February 15, 2011 CBCC Conference Call

Community-Based Collaborative Care Working Group Meeting

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Agenda

1. (05 min) Roll call, approve minutes February 8th, call for additional agenda items & accept agenda
2. (20 min) Review action items [1]
3. (35 min) Review NQF 0105 New Episode of Depression

Anti-depressant Medication Management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment

Minutes

1. Action Items

Emergency Care approval of SHIPPS

SHIPPS Scope - Sydney HL7 WGM

TSC Approval

NQF Review for Comment and what will CBCC response look like

Privacy Consent Functions, Functional description and Conformance Criteria

2. Resolutions

Motion to accept minutes 20110208 Serafina/Ioana

EHR WG approval for co-sponsor 20110208

===3. Updates/Discussion===

Steering Committee and TSC Approval

Email from Edward Tripp February 14, 2011

The SHIPPS project scope statement passed with 1 affirmative and 3 abstain votes. The 11 other work groups that did not participate in the poll were counted as abstain for the purposes of quorum.

Domain Experts Steering Division (DESD)

Project Scope Statement Semantic Health Information Performance and Privacy Standard (SHIPPS)

• Summary - Passed (1/0/3/1)
  • Number of participants: 4
  • Most popular option: Abstain
  • Votes in favor: 1
  • Comments: 1
• Non-participating work groups counted as abstaining solely for the purpose of counting quorum: 11

SHIPPS Scope

Max expressed that in Sydney HL7 WGM people were concerned about the scope being too broad

Richard: We have encouraging support both from Structured Documents as well as the EHR working groups. The challenge is that we are talking about ‘bigger systems picture’ in other words, where the data is coming from and what the data really means. We have to put the data in the context so we can describe the meaning. In the US it is about meaningful use but I think it applies anywhere. We can’t chop the project in two and then come out with a useful product. Richard suggested that Max make a suggestion.

Action Item: Susan suggested this be put on the Agenda

Action Item: Next steps from SD to TSC

Ioana: Heard from Linda Fachetti, who indicated some folks from VA are interested in Behavioral Health and would like to join us.

Review of Minutes 20110208

NQF measures and Meaningful Use Stage

• 0004 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
• 0105 New Episode of Depression
• 0103 Major Depressive Disorder: (Diagnostic Evaluation)
• 0104 Major Depressive Disorder: (Suicide Risk Assessment)
• 0112 Bipolar Disorder: Monitoring Change in Level-of-Functioning
• 0027 Smoking cessation (Medical assistance) Bold text
• 0028a Smoking cessation (Measure pair: Tobacco Use Assessment)
• 0028b Smoking cessation (Heart Failure: Tobacco Cessation Intervention)
• OT3-022-10 Depression Utilization of the PHQ-9 Tool

Richard: Question is are we proposing new measures for stage two are we already moving the focus to stage three measures for the US Realm 2015

Mary Ann: Question is will this affect what we will be publishing in the Draft for Comment in May? Do we need to take this into consideration?

Richard: The work we are doing in this committee is an important extension of the modeling of what is the standards measure at this point. We’ve moved the discussion beyond the billing record; we are more focused on the clinical record and process in order to define what the measure really means.

Mary Ann: I also understood if we add risky comments we may see the measure put on the back burner.

Richard: There is quite a lot of commitment for these measures with the source political so once the measures are on the table they are here to stay, the question is how loosely defined are they and what do we do in order to tighten them up.

Action item: NQF Review for Comment and what will CBCC response look like.

Review of Action Items in Tracker

Working group approval for co-sponsor 20110208

Follow up with Jim who is liaison and we will be submitting the Privacy consent functionality in the EHR functional format. Follow up on Functional Analysis

Action Item: Provide EHR (Jim) the Privacy Consent Functions, Functional description and Conformance Criteria. Final content deadline March 27, 2011. Consent Management functionality already defined in the Privacy Security Model and the approved Privacy Model. Ioana will take this and put the information in the EHR formal of functions e.g. Infrastructure/Supportive section.

Action Item: Privacy Consent Functions in EHR functional Model

PQRI Implementation Guide may be useful in terms of a modeling perspective.

Richard: This gets a lot of visibility from a quality perspective so if there is something in the modeling we should look at it sooner than later. Don’t reinvent anything.

Richard: PQRI is a separate process that could have as much influence as the Meaningful Use Stages

Serafina: Stage 1, 2 Meaningful Use for implementation e.g. what kind of functionality does your EHR need to support. PQRI initiative is a voluntary physician reporting initiative.

Ioana: Could be an overlap as they have to implement NQF measures e.g. depression and alcoholism. Their process is independent and voluntary and may be ahead.

Serafina: PQRI enables physicians to get an incentive payment for their Medicare reporting. Medicare patients and it’s an incentive for physicians to get quality data into their CMS. Meaningful use also provides incentive payments to providers and Health Care organizations – this is a separate payment.

NQF 0104 Major Depressive Disorder: (Suicide Risk Assessment) Highlights of the discussion

• In claim based data we want to talk about medication dispensed

• In the EHR data we want to talk about medication prescribed

• Numerator and denominator

• • We need to come up with a way of representing/deciding how we are going to distinguish between the initial patient population, the denominator and the numerator

• • We only need to distinguish between the denominator and the numerator because this is what we need to compute the measure. The initial population is the denominator

• • The initial population will have e.g. 5 constraints applied to both the numerator and denominator

• • The population we are dealing with has depression, this is the denominator and the people who got the treatment is the numerator

• • What we need to model those special additional constraints that apply to the numerator, which will tell us who are those people who got the right treatment. Then we compute the ratio and the closer that ratio gets to 1 the better off these people have been treated

• • We are interested in whether we call it initial population or denominator. It’s the larger number on which we build the ratio

• • So what we are interested in are the constraints in the numerator that are not in the denominator. That’s exactly right; we need to identify all constraints and then the ones that apply only to the numerator

• • Constraints for numerator who meet the criteria of the measure

• Another discussion is how we apply the measure

• The measures are not looking at outcome. Furthermore one of the outcomes is cost

• Limitations we need to include as much information in order to compute the measure correctly e.g. get all data to compute measure

• Duplication e.g. how many times a patient gets the same treatment. Gaming the systems, cost analysts otherwise people are treated again and again

• • There is recognition that this is how the world is working, this is the data we have to deal with. We are only able to use the data on have, not what happened previously e.g. outside of the measure period

• • We need to build in margin of error as a function of duplication

• • Is there a measure for duplicate services?

• Get a better picture with aggregated data through interoperability – better picture of services

• These measures are remarkably complex, yet what we are trying to accomplish is quite simple

Meeting adjourned 3.10