Collecting Data
CMS’s quality improvement agenda and movement for a pay-for-
performance (P4P) healthcare system is spearheading the need for
a clinical data warehouse for physicians. One West Tennessee
healthcare provider group is ahead of the game by serving as a test-
site for data submission.
With technology spearheading the Centers for Medicare & Medicaid Services’ (CMS)
quality improvement agenda and pay-for-performance (P4P) on the horizon, it was just a
matter of time before CMS implemented a clinical data warehouse to house and analyze
data for quality management of health care provided to Medicare beneficiaries.
Within the next two years, physician offices will be able to develop more defined care
plans for their patients using reports generated from patient data submitted to the Quality
Improvement Organization (QIO) clinical warehouse.
The QIO clinical warehouse is a national repository for healthcare data submitted by
nursing homes, hospitals and physician offices. In the clinical warehouse, data about a
large patient population is analyzed to perform clinical quality management and medical
research. Data warehousing has traditionally been used in a business context, in order to
answer questions about sales and events in a business.
Nursing homes and hospitals currently submit data to the QIO clinical warehouse
using a data abstraction tool. A data abstraction tool collects data by asking process-of-
care questions relevant to a clinical topic. All data must be submitted to the clinical
warehouse via QualityNet Exchange (QNet Exchange). Established by CMS, QNet
Exchange (www.qnetexchange.org) is the only CMS-approved site for secure
communication and data exchange.
In 2003, hospitals began reporting data on CMS quality measures to the clinical
warehouse using the CMS Abstraction and Reporting Tool (CART). In January, nursing
homes began submitting data to the clinical warehouse using the Nursing Home
Improvement Feedback Tool (NHIFT).
Clinical Warehouse and DOQ-IT
There is a national movement towards electronic health records (EHRs) in all health
care settings according to the Medicare Modernization Act of 2003 (MMA) and
physician offices are at the forefront. Submitting data to the clinical warehouse is
voluntary. Currently, data can only be submitted through an EHR. The Doctor's Office
Quality-Information Technology (DOQ-IT) program was launched by CMS to improve
quality of care, patient safety and efficiency for services provided to Medicare
beneficiaries by promoting the adoption of EHRs in physician offices.
Submitting data to the clinical warehouse would be beneficial to physicians,
according to Jennifer McAnally, QSource EHR implementation advisor for the DOQ-IT
project.
“CMS will provide real-time data to physicians to help them review certain patient
populations to determine if the patients are improving, staying the same or getting
worse,” said McAnally. “Physicians will be able to tailor treatment and improve the
health of the patients they see. Providers are going to be able to review data on a very
granular level through CMS data and EHR data.”
Ahead of the Game
The Health Loop, a healthcare provider in Memphis, is ahead of the game when it
comes to CMS's plans. It has not only implemented an EHR in all 10 clinics, but is also a
test site for clinical data warehousing software being developed by NextGen, its EHR
vendor.
The Health Loop is a network of 10 clinics formed after a local government mandate
combined the six primary clinics run by the Shelby County Health Department and four
clinics run by The Regional Medical Center (The Med) into one network. The Med and
the Shelby County Health Department fund The Health Loop.
Bob Stolarick, DDS, administrator with the Memphis and Shelby County Health
Department, had a “STEEP” vision of how health care should be and knew an EHR was
necessary to make his vision a reality.
In 2002, Stolarick submitted his vision to CMS in the form of a grant proposal. His
proactive approach paid off. Shortly after, The Health Loop was awarded a $1.9 million
grant.
After a yearlong selection process, The Health Loop chose NextGen out of 105 EHR
vendors. After eliminating EHRs that were out of their price range and did not meet their
specifications, Stolarick said the remaining vendors were scored on their request for
proposals, scripted demos, site checks and a run-through using the EHR. NextGen scored
the highest.
In March 2004, The Health Loop converted its old practice management system
(PMS) to NextGen, so that the EHR and PMS would integrate. In July 2004, The Health
Loop began phasing in different components of the EHR at two clinics. Some
components of phase one included patient history, allergies, prescribing, and initial visit
documentation.
Implementing the EHR at the first two “pioneer” clinics was a challenge, said Diane
Pace, PhD, The Health Loop EMR coordinator. “We were training staff how to use it,
developing the software to meet our needs and implementing it, all at the same time.”
During the final phase in October 2005, other EHR components such as, patient
planning, office referral, direct-lab interface, coding and charge posting, were
implemented at the two clinics.
The EHR was implemented at phase one in the remaining eight clinics during
February and July 2005. The Med Quick Care clinic began phasing in the EHR in
January.
With an EHR, Pace said staff members are able to identify pending labs that have not
been signed off and issue computer-generated prescriptions.
The EHR has improved communication between staff members and allowed them to
make more qualified and accurate decisions, Pace added.
“You have more access to records across the entire organization,” Pace said.
The Health Loop is also a test site for the development of NextGen’s clinical data
warehousing software. While attending a NextGen user-group meeting in November, the
software vendor asked practices to voluntarily submit their patient data to be used to test
NextGen’s data extraction tool. NextGen was looking for sites to test their extraction tool
and it looked like a great opportunity,” Pace said. “We want to be on the front end of
ensuring the validity of an instrument we’re going to be using.”
The Health Loop began to submit patient data in January. NextGen will perform a
one-time extraction to ensure the software is working correctly. Once the tool is ready for
use, NextGen will expand its research group by including more practices, and routine
extractions will be performed on data related to chronic illnesses, Pace said.
Clinical Warehousing and Pay-for-Performance
Among other cost saving measures, the MMA of 2003 called for CMS’s method of
paying providers to be revamped.
CMS wants to be sure Medicare beneficiaries are getting care that is adequate and
cost-efficient. Traditionally, specific services and procedures provided to patients
determine provider payment.
P4P represents a break in conventional thinking about provider payment. Under P4P,
providers who manage their patients’ diseases to provide better outcomes would be paid
more. CMS will evaluate data that is stored and analyzed in the clinical warehouse to
determine the quality of care and the provider would be paid according to the patient’s
outcome.
“The ultimate goal is for providers to send data to CMS, so CMS can see if providers
are giving the right care at the right time, and they’re going to pay accordingly,”
McAnally said. “We have a system that rewards overuse and we need a system that
rewards improvement and quality of care, not abundance of care. CMS wants doctors to
be accountable for the quality of care they're providing.”
How QSource Can Help
Physician offices interested in DOQ-IT, should visit www.qsource.org or contact
Gayle McRae, Physician Office Program Manager, at 800.528.2655 ext. 2619 or via
email at gmcrae@tnqio.sdps.org.
The DOQ-IT team has tools available to assist your practice in selecting and
implementing an EHR and reporting the 40 DOQ-IT quality measures to the clinical
warehouse.