“Mastering eMeasures - Charting a Course To Align Quality And Payment”

1. “Mastering eMeasures - Charting a Course To Align Quality And Payment” a complimentary webinar from healthsystemCIO.com, sponsored by Encore Health Resources

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4. Objectives • To learn from those who – through trial and error – have found success • To leave today’s presentation with specific, actionable advice which can immediately be put into practice • To absorb the underlying principles which have made a “win” possible, so they may be applied in your facility

5. Agenda – Panelists Liz Johnson, VP, Applied Clinical Informatics, Tenet Healthcare Corporation Michael Nelson, VP, Information Services, Universal Health Services, Inc.

6. Agenda – Continued A Word from our Sponsor – Linda Lockwood, Associate Partner, Encore Health Resources Q&A With Panelists – Moderated by Anthony Guerra, founder/editor, healthsystemCIO.com

7. “Mastering eMeasures – Charting a Course To Align Quality And Payment”healthsystemCIO.com Liz Johnson, MS, FHIMSS, CPHIMS, RN-BC VP of Applied Clinical Informatics HHS Health Information Technology Standards Committee Member Modern Healthcare 2010 Top 25 Clinical Informaticist HIMSS 2010 Nursing Informatics Leadership Award & HIMSS50 in 50: Memorable Contributors in HIMSS’ 50 Year History

8. Agenda eMeasures History Approach Tracking Lesson Learned

9. Quality Is Center Stage in the Road to Reimbursement

10. National Quality Forum “Electronify” A Measure = EHR Source: NQF Webinar “Implementing Electronic Measures 101: The What, Why, and How”; July 28, 2011

11. Tenet’s Approach to “Electronify” a Measure eMeasure Requirements Measuring Quality with eMeasures Content • Capture the right data in the right format enabled by workflow to support Meaningful Use Stages 1-3 and other related initiatives • Support Tenet’s overall BI Objective, joining of Clinical and Operational data in a common repository EDW Processes Workflows Data Capture PBAR* Cerner* EDW* Decision-making • MU Dashboard

12. It Started with a Reference Library We created a reference library that contained the each measures definition, codes, data elements, derived data to support measure calculation 12

13. What Workflows, Content & Order Sets were used for each eMeasures? *end user training 13

14. Sample - Data Input Supporting eMeasures Admission History Nursing Vital Signs Education Problem List Discharge Admission Inpatient Stay Summary of Care Education Physician Medication Reconciliation Problem List Stroke Orders Evidence based orders support Stroke Quality requirements for Meaningful Use

15. We Track Design Decisions and Issues

16. Managing Risk

17. Risk Details by eMeasure

18. Integrated Clinical BI Strategy Overview Initial Focus • Power Insight • Cerner ODS

19. EDW Meaningful Use Dashboard

20. Lesson Learned • Make decisions now with the future in mind • Stage 2 and 3 expected requirements • Accountable Care Organizations • Pay for performance (quality based) • Overlap between CMS Core Measures and CMS EHR Clinical Quality Measure programs exists • These will not be 100% “harmonized” • Will require expansion of hospital quality programs • The data matters, a lot • Summary analysis of the CMS regulations is not enough - need to get to the data level (measure by measure) • Data must be discrete, at the lowest level • Can’t build for the future without the data in mind • Must be able to aggregate, calculate and report • Workflows will have to be redesigned with specific training

21. Lesson Learned • Communicate, communicate, communicate • Help users understand what is coming • Set expectations, things will change • It is a journey that has many side trips and distractions – never forget it is about improving patient care • Have a team dedicated to tracking, interpreting and attesting • It’s a balancing act that requires effective governance to manage other priorities (e.g. 5010, ICD-10) • Engage your clinicians, early, often and get their input 21

22. Michael Nelson, VP, Information Services, Universal Health Services, Inc. Building an eMeasure Foundation for the Future: UHS and the Meaningful Use Journey

23. Today’s Objectives • eMeasures: Setting the Foundation for the Future of Healthcare • The UHS MU Journey – Getting to the details • Clinical IT History • Current State • How we approached MU • Our timeline • Building for the future • Where is my data? Defining a source of truth • Lessons Learned

24. Creating an eMeasure Foundation for the Future This is not only about Meaningful Use… Meaningful Use eMeasures …it’s about creating an eMeasure foundation for the future New Care Models

25. UHS Information Technology - History • 2007 focus on stabilizing Clinical Software applications • 2008 upgraded existing applications to improve functionality • 2009 developed a strategy and conducted Selection Project • Cerner selected as primary vendor • Scope includes ED, Nursing, Rx, Lab, Rad, OR, Med Recs, etc. • 2010 conducted design, configuration and initial testing • 2011 converted initial site and 2 additional facilities • 2011 design and enhancements for MU compliance • 2011 Inpatient CPOE and MU requirements targeted for go-live 3

26. UHS Replaced Clinical Systems in “Red” with Cerner Software-Enabling a Foundation for eMeasures Revenue Cycle Patient Registration Scheduling Interface Engine Patient Accounting Patient Accounting Doc Imaging OR incl. Scheduling Materials Management Accounts Payable General Ledger Human Resources Payroll “Core” Clinicals Order Management Nursing Clinical Documentation MD Data Viewer Data Repository Mobile Results PDA • No installed product for: • Computerized Physician Order Entry • Bedside Medication Administration (barcoding) • Medical Device Integration Ancillary Systems Emergency Dept PACS Lab Pharmacy Radiology Medical Records Transcription Quality Management

27. UHS Milestone Timeline: Keeping our Eye on the Target Phase 1 Phase 2 Oct Feb Mar Sept Nov Dec Jan Sept. 18: Facility #4 Integrated Testing Oct. 1: Facility 5-9 Activation of Database Nov. 6: Facility #4 Integrated Testing Dec. 7: Facility #1 Inpatient CPOE Live Jan. 29: Facility #2 & 3 Inpatient CPOE Live Feb 12: Facility #4 Go-live Fusion Nov. 1-Dec. 15 MU CPOE Testing Additional Gap Items Dec – Feb: Reporting Production Usage Education March: Review compliance Optimize Prepare to attest Sept. 1-Nov. 1: MU Design Decisions MU Build CPOE MU UHS MU Assessment Final Findings

28. MU Setting a Platform for eMeasures • Meaningful Use provided the incentive for UHS to accelerate our Cerner implementations • UHS understood that this initiative must be grounded in improving clinical outcomes and patient care, while looking ahead to Stage 2 • We quickly realized that you have to be in “the details” to properly handle eMeasures

29. The MU Journey: Vendor Dashboards to eMeasure Reality • UHS had received vendor dashboards-we knew we had gaps • Significant work to get our hands around all the requirements • As usual there are the People, Process and Technology components to meet the data capture and reporting for eMeasures • Strong preference to get this right for MU asap and deploy an MU compliant new Clinical System as opposed to going back to multiple facilities for subsequent MU upgrades • Requires a lot of work to address Stage 1 and planning for what is likely in Stage 2

30. Getting to the Data Level for VTE 1: Data Map Sample(700+ Line Items Like This for MU eMeasures)

31. How We Did It: The UHS MU Approach to Date Validate data elements against federal data eMeasure requirements Populate the tool with design decisions, issues, risks & workflows Conduct a measure by measure review of data, workflow and content Conduct risk analysis and manage risks and issues *Make Meaningful Use modifications Coordinate with a multi-disciplinary team to reach consensus Produce work plan with key tasks by functional area *Current work

32. Where is UHS Now? • We have completed our comprehensive Meaningful Use Assessment-and have started our “Modification” phase, building to close gaps in system design, content, workflow and process • We must execute this modification phase quickly while maintaining go-live schedule • We have developed a comprehensive program management infrastructure-how we will manage attestation, communication and education with our hospitals • Establishing focused project management, governance and decision making • People, Process and Tools • Incorporating lessons learned from initial go lives with clinical documentation and orders, identifying overlaps and efficiently making key organizational decisions (i.e., electronic medication reconciliation, CPOE adoption and roll out)

33. Where is My Data: Defining a “Source of Truth” • Like most hospitals today we collect core measures by manual chart review, and enter them into our Core Measure system • For eMeasure data capture we recognized the data must be in a new format, and eventually reported electronically • However there are some overlaps and it is important to clearly define “what” data are being entered “where” and by “whom” • For MU we needed to define a “source of truth” • For UHS that is Cerner • But it requires design, configuration, processes and proper deployment to work for MU

34. Lessons Learned • Design and build with the future in mind: Must design for Stage 2, not just Stage 1 • Build all your data elements to support eMeasure capture • Build and focus on implementing all Menu Set items • Set your targets higher than national standards knowing they will increase • Design your orders sets and content to capture all Core Measures for Quality • Focus on sharing and exchanging data • Messaging: Focus on improving quality of care and patient safety, not meeting the measures for payment • Engage your clinicians: This is about using the system in a “meaningful way” design the system to support clinician workflow, bring your physicians to the table to participate when ever possible

35. Lessons Learned • Truly understand the scope: the MU effort is tremendous • You must get to the “details” of the data to capture eMeasures inclusive of processes, content and workflow • You must track status and progress down to the detailed data element level • Your team is critical: You must have enough of the right people available to administer the program and make the decisions required to complete the build.

36. Lessons Learned • MU cannot be accomplished in a silo: This is NOT an IT effort alone, Quality, Compliance, Nursing, and Physicians must all be at the table making decisions together. • Integrate, Integrate, Integrate: Your implementation team and MU team must be seamless, work plans need to be integrated, teams need to make design decisions together, and meet on a weekly basis. Everyone owns this process and success

37. Linda Lockwood,Associate Partner,Encore Health Resources eMeasures

38. Road to Reimbursement Reform

39. The Evolving Model of Care • Integrate data to display results and provide capabilities (referrals, e-Rx) for individual pts • Aggregate, calculatedata for analysis across populationsfor cost, quality, risk and chronic disease • Securely move and exchange this data with key stakeholders • Capture EHR and demographic data in a secure discrete manner 39

40. The CoreQUEST™ Solution • Encore’s CoreQUEST™ solution optimizes and accelerates • the use of eMeasures The CoreQUEST™ Solution • CoreQUEST™ • Our Method • CoreGPS™ • Our Tool • CoreTEAM • Our People Encore Healthcare Reform Wiki and Knowledge Base

41. The CoreGPS™ Data Tool • 24Eligible Hospital (EH) measure definitions as well as the 15 quality eMeasures deconstructed (39 total): • 100+individual data elements • 700+unique data element mappings • 70+value sets consisting of over 3,500 individual codes • 25 Eligible Professional (EP) measure definitions as well as 44 quality eMeasures deconstructed (69 total) • 200+individual data elements • 2200+unique data element mappings • 550+value sets consisting of over 7,000 individual codes Based on OVER 1,700pages of government rules & industry specifications

42. Q&A Click the “Ask a Question” button located on the bottom of your screen, type in your question and then click submit. Liz Johnson, VP, Applied Clinical Informatics, Tenet Healthcare Corporation Michael Nelson, VP, Information Services, Universal Health Services, Inc. Anthony Guerra, editor, healthsystemCIO.com

43. Closing • At this point, you will see a window open to our PowerPoint presentation, which you can then download. If not, go to healthsystemcio.com/documents/EncoreWebinar.pptx • Within 24 hours, an archive of this event will be available for 3 months. It may be accessed by using the same link you registered with. • For more information on Encore Health Resources, go to encorehealthresources.com or view the browser window which has opened on your computer.

44. Thank You! We hope you will join us for more healthsystemCIO.com Webinars in the future Questions/Comments – Anthony Guerra aguerra@healthsystemCIO.com 201-638-2727