Asia Menor

Intent

The organization systematically manages patient information and uses the information for population management, to support patient care.

Element A: Reporting Based on Electronic Information 3 points

The organization uses electronic data capability to integrate at least two categories of patient clinical information and to produce the following on at least 50% of its commercial HMO/POS members, updated at least twice annually.

1. Actionable reports/query lists from an electronic disease registry or data warehouse that is updated at least twice annually

2. Computerized registries that are updated at least twice annually

3. Successful self-reporting of at least one of the four HEDIS measures below, electronically generated organizationwide using lab results or clinical findings:

1. Cholesterol Management—LDL Control 2. Diabetes Care—LDL Control

3. Diabetes Care—HbA1c Control 4. Controlling High Blood Pressure

Scoring _{The organization} 3 points 2 points 1 point 0 points

performs all 3 items The organization performs 2 items The organization performs 1 item performs no items The organization

IT Required: Intermediate

Source of Content: P4P IT Domain Measure 1

The organization can integrate different types of electronic data and use them for patient care and quality improvement.

Definitions

Actionable report/query list. Quality improvement reports for individual

physicians or practice sites that include patient-level data and prompt action regarding individual patients.

Computerized registry, data warehouse or other electronic data capability. A searchable source of data for all patients or all patients with a particular condition, not just those for whom the organization wishes to prompt action.

Details: This element requires PO-level integration of relevant electronic data sets,

including only:  Visits/claims  Lab claims  Lab results  Prescriptions Explanation

APPENDIX I: IT Survey Instruments 2007 IT Survey Instrument

 Inpatient stays or ER visits  Radiology findings or claims

 Clinical findings: blood pressure, BMI, tobacco use, substance abuse or other  Findings relevant to clinical guidelines

The element requires the use of an electronic disease registry, data warehouse or other electronic data capability to integrate at least two of the multiple sources listed above. The organization should be able to report the resulting data by practice site or by individual physician.

Note: Eligibility lists do not count as a relevant data set—the use of eligibility data is assumed.

Required submission

Include supporting documentation for each item your organization performs. Supporting documentation includes computer-generated reports or screen shots (with all protected health information [PHI] de-identified) that:

 Show results of the activities  Indicate the periodicity

 Show use of two sources of data.

Below are examples with two sources of data in each. Actionable reports for a physician or practice site

 A list of patients who have been diagnosed with diabetes and who have HbA1c >9.0 (visits/claims data and laboratory results)

 A list of patients who have been diagnosed with asthma and who have not filled a prescription for a long-acting medication in the past year (visits/claims data and

prescription-filled data)

 A list of eligible patients (visit data to find patients who should not be excluded

from the measure) missing breast cancer screening (radiology findings or claims)

or cervical cancer screening (laboratory findings or claims)

 Electronic query list of children who visited the ER for asthma and had no follow- up visit to PCP within a week (ER records plus visit data)

Computerized registries for a physician or practice site

 A list of all patients diagnosed with CHF by practice site (visits), showing hospitalizations and ER visits in the past year (inpatient or ER records)

 Electronic query list or report of all patients with diabetes (visits or pharmacy data) and their clinical lab results, most recent visit and most recent pharmacy fills (one

condition, three data sets)

 Electronic query list or report of all patients' most recent lab results and office visits

 A list covering all patients with hypertension (visits) and their last three blood pressure readings (clinical findings)

Reports using visit data for diagnoses, lab data and or clinical data to produce

HEDIS measures across the PO

 Any one of four specific HEDIS measures that include lab results or clinical findings in the numerator

APPENDIX I: IT Survey Instruments 2007 IT Survey Instrument

Element B: Identifying Important Conditions 2 points

The organization uses electronic data to identify the following diagnoses and conditions among all of its commercial HMO/POS patients.

1. Most frequently seen diagnoses

________________________________________________________________________________ ________________________________________________________________________________ 2. Most important risk factors in the organization’s patient population

________________________________________________________________________________ ________________________________________________________________________________ 3. Three conditions that are clinically important in the organization’s patient population

(1) _____________________________________________________________________________ (2) _____________________________________________________________________________ (3) _____________________________________________________________________________ 4. Patients identified for participation in care management

Scoring _{The organization} 2 points 1 point 0 points

identifies 4 items identifies 2-3 items The organization identifies 0-1 items The organization

IT Required: Basic

Source of Content: Modification to NCQA’s PPC 2004–2005 and Disease Management standards

Condition-Specific:No

Explanation The organization mines its data for population management, using electronic clinical data to manage populations and to direct patients to care management programs.

Details: The organization analyzes electronic data on its entire commercial

HMO/POS population to pursue these activities.

This does not require an electronic health record (EHR), but does require at least a system that includes electronic clinical patient information, such as the following, in searchable, coded fields.

 Current and past diagnoses  Dates of previous clinical visits  Billing codes for services

 Status of age-appropriate preventive services (immunizations, screenings, counseling)

 Age-appropriate risk factors (obesity, smoking, substance abuse and others appropriate for younger patients)

APPENDIX I: IT Survey Instruments 2007 IT Survey Instrument

 Blood pressure  Height, weight and BMI  Laboratory test results

Definitions

Most frequently seen diagnoses. Diagnoses that the organization sees most often,

which may include single episode conditions, such as colds or urinary tract infections, or chronic conditions.

Risk factors. Behaviors, habits, age, family history or other personal traits that may

increase the likelihood of poor health outcomes. This does not include diagnosed conditions. It is acceptable if only some of the factors have been collected, or if factors have only been collected for a portion of the population (e.g., diabetics who smoke or cardiac patients who are overweight).

Clinically important conditions. Chronic or recurring conditions that the

organization sees, such as otitis media, asthma, depression, diabetes or congestive heart failure. In some cases, the most frequently seen diagnoses may be the same as the clinically important conditions.

Patient eligibility for participation in care management. Patients whose data

indicate the diagnoses, risk factors or conditions that the organization addresses in a care management program.

Criteria: The organization may use any of the following criteria to identify the most

frequently seen diagnoses, the most important risk factors and the three important conditions.

 Number of patients with the conditions, problems or risk factors  Number of visits for the conditions or problems

 Total fees billed or other measures of cost associated with the conditions, problems or risk factors

Note: For Item 3 only, the organization may choose conditions because they are measured in the P4P Clinical Domain.

In addition, the organization may use the following criteria to identify the three important conditions.

 Ability to treat or change the conditions or problems (how amenable the conditions are to care management; availability of clinical guidelines)  Other grounds, such as conditions for which the organization measures

performance or receives rewards for performance, such as P4P rewards; conditions that the organization has selected or targeted to improve performance, such as depression.

Required submission

1. Lists of results for Items 1–3, and

2. Computerized reports showing data for Items 1–3, and

3. A brief written explanation of the methodology for determining the most frequently seen diagnoses; most important risk factors in the organization’s patient

population; and the three conditions that are clinically important in the organization’s patient population, and

4. For Item 4, a brief written explanation or existing protocol or procedure for how the organization identifies eligible patients for participation in care management and refers them for care management programs

APPENDIX I: IT Survey Instruments 2007 IT Survey Instrument

Measure 2: Electronic Clinical Decision Support at

8 points