MUSE International Session # 1176 Wednesday 5/30/2012 at 2:30PM Glen R. DAbate Finding the Meaning in Meaningful Use Meaningful Use

Introduction Development of Data Repository (DR) for clinical analysis at MEDITECH (1994) Genesis of Acmeware (1998) DR Auditor & 5.4 SR3 makes DR a viable solution (2002) Diabetes, coronary arterial disease, and other quality reporting with Affinity Health (2006) ARRA Meaningful Use – DRs potential is finally being realized (2010)

Session Overview Review of MEDITECH EHR and module certified recommended data sources and workflow to achieve CMS Meaningful Use (MU) Quality Measures (QM) attestation Look at the MEDITECH supplied Data Repository (DR) based SQL scripts and how these can be modified and enhanced to meet attestation requirements Examine the technologies employed and the required skill-set of staff to produce these solutions Review MU quality measure data validation reports Demonstration of a sampling of custom MU analysis reports Emergency Department Turnaround By ED Provider Emergency Department Turnaround By Hour-of-Day VTE Prophylaxis Performance Rate Trend By Unit Core Measure Dashboard Report

MEDITECH Recommends DR for ARRA Meaningful Use Solution

Why Data Repository Data retention in DR MEDITECH supplied Structured Query Language (SQL) scripts Performance Ability to add indexes as needed SQLs native dataset processing Separation of transaction processing (i.e., MEDITECH applications) from report processing Direct access to other vendor certified quality data in via open standards connections (OLE, ODBC) Wide array of report presentation options

What are MEDITECH Best Practices? MEDITECH Best Practices documents are available for review and assessment from their web site at: ( An organization must determine what MEDITECH applications and workflow are in place that meets the Best Practices and where and how they deviate from these practices This includes identifying where and how MU quality data is being captured when other than the specified Best Practices location (e.g., different CDS Queries, another MT module, a certified third party product) The closer your workflow and practices parallel the MEDITECH Best Practices, the less customization is required to the MEDITECH DR MU QM scripts

MEDITECH ARRA Web Site MEDITECH ARRA Implementation Plan Best Practices Documentation MU Checklist List of NPR/DR DPMs/Table Impacted SQL Script Templates Much more…

MEDITECH DR SQL Scripts SQL Scripts to use as a basis for compiling and reporting MU quality performance measures Basic instruction on how to implement and customize scripts Tables may need to add to this list based on your workflow RxNorm code data is often not complete – verify with your formulary vendor data Stroke Scripts

CMS Guidelines on Modifying MEDITECH Workflow & Scripts For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, is an eligible professional or eligible hospital limited to demonstrating meaningful use in the exact way that EHR technology was tested and certified? For example, if a Complete EHR has been tested and certified using a specific workflow, is an eligible professional or eligible hospital required to use that specific workflow when it demonstrates meaningful use? Similarly, if the EHR technology was tested and certified with certain clinical decision support rules, are those the only clinical decision support rules an eligible health care provider is permitted to use when demonstrating meaningful use? they can successfully demonstrate meaningful use even if their exact method differs from the way in which the Complete EHR or EHR Module was tested and certified In most cases, an eligible professional or eligible hospital is not limited to demonstrating meaningful use to the exact way in which the Complete EHR or EHR Module was tested and certified. As long as an eligible professional or eligible hospital uses the certified Complete EHR or certified EHR Modules capabilities and, where applicable, the associated standard(s) and implementation specifications that correlate with the respective meaningful use objective and measure, they can successfully demonstrate meaningful use even if their exact method differs from the way in which the Complete EHR or EHR Module was tested and certified. CMS FAQ 10473

Examples of Workflow Modifications Use of a CDS Query Mnemonic that is based on a hospitals existing workflow (e.g., identifying patients on a Clinical Trial) Identification of data in a method that differs from MT Best Practices (e.g., check for VTE Diagnostic Testing by looking at Ordered Procedures rather than a CDS Query) Identification of Emergency Department (ED) Decision to Admit Date/Time directly from another certified other-vendor ED system (rather than MEDITECH EDM) Modification of scripts to save detailed data about the measure within a datamart for later analysis (note this data cannot be used for producing numerator, denominator, or exclusions values for CMS attestation!)

From MEDITECH Best Practices VTE1Q.1 is Best Practice Query Mnemonic for Capturing Patients on a Clinical Trial

Script Code Change to Address Clinical Trials Workflow Query Mnemonic Replaced Non Multiple Clinical Queries Table Selected Original Script Code Modified Script Code Script mtzcus_VTE_1

2 nd Example of Workflow Modifications Use of a CDS Query Mnemonic that is based on a hospitals existing workflow (e.g., patients on a Clinical Trial) Identification of data in a method that differs from MT Best Practices (e.g., check for VTE Diagnostic Testing by looking at Ordered Procedures rather than a CDS Query) Identification of Emergency Department (ED) Decision to Admit Date/Time directly from another certified other-vendor ED system (rather than MEDITECH EDM) Modification of scripts to save detailed data about the measure within a datamart for later analysis (note this data cannot be used for producing numerator, denominator, or exclusions values for CMS attestation!)

VTE Diagnostic Test Order Query Best Practice recommends setting up CDS with VTE test query

VTE Testing Identification A client who had configured their Order Entry system such that certain imaging procedures were only ordered for the specific purpose of ruling out VTE. Therefore, rather than add a new CDS Query and Response, the script exclusion logic was modified to look for the presence of these procedures. Original Script Code Modified Script Code No JOIN to OE Queries Use Ordered Procedure to ID VTE Testing VTE Diagnostic Test NOT Ordered

3 rd Examples of Workflow Modifications Use of a CDS Query Mnemonic that is based on a hospitals existing workflow (e.g., patients on a Clinical Trial) Identification of data in a method that differs from MT Best Practices (e.g., check for VTE Diagnostic Testing by looking at Ordered Procedures rather than a CDS Query) Identification of Emergency Department (ED) Decision to Admit Date/Time directly from another certified vendor ED system (rather than MEDITECH EDM) Modification of scripts to save detailed data about the measure within a datamart for later analysis (note this data cannot be used for producing numerator, denominator, or exclusions values for CMS attestation!)

SQL Linked Server Provided the Solution Create a Linked Server from your certified MEDITECH DR System directly to your certified ED vendor system DR Server Original Script Code Modified Script Code

Examples of Workflow Modifications Use of a CDS Query Mnemonic that is based on a hospitals existing workflow (e.g., patients on a Clinical Trial) Identification of data in a method that differs from MT Best Practices (e.g., check for VTE Diagnostic Testing by looking at Ordered Procedures rather than a CDS Query) Identification of Emergency Department (ED) Decision to Admit Date/Time directly from another certified other-vendor ED system (rather than MEDITECH EDM) Modification of scripts to save detailed data about the measure within a datamart for later analysis (note this data cannot be used for producing numerator, denominator, or exclusions values for CMS attestation!)

Modify Script Output to Capture Details Add INSERT Statement Original Script Code Modified Script Code

Technologies Required MEDITECH Data Repository (MAGIC, CS, M-AT) SQL Server 2005, 2008, 2008 R2 RDMS (on which DR resides) Microsoft Management Studio (MMS) (for generation, review, and modification of MEDITECH transact-SQL stored procedure scripts) SQL Server Reporting Services (SSRS) 2008 R2 (report authoring and presentation) Internet Information Server (IIS) web server with SSRS Report Manager installed or SharePoint Services with SSRS in SharePoint Integrated Mode Browser to view reports on portal within the intranet

Developer(s) Aptitude Requirements Solid understanding of the ARRA Meaningful Use Core Measures, Menu Set Measures, and Clinical Quality Measures Basic knowledge of the MEDITECH application modules involved in capturing MU measures High proficiency in understanding and identifying where MEDITECH application data is stored within the MEDITECH DR tables High proficiency in Microsoft Transact-SQL Proficiency in SQL Server Reporting Services report authoring.

DR Script Data in SSRS for Attestation Data derived directly from enhanced DR scripts can be presented in SSRS in a table for easy transcription to CMS web site for attestation Each number can provide a hyperlink to detailed patient data in a non-certified datamart that you create for the purpose of valuation

Validating Patient Exclusions VTE-2 (ICU Patient) Exclusions

About the Demonstrated Reports This represents a small sample of the possibilities of data analysis and presentation using ARRA MU data These sample reports have been implemented at Acmeware client sites Most data presented is live data, though not from site(s) where the report was originally developed Identifiable information has been removed or replaced

Analysis Question We would like to look at our average CQM ED performance measures (i.e., arrive to depart time & decision to depart time) by Emergency Provider for the current attestation period. We want to omit providers if they have less than 5 ED patients.

Analysis Question We are interested in knowing if there are certain times of the day where our ED measure performance numbers are better or worse?

Analysis Question We would like to view and analyze how each unit (including ICU units) in our hospital facility is complying with regard to VTE prophylaxis performance measures and we would like to trend this over the current full-year attestation period

Analysis Question We would like to view an instantaneous snapshot of the performance of our Core Measures in a format that will please our organizations executives?

Summary MEDITECH has developed comprehensive ARRA MU Best Practices that do not always match your current workflow practices You can and will need to modify the DR-based CQM, CM, and MSM SQL scripts to function properly with your environment and workflow Data used for attestation must come directly from the modified scripts however, there is no reason you cannot capture the details behind these measures at the same time With a detailed MU datamart and a little knowledge of SQL Server Reporting Services, you can create very cool custom, purpose specific, MU analysis reports You can do this!

Discussion, Questions & Answers

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