- Data Governance. Data is the crux of healthcare improvement. It is critical to establish a data governance council consisting of an interdisciplinary team that is responsible for developing a set of processes that serve as a quality control mechanism for handling information. These mechanisms define lines of responsibility and establish methods to foster the accessibility, completeness, and integrity of data. Strong data governance that can validate the accuracy of the data is critical to instill trust among clinicians. The absence of a data governance structure exposes the risk of clinicians contesting the accuracy and usefulness of the performance information produced by the data, thereby reducing its value to continuous improvement initiatives.
- Health IT Strategy. An organization must develop a health IT and analytics strategy to determine the types of health IT necessary to support the clinical and operational processes of the organization. The most essential component in the development of a successful health IT strategy is to gain consensus from all affected stakeholders. Attempting to implement a strategy without the buy-in from the affected stakeholders will be extremely difficult, if not impossible, because clinicians will not support the efforts and may challenge the types of health IT implemented.
- Systems and Technology Framework. The systems and technology framework of healthcare organizations is very complex. Organizations must inventory the various systems and develop a blueprint to guide system selection, technical and functional builds, consistent standards, and information output. All of these aspects affect clinical operations, and the implications must be considered and risks mitigated. Neglecting this activity will have serious implications on system integration and data aggregation efforts.
- System Integration and Solution Architecture. Healthcare organizations have various technology systems and platforms that were typically implemented at a point in time to serve a specific business need without extensive thought or planning given to system integration. The result of this approach is that these systems are not designed to “speak to each other”. Organizations must build an enterprise architectural approach that allows platform integration of multiple disparate systems, supports system interoperability, and establishes a centralized master data management structure.
- Solutions Search and Selection. Commonly, a systems and technology inventory reveals gaps in the framework, and the organization must embark on a search and selection process to identify a system to fulfill the need(s). It is important to establish a systematic approach to IT system selection so that the evaluation of the systems is comparative. More important, the organization must enlist the help of an interdisciplinary team to evaluate and score the systems based on a pre-defined list of functionality and standards. The process must be executed very methodically, starting with defining the system requirements, developing the evaluation criteria, training the evaluation team, conducting the system demonstrations, reviewing test cases, and selecting the system of choice. In addition, the organization must establish an enterprise approach to system search and selection, which can help minimize ad hoc purchases that can conflict with the overall integration strategy.
- Workflow Redesign. Clinical workflow redesign is integral with any health IT solution implementation. Before even embarking on system selection, an organization must first understand the clinical workflow. This will provide insight to the existing processes and protocols and enable the organization to select a technology solution that will best support clinical operations by incorporating solution sets that promote workflow redesign around functional roles, care model redesign, clinical decision support, and clinical protocols. Failure to consider the clinical implications when selecting a system will lead to an underutilized system and decrease efficiencies.
- Clinical Health IT Optimization. Clinical care optimization is critical to maximize the value of the health IT system. Health IT systems are rarely used to their fullest potential. This underutilization can have negative impacts on many facets of a healthcare organization, including patient safety, quality of care, clinical performance, staff satisfaction, and revenue capture. The organization can improve the functional use of systems and applications through utilization evaluation, reeducation of clinical documentation requirements, and system functionality retraining for clinical staff. Failure to optimize clinical health IT systems leaves the organization vulnerable and at risk for poor coordination of care, fragmented communication, performance penalties, staff turnover, and decreased revenue.
- Integrated Analytics and Reporting Strategy. An integrated analytics strategy is imperative to establish a streamlined approach to developing, managing, updating, and reporting performance measures. Many organizations are faced with various regulatory, accreditation, and quality program reporting requirements. Typically, report writers will build ad hoc reports according to the specifications requested, but report reviews reveal that many of these reports include the same metrics. Organizations must catalogue the performance measures contained in all reports. This accounting should include the details of the measure (e.g., numerator and denominator), discreet data needed to calculate the measure, the source system for the data, the purpose of the measure, the report measure owner (both requester and developer), the user(s) of the information, and the user status (internal or external). This will help the organization to delineate the various reports, identify duplications, and establish consistency across the clinical analytics and reporting requirements.
- Clinical Informatics and Analytics. In line with the analytics and reporting strategy, an organization must define an approach and process to ensure that solution capabilities enable the collection of discreet clinical data that supports the development of reliable, action-oriented reports. An important component to developing a sound clinical informatics and analytics process is having an interdisciplinary team composed of IT, clinical, and report analyst representatives. This team composition will ensure that the information needed from the clinical team is addressed, the technical team can build it, and that it is structured so that analysts can easily generate the necessary reports.
- Actionable Data Analytics. Once the type of information that is needed for analytical reports is determined and the process by which this information will be captured is defined, an organization needs to determine the most effective way to present the information, to whom the information should be provided, and how frequently in a timely manner. Most important is designing reports that present data in a usable, action-oriented, and meaningful way. The way in which data is presented can make the difference between impactful care management and quality improvement results and futile care coordination efforts.
This new download from GE Healthcare Camden Group focuses on how successful organizations:
- Identify current information technology solution needs and challenges
- Categorize existing issues in capturing and aggregating data as well as translating this information into clinical workflows
- Create the blueprint for an information management and data governance strategy
- Document and prioritize steps related to the "future state" information technology solutions framework and management strategies needed to support current and future business needs.
To download the PDF document, please click the button below to access the download page.
By Tara Tesch, MHSA, Senior Manager, GE Healthcare Camden Group
This is the third of three articles in the Population Health Alliances series. The first article examined physician engagement strategies and detailed specific strategies that have proven successful for alliances. The second article focused on the value of true care redesign.
High-performing organizations possess robust information technology ("IT") infrastructure and associated tools to deliver, track, and document patient-centered, evidence-based care at the point of service and can disseminate actionable and meaningful data quickly and transparently. IT infrastructure implementation is an iterative process and rarely do organizations have a “fully baked” IT solution at the onset of implementation.
There is no single vendor that can provide a comprehensive data analytics solution to meet all needs (see graphic below) at this time.
Future State CI Network Platform
© The Camden Group 2015
In order to truly impact how care is delivered, end users must have actionable information in real time to support care redesign efforts. Providing patient-relevant decision support at the point of care can improve provider effectiveness in delivering appropriate and necessary interventions, furthering the organization’s goals of improving individual and population health. Too many organizations stall in developing their IT infrastructure by letting “great get in the way of good.” IT should support the care not drive it, therefore, systems and tools must translate and support care redesign. Too much data that is not well organized or analyzed can simply create confusion and cloud the necessary focus required to impact population health.
It is critical for population health alliances to have a well thought-out IT strategy and data management plan that will provide connectivity between members. The strategy should call for a means to collect the data, offer a robust tool to aggregate the data, and support reporting that will translate information into behavioral change and allow providers to more effectively communicate with and engage patients. The key factor for success: build your strategy beginning with the end in mind.
Data Governance Strategy Build
© The Camden Group 2015
Success begins with the development of an information management and data governance strategy, which includes a data governance structure (who is going to own it, clean it, analyze it), organizational structure (what resources and types are required), and core data needs (reportable, transactional). An objective of the strategy is to take data and create meaningful information that leads to action-oriented knowledge. Out of the strategy, capabilities will be identified that drive interoperability and analytics requirements. These requirements should provide the criteria for selecting health information technology (“HIT”) that support the business and clinical needs of the alliance. Avoid buying the tool then trying to create a strategy around it; this will inevitably fail.
Designing the data strategy requires a sophisticated understanding of the alliance’s business and clinical objectives, clinical guidelines and care processes, and requirements of analytics to support these activities. First, define the end goal (outputs) such as care management or value-based contracting, and identify the data sources that will be used (i.e., EHR, claims, ADT, etc.). Next, determine how the data will be used to support the outputs; will it be reportable and retrospective (e.g., risk stratification, predictive modeling, scorecards) or transactional and action-oriented (e.g., point of care, gap closure, alerts, real time analysis to support decision-making).
To be successful, this planning process must include clinical/operational leadership (e.g., chief medical informatics officer, care management leads), in addition to finance and the member organization chief information officers. Staffing should include a data architect and a clinical informaticist able to translate the data into clinically meaningful information.
Once the strategy has been defined, identify the data requirements and associated capabilities. This may include standard processes and reporting templates – tools to automate the current state and optimize care delivery. Next, select a vendor that either has the ability to grow with your organization as it evolves or decide to pursue a “plug and play” vendor approach. Either way, the vendor must support the alliance’s CIN data requirements and capabilities.
In the end, it is critical to maintain strong, positive relationships with clinicians during the design and development of these key technology capabilities. Clinicians drive the clinical care of patients and care models to support the delivery of clinical protocols. Organizational and individual needs will evolve based upon initial successes and challenges, and clinicians will bring forth a multitude of suggested and needed changes after the initial “go live.” Technology is the tool to support the clinical requirements, and developing ongoing processes to solicit clinician feedback for continued improvement is an important contributor to long-term success.
Ms. Tesch is a senior manager with GE Healthcare Camden Group in the clinical integration practice with more than 18 years of experience as a healthcare leader and strategist. Ms. Tesch specializes in value-based care delivery strategic planning, CIN development and implementation for commercial, Medicare, and Medicaid populations, health information technology data governance and analytics strategy, as well as care management strategy, design, and implementation. She has worked with a variety of healthcare providers, including integrated delivery networks, academic health centers, regional referral centers, rural community providers, and national non-profit and faith-based health systems. She may be reached at [email protected].
Now that healthcare in America is evolving as rapidly as technology, hospitals are expected to transform their archaic IT systems to meet reform requirements or face significant penalties from the government. Add to the mix a lack of skilled IT workers and an operating system that is already functioning at a loss, and the next few years look very grim. How can hospitals meet the mandates and recover their cumbersome IT systems? This infographic from Innotas outlines what these facilities need to implement to meet a brighter future.
To view a full-size version of this infographic, click here.
The Deloitte Survey of U.S. Physicians provides data-driven insights on physicians’ perceptions of the health care system and their thoughts on health care reform. Research conclusions include their perspectives and attitudes about health care reform, the future of the medical profession, and HIT. As they have done in past years, the Deloitte Center for Health Solutions conducted a survey and compiled the findings in an infographic, below.
The survey polled a nationally representative sample of up to approximately 600 U.S. primary care and specialist physicians to understand their perspectives and attitudes about health care reform, the future of the medical profession, and HIT.
Most U.S. physicians are concerned that the future of the medical profession may be in jeopardy and consider many changes in the market to be a threat. They believe that the performance of the U.S. health care system is suboptimal, but the Affordable Care Act is a good start to addressing issues of access and cost.
- Nine out of 10 physicians are interested in mobile health technology; those who are not tend to be older and have long-established solo practices.
- Users of the technology outnumber non-users in favoring its benefits for accessing clinical information, researching diseases and treatments, and pursuing continuing education.
- Three out of four physicians say EHRs increase costs and do not save time.
To keep you updated with information on the Medicare and Medicaid EHR Incentive Programs, CMS recently added one new FAQ and updated seven FAQs to the CMS FAQ system. We encourage you to stay informed by taking a few minutes to review the new information below.
- For Measure 2 of the Stage 2 Summary of Care objective for the EHR Incentive Programs, may an eligible professional, eligible hospital, or critical access hospital count a transition of care or referral in its numerator for the measure if they electronically create and send a summary of care document using their CEHRT to a third party organization that plays a role in determining the next provider of care and ultimately delivers the summary of care document? Read the answer.
- If my practice does not typically collect information on any of the core, alternate core, and additional clinical quality measures (CQMs) listed in the Final Rule on the Medicare and Medicaid EHR Incentive Programs, do I need to report on CQMs for which I do not have any data? Read the answer.
- Can eligible professionals use CQMs from the alternate core set to meet the requirement of reporting three additional measures for the Medicare and Medicaid EHR Incentive Programs? Read the answer.
- If one of the measures for the core set of CQMs for eligible professionals is not applicable for my patient population, am I excluded from reporting that measure for the Medicare or Medicaid EHR Incentive Programs? Read the answer.
- If none of the core, alternate core, or additional clinical quality measures adopted for the Medicare and Medicaid EHR incentive programs apply, am I exempt from reporting on all CQMs? Read the answer.
- If the denominators for all three of the core CQM are zero, do I have to report on the additional CQMs for eligible professionals under the Medicare and Medicaid EHR Incentive Programs? Read the answer.
- For the Medicare and Medicaid EHR Incentive Programs, if the certified EHR technology possessed by an eligible professional generates zero denominators for all CQMs in the additional set that it can calculate, is the eligible professional responsible for determining whether they have zero denominators or data for any remaining CQMs in the additional set that their certified EHR technology is not capable of calculating? Read the answer.
- I am an eligible professional who has successfully attested for the Medicare EHR Incentive Program, so why haven't I received my incentive payment yet? Read the answer.
Make sure to visit the Medicare and Medicaid EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
The last day to begin a 2014 reporting period for first-year Medicare eligible professionals is October 3rd.
Here are a few key points eligible professionals who have not yet started participation in the Medicare EHR Incentive Program should know.
- October 3rd is the last day to start the 90-day reporting period in 2014 for the Medicare EHR Incentive Program.
- If you start participation by October 3, you will have the opportunity to receive an incentive for 2014, and if you continue to achieve meaningful use, can earn incentive payments for 2015 and 2016 participation.
- If you wait and start participation in 2015, you will not be eligible to receive incentive payments, but can avoid payment adjustments.
- You will not avoid the payment adjustment in 2015, as you will not be able to attest to 90 days of data by October 1, 2014.
- If you applied for a 2015 hardship exception by July 1, 2014, you may avoid the payment adjustment.
- If you attest to 2014 data by February 28, 2015, you will avoid the 2016 payment adjustment.
Medicare eligible professionals must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.
For More Information
To learn more about other eHealth events and National Health IT Week, visit the CMS Events page on the eHealth website. For more information about the EHR Incentive Programs, visit the CMS EHR website.
It could be said that data is the fuel and HIT systems are the pipeline for managing Population Health. Building the data infrastructure for a population health program is a complex undertaking with considerable upfront investment. Provider organizations must build a strategy, manage their cost structures, and understand the accountable care functions and IT systems that are necessary to make ACOs, CINs, and other population health initiatives function properly.
This infographic by Logicalis examines the rapid change affecting the healthcare IT field--and provides some valuable statistics regarding:
- Mobile Communications
- Use of Analytics for Care Improvement
- Patient Access & Engagement
To view a full-size version of this infographic, please click here.
If you are an eligible professional participating in the EHR Incentive Programs, you will be required to meet Patient Electronic Access measures. Patients’ access to their EHRs can help them make more informed decisions about their health care and improve efficiencies in health care delivery.
In order to meet 2014 Stage 1 requirements, you must provide more than 50% of your unique patients with timely access to their health information within four business days of the information being available to you. If you are in Stage 2, you must also demonstrate that more than 5% of your unique patients view online, download, or transmit to a third party their health information.
New CMS Guidance for Calculating Patient Electronic Access Across Multiple Providers
If you are an eligible professional, new CMS guidance may help you meet the Patient Electronic Access objective.
Stage 2 Measure #2: Eligible Professionals in the Same Group Practice
Eligible professionals in group practices are able to share credit to meet the patient electronic access threshold if they each saw the patient during the same EHR reporting period and they are using the same certified EHR technology. The patient can only be counted in the numerator by all of these eligible professionals if the patient views, downloads, or transmits their health information online.
Stage 2 Measure #2: Providers with the Same Patient
If multiple eligible providers who see the same patient and contribute information to an online personal health record (PHR) during the same EHR reporting period, all of the eligible providers can count the patient to meet requirement if the patient accesses any of the information in the PHR. In other words, a patient does not need to access the specific information an eligible provider contributed, in order for them to count the patient to meet their threshold.
Stage 1 and Stage 2 Measure #1: Providers with Patients who Opt-Out
A patient can choose not to access their health information, or “opt-out.” Patients cannot be removed from the denominator for opting out of receiving access. If a patient opts out, a provider may count them in the numerator if they have been given all the information necessary to opt back in without requiring any follow up action from the provider, including, but not limited to, a user ID and password, information on the patient website, and how to create an account.
On Friday, August 29, CMS released a final rule that allows providers participating in the EHR Incentive Programs to use the 2011 Edition of certified electronic health record technology (CEHRT) for calendar and fiscal year 2014.
The rule grants flexibility to providers who are unable to fully implement 2014 Edition CEHRT for an EHR reporting period in 2014 due to delays in 2014 CEHRT availability. Providers may now use EHRs that have been certified under the 2011 Edition, a combination of the 2011 and 2014 Editions, or the 2014 Edition for 2014 participation.
Under the modified attestation schedule, providers that were not able to fully implement 2014 Edition certified EHR technology in time to successfully attest to meaningful use due to vendor delays will be able to use 2011 Edition CEHRT or a combination of 2011 and 2014 Edition to attest to either stage 1 or stage 2. Providers will also be able to attest to meaningful use under the 2013 reporting year definition and use 2013's clinical quality measures.
The College of Healthcare Information Management Executives has supported giving providers more options for attesting in what has been a challenging year for CIOs. However, the organization was disappointed the rule will still require a full year of attestation in 2015.
"Roughly 50 percent of eligible hospitals and critical access hospitals were scheduled to meet stage 2 requirements this year and nearly 85 percent of EHs and CAHs will be required to meet stage 2 requirements in 2015,” said CHIME CEO Russ Branzell in a statement. “Most hospitals that take advantage of new pathways made possible through this final rule will not be in a position to meet stage 2 requirements beginning Oct. 1, 2014. This means that penalties avoided in 2014 will come in 2015, and millions of dollars will be lost due to misguided government timelines.”
Beginning in 2015, all eligible providers will be required to report using 2014 Edition CEHRT.
2014 Participation Options
Under the rule, providers are able to use 2011 Edition CEHRT, and have the option to attest to the 2013 Stage 1 meaningful use objectives and the 2013 definition CQMs.
Providers scheduled to meet Stage 1 or Stage 2:
Combination of 2011 & 2014 CEHRT
Providers scheduled to meet Stage 1:
Providers scheduled to meet Stage 2:
- 2013 Stage 1 objectives and 2013 CQMs; or
- 2014 Stage 1 objectives and 2014 CQMs; or
- 2014 Stage 2 objectives and 2014 CQMs
Providers scheduled to meet Stage 1:
- 2014 Stage 1 objectives and 2014 CQMs
Providers scheduled to meet Stage 2:
- 2014 Stage 1 objectives and 2014 CQMs; or
- 2014 Stage 2 objectives and 2014 CQMs
CEHRT Flexibility Resources
To help the public understand the final rule’s changes to 2014 participation, CMS has developed the following resources:
- CEHRT Interactive Decision Tool – providers answer a few questions about their current stage of meaningful use and Edition of EHR certification, and the tool displays the corresponding 2014 options.
- 2014 CEHRT Flexibility Chart – chart provides a visual overview of CEHRT participation options for 2014.
- 2014 CEHRT Rule Quick Guide – guide provides corresponding resources based on the option a provider chooses to participate in the EHR Incentive Programs in 2014.
Extending Stage 2
The rule also finalizes CMS and ONC’s recommended timeline to extend Stage 2 through 2016. The earliest a provider can participate in Stage 3 of meaningful use is now 2017.
For More Information