Priorities/Recommendations: Quality and Process Improvement 1-11-2012 Draft

1-11-12 Draft

ONC GOAL: “Improve Care, Improve Population Health, and Reduce Health Care Costs through the use of Health IT,” discuss the specific ways health IT is contributing to the goals of health care reform: improved care, improved population health, and reduced per capita costs of health care. Widespread adoption of EHRs, information exchange, quality improvement initiatives, and health care reform pilots are required to implement the Affordable Care Act. As part of each of these activities, the government is investing in and leveraging health IT to transform the health system.”
LONG TERM QUALITY ALLIANCE (LTQA) GOAL: “To improve the effectiveness and efficiency of care and the quality of life of people receiving long-term services and supports by fostering person- and family-centered quality measurement and advancing innovative best practices.”
GOAL: In harmony with the various federal, state, association, and provider quality initiatives support the use of health information technology in providing the person centric longitudinal care quality measurements necessary for providers to measure quality outcomes.

Expand to include the benefits and processes around quality. Expand on Quality besides just the measurements
Process to describe and inform quality measurements

RATIONALE: Within the healthcare system there are various initiatives with a focus on quality improvement. In 2012 the major LTPAC programs backed up by either legislation or regulations are:
  • CMS Quality Measurements
  • Meaningful Use Electronic Quality Measurements developed under the HITECH Act
  • 2012 National Quality Strategy
  • Long Term Quality Alliance

Within these programs are various measurements for the same quality indicator. Also, as all providers will attest, measurements of quality indicators often dictate changes in processes. Plus, to date most of the quality indicators are disease or condition specific based on episodic care by a silo provider.
In order to achieve the national ultimate goal of an integrated, dynamic, longitudinal person centric electronic health record there is a need to include providers other than acute (hospitals) and ambulatory (physician office) care. The new care models such as accountable care organizations (ACO), accountable care communities (ACC), and Beacon Communities as well as the new payment models will require longitudinal care quality measures. Decision support, chronic care, and co-morbidities will require more comprehensive quality measurements that are not based on episodic silo provider care.

  • Encourage involvement of LTPAC stakeholders in quality measurement programs to be aware of their proposed initiatives and provide LTPAC input.
  • Support the efforts of the National Quality Forum to harmonize quality measurements across the spectrum of care.
  • Support the Long Term Quality Alliance program to propose the quality measurement requirements of all LTPAC providers.
  • Encourage research in longitudinal person centric quality outcome measurement in chronic and co-morbidity care.
  • Work with LTPAC technology vendors to assist providers in quality outcomes.
  • Work with ONC and the Federal Advisory Committees on including LTPAC providers in assisting eligible hospitals and eligible physicians with meeting their electronic quality measurements that require LTPAC involvement.
  • Assist quality measure developers in LTPAC gap analysis identification and prioritization

  • Identify HITECH Act Stage 1,2, & 3 “Meaningful Use” electronic quality measures requiring the support of LTPAC providers and vendors. Provide information to LTPAC providers and vendors as well as the ONC Federal Advisory Policy and Standards Committee.
  • Support ONC (S&I Framework LTPAC Workgroup) and NQF (LTPAC Quality Workgroup) with electronic quality measurement and reporting/transmission and current status of standards and approaches currently being used or advanced

  • Ensure medication management quality measures are developed including polypharmacy across the spectrum of person centric longitudinal care.
  • Ensure quality measurements are a part of all transitions of care initiatives. As an example:

  • Work with NAHC/HCTAA on identifying quality measurements in the clinical information exchange between Home Care agencies and hospitals/physicians.
  • Work with ASPE and Geisinger and their work with using the MDS and OASIS in the transitions of care.

  • Advance the use of key person- and family-centered quality indicators specific to adults who require long-term services and supports (LTSS) that are focused on improvement in care transitions and health related quality of life, and reductions in potentially avoidable hospitalizations, re-hospitalizations and total health
  • Advance the use of key person- and family-centered quality indicators specific to adults who require long-term services and supports (LTSS) that are focused on improvement in care transitions and health related quality of life, and reductions in potentially avoidable hospitalizations, re-hospitalizations and total health care costs.
  • Support the LTQA strategies for furthering the quality of care in SNFs ensuring that person centric longitudinal care is included.

external image placeholder?w=307&h=194
  • Support NQF Health Information Framework and the Quality Data Management initiative
external image placeholder?w=360&h=261
Suggested Speaker(s) at Summit:

ONC Goal III:Inspire Confidence and Trust in Health IT (Goal III focuses on government efforts to update its approach to privacy and security issues related to health IT.)

Goal: Sample text
Rationale: Sample text


  • Elements of Compliance embedded in EHRs
    • Need to be seamlessly included in HIT
    • Ensure regulatory and payment policies support EHR implementation
    • Information Streams
      • Identify key streams
      • Identify the gaps
        • Order entry and communication processes with physicians
  • Prioritize the gaps
  • Include the floor and ceiling
  • Determine LTPAC Collaborative approach/levers that can be pulled to address the gaps
  • LTPAC Quality Measures
    • What standards are being advanced to measure and report?
  • Identify MU measures for reporting working in LTPAC
    • Physician and NP
    • Nursing measures (Liz working with ANA and on a project related to nursing quality measures)
  • By helping to advance quality measures they can be connected to clinical decision-support tools. By engaging with quality and outcomes.
    • Back quality and outcomes to products - utilize vendors to embed products to help their clients


  • Discussed issues with quality measurement and reporting/transmission and current status of standards and approaches currently being used or advanced
(Pharmacy eHealthIT Collaborative)
  • Has brought together the 9 CEOs to develop a collaborative and speak with one voice; funded the collaborative and hired Shelly
  • Created a Pharmacists EHR profile
  • Working with system vendors to do their own certification
  • Opened collaborative to associate members to help pay for expenses
  • Met with Farzaad and are working with Betsy Ranslow and how to engage pharmacists in the process; what ONC can help do for MU that pharmacists can support (e.g. e-prescribing initiatives)
  • Working with SDOs: X12; NCPDP, HL7 (Shelly has been attending)
  • Working with PCPCC and their CeHA group
    • Need a LTPAC person in Accountable Connections group
      • Looking at under levered resources (Follow up with Shelly)
  • ASPE-AHIMA Project (Report and Tools) on applying content and exchange standards on MDS and OASIS is going through clearance
    • Patient assessments
    • Patient assessment summary documents for HIE (Geisinger/Keystone partnership to use assessment summary)
    • Question about whether CARE has been considered for this project – investigated but couldn’t spend resources to standardize a tool that was still under development
      • Baseline functional assessment information needs to find a home quickly
      • New Contract – Sole Source to AHIMA – Contract objectives
        • Support S&I Framework including working with HIT Policy and Standards Committee to bring forward the issues in collaboration with ONC (also include John and Larry with issues that will be advanced). Provide some technical assistance (think about what is the assistance needed – how is it done?) Group discussion -
          • Identify the information/information streams that inform clinical practice and care planning
          • Identify Gaps (functional status, life sustaining treatments, engagement of patient, change in condition and predictive modeling, etc.)
          • Identify the Needed Upgrades
  • Environmental scan of what is happening in HIE in LTPAC HIT; review of state Medicaid HIT plans, challenge grants, beacon communities and describing where LTPAC is across activities
  • Other Provider Study (ineligible providers) will be re-launched.

  • Working with NAHC/HCTAA on identifying technical standards to exchange the Home Care POC with the physicians to physicians can receive it into their EMR and have it part of their normal workflow. They can approve the POC and send it back. Ability to send back and forth with updates to reflect the collaboration as care and treatment changes.
    • Happens today through mail, fax, phone with administrative staff
    • Delays in process impacts billing cycle
    • Home care is embracing this process to agree on standards to allow this type for the sector. VNSNY is exchanging the POC electronically, but not in scale to a national role out.
    • Using a process with NY eHealth Collaborative (state HIE) and using a stakeholder list of participants from around the country
    • Ground breaking approach to continuing iteration and exchange that hasn’t been addressed in existing standards and approaches
      • Allows LTPAC to advance an approach that supports collaborative care that can be leverage for other processes
  • Standards processes – some picked up in Rosetta Stone as assessment data; a segment that is orders, treatments, DME that will need to be determined. Will work in conjunction with S&I
    • Will define a document type that has text segments until standards are developed
    • Process can be leveraged for other plan of care processes (e.g. NH physician plan on care/orders could use this same framework); consider how the transfer form informs these plan of care; pharmacy consultation processes
  • Needs funding for moving the approach through standards initiatives (single source or cobbled together)
    • Partner with a 3026 Grant Applicant (Longitudinal Care)
    • Value to leverage the standards not just for the home care POC process but others
    • Allscripts may be interested in partnering
    • S&I Framework to support some technical development
    • CMS Innovation Center
    • Private investors

Suggested Speaker(s) at Summit: