March 8, 2011 CBCC Conference Call

Attendees

• Jon Farmer
• Michelle Johnston
• Mary Ann Juurlink Scribe
• John Moehrke Security Co-chair
• Milan Petkovic
• Diana Proud-Madruga
• Ioana Singureanu
• Richard Thoreson CBCC Co-chair
• Serafina Versaggi
• Tony Weida
• Craig Winter

Agenda

1. (05 min) Roll Call,& Accept Agenda
2. (05 min) Approve Minutes February 15th
3. (05 min) Review Action items [1]
4. (10 min) Privacy Consent Functions in EHR functional Model (Ioana)
5. (10 min) NQF Review for Comment (Mary Ann,Serafina)
6. (10 min) NEW PROJECT Proposal HL7 Confidentiality Codes - review and update (Suzanne)
7. (10 min) Request for items for May 2011 Working Group Meeting in Orlando, Florida. Please contact Suzanne to add to agenda

Back to CBCC Main Page

Minutes

1. Action Items

Action Item: Topic for discussion in May meeting - Confidentially codes

Action Item: Preliminary discussion about confidentially codes prior to May meeting

Action item: Review the possibility of adding in diagrams to NQF Comments

2. Resolutions

Motion: 20110215 Minutes approved Richard/Serafina

3. Updates/Discussion

No further information regarding Meaningful Use stages regarding the 8 Behavioral Health eMeasures. This relates to the February 15, 2011 notes.

NQF Review for Comment April 1st submission

• Reviewing the translation of the NQF Endorsed eMeasures to the retooled versions in preparing for the review for comment.
• Comparing NQF Endorsed narrative and to the complexity of the numerator / denominator in the retooled version
• Reviewing from a general perspective e.g. modeling of measures
• Reviewing terms to ensure consistency from measure to measure e.g. negative diagnosis history, episode of care. All measures are using these concepts
• The CBCC WG will illustrate issues with examples

Right Direction

The NQF_Retooled_Measure_XXXX.xlsx provides the vocabulary and codes that go with the NQF Endorsed concepts which is a standard code list. This a great step in the right direction. However what we are seeing is an inconsistency of how they are expressed across the measures.

Issues:

• Approach that was taken with NQF Endorsed vs NQF_HQMF
  • The NQF Endorsed describes procedurally how to calculate e.g. do this and then do that.
  • The NQF_HQMF (the retooled version) is not about ‘how’ but ‘what criteria’ (e.g. nested and/or). Often when you provide only criteria there is more than none way of doing the calculation.
• The simple narrative in the original NQF Endorsed version was used to come up with a new format (NQF_HQMF). These pseudocodes are difficult to comprehend creating ambiguity in the measure. We think the NQF Endorsed version is more descriptive and clear with respect to the intent of the measure.
• Missing information e.g. stratify by age group but in the measure itself there is nothing that reports on age group
• Are things implied, it looks like pieces were dropped, assumptions made when moving from NQF Endorsed to NQF_HQMF
• Why talk about an initial population, is this something separate from the denominator? We felt we only needed to talk about numerator and denominator as that is what the measure requires
• The model has to define if data is coming from a system, network or an individual. We are thinking everyone is a lone ranger. If you are practicing medicine as a lone ranger you are not providing good care. (Don Berwick speaking at HIMMS). It’s in a doctor’s interest to act as a lone ranger so to get credit for something.
• Nobody is concerned about costs yet but we will be, so getting a response from a 5 different doctors and they are being rated this is a problem. Cost will be in scope in a year.
• We need to start to include Health Home in these quality measures
• It’s the provider community that is invisible. Struggling to figure out what is in the denominator what population will I be judged by e.g. network population, e.g. personal lone ranger doctor population. If it is a network we need to take into consideration what others have done for the same client. As a long ranger doctor you can do what you want.
• What good are these measures if they are done for individual providers?
• What happens to a patient gets a diagnosis with one doctor and goes elsewhere for care. Where does this patient get counted?
• Quality measure is one thing within a network and one thing for the network itself and potentially we would probably want to keep track of those people who move from network to network.
• These are process measures
• The next level are outcome measures, in order to do this we need to be able to go across silos
• We need to let them know that there is a real problem when we are doing the quality measure by individual doctors, not a useful measure, an ambiguous measure, because the services is being provided by multiple providers.
• Indicator to know if the calculation has been made intra or inter organization.
• Serafina creating a presentation, which is for our group only not part of comment period

NQF Review for Comments Submission

• Example of the comment period, category/substantive/if yes explain
• Can we include modeling diagram into the comments? Probably not, it seemed very limited
• Through the submission we need to let Floyd understand what we have learned and that the NQF_HQMF leaves a lot to be desired. The loss of precision of the original work (NQF Endorsed) by not capturing important elements of the workflow that is necessary to understand the intent of the measure. Workflow that will be very different if we are talking about an individual doctor as part of a Health Home network vs an entire network. What data do we use to establish a ‘negative 60 day diagnoses?
• People will report things incorrectly when interpreting the numerator and denominator differently.

Next Steps

• We also need to standardized the measure e.g. numerator and denominator to create consistency from the NQF website to the retooled versions as well across eMeasures
• We would like to see a narrative describing the numerator and denominator along with definition (e.g. what is the intake period, e.g. the negative diagnosis period) in order to understand intent. There appears to be inconsistent use of the concepts as they were developed independently by different groups. The NQF_HQMF is probably misleading.

Modeling

We are looking at the patterns in these measures and modeling them so they can be used consistently.

• Using the narrative
• Defining concepts in plain English
• Add NQF_Retooled_Measure_XXXX.xlsx values to the concepts
• Having value sets is great but it is important to understand them in the context of an information model in order to show where these concepts occur

Meeting adjourned at 2.57 PM EST