(Left to right) Melissa Levis, Lead Technical Project Manager, Bryan Cudmore, VP Account Management and Mahgan Town, Business Analyst worked to help improve data quality for Hixny participants.
It’s been six years since the Centers for Medicare & Medicaid Services (CMS) began requiring hospitals and healthcare providers to demonstrate the “meaningful use” of electronic health records (EHRs) against both technical and clinical benchmarks. In 2015, though, CMS specifically refocused this standard toward improving health outcomes.
To that end, the New York State Department of Health (NYSDOH) established a minimum data standard for providers to meet in tracking health factors that fulfill the current federal meaningful use requirements. Called the Common Clinical Data Set, these approximately 20 data points include items like smoking status and blood pressure readings, which most providers should already be assessing and find readily available.
As the state moves toward a new Medicaid reimbursement model—value-based care—that will compensate providers based on the quality of care they provide, the Common Clinical Data Set serves as a foundation for layering the quality of data reported over the quality of care provided.
How Hixny is Helping
Bryan Cudmore, VP Account Management for Hixny, sees value-based care as a culture shift for hospitals and other organizations, providers and even patients. “It’s transforming healthcare from fee-for-service to providing high-quality care at lower cost. Hixny is at the heart of all this, because all patients are going to multiple providers for care. To be able to provide high-quality care, providers need the data from all of those encounters,” Cudmore says.
Throughout 2017, Hixny conducted a data quality assessment to help participating providers prepare for the shift toward value-based care and comply with the evolving meaningful use requirements. At the same time, the effort helped Hixny prepare its own system for the changes by establishing a baseline for data quality and a plan of attack for streamlining information and ensuring consistent coding.
“We’re explaining the volume and the quality of the data sets, what to send and why to send it,” explains Melissa Levis, Lead Technical Project Manager. “We’re trying to educate providers and help them make sure that, first, they’re entering all of those data points into their EHRs, and then, that their EHRs are properly set up to get that information into our system correctly and in the same language, so other providers can access it.”
Cudmore says that the assessment and follow-up is intended to help providers navigate the culture shift efficiently and successfully. It prepares them to meet the standards used to determine the meaningful use of EHRs before those standards are applied to the new value-based payment model.
“We’ve been able to use our system analytics to look at aggregated data, to see where our participant data is generally working, and where we need to focus some attention,” he explains. “The last mile is always a manual review, but we can be more targeted if we use analytics first.”
Some of that targeting involves helping hospitals and providers configure their EHR systems to allow for the transfer of all of the necessary data in the Common Clinical Data Set. Other efforts focus on ensuring that all Hixny participants use the same national coding standards—including Logical Observation Identifiers Names and Code (LOINC) for lab results—to report their findings. That way, all providers know the language to use to access the information they need at the point of care.
“For providers, having clean, real-time data available is essential to patient care. When the data they search for in our system shows up right away, that improves trust,” Cudmore explains. “For Hixny, receiving clean data helps us consolidate information to make it useful to providers. So, for example, if an individual has hypertension and sees six specialists and a primary care provider, proper coding allows us to de-dupe the reports and make the volume of data easier for all the providers to use.”
What’s Next for Data in Value-Based Care?
As Cudmore explains, there are numerous government and industry organizations involved in value-based care and payment construction. All of them expect that providers are making available the data they generate about patients in an easily usable form—and that providers are accessing the data made available by others to inform and improve quality of care.
“Sending the data to Hixny is much more efficient than old-school fax or email,” Cudmore says. “That way, not only localized records but all records are available to all of the providers.”
The evolution of data use and accessibility within the healthcare system will continue to play an increasingly central role in care decisions. In fact, Cudmore says, successful reimbursement will depend on the quality of data being provided and used by organizations.
That’s why Hixny’s next step in its data quality evaluation is to publish its contributor statistics, as mandated by NYSDOH. The report will indicate which organizations and providers are contributing their information to Hixny, and how that information measures up against the state’s requirements for submission. With some 1,300 participants being evaluated on the contribution, quality and completeness of 20 data elements, the project remains complex.
“At Hixny, we see the Common Clinical Data Set as a good place to start and very important, but it’s not exhaustive and it doesn’t provide the full picture like narrative reports do,” Cudmore says. “We hope that this report, in addition to showing compliance with the data guidelines, will help create more transparency about why specific facilities are or aren’t participating.”
Overall, Cudmore explains, conducting the evaluation at this stage creates greater pressure to meet the new standards within the community of Hixny participants. That, in turn, positions the region to continue leading the way in using data to improve the quality of patient care.