|  | Quality information is sent to Multi-hospital Measurement & Reporting |

**3**

**4**

**5**

**6**

**1**

**2**

**4**

**7**

**6.1 Hospital-based Care**

- 6.2.1 Receive listing of defined measures & abstraction guidelines

**6.2 Hospital-level Measurement and Feedback**

- 6.2.3 Prepare initial report on quality & transmit to hospitals

- 6.2.5 Re-run analysis and initial report if necessary

- 6.2.4  Receive corrections

**6.3 Multi-hospital**
**Measurement and Reporting**

**Hospital-based Care Quality Information Collection and Feedback Flow**

## Hospital-based Care Quality Information Reporting Flow

- 7.2.3 Transmit preview report of quality measures for validation/ correction

**7.1 Hospital-based Care**

- 7.1.3 Identify areas for improvement

- 7.1.6 Implement quality improvement initiatives

- Health Researchers

- Public Health Monitoring Systems

- Consumers

- 7.1.1 Receive preview report of  quality measures for validation

- 7.1.2 Provide corrected quality information if necessary

- 7.1.5 Refine internal quality improvement practices as appropriate

- 7.2.4 Re-calculate quality measures as needed

- 7.1.4 Refine HIS to prompt quality improvement at point of care and support efficient quality reporting

**Perspectives/Roles**

**Information Sources & Recipients**

**7.2 Multi-hospital**
**Measurement and Reporting**

- 7.2.1 Collect
- Information

- 7.2.5 Format and publish quality information

**8**

**9**

**10**

**11**

| Scenario Flows |  |
| --- | --- |
|  | Quality measures are sent for validation and/or correction |
|  | Corrected quality information is sent |
|  | Corrected reports are sent for validation and/or correction |
|  | Published data is available to users |

- 10

- 11

- 8

- 9

**Hospital-based Care Quality Information Reporting Flow**

## Quality Perspectives and Roles

- Clinicians
- AQA measures
- physicians and potentially other clinicians in the future as additional quality measures are developed
- Flow of quality information through an EHR whenever a specific clinician can be identified as accountable for adhering to best practice
- Multi-entity measurement and reporting
- collection and matching of data from a number of sources to produce patient level and aggregate quality indicators
- Examples could include services performed by CMS or organizations providing health information exchange services

## Clinician Quality Information Collection and Feedback Flow

- 8.1.4  Filter EHR data for information matching inclusion/ exclusion factors

- 8.1.2 Document patient care

- 8.1.1 Evaluate and treat patient

- 8.2.1 Receive listing of defined measures & extraction guidelines

- Health Researchers

- Public Health Monitoring Systems

- Consumers

- Health Care Payors

- Quality Organizations

- Lab/PBM

- Processing Entities

- Providers

**8.2 Multi-entity Measurement and Reporting**

- 8.1.8 Validate initial report and transmit corrections if required

- 8.1.7 Format and transmit patient information & admin data sets

- 8.1.6 Augment claims data with EHR data & manual extraction of patient data

- 8.2.2 Collect and analyze data for quality measure

- 8.2.3 Prepare initial performance report & transmit to clinician

- 8.2.5 Re-run analysis and initial report if necessary

-  8.2.4 Receive corrections

**Perspectives/Roles**

**Information Sources & Recipients**

- 8.1.3 Receive listing of defined measures & extraction guidelines

- 8.1.5  Discharge patient

**1**

**2**

**3**

**4**

**5**

**6**

| Scenario Flows |  |
| --- | --- |
|  | Defined quality measurements to be reported are sent to clinicians & Multi-entity Measurement & Reporting |
|  | Notice is given to HIS to support clinical decisions and augment recorded data |
|  | Quality info is sent to Multi-entity Measurement and Reporting |
|  | Initial report is sent for validation and/or correction |
|  | Corrections are sent to Multi-entity Measurement and Reporting |
|  | Revised quality data are sent for validation and/or correction |

**3**

**4**

**5**

**6**

**1**

**2**

**Clinician Quality Information Collection and Feedback Flow**

## Clinician Quality Information Reporting Flow

- Health Researchers

- Public Health Monitoring Systems

- Consumers

- 9.2.3 Aggregate data

- 9.2.7 Format and publish information

- 9.1.1 Receive preview report of calculated quality measures

-  9.1.4 Identify areas for improvement

- 9.1.6 Implement quality improvement initiatives

- 9.2.5 Transmit preview report for validation/ correction

- 9.2.4 Calculate quality measures for each clinician

- 9.1.2 Provide corrections if necessary

- 9.1.5 Refine internal quality improvement practices as appropriate

- 9.2.6 Re-calculate quality measures if required

- 9.1.3 Refine HIS to prompt quality improvement at point of care and support efficient quality reporting

**Perspectives/Roles**

**Information Sources & Recipients**

**9.2 Multi-entity**
**Measurement and Reporting**

- 9.2.1 Collect
- Information

- 9.2.2 Match Records

**12**

**8**

**9**

**10**

**11**

| Scenario Flows |  |
| --- | --- |
|  | Patient-level quality information is transmitted for aggregation from other sources (e.g. all payors) |
|  | Preview report of quality measures is sent for validation and/or correction |
|  | Corrected quality information is sent |
|  | Corrected reports are sent for validation and/or correction |
|  | Published data is available to users |

**10**

**11**

**8**

**9**

**12**

**Clinician Quality Information Reporting Flow**

## Prototype and Detailed Use Cases

**Prototype Use Case**
- High level overview of use case direction
- Not all events and actions
- Opportunity to provide feedback before publication of the draft detailed use case
**Detailed Use Case**
- Fully describes events and activities from a variety of perspectives
- Based on input from the prototype use case
- Will add some common “mini-flows” and processes
- Opportunity to provide feedback before publication of the final detailed use case

## Feedback Process

**Methods**
**–  **Prototype use case and instructions for providing feedback available on the ONC website at  _[http://www.hhs.gov/healthit/usecases/quality.html](http://www.hhs.gov/healthit/usecases/quality.html)__ _
**Comments**
- –  Concise comments on both the strengths and weaknesses of the use case approach
- –  Identify issues and recommend how they can be improved or changed
- –  Confirm strengths and explain why it is important to  retain them
- Identify specific quality measures that should be included in the detailed use case