CHCANYS Data Warehouse

CHCANYS Data Warehouse: Center for Primary Care Informatics (CPCI)
NYS HIMSS Chapter Conference
April 23, 2014
Amy Grandov, Managing Director NYS‐HCCN, CHCANYS
Jeff Brandes, CEO, Azara Healthcare
Agenda
• CHCANYS’ CPCI Program Overview
• CPCI Key Features
• Beyond New York – Azara DRVS roadmap
CHCANYS CPCI Program Overview
About CHCANYS
• Community Health Care Association of New York State (CHCANYS) is the state’s Primary Care Association (PCA)
• Mission to ensure that all New Yorkers have access to high quality community‐based primary health care services • Serve all Federally Qualified Health Centers (FQHCs) across the state; 61 member organizations operating over 500 sites
• Supports FQHCs through advocacy, policy leadership, education, programs and initiatives across broad functional areas, including Health IT and Quality Improvement
4
About FQHCs in NYS ‐ 2013
• Federally designated and regulated primary care programs located in all 50 states and US territories
• Serving 1.6 million patients, 7 million + visits; comprehensive model of care; high performing
₋
₋
₋
5
₋
₋
23% uninsured; 52% covered by Medicaid or CHPlus
70% at or below 100% Federal Poverty Line
115,000 homeless or migrant/seasonal workers; 100,000 over 65 yrs
3/4ths are racial and ethnic minorities
1 in 4 best served in language other than English
Healthcare Landscape
• Federal and State health reform require expanded primary care capacity which addresses population health goals in fully integrated settings
• In New York State, FQHCs are expected to double capacity to serve nearly 3 million New Yorkers by 2015
• New York’s FQHCs have one of the highest adoption rates for EHRs in the country (97%) – but technology is not a guarantee that quality outcomes will improve
• New models of care delivery and payment (e.g., accountable care organizations/ACOs)
6
Center for Primary Care Informatics • CHCANYS has developed the New York State Center for Primary Care Informatics (CPCI) – Priority goal in CHCANYS Strategic Plan
– Supports improvements in quality, patient and population health outcomes
– Supports growth & success in a changing environment
7
CPCI: Three Components
1. A statewide reporting and analytics solution for NY’s FQHCs
– Collects and normalizes data from multiple sources to create an integrated database for enhanced analysis & reporting. – Provides actionable data and valuable reporting at individual health centers.
2. Program of technical assistance delivered by CHCANYS staff ‐ Supported through several high profile partnerships
‐ Federal, state and private funding
3. Planning toolkit with centralized access to geographically‐
relevant data
8
Phase 1
Scope
Phase 2
ƒ Practice management
ƒ Payer
ƒ Health records (EHR)
ƒ Federal (e.g., census, labor)
ƒ State (e.g., SPARCS)
Analysis and reporting for:
Analysis & reporting for:
ƒ Quality Improvement ƒ Pay‐for‐Performance (P4P)
ƒ Care Management Tools
ƒ Partnerships, New Care Models
ƒ Patient Centered Medical Home ƒ Planning for growth
(PCMH)
Benefits
ƒ Fund development
ƒ Health Homes
ƒ Advocacy
ƒ Meaningful Use
ƒ UDS (Uniform Data System)
9
ƒ Demonstration of VALUE delivered by the FQHC model ‐ the Triple Aim: higher quality, better outcomes, lower cost
CPCI Technology
ƒ Pre‐built set of 50+ “one click” reports
ƒ
ƒ
ƒ
ƒ
ƒ
Mandated & Regulatory (UDS, Meaningful Use, Quality Measures)
Grants (Cancer and Preventative Health Screening)
PCMH Support
Chronic Disease Management
User driven dashboards and charting
ƒ Wide range of data views ƒ
ƒ
ƒ
ƒ
Enterprise Level
Health Center
Individual Care Provider
Patient Level detail
ƒ SaaS Model (Software as a Service)
ƒ Browser based User Interface, ƒ No on‐premise infrastructure ƒ Regular updates keep reporting criteria current and evolve to support changing needs
10
Site Comparisons
Individual Site
Provider Benchmarks
Actionable Patient Detail
Benefits
Easy and Efficient
– Free up analyst time for analysis vs. data collection
Quality Improvement Tools & Reports
– Benchmark & collaborate with peers
– Identify best practices & areas of opportunity
11
Benefits
Tools to Improve Population Health
– Patient Registries
Care Coordination and Care Management
– Visit planning tools to make care team more efficient & support providers
12
Grant Funding and the CPCI
CDC Cancer Prevention Grant
CPCI is the foundation behind the Cancer Prevention Quality Improvement program
Performance reporting supports design & development of Improvement efforts
Evaluation and measurement in screening & follow‐up for 3 cancers: • Cervical
• Breast • Colorectal 13
HRSA HCCN Grant
CHCANYS’ new health center controlled network
• 33 FQHCs participating
• Financial support to offset CPCI costs
• CPCI performance reporting will identify areas of opportunity and best practices
NYS Cancer Screening Registry of the CPCI:
Project Overview
• A collaborative demonstration project of the NYS Department of Health/Community Health Care Association of New York State/IPRO
• NYS DOH one of only two health departments in the nation to receive this five‐year grant
• Working in collaboration with NYSDOH and IPRO to develop a cancer screening registry within CPCI
• Implementing a large‐scale, innovative demonstration project to contribute to building organized cancer screening efforts that impact population level cancer screening rates.
• Funding for connections to CPCI 14
NYS‐HCCN Grant Goals
Grant goals: 100% of
¾ Participating health centers’ sites have implemented a certified EHR
¾ Eligible providers (EPs) use a certified EHR
¾ EPs attest & receive EHR Incentive Program payments
¾ Participating health centers meet HP 2020 goals on two UDS clinical quality measures
¾ Participating health centers have achieved/ maintained/increased Patient Centered Medical Home (PCMH) recognition
15
CPCI Pilot & Roll Out
January – March‘14
March ‐ December ‘13
16. Betances (eCW) December ‘12 – February’13
October ‘12
11. Ezras Choilim HCNNY (all eCW) 4. Anthony Jordan Health Center
1. Community Healthcare Network (eCW)
2. Greater Hudson Valley Family Health Center (GE Centricity)
3. Institute for Family Health (EPIC)
16
April ‘12
Community Health
Center (Allscripts) 12. Morris Heights 5. Open Door Family Health Center (GE Centricity)
Medical Center
6. CHC of the North 13. Lutheran Family Health Country
Centers (eCW)
7. Schenectady 14. Access Family Health Community Services
Health Center 8. Hudson River (NextGen)
HealthCare 15. Regional 9. Whitney Young Jr. Primary Care CHC
Network (eCW)
10. Oak Orchard CHC
17. Settlement (GE Centricity) 18. CHC Richmond (eCW)
19. Brownsville (NextGen)
20. Damian Family Care Center (eCW)
21. William F. Ryan Health Center (eCW)
22. NOCHSI (Vitera)
23. Bedford‐
Stuyvesant (eCW)
24. Housingworks
(eCW)
25. Project Renewal (eCW)
26. HealthCare Choices (eCW)
27. Finger Lakes (eCW) 28. Acacia (NextGen)
Participation
is Statewide
NYC Detail
Admin Site
Service Sites
17
Architectural Overview
•
Data from disparate EHR and EPM systems refreshed daily
•
Extensive data quality analysis
•
Data unified in EHR‐agnostic Data Warehouse for apples to apples comparison
•
Simple, web‐based reporting interface from any major browser
•
User role differentiation and data blinding
•
Graphical and text based depictions of datasets
•
External data links geographic characteristics to patients & providers
18
18
Challenge: Data quality
Data not captured in structured fields in EHR
Data missing in EHR
19
Mapping incomplete or not updated
This measure doesn’t seem right…” Measure specifications vary between reports
Connectivity issues
Response: Data Quality Initiative
• CHCANYS launched a Data Quality Initiative to explain and improve clinical data quality for all CHCANYS health centers connected or preparing to connect to the CPCI
– “Data Validation 101” curriculum & webinar
– Data Quality Collaborative
• Data Validation process an unexpected benefit of connecting to CPCI
– Quality of Documentation = Quality of Clinical Care
20
CPCI Key Features
22
PLANNING
MEASURE
ANALYZER
VISIT
REGISTRY
REPORTS
DASHBOARDS
Types of Reporting
Data represents a fictitious environment of 4 health centers. No PHI is being revealed.
CPCI Home Screen
Data represents a fictitious environment of 4 health centers. No PHI is being revealed.
23
Compliance Reports – Quality Measures
Data represents a fictitious environment of 4 health centers. No PHI is being revealed.
24
Compliance Reports ‐ Meaningful Use
Data represents a fictitious environment of 4 health centers. No PHI is being revealed.
25
Measure Analyzer
•
•
View details of any measure including report parameters, measure specification, provider‐level detail, patient detail and more
Launch the Measure Analyzer by selecting the measure name or selecting from the Measures menu
Measures
26
Measure Analyzer
Green line = target
Blue line = results
Benchmark against other centers
Drill down in OWN data only
Data represents a fictitious environment of 4 health centers. No PHI is being revealed.
27
Patient‐Level Detail
• To further understand a provider’s performance on a particular measure, select the Detail List button from the Measure Analyzer menu to drill into the patient level details
Display patient‐level detail for this provider
28
Patient‐Level Detail Spot‐Check
•
Spot check about 10 patients against data in EHR
• 5 patients in the numerator ( ‘1’ in the Numerator column)
• 5 patients in the denominator only (‘0’ in the Numerator column)
• Consider exclusions if applicable (‘1’ in the Exclusion column)
•
Export to Excel for further analysis
Hover over a name to display patient details
29
Page through results
Export list to Excel
Dashboards
Data represents a fictitious environment of 4 health centers. No PHI is being revealed.
30
.
Registry Reports
Data represents a fictitious environment of 4 health centers. No PHI is being revealed.
31
Patient Visit Planning Report
Data represents a fictitious environment of 4 health centers. No PHI is being revealed.
32
Provider Report Card
Data represents a fictitious environment of 4 health centers. No PHI is being revealed.
33
Azara DRVS Beyond New York
Azara Healthcare Our History
– Large investments via formal partnership with Mass League – Specialty in large scale data reporting & analytics Customers and Patients
Key Relationships
– 4 Primary Care Associations
– 6 Networks
– 12 states
Focus on Community Health
41
47
41
42
42
423
41 41
420
428
35
– Set up specifically to deliver DRVS to the Community Health marketplace using a Software as a Service (SaaS) model
35
35
41
– Data on 9 million+ patients
– Nearly 100 CHC’s live Our Perspective
The future leaders in healthcare will be successful in aggregating and organizing clinical, operation and financial data to quantitatively demonstrate the value and efficacy of their care.
•
36
The depth, quality and accessibility of your data is critical to your success
• EHR will always be the system of record
Driving Performance at the Center
Appetite for Data ‐ Shift perspective from data creation for external requirements to regular
internal consumption
37
Azara’s Vision for DRVS
Clinical, Financial and Operational Data from Health Center EHR
Claims Data from Payers
• Compliance
• Quality • Visit Planning
• Efficiency
• P4P
• Cost/Risk
• Provider Continuity
DRVS
DRVS
Reporting &
Analytics
Inpatient and Emergency ADT Data
38
• Transition of Care
• Risk Stratification
Patient
Experience
Patient Survey Data
•
•
•
•
Statewide Data Warehouse to support QI initiatives priority goal in 2010 Established statewide QI network, MOQuIN, in 2011
Installed Data Aggregation and Reporting Solution in late 2011
Focused MOQuIN effort on 6 Diabetes related metrics
•
•
Leveraged infrastructure to win contract to administer State Health Home Plan Amendment (2703B)
•
•
•
Increased payments to CHC’s of $65 PMPM
2012 HCCN Grant Awardee
Infrastructure will serve as basis for IPA comprised of community health centers
•
39
Improved a1c under control by 25% in first year
Key element of demonstrating clinical integration
39
Case Study: Missouri PCA
Case Study: Indian Health Center
•
Strategic Goals for Data Usage
•
•
•
•
•
•
•
•
PATIENT CENTERED Health Care
Manage Population Health
Manage Patient Health
Identify Access Issues
Identify Disparity Issues
Regional, State & Federal Reporting Quality Management
Meaningful Results in a short time across a variety of areas
• Chronic Disease Management
• Diabetes Foot Exams increased 19% over 120 day period
• Preventative Cancer Screenings increased 7‐15%
• Providers teams lagging the average were identified and assisted
40
Leveraging the Platform
•
•
•
•
41
Immunization Registry
MA Payment Reform CQI Reporting
Integrating Acute Care Data
Centralized Countywide Reporting
Questions or Further Information
CHCANYS Health IT Program
Lisa Perry, Senior VP Quality and Technology Initiatives lperry@chcanys.org
Amy Grandov, Managing Directory NYS‐HCCN agrandov@chcanys.org
CHCANYS website: www.chcanys.org
Azara Healthcare
Jeff Brandes, CEO Azara Healthcare jeff.brandes@azarahealthcare.com
Azara website: www.azarahealthcare.com
43