analytics and population health management initiatives · ranges from clinical inpatient...
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Dan Exley Executive Director, Data Strategy & Reporting
Memorial Care
Dr. Barbara AntunaMedical Informatics Specialist
Health Language – Wolters Kluwer
Sarah Bryan Director, Product Management
Health Language – Wolters Kluwer
Code Groups The building blocks for your big data analytics and population health management initiatives
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Dan Exley | Executive Director, Data Strategy and Reporting, MemorialCareDan Exley is the Executive Director, Data Strategy and Reporting at MemorialCare Hospital and Health Care in the Greater Los Angeles Area. He has been working in healthcare for over 20 years. Dan is responsible for reporting activities related to MemorialCare’s electronic medical record system (Epic), as well as enterprise-wide data use initiatives, such as the executive dashboard system and enterprise data warehouse. He is one of the developers of a Medical Informatics Certificate program that is currently offered at National-Louis University in Chicago, and is also the program coordinator for the ONC HIT Community College program at Orange Coast College in Costa Mesa, CA.
Dr. Barbara Antuna | Medical Informatics Specialist, Health LanguageDr. Barbara Antuna is a Medical Informatics Specialist at Health Language. She is board certified in Clinical Informatics by the American Board of Preventive Medicine (ABPM) and continues to practice emergency medicine. Her experience ranges from clinical inpatient informatics using Epic and MEDITECH, to involvement in data normalization efforts and synonym development for Provider Friendly Terminology (PFT) at Health Language.
Sarah Bryan | Director of Product Management, Health LanguageSarah Bryan is Director of Product Management for Terminology Product Solutions, for Health Language, a part of Wolters Kluwer Health. In her eight years with Health Language, Sarah has been responsible for delivering terminology management solutions to providers, payers, HIEs, and health IT vendors, to enable interoperability through effective utilization of standard terminologies.
Speakers
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Polling Question One
What are you doing now to manage your code groups/value sets/clinical definitions?
a. Spreadsheets
b. Proprietary Systems
c. Vendor Supplied Software
d. List them in the Application Code
e. Other
4
Presentation Overview
1. MemorialCare – customer use cases
2. Code Groups – the clinical perspective
3. Challenges with code groups
4. Benefits of a code management solution
Dan Exley, MMI, FABC
Executive Director, Data Strategy
Code Groups:The Building Blocks
for Analytic Initiatives
Six Nationally-Recognized Hospitals
Orange Coast Memorial Saddleback Memorial
San Clemente
Saddleback Memorial
Laguna Hills
Long Beach Memorial Miller Children’s & Women’s
Hospital Long Beach
Community Hospital
Long Beach
Two Award-Winning Physician Groups
More than
200 care sites
from the South Bay
to San Clemente
Care Sites
Total Assets: 3,059,000,000
Total Annual Revenue: 1,999,000,000
Patient Discharges: 68,841
Patient Days: 309,839
ED Visits: 198,647
Babies Delivered: 10,262
Just the Facts FY-2014
Affiliated Physicians: 2,600
Surgeries: 34,480
Employees: 11,192
Commercial/Medi-Cal lives: 123,907
Senior lives: 54,914
Some Key FY’ 16 Initiatives
Advance our
Population
Health roadmap
Participate in
CMS Bundled
Payment
initiatives
Leverage and
Optimize
Research
capabilities
Continue
readiness for
population-
based
payment
Pursuing a Common Playbook
Challenges with
Master Data ManagementAn Enterprise Code
Group Pre-requisite?
Historical
Inter-departmental and Intra-
Organization Silos
Acknowledging the vital role of
professional terminologists
• EMR (Epic and Other)
• Transactional System Reports
• Decision Support System
Reports
Grouping Things Together
• Enterprise Data Warehouse(s)
• External Reference
Terminology
• Local/De-facto terminology
• Externally defined measure definitions
• Reference sets different by program, payor, etc.
• Some measures calculated by 3rd party software
• Some measures calculated by in-house
(audited) development
Pay for (Provider) Performance
$
Sample of One External Measure Program Set
• Development of reports for different PI activities in support of Physician Best Practice Teams and Enterprise-wide Service Line Committees
• Customers often go to many different supporting groups for information about their initiatives - $ Decision Support, Epic Reporting, Enterprise Data Warehouse, 3p Vendor
• Challenges aligning definitions for different use cases and audiences
Performance Improvement Informatics
+
SQL_SEP_PreMetric_IV_Antibiotics:
MEDNAME.THERA_CLASS_C IN (10, 11, 41) OR MIX_MEDICATION.THERA_CLASS_C IN (10, 11, 41)
SQL_SEP_PreMetric_IV_Bolus:
SIMPLE_MIX.SIMPLE_MED_ID IN (79032) OR (MEDID.SIMPLE_MED_ID IN (79032)
SQL_SEP_PreMetric_Vassopressors:
SIMPLE_MIX.SIMPLE_MED_ID IN (77117, 77110, 77111, 77131, 77509) OR MEDID.SIMPLE_MED_ID IN (77117, 77110, 77111, 77131, 77509)
SQL_SEP_PreMetric_IV_Fluids:
FLOMEAS.FLO_MEAS_ID IN ('12106', '102106', '102105', '22106','32106','32105','42106','42105','52106','52105','62106','62105','72106','72105','82106',
'82105','92106','92105','3343','12105','22105','5050','12102','52','55','12500685','12500694','12500686','12500687','12500688','12500689','12500690','12500691',
'12500692','12500693','12500684','112106','112105','12500683','122106','122105','12850324','12850323')
Limited Transparency
Glossaries
• Provide support for prospective analysis, study feasibility, and active, IRB-Approved research
• Study sponsors and/or Principle Investigators not always clear on specific criteria (inclusion or exclusion) for the study guidelines
• ICD10 throws a particular wrench in here, with few exceptions
Research
Sample Research Group
Diagnoses That Drive Report Filtering to Meet
“Minimum Necessary” Policy
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Polling Question Two
Are you using clinical data (i.e. SNOMED, LOINC) or unstructured data in your data repository?
a. Yes
b. No
c. Not currently, but we plan to in the future
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Presentation Overview
1. MemorialCare – customer use cases
2. Code Groups – the clinical perspective
3. Challenges with code groups
4. Benefits of a code management solution
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Terminology Barriers Are Pervasive
My doctor said it was heart failure
SNOMED CT code: 42343007-Congestive
heart failure
ICD-9-CM: 428-Congestive heart failure,
unspecified
ICD-10-CM: 150.9 –Heart failure, unspecified
LOINC 30934-4 B – Type natriuretic
peptideRxNorm: 3407 -
Digoxin
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The Importance of Code Groups
How do code groups relate to business rules and use cases?Code groups or value sets are critical building blocks for todays business rules which in turn are used as tools to solve larger Health IT initiatives. Simply put, they can be thought of as ‘bags of codes’ that represent clinical concepts.
Accountable Care Organizations, quality improvement, health information exchange, analytics, and population health management initiatives all create a need to manage code groups (aka value sets) to support a variety of activities:
Quality Measures – Attesting for Meaningful Use, PQRS, HEDIS, Stars
Population Identification – Care Management, Population Health and Analytics
Sensitivity codes
Decision Support
Benefit Policies
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Code Groups & Business Rules
How do code groups relate to business rules and use cases?Code groups or value sets are critical building blocks for todays business rules which in turn are used as tools to solve larger Health IT initiatives. Simply put, they can be thought of as ‘bags of codes’ that represent clinical concepts.
Results Supports CGM Use Cases:
• Claim costs and utilization patterns
• Reports (e.g. quality metrics, care management cohorts)
• Cohort with co-morbidities• Other (Application Pick Lists,
Sensitivity codes, Medical Benefit Policies)
Code GroupsExecutable
RuleManage
TerminologiesRules
AuthoringEvaluate
Rule
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Code Groups within Population Cohorts
Code groups can also be used to create a rule that identifies a cohort, or population, to be evaluated in a care management program or a research study. For example, a care management program may want to monitor a population of patients that meet specific criteria.
Heart Failure (diagnoses)
Ejection Fraction
(test results)OR < 40%][ AND
BNP(lab tests)
> 300 pg/ml
] ] -ARB/ACEI Exclusions (diagnoses)
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24,500 patients
Population of Diabetes – Different Ways to Define Them
Richesson RL, Rusincovitch SA, Wixted D, et al. J Am Med Inform Assoc 2013; 20:e319-e326
Many Faces of Diabetes
ICD-9-CM 250.xx Codes CMS CCW NYC A1C Registry SUPREME-DM
Diabetes-associated medications DDC phenotype eMERGE
2924,500 patients identified by criteria from any of the three terminology domains
Many Faces of Diabetes
Variability With Different Terminology Domains
MEDS LABS
DIAGNOSES
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Many Faces of Diabetes
24,500 patients identified by criteria from any of the three terminology domains
DIAGNOSES
LABSMEDS
22% of Your Population
Variability With Different Terminology Domains
MEDS LABS
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• Increase in claim costs and utilization
• Lack of adherence to treatment plans
• Lower payments in P4P programs
Many Faces of Diabetes
Impact of Inaccurate Code Groups?
MEDS LABS
DIAGNOSES
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MEMBERS WITHDEPRESSION
HIV+MEMBERS
MEMBERS WITHDEPRESSION
HIV+MEMBERS
Code Groups and Sensitivity Codes
Create a cohort of all HIV+ members with a co-morbid of depression
Depression is a major barrier to HIV
treatment outcomes
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Polling Question Three
What does your organization use code groups for? a. Defining population cohorts for care management
b. Defining population cohorts for research and analysis
c. Defining sensitive codes to ensure compliance
d. All of the above
e. None of the above
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Presentation Overview
1. MemorialCare – customer use cases
2. Code Groups – the clinical perspective
3. Challenges with code groups
4. Benefits of a code management solution
35
The Importance of Code Groups in Analytics
Forward-thinking initiatives such as: Accountable Care, Quality Improvement, Health Information Exchange, Analytics, and Population Health Management all create a need to manage code groups (aka value sets) to support a variety of activities:
Quality Measures Attesting for
Meaningful Use, PQRS, HEDIS, Stars
Population Identification
Care Management, Population Health
and Analytics
Decision Support
Sensitivity Codes
Benefit Policies
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Code Group Pain Points
Conflicts regarding terminology intake, management, and distribution are inevitable without an enterprise terminology management strategy.
Hard-Coded Business
Rules
Multiple IT Systems
The Spreadsheet
Chaos
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Benefits of a Code Management System
Single Source of Terminology TruthIncrease accuracy for your code groups through the creation of a single, integrated and trusted source of truth for all local and standard code groups across your organization.
Terminology GovernanceReduce operational overhead by aligning terminology and code group definitions, intended use, and versioning across business domains and all your clinical applications.
Always Up To DateStay current with content updates from the world’s leading terminology standard bodies.
Systems IntegrationIntegrate seamlessly within your current environment
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Our Enterprise Terminology Platform
1. CONTENT200+ standard and
enhanced terminologies,
mappings, code groups,
and synonym libraries
2. SOFTWAREto view, manage, export,
and standardize all
clinical content on a
single platform
3. TOOLSto map, model, search,
remediate, customize,
and group terminologies
4. SERVICESIncluding custom
mapping and modeling,
terminology consulting,
claims analysis,
and more
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Q&A
Thank You
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