1. Meaningful Use Reporting: Build or Buy?
What is the Best Approach?
By
Steve Nitenson - RN, BSN, MS, MBA, Ph.D.
Sr. Healthcare Solutions Architect, Perficient
Oct 28th, 2011

2. Agenda Topics
 Build vs. Buy – Won’t my EHR vendor handle this for me?
 What does it take to develop a single clinical quality
measure and reporting requirements?
 Review the current state of the market with respect to
clinical quality measures
 Understand the lifecycle of a clinical quality measure and
measure processing challenges
 What a pre-built clinical measure healthcare BI
framework should have with a focus on “meaningful
use” reporting
 Q&A
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3. What are the Options?
Options Pros Cons
Do Nothing Low cost Inability to meet reporting
Low disruption requirements
Lack of information to make
decisions
Internal Development Control of your data Long time to bring to use
Control of your timeline Costs to fund effort is high
Highly customized to your Risk of minimal innovation
organization You bear the risk of failure
Control your success
Rely on EMR vendor Good for data acquisition Creation of reporting and
solution Electronic submission dashboards using vendor BI
tools by your staff
Hidden costs of development
Buy a certified Meaningful ONC certified solution Data quality challenges
Use solution Yearly updates on measure Variability in maturity of EMR
calculations/new measures implementations
Actionable information from
dashboards/trends
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4. EHR Vendors: Meaningful Use Reporting Requirements
170.304 (j) Calculate and submit clinical quality
reports – Eligible Professionals
• 3 core and 3 alternate core quality measures
• 3 measures out of additional 38 quality measures
• Report submission using PQRI XML 2009 format
170.306 (i) Calculate and submit clinical quality
reports – Eligible Hospitals
• 15 clinical quality measures
• Report submission using PQRI XML 2009 format
170.302 (n) Automate measure calculation
• 16 EHR usage measures for Eligible Professionals
• 14 EHR usage measures for Eligible Hospitals
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5. Clinical Quality Measure Challenges
“Client measure applicability
may be different from the
certified set” “We do not have in-house
clinical expertise to validate
“Our hardcoded approach is and manage measure
not a scalable solution – we definitions…”
have to revisit our strategy
very soon” !
“Our customers are asking for
“Ongoing effort and cost of custom measures in addition
maintenance given the volatility to support on other quality
in measures is one of our major initiatives like PQRS”
concerns”
Usability, flexibility, scalability as well as maintenance costs are
some of the key concerns…
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6. Is your EHR Vendor’s Efforts Enough
Minimal Certification Strategy Challenges ?
While many EHRs have minimally completed the “meaningful use” certification for
clinical quality measures, there are significant challenges ahead…
Challenges for EHR clients – Hospitals Challenges for EHR vendors
& Physician Practices themselves
• Clinical quality measures relevant for • To add new clinical quality measures,
many clients will be different from the vendors will need significant effort and
small set of certified measures cost for:
• Clients may not be able to comply with o CQM specs, software development
the “meaningful use” requirements and QA/testing
despite using a certified EHR o ONC certification of additional
• Need for custom measure definitions measures
for customer / regulatory needs • Ongoing effort and cost in maintaining
an increasing list of clinical quality
measures
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7. Hospital Electronic Health Record
Clinical Quality Reporting Requirements
Comply with
1 Meaningful use §170.306 (i) Calculate and submit clinical quality measures (EH)
criteria
NQF 0371 VTE prophylaxis within 24 hours of arrival
NQF 0372 ICU VTE prophylaxis
Report NQF 0373 Anticoagulation overlap therapy
2 15 clinical NQF 0374 Platelet monitoring on unfractionated heparin
quality NQF 0375 VTE discharge instructions
measures NQF 0376 Incidence of potentially preventable VTE
NQF 0435 Ischemic stroke—Discharge on anti-thrombotics
NQF 0436 Ischemic stroke—Anticoagulation for A-fib/flutter
NQF 0437 Ischemic stroke—Thrombolytic therapy for patients
arriving within 2 hours of symptom onset
NQF 0438 Ischemic or hemorrhagic stroke—Antithrombotic
therapy by day 2
… ….
… ….
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8. Ambulatory EHR
Clinical Quality Reporting Requirements
Comply with
§170.304 (j) Calculate and submit clinical quality measures (EP)
1 NIST test
procedures
NQF 0013 Hypertension: Blood Pressure Measurement
NQF 0024 Weight Assessment and Counseling
Report NQF 0028 Tobacco Use Assessment and Cessation
2 6 core NQF 0038 Childhood Immunization Status
measures NQF 0041 Preventive Care and Screening: Influenza Immunization
…
NQF 0421 Adult Weight Screening & Follow-Up
NQF 0001 Asthma Assessment
Report ANY NQF 0002 Appropriate Testing for Children with Pharyngitis
3 3 out of 38 NQF 0004 Initiation and Engagement of Alcohol and Other Drug
additional
Dependence Treatment: (a) Initiation, (b) Engagement
measures
NQF 0012 Prenatal Care: Screening for HIV
… ….
…. ….
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9. NQF 0061: Measure Specification
Measure Description
Denominator Selection
Numerator Processing
Relevant concept codes
NQF 0061: EP Measure Specifications
Source: NQF_HQMF_HumanReadable_0061.pdf
NQF_Retooled_Measure_0061.xlsx 9
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10. Clinical Quality Measure Implementation Life Cycle
Key Steps in Clinical Quality
Measure Implementation
Clinical Concepts Clinical Data Denominator Numerator …. Numerator Measure
at Point of Care Extraction Selection Group 1 Group n Status
Extract / standardize data Develop condition processing
using clinical terminologies algorithm/ rules engine to
distribute patients in various
numerator buckets
Use of appropriate clinical Apply rules – including Measure status determination
concepts at point of care - exclusion criteria – for based QDC matrix
observations, clinical identifying patients in the
documentation, results, exclusions denominator
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11. NQF 0061: Denominator Selection
Denominator
Denominator Definition
(#Qualified Patients)
Patient Demographic Filters
If blood pressure • Age range: 18 to 75
observation
C1 False Group 1 – Numerator (as on Date of Encounter)
exists Assign processing
(2000F) • Gender: Both
True
with 8P
Condition Group
Are part of a visit in Entire reporting
If diastolic less
True
period with:
than 80 C2 Assign (3078F) • Any of following ICD9 Codes:
250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12,
False If systolic less 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31,
than 130 True Group 2 – Numerator 250.40, 250.41, 250.42, 250.43, 250.50,
250.32, 250.33,
C4 Assign (3074F)
250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63,
processing 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82,
250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01,
False 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41,
True 648.00, 648.01, 648.02, 648.03, 648.04
If diastolic C3 Assign (3079F)
between 80-89 AND
If systolic in • Any of following CPT/HCPCS codes:
False 97802, 97803, 97804, 99201, 99202, 99203, 99204,
Assign (3080F) 130-139 True Group 3 – Numerator 99213, 99214, 99215, 99304, 99305,
99205, 99212,
C5 Assign (3075F) processing 99306, 99307, 99308, 99309, 99310, 99324, 99325,
99326, 99327, 99328, 99334, 99335, 99336, 99337,
False 99341, 99342, 99343, 99344, 99345, 99347, 99348,
99349, 99350, G0270, G0271
Assign (3077F) 11
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12. NQF 0061: Measure Status Analysis
BI/Dashboard
visualization
Measure Status CPT-II Codes Patient Count
(Numerator)
Meets Performance 3074F & 3078F, 3075F & 3078F 688
Medical Performance Not applicable for this measure -
Exclusion
Patient Performance Not applicable for this measure -
Exclusion
System Performance Not applicable for this measure -
Exclusion
Other Performance Not applicable for this measure -
Exclusion
Performance Not Met 3077F & 3078F, 3077F & 3079F, 67
3077F & 3080F, 3074F & 3079F,
3074F & 3080F, 3075F & 3079F,
3075F & 3080F, 2000F-8P
Denominator Count 755
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13. Clinical Quality Measures: Implementation Challenges
Clinical Data Capture & transformation Numerator Processing
• Building clinical concepts into clinical • Multiple condition flows & variables for
applications e.g. EHR single measure
• Ability to use the concepts for mapping • Measure-specific variances in condition
relevant clinical data related to patients logic & measure status grouping
and encounters • Extracting usable information from
• Data cleansing & terminology mapping for clinical documentation and mapping
to ensure data consistency clinical concepts
Clinical Concepts Clinical Data Denominator Numerator …. Numerator Measure
at Point of Care Extraction Selection Group 1 Group n Status
Denominator Selection Measure Status Analysis
• Mapping clinical concepts and • Maintain status mapping for
extracting qualified patient population multiple measures and
• Variances in coding standards based on condition groups
source systems • Provide analysis capabilities
• Measure-specific variances in criteria around measure status for
for diagnosis, procedures, etc. causal analysis, etc.
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14. Can you Buy a complete, certified Solution – It Depends…
The BI you may select should offer a simple and fundamentally new
approach to Healthcare Business Intelligence (BI)
–More than 600 pre-built measures and Key Performance
Indicators
–Accelerated compliance to Meaningful Use and ACO quality
reporting requirements.
The BI should use state-of-the-art BI and analytics tools to enhance
clinical decision support, performance benchmarking, and persona-
based dashboards from data across a wide range of clinical and
financial systems.
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15. Powerful Regulatory Compliance Tool
ONC-ATCB 2011/2012 certified for all 44 EP and all 15 EH
Meaningful Use quality measures
Guaranteed support for 100% Meaningful Use Stage 2
and Stage 3 compliance
100% PQRI measures coverage
200+ inbuilt measures / KPIs for financial and operational
reporting
100% coverage of all 65 quality performance measures
required by ACOs for the Shared Savings Program
100% coverage of 88 JCAHO measures
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16. Sustainable Model for Healthcare BI
Powerful End User Capabilities: Real-time clinical alerts to enhance point-of-care
decision support. Health BI supports both clinical and financial data, which provides
a 360 degree view of population health management.
Quality Management: Health BI provides a comprehensive measure library based
on specifications recommended by leading quality and regulatory organizations
such as HEDIS, ADA, AHRQ and NCQA. With an extensive range of customizable
persona-based dashboards, Health BI provides drill down capabilities for advanced
analytics, decision support, performance benchmarking, and complete physician
practice clinical quality reporting.
Utilization Management: Deployed by a leading MCO for effective utilization
management through integrated clinical and financial reporting.
Extensible: Offering a Proprietary Clinical Measure Processing Framework to
configure and deploy clinical rules for implementation of changing evidence-based
guidelines and quality measures, Health BI offers multi-server architecture and
cloud-based deployment options that provide easy and rapid scalability.
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17. Solution Highlights
• Comprehensive BI framework for healthcare
providers – ONC-ATCB 2011/2012 Certified
for Meaningful Use
• Disease registries for clinical reporting on
both outcome and process measures
• Business reporting and financial management
dashboards for reporting and improving key
performance measures
• Robust integration framework - integration
with leading financial & clinical applications
• Robust, flexible and cost-effective technology
built on BI platform
• Rapid deployment time – providers can get
started within a couple of months!!
• Highly cost-effective solution – 40%+ cost
saving over other BI solutions
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18. Key Capabilities
Market Coverage
Physician Practices, Hospitals, IDNs,
MCOs, ACOs & HIEs
End User Capabilities
Actionable intelligence,
performance benchmarking,
custom dashboards, clinical
decision support and
integrated analytics
Architecture and
Deployment
Modular, Scalable,
Flexible & Interoperable
Clinical Measure
Processing Framework
Regulatory Reporting and Rule Based, Highly Flexible
Compliance and Easily Configurable
Meaningful Use, HEDIS,
PQRS, ACO, JCAHO
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19. Market Coverage
Health BI Market Coverage
Market Coverage
Physician Practices, Hospitals,  Strong coverage of provider
IDNs, MCOs, ACOs & HIEs
markets – across physician
practices, hospitals, and IDNs
 Integrated reporting for multiple
hospitals facilities and associated
physician practices – key
success factor for MCOs and
ACOs
 Completely integrated approach
to clinical quality reporting and
financial & operational reporting
 Extensive coverage of HIE
reporting requirements
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20. Architecture and Deployment
Health BI – Architecture and
Architecture and
Deployment
Deployment
Modular, Scalable,
Flexible & Interoperable  Modular and scalable architecture
 Standards-based approach to
healthcare business intelligence
 Easy 4-step integration with a wide
range of partner applications in less
than 45 days
 Incorporates Service Oriented
Architecture and cloud-based
deployment models
 Easily customizable for specific
partner and client requirements
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21. Architectural Highlights
Dimension Advantage
Easy to Flexible architecture designed to integrate effectively and
integrate rapidly with a wide range of partner applications
Comprehensive Supports both clinical & financial aspects of patient care
for developing 360 degree view of Population Health
Management Processes. Health BI’s
modular,
Extensible Proprietary rules-engine to configure and deploy clinical scalable and
rules to support ever growing evidence-based guidelines standards-based
and quality measures approach to
Cloud-enabled Supports deployment on both private and public cloud healthcare BI/
infrastructure, with capability to provide CQM Framework Analytics has
as a service been very well
received in the
Service- Highly flexible web-services based architecture for ease of marketplace
oriented integration and distributing information through various
channels (devices, browser, thick-client, Apps) Health BI can be
Interoperable Supports multiple standards (e.g. XML, flat-files, HL7, CCR integrated with a
/ CCD) and multiple clinical terminologies healthcare
applications in
less than 45 days
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22. Health BI is powered by BI-Clinical
Step 2: Scorecard Partner Analytics Ambulatory
Partner integration User Interface
Application
Analytics Hospitals & IDNs
UI Layer
UI Link Analytics, Scorecard,
Trends, MCOs & HMOs
Partner Benchmarking, Ad-
Point of
Care
Step 3: Reporting hoc reporting & BI-Clinical Data
repot schedules Submission
Module Configuration
Partner
BI-Clinical Datamarts & On-
Applicatio
App UI Step 4: Point-of- demand
n Layer
Integra- Partner Cubes
Application tion Care integration App
processing
processing Interface BI-Clinical Measure Clinical
logic BI- (optional) Processing Framework Alerts
Clinical
Adaptor
Partner App BI-Clinical
Staging Audit
Step 1: BI-Clinical Database Database
Applicatio
Database
Partner Views creation
Application
n
DB
database(s) Partner App Adapter
Views
Partner App BI-Clinical Framework Modules
Health BI can be integrated with HIT Vendors in just 30-45
days!
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23. Clinical Measure Processing Framework
Health BI – CMP Framework
 Highly flexible and configurable rules
engine for measure definition and
modification
 User friendly interfaces that allow
clinical experts to define custom
measures
 Powerful data abstraction module
to support data capture by chart
reviewers
Clinical Measure
Processing Framework  Deep drill down capabilities to get
Rule Based, Highly Flexible
and Easily Configurable extensive visibility into patient
information
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24. Clinical Measure Definition Capability
Example: STK-1
Example: PQRI #1
Health BI provides a user-friendly interface for clinical experts to define custom measures
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25. Regulatory Reporting and Compliance
Health BI – Reporting and
Compliance
 Only 3rd party reporting solution that
is ONC-ATCB 2011/2012 certified for
both EH and EP clinical quality
measures
 Comprehensive coverage of
Meaningful Use, HEDIS, PQRS,
ACO and JCAHO reporting
requirements
 600+ in-built measures and key
performance indicators for
comprehensive clinical, financial,
Regulatory Reporting and Compliance
operational and regulatory reporting
Meaningful Use, HEDIS, PQRS, ACO,
JCAHO  Pre-built disease registries for
population care and chronic condition
management
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26. Regulatory Reporting
BI-Clinical 10.3 is the ONLY comprehensive
ONC-ATCB 2011/2012 Certified BI solution:
• Certified for ALL 15 Meaningful Use Stage 1
criteria for Eligible Hospitals (EH)
• Certified for ALL 44 clinical quality measures in
Meaningful Use Meaningful Use
Stage 1 for Eligible Providers (EP)
EP Measures EH Measures
BI-Clinical provides guaranteed coverage for
current and future regulatory requirements,
including
• Meaningful Use Stage 2 criteria
• 200+ PQRS measures
• ACO Performance guidelines
ACO
Performance PQRS 2011
Measures Measures
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27. End-User Capabilities
Health BI – End-User Capabilities
Leverages cutting-edge technologies
to provide advanced analytics and
reporting capabilities
Extensive drill-down and slice-and-dice
capabilities to generate actionable
intelligence
Integrated financial and operational
analytics and reporting
End User
Capabilities Ability to provide Point-of-Care
Actionable intelligence,
performance Decision Support and patient querying
benchmarking, custom capabilities to partner applications
dashboards, clinical
decision support and
integrated analytics
Certified for Meaningful Use report
submission in prescribed format
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28. End User Capabilities (1/2)
KPI Scorecards & Trends Benchmarking & Drill-down Analytics
Meaningful Use Submission Reports Clinical Decision Support at Point of Care
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29. End User Capabilities (2/2)
Physician / Facility Scorecards Persona-based Dashboards
Integrated Financial Analytics Integrated Operational Analytics
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30. Who We Are What We Do Our Work Our Approach Our Team
Thank you
Steve Nitenson - RN, BSN, MS, MBA, Ph.D. Demo Contact:
Sr. Healthcare Solutions Architect Babita Patel - MBA
650-291-7792 mobile 713.554.4011 direct
Steve.Nitenson@perficient.com Babita.Patel@perficient.com
www.healthcare.perficient.com/landingpages/HealthBIIndex.html
Here is a link to all Healthcare white papers:
http://www.healthcare.perficient.com/RegulatoryCompliance.aspx