Physicians and hospitals actively contributing HL7 or CCD data to the statewide exchanges who partner with KHS benefit from access to aggregate clinical data from the longitudinal patient record through web-based dashboards. KHS has made it a priority to capture the voice of the physician in development and delivery of the KHS dashboards by engaging a pilot group of Kansas physicians and hospital professionals.
With word spreading of the MACRA Final Rule, questions and concerns of how to thrive in the new era of healthcare are on the rise. According to CMS, MACRA aims to create a more relevant, patient-centered Medicare program by promoting quality patient care while controlling escalating costs through the Quality Payment Program (QPP). The QPP has two tracks you can choose, the Merit-Based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models. The MIPS composite score consists of three performance categories for the 2017 reporting year: Quality, Clinical Practice Improvement and Advancing Care Information. The KHS analytics dashboard reports now available are designed to help prepare physicians and hospitals for MIPS reporting in all three categories.
These dashboards include:
High Risk Patient
High Risk Patient dashboard identifies patients considered most at risk for poor health outcomes, high resource utilization and in need of care coordination. Identifying high risk patients can help meet the Clinical Practice Improvement (CPI) requirements under MIPS. For this analysis, high risk patients are defined as patients with three or more chronic conditions and five or more emergency department visits in a 12‐month period.
Quality Metrics dashboard displays analysis of preventive care procedures commonly required and approved for quality reporting programs for clinic practices. Individual measures are structured to meet NCQA, CMS, and HEDIS requirements. Current reported measures include screening for colorectal, cervical and breast cancers, osteoporosis, and pneumonia and influenza vaccines.
CMS has identified seven clinical conditions for which hospitals could receive a readmit penalty if a patient is readmitted at the same or any other eligible facility within 30 days of discharge for any reason. Readmission measures include acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, elective hip or knee replacement, stroke, pneumonia, and coronary artery bypass graft.
Disease Registries display specific patient populations with certain high or at risk conditions, and sets the stage for physicians to take steps that mirror many of the MIPS CPI activities. The disease registry data provides information about the health status of communities and identifies opportunities for care coordination, referral to community resources, and evidence‐based practices.
Population Health presents opportunities for community resource coordination and planning for at risk members of a defined geographic region. Analysis is currently provided on 11 predetermined criteria selections such as hypertension, ischemic heart disease, pre‐diabetes, diabetes, heart failure, and A1C poor control, to name a few.
Additional dashboards are currently under development by the KHS business intelligence team.
Web-based analytics subscribers can run and view reports derived from the patient data in the health information exchange, as well as download and import the data into other software tools. The dashboards present report details in a dynamic way, allowing the authorized user to manipulate the view of the data and isolate key data points.
Analytics at work in Kansas:
Use of Business Intelligence Tools in the Transition to MIPS
Using Clinical Data to Improve Patient Outcomes