Understanding the Measure Definitions Value Sets
Improving Transparency Info Snippets Value Sets Measure Investigation Tool (MIT) Center Mappings Azara Proprietary & Confidential 34
Understand the Measure Definition DRVS Measure Info Snippets from a Scorecard. How are the Numerator, Denominator and Exclusions defined? 35
Understand the Measure Definition |2 DRVS Value Sets from the Measure Analyzer. What are the values that satisfy the measure? 36
Value Set Content Check the different types of data that make up the measure. Sort by Numerator, Denominator, or Exclusion to find the values you are seeking. Azara Proprietary & Confidential 37
Value Set Content |2 A1c Results ⎻ Note the different types of data listed under the “Code System” column – Lab Results, LOINC, ICD-10, Clinical Structured Data. Azara Proprietary & Confidential 38
Value Set Content |3 View what is mapped from your EHR. ⎻ Click the “i” icon to display your EHR specific Lab Results names and Clinical Structured Data. 39
Data Validation Tools Measure Investigation Tool Measure Validation Workbook Mapping Document and Administration Questionable Values Dashboard
Measure Investigation Tool (MIT) Designed to investigate why a patient is or is not meeting the criteria of the components of a measure. Identifies the specific criteria as to why a patient is in the numerator, denominator, or exclusion. The MIT is only available for patient-based measures Watch for continued improvements as we continue to provide users to view details of the observations and value sets behind each measure. Azara Proprietary & Confidential 41
Measure Investigation Tool (MIT) - Access Right click on any patient in the Detail List. ⎻ Select ‘Investigate Measure’ Azara Proprietary & Confidential 42
MIT Example #1 The MIT displays when the patient’s information meet the measure’s criteria. Azara Proprietary & Confidential 43
MIT Example #1 – Patient Eligibility Patient In Measure ⎻ Needs to be >= 18 years old 44
MIT Example #1 – Patient In Denominator Patient In Denominator ⎻ Has diabetes and a qualifying encounter. Azara Proprietary & Confidential 45
MIT Example #1 – Patient In Numerator Patient In Numerator ⎻ A1c Result < 8 and within 12 months Azara Proprietary & Confidential 46
MIT Example #1 – Sourcing Data Understand Where Data Comes. ⎻ The ”Blue Pills” display the types of data that count for the section. Azara Proprietary & Confidential 47
MIT Example #2 – Not In Measure Patient Not In Measure Criteria. ⎻ Click on the ‘doctor’ icon ⎻ Enter MRN Azara Proprietary & Confidential 48
MIT Example #2 – Not In Measure Patient Not In Measure Criteria. ⎻ Age is 17 years and does not meet specifications. Azara Proprietary & Confidential 49
Measure Validation Workbook Designed to investigate why a patient is or is not meeting the criteria of the components of a measure. Identifies the specific criteria as to why a patient is in the numerator, denominator, or exclusion. Watch for continued improvements as we continue to provide users to view details of the observations and value sets behind each measure. Azara Proprietary & Confidential 50
Measure Validation Workbook Accessible in DRVS. Use for ongoing validation. Azara Proprietary & Confidential 51
Create a Workbook Name workbook. Choose measures – standard vs custom. Select number of patients to include in the workbook. Azara Proprietary & Confidential 52
Create a Workbook Azara Proprietary & Confidential 53
Data Health – Questionable Values Dashboard Displays suspicious data coming over from the EHR Allows users to efficiently identify data entry errors Criteria for suspicious data, i.e. it is unlikely your center has patients who are older than 120 years Azara Proprietary & Confidential 54
Data Health – Questionable Values Dashboard Drilling down to patient level detail and the measure analyzer helps pinpoint data entry errors and trendlines Azara Proprietary & Confidential 55
̶ ̶ ̶ Review Mapping Administration Review your current EHR to DRVS data mapping. Review EHR to DRVS mapping for Labs, Structured Clinical Items, Patients Demographics, etc. Identify all of your EHR data in DRVS that is currently unmapped. Identify any incorrect mapping. 2 3 1 Azara Proprietary & Confidential 58
Review Mapping Administration Understand what is displayed. ⎻ Mapping Summary Table - All DRVS components mapped from your EHR. ⎻ EHR Mapping Details Table - ”Raw” information from your EHR (i.e. Lab Order Name). Azara Proprietary & Confidential 59
Review Mapping Administration Understand the impact of the mapping. ⎻ Modify the Time Period - Look at recent/relevant mappings entering DRVS. ⎻ Distinct count - The unique number of “Source EHR Text” values entering DRVS. ⎻ Count – Frequency of times the value enters DRVS from your EHR. Azara Proprietary & Confidential 60
Review Mapping Administration Identify values that require mappings (i.e. Unmapped). ⎻ Categorize all ”unmapped” values into a category. ⎻ Use Ignore/Archive when values do not match an appropriate category. Azara Proprietary & Confidential 61
Review Mapping Administration Understand DRVS mappings that do not exist. ⎻ Not all DRVS values are mapped and captured from your EHR. ⎻ DRVS Values with 0 Count Tab – Displays structured values not mapped from your system. Azara Proprietary & Confidential 62
Use Case #1 | Data Hygiene November is National Diabetes Month and your organization’s QI team is working on the Diabetes A1c > 9 or Untested measure. As part of the team’s regular data hygiene activities, you will: – Examine overall trendlines to look for spikes and dips in the data – Check patient-level detail to make sure data is coming over correctly from the EHR – Identify data entry errors Azara Proprietary & Confidential 63
#1 Step By Step | Data Hygiene 1. Go the Measure Analyzer for A1c > 9 or Untested by using the search bar in DRVS. 2. Click on the measure and open up the Measure Analyzer to look for unusual spikes/dips/lack of data in the trendline. 3. Click on Detail List > right click on a patient name to Investigate Measure. 4. Go to the Data Health - Questionable Values Dashboard and check number of questionable A1c values. Azara Proprietary & Confidential 64
Registry Theory and Training Learn how to create custom registries in DRVS.
The Value of Registries Stock Registries ⎻ Deployed as a module element to all clients. ⎻ Contain subject-specific patient lists. ⎻ Provide enhancement to stock measures. Custom Registries ⎻ Created for one tenant, or single center. ⎻ Contain lists of patients for any need. ⎻ Enhance measures valued by center. ⎻ Stand-alone registries not related to measures. Azara Proprietary & Confidential 66
The Value of Registries • Lists of patients A RE • Useful for data review • Allow exploration of a patient group • Measure reports • DIY Measure filters A RE N OT • Exportable patient databases Azara Proprietary & Confidential 67
Clinical Patient Registries Clinical patient registry reports contain a core data columns: ⎻ Patient name, MRN, health center, usual provider, race, ethnicity, language, sex, age, date of birth, payer, phone number, date of last encounter, and date of next appointment. Stock clinical registries include: ⎻ Primary Care: Adult Female ⎻ Primary Care: Adult Male ⎻ Primary Care: Adult ⎻ Primary Care: Pediatrics ⎻ Asthma ⎻ Depression ⎻ Diabetes ⎻ HIV ⎻ Hypertension ⎻ Immunizations ⎻ Anticoagulation ⎻ Social Determinants of Health ⎻ Flu- Adult Azara Proprietary & Confidential 68
Considerations When Building a Registry Do the prep work first. Measure twice cut once. Write a brief aim statement for the registry: “ Build a report that can track all relevant results, screens, and demographic information for all diabetic patients seen within the last year.” When do we consider a new stock registry or updating an existing stock registry? Ways to build a custom registry. ⎻ Copy an existing registry and add column(s). ⎻ Create ‘New Registry’ Evaluate if data elements are available. If not currently available in DRVS, there may be additional cost. Azara Proprietary & Confidential 69
Requirements – Understand What You Need/Want Category Question Response Purpose What will you be using the registry for? Users Who will be using the registry? (May be more than one type of user) How often do you think you will use the registry? (Daily, weekly, monthly, Frequency quarterly, once) When do you need the registry? Priority Are there any grants/programs tied to it’s use? Inclusion What specific criteria gets the patient on the registry? Are there any measure Criteria criteria, numerator, denominator or exclusions to follow? Exclusion Are they any patients you don’t want to show up? Criteria Data What information do you want to show up on the registry and in what order? Elements Azara Proprietary & Confidential 70
Designing a Usable Registry - The Details General ⎻ Name, description ⎻ Center ⎻ Created by ⎻ Enable Inclusion Criteria ⎻ Age, to/from ⎻ Sex At Birth ⎻ Observation(s), and/or Exclusion Criteria: Observation(s), and/or Data Elements Azara Proprietary & Confidential 71
Registry Data Elements - By Category Static ⎻ Patient level data ⎻ Name, Sex, Gender, DOB, etc. ⎻ Information may only be available on ‘rollover’ on registry view; on export in excel column. Dynamic ⎻ Sourced from Observations ⎻ Columns set manually Date Alphanumeric value(s) Numeric value(s) Code ⎻ Column settings affect display in registries and measure details In general, the column reflects the most recent value in the time period. ⎻ Exception – Medications active in the last 12 months Azara Proprietary & Confidential 72
Data Elements Constantly being updated. ⎻ Demographics ⎻ Diagnosis ⎻ Encounter ⎻ Immunization ⎻ Lab ⎻ Medication Data ⎻ Other Data elements are associated modules. Azara Proprietary & Confidential 73
General Display Name ⎻ Title of registry, shows on left navigation under registry Center ⎻ Choose specific center; can only build for one center but shows for all sites Description ⎻ Describe the registry so users who are not familiar with it will understand its purpose and key inclusion criteria Enabled ⎻ If checked, all users in CHC can view registry; if unchecked, on admin users can see it ⎻ Some registries may have a higher level of security ⎻ Security column on Registry Admin view – shows and restrictions ⎻ Managed through user security Azara Proprietary & Confidential 74
Inclusion/Exclusion Criteria Min/Max Age Sex at birth Inclusion Observations Inclusion Operator ⎻ And/Or: can only use one Exclusion Observations ⎻ Same list as Inclusion Observations Exclusion Operator ⎻ And/Or: can only use one Azara Proprietary & Confidential 75
Registry Administration - Access Azara Proprietary & Confidential 76
Registry Options Azara Proprietary & Confidential 77
Registry Builder| General Azara Proprietary & Confidential 78
Registry Builder| Inclusion Criteria Azara Proprietary & Confidential 79
Registry Builder| Exclusion Criteria Azara Proprietary & Confidential 80
Registry Builder| Data Elements Azara Proprietary & Confidential 81
Data Elements that Appear in Hover-over Address 1 Patient Expired Address 2 Patient Inactive Center Name Phone Number City Race Date of Birth Sex Date of Death State Email Address Unscrubbed Ethnicity Unscrubbed Language Ethnicity Unscrubbed Race Family Size Usual Provider Homelessness Status Veteran Status Language Zip Code Migrant Status Azara Proprietary & Confidential 82
Things to Remember Data elements can be moved up and down to change viewing location in the registry. Demographic items will appear in the hover-over. Include data elements that are associated with the inclusion/exclusion criteria so you can see why a patient is included. Consider use of individual/custom filter settings. New clinical data is processed nightly and will show up on a registry the next day Azara Proprietary & Confidential 83
Use Case #2 | Registries Your care management team is working on a new Women’s Rising Risk grant to for women with the following criteria: – Over 18 – Diagnosis of hypertension – Diagnosis of depression – NOT pregnant The team will be conducting outreach to these patients to schedule appointments, during which they would like to close the following gaps in care: – Cervical Cancer Screening – Breast Cancer Screening Azara Proprietary & Confidential 84
#2 Step By Step | Registries 1. Go to Admin > Report Configuration > Registry Administration. 2. Click New Registry. 3. Create a Display Name, Description, and check/uncheck Enable. This description and name should indicate why the registry was created; for our example, we want to include the Women’s Rising Risk grant name in the title and description. 4. Select Inclusion and Exclusion Criteria: – Over 18 – Female – Inclusion: Dx of Depression and Hypertension – Exclusion: Active Pregnancy – Remember to select an operator. 5. Choose data elements and order as desired: – Relevant demographic data that will allow team to conduct outreach such as name, phone number, address, etc – Date of last cervical cancer screening – Date of last breast cancer screening 6. Hit Save. 7. View and run the registry either from the Registry Administration page or by clicking on Registries on the left navigation bar and selecting your registry in the custom section. Azara Proprietary & Confidential 85
Scorecards Theory and Training Learn how to create custom scorecards in DRVS.
Scorecard Report Provides a quick performance snapshot for a group of measures at an organization. – – Performance Indicator – Result (%) – Target (%) Measure – Baseline Performance / Change – Exclusions – Denominator – Numerator
Custom Scorecards Designed for specific center or PCA needs. Core functionality is the same as stock Scorecards
Using a Scorecard 1. Filters 2. Info snippet 3. Export the measure detail 4. Drill down by clicking on the measure name 5. Targets 6. Measure components Azara Proprietary & Confidential 89
Scorecard Display Options Use the additional display options for different ways to view the measures in a scorecard report.
Display Baseline Performance Choose a baseline period to compare to current results. Consider setting favorite or editing default filters if you always want the baseline present. azarahealthcare.com 91
Display Groupings in Scorecard Format Grouping displays results by selected category for easy comparison e.g., providers, location, race, language. Includes all measure components. Scorecard shows all measures for that specific grouping e.g., provider. azarahealthcare.com 92
Display Groupings in Crosstab Format Grouping displays results by selected category for easy comparison e.g., providers, location, race, language. Shows only the measure results. Crosstab shows the measure results for each specific grouping e.g., provider. azarahealthcare.com 93
Display Care Gaps Shows each individual patient's compliance with the measures present on the scorecard and the number of care gaps per patient. Displays one patient per row with clinical quality measure gaps identified in the columns. azarahealthcare.com 94
Creating a Custom Scorecard Basic Set up 1.Display Name and Description 2.All Centers or single center access 3.Default Period Type 4.Default Provider role - Usual vs Rendering Provider 5.Show Exclusions 6.Enable
Creating a Custom Scorecard Measure Selection 7. Auto search for the measure 9 8. Choose the desired measure using the magnifying glass 9. Use the three lines to re-order the measures
Managing Scorecards In the Left Nav, click Admin > Report Configuration > Custom Scorecards. View: Open and view the scorecard report. Edit: Make changes to any aspect of the scorecard report Options: Choose Disable to remove the custom scorecard from the left nav You are not able to copy a scorecard. menu. Delete: Permanently remove the custom scorecard. As in product Azara Proprietary & Confidential 97
Use Case #3 | Scorecards Your CHC is implementing patient visit planning and want to create a scorecard to compare performance before and after the PVP Pilot. The scorecard needs to include the following criteria need to be included for the evaluation of the pilot: – Three measures Flu immunizations, depression screening and breast cancer screening performance. – Show the performance for the three providers in the pilot. – The pilot started in August 2018. In addition, you want to be able to view care gaps and easily compare the three providers. Azara Proprietary & Confidential 98
#3 Step by Step | Scorecards 1. Go to Admin > Custom Scorecards Report > Report Configuration > Custom Scorecards. 2. Name your scorecard and enter a description. 3. Select Month for the default period type- Month 4. Choose a provider role – rendering or usual provider. 5. Select Month as the period type for the second widget. 6. Use the looking glass to choose the measures. 7. Create the scorecard. 8. Choose the provider filter and select 3 providers. 9. Set Baseline period to August 2018. 10. Go to the Settings and select set default filters, save filters as default. 11. Go to filter icon > display options and check off crosstab and grouping 12. Group by provider and save as favorite. 13. Go to filter icon > display options and check off care gaps. 14. Save as a favorite.. Azara Proprietary & Confidential 99
Measure Targets Create measure targets in DRVS.
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