Appendix 3_AHQT Technical Readiness Assessment Survey DRAFT.docx

AHQT Technical Readiness Assessment Questions and Technical Readiness Tier Assignment

Appendix 3

Table of Contents

List of Figures

List of Tables

AHQT Technical Readiness Assessment iii

Question Flow and Tiering The Quality Improvement Organization (QIO) readiness assessment uses a mix of foundational, technical, administrative, and operational questions to assess readiness to transition systems and infrastructure to access, share, and use data electronically for quality improvement. All questions are equally important and are intended to help QIOs comprehensively assess respondent progress in this transition over the next five years. Figure 1 shows the question logic for the Foundational and Technical questions that categorizes respondents at Technical Readiness Tiers 0, 1, 2, and 3.

Figure 1. Logic Flow Governing Technical Readiness Tiers (High-Level View)

General and Foundational Questions Question #1 Please identify your facility’s primary point of contact (POC) or Facility Champion for collecting the information needed in this assessment:

· Name / Title

· Organization Name / Facility

· Address/Phone Question #2 Does your organization have sufficient internet connectivity to support operations? Please indicate “Yes” if your organization is practicing in an area with sufficient internet access and does not face insurmountable barriers to obtaining such infrastructure (e.g., lack of broadband).

Yes No Question #3 Are you an eligible hospital or critical access hospital (CAH) that has successfully attested to the Medicare Promoting Interoperability Program or a clinician practice that has attested, logged in, and uploaded or directly submitted data for the Merit-based Incentive Payment System (MIPS) Promoting Interoperability performance category requirements in the Quality Payment Program within the past [2 years]? (Promoting Interoperability was previously known as the EHR Incentive Program or Meaningful Use). Please indicate “No” if (a) you are not required to report Promoting Interoperability, (b) you received a hardship exception, or (c) if you did not achieve the minimum score required for successful attestation (score greater than zero for clinician practices or a score greater than 60 points for hospitals).

1. Yes No Question #4 If you answered “No” to Question #3, please respond. Skip if your answer was “Yes”.

Do you currently use an electronic health record (EHR) or other Health Information Technology (IT) solution across your organization?

1. Yes, we have a single EHR or a combination of Health IT solutions that are interoperable across all our service units.

Yes, but we have multiple vendors and versions of Health IT solutions that are interoperable across some parts of the organization.

Yes, but we have multiple vendors and versions of Health IT solutions that are not interoperable across the organization.

Yes, but we use a combination of electronic and paper-based processes.

No, we do not currently use an EHR or Health IT solution within our organization.

Organizational Structure Questions Question #5 Please rate your agreement with the following statement: “My organization is committed to adopting technological solutions to improve quality of patient care.”

1. Disagree Somewhat disagree Neither agree nor disagree Somewhat agree Agree Question #6 In my organization, quality improvement is managed by:

(Examples of responsibilities may include reporting to quality improvement programs, identifying focus areas for improvement, analyzing quality metrics using patient data, developing, and implementing quality improvement initiatives, etc.)

1. No one (there are no dedicated full- or part-time staff with quality improvement responsibilities) A single staff member has quality improvement responsibilities along with other non-quality related responsibilities A small internal group (2–5) of quality improvement staff A large internal group (more than 5) of quality improvement staff A combination of internal staff and third-party contractor(s) / vendor(s) Question #7 Rank Order question: Allow “Not Applicable” as an answer; allow items to be unranked.

How would you rank the following barriers to leveraging technology for developing a digital quality measurement infrastructure across your organization, with 1 as the largest barrier and 5 as the smallest? Please rank options (a) through (d). If these barriers do not apply to your organization, please select (e) – Not Applicable.

1. Budget: We do not have the necessary budget or financial resources.

Training: We do not have the necessary training.

Broadband: We lack access to necessary broadband services in our area.

Staff: We do not have the necessary support in terms of trained staff with the skillset required.

Not Applicable Resource Availability Questions Question #8 In my organization, Health IT is managed by:

1. No dedicated full-time or part-time staff A single staff member with other non-Health IT responsibilities A small internal dedicated Health IT department (1–5 staff) A large internal dedicated Health IT department (more than 5 staff) A combination of internal staff and third-party contractor(s) / vendor(s) Question #9 Skip this question if you answered “a” to Question #8.

Does your practice or facility have the capability to develop or modify your current technology services in-house? (Examples include Fast Healthcare Interoperability Resources (FHIR®) collection, information exchange, and reporting)

1. Yes No Operational Readiness Questions Question #10 Do you currently leverage data and conduct analytics to optimize patient outcomes for your patients?

(Examples may include tracking population health outcomes to inform personalized care strategies; developing data-driven interventions to proactively reduce harm and increase patient safety; and use of digital tools such as dashboards to help gain a broad view of your patient population and apply targeted interventions, etc.)

1. Currently do not have the capability to leverage data and conduct analytics to improve quality of care Have the capability to leverage data or run reports, but do not conduct any analytic or quality improvement activities Have established workflows and regularly analyze our patient data to identify gaps in care and implement improvement activities Question #11 Before implementing activities to optimize your technical infrastructure to improve quality of care, it is important to analyze the current state of your organizational resources and technical capabilities to identify gaps and areas for improvement. Please rate your current progress toward analyzing and implementing solutions (indicate by a “Y” for “Yes” and “N” for “No”) for the following.

Table 1. Current State of Organizational Resources and Technical Capabilities

IT infrastructure (technical capabilities of your Health IT systems, such as hardware, software, networking)

Resource needs (staffing, training, funding, etc.)

Operational and technical workflows (patient engagement, data exchange and integration processes)

Question #12 Do you participate in Medicare Advantage (MA) quality reporting programs?

1. Yes No Technical Readiness Questions Architecture Question #13 Skip this question if you answered (e) to Question #4.

Can your EHR integrate the information contained in summary of care records received electronically (not eFax) without the need for manual entry?

Note: This refers to the ability to add or incorporate the information to the EHR without special effort. (This does not refer to automatically adding data without provider review. This can be done using software to convert scanned documents into indexed, discrete data that can be integrated / included in the EHR.)

1. Yes, routinely Yes, but not routinely No N/A Infrastructure Question #14 What changes, if any, are you planning for your primary EHR system within the next 12 months? (Please check all that apply.)

1. Initial deployment Vendor switch Optimization of functionality for new releases Significant additional functionalities (e.g., adding modules) No major changes planned Planned update to newer version of EHR Question #15 Skip this question if you answered (e) to Question #4.

Who is your EHR vendor?

1. Allscripts Athenahealth eClinicalWorks Epic

CPSI

Meditech NextGen Oracle Cerner System built in-house Other: (Include free text option for addition of vendor name) Question #16 Skip this question if you answered (e) to Question #4.

Is the EHR version you are using compliant with the most recent ONC-certified criteria for Health IT?

Note: The ONC Certified Health IT Product List (CHPL) is the authoritative, comprehensive listing of Health IT products that have been tested and certified under the Health IT Certification Program administered by the Office of the National Coordinator for Health IT (ONC). Available at: CHPL Search (healthit.gov)

1. EHR does not comply with the most recent ONC-certification criteria for Health IT EHR does not comply with the most recent ONC-certification criteria for Health IT but there is a plan to upgrade to the ONC-certified version EHR does not comply with the most recent ONC-certification criteria for Health IT and there is NO plan to upgrade to the ONC-certified version EHR complies with the most recent ONC-certification criteria for Health IT Question #17 If you selected (d) for Question #16, please answer; otherwise, skip to Question #19.

If you have one Health IT product that meets the ONC Certification Criteria for Health IT, please provide your CHPL ID: Certified Health IT Product List (CHPL) Public User Guide Question #18 If you selected (d) for Question #16, please answer; otherwise, skip to Question #19.

If you have multiple Health IT products that meet the ONC Certification Criteria for Health IT, please provide the CHPL IDs: Certified Health IT Product List (CHPL) Public User Guide Question #19 Which of the following technology-based capabilities does your organization utilize? Please select one option for each of the following capabilities (a) through (o)] in Table 2 (indicate by a “Y” for “Yes” and “N” for “No”). For more information on the certification criteria, please refer to Appendix C – ONC Certification Criteria.

Table 2. Technology-Based Capabilities Used

0. E-Prescribing

Query of Prescription Drug Monitoring

Support Electronic Referral Loops by Sending Health Information

Support Electronic Referral Loops by Receiving and Reconciling Health Information

Provider to Patient Exchange

Syndromic Surveillance Reporting

Immunization Registry Reporting

Electronic Case Reporting

Electronic Reportable Laboratory Result Reporting

Public Health Registry Reporting

Electronic Clinical Quality Measures

Patient Demographic and Health Information

Clinical Decision Support

Physician Order Entry

Exchange electronic health information with, and integrate such information from other sources

Question #20 Does your organization offer a patient portal?

1. Yes, it is part of our EHR vendor products Yes, we are using a third-party vendor No Question #21 Answer only if you selected (a) or (b) for Question #20; otherwise, skip.

Select all features included in your patient portal. Indicate by a “Y” for “Yes” and “N” for “No” for all that apply.

Table 3. Features Included in Your Patient Portal

0. Online Bill Pay

0. Appointment Scheduling and Reminders

0. Secure (HIPAA-Compliant) messaging with provider

0. New Patient Registration conducted electronically

0. Patient’s Ability to Update Demographic Information

0. View, Download, Transmit Medication List

0. View, Download, Transmit Medical History

0. View, Download, Transmit Lab, and Test Results

0. View Resources and Educational Materials

0. Share health information with an external entity

0. Submit patient-generated data from wearable devices (e.g., blood glucose, weight, etc.) into the EHR

0. Link their medical information with an app of their choosing using SMART on FHIR® apps (ex, Apple Health KIT)

Question #22 Answer only if you selected (a) or (b) for Question #20; otherwise, skip.

What percent of your patient population has signed up for a patient portal account?

1. 0%–10% 11%–25% 26%–50% 51%–75% 76%–89% 90%–100% Data Submission Processes Question #23 Answer if you responded “Yes” to Question #2.

Do you transmit data externally in an electronic format to public health agencies or registries?

1. Yes, we have sent production data more than once within the last 12 months Yes, we have sent production data at least once within the last 12 months Yes, but we have not sent production data within the last 12 months We do not have the capability to transmit data to public health agencies or registries N/A Question #24 Dependent on answering “Yes” to Question #2.

Can you electronically query patient health information (examples include medications and outside encounters) from sources outside of your organization or hospital system?

1. Yes No Question #25 Skip this question if you answered (e) to Question #4.

Does your primary EHR have the capability to export multiple records from its system?

Note: This is sometimes referred to as "bulk" export. This functionality enables analytics and reporting, population management, or switching EHR systems.

1. Yes No Question #26 Skip if you answered “No” to Question #25.

If you answered yes [to having an EHR capable of bulk export], have you used this capability to support any of the following? (Please check all that apply.)

1. Analytics and reporting initiatives Population health management Switching EHR systems Identifying and supporting quality improvement activities Have not used the capability yet Other Question #27 Skip this question if you answered (e) to Question #4.

Does your organization conduct or review a security risk analysis as part of your risk management process?

Note: This includes activities like addressing encryption / security of data, implementation of security updates, and/or correcting identified security deficiencies.

1. Yes No Question #28 Are you currently reporting data electronically to any federal or state government quality improvement initiatives (e.g., Medicare programs, CMS Innovation Center models, or Medicaid programs)?

1. Yes No Question #29 How do you use FHIR® in your organization? Select all that apply.

1. Quality Measurement submission Prior Authorization SMART on FHIR® patient apps FHIR® Bulk Data Exchange Clinical Decision Support (i.e., CDS Hooks) Conducting analytics and populating dashboards Health Information Exchange to external entities Other, please specify:

Do not utilize FHIR® Question #30 Answer only if you selected “Yes” to Question #12.

If you participate in Medicare Advantage (MA), do you submit electronic clinical quality measure data to managed care organizations?

1. Yes No Question #31 Excluding Medicare Advantage, do you submit electronic clinical quality measure data to other payor organizations?

1. Yes No Question #32 Answer if you selected “Yes” to Question #31.

If you answered “yes” to submitting electronic clinical quality measure data to other payor organizations, please indicate which of the following organizations receive eCQM data.

1. Non-Governmental Organization Centers for Medicare & Medicaid Services (CMS) Centers for Disease Control and Prevention (CDC) Health Resources & Services Administration (HRSA) Other (please describe):

Question #33 Answer if you selected “Yes” to Question #2 and Question #28.

If you currently report data electronically to federal or state government quality improvement initiatives (e.g., Medicare programs, CMS Innovation Center models, or Medicaid programs), can you analyze quality reporting data prior to submission?

1. Yes No Question #34 Answer if you selected “Yes” to Question #2.

What is your level of participation in a state, regional, and/or local health information exchange (HIE) or health information organization (HIO)?

1. HIE / HIO is operational in my area, and we are participating and actively exchanging data in at least one HIE / HIO HIE / HIO is operational in my area, but we are not participating HIE / HIO is not operational in my area Question #35 When a patient transitions to another care setting outside of your organization or hospital system, what is the frequency (indicate by a “Y” for “Yes” and “N” for “No”) with which you use the following methods to SEND the summary of care record?

Table 4. Frequency of Use of Methods for Sending Summary of Care Record

0. Mail or fax eFax using EHR

Provider portals that allow outside organizations to view records in your EHR system

Interface connection between EHR systems (e.g., HL7 interface)

Login credentials that allow access to your EHR

HISPs that enable messaging via direct protocol

Regional, state, or local HIE / HIO

EHR vendor-based network that enables exchange with vendor’s other users (e.g., Epic Care Everywhere)

National networks that enable exchange across different EHR vendors (e.g., Common Well, eHealth Exchange, Carequality)

Other (please specify)

Question #36 When a patient transitions to another care setting outside of your organization or hospital system, what is the frequency (indicate by a “Y” for “Yes” and “N” for “No”) with which you use the following methods to RECEIVE the summary of care record?

Table 5. Frequency of Use of Methods for Receiving a Summary of Care Record

0. Mail or fax eFax using EHR

Provider portals that allow outside organizations to view records in your EHR system

Interface connection between EHR systems (e.g., HL7 interface)

Login credentials that allow access to your EHR

HISPs that enable messaging via direct protocol

Regional, state, or local HIE/HIO

EHR vendor-based network that enables exchange with vendor’s other users (e.g., Epic Care Everywhere)

National networks that enable exchange across different EHR vendors (e.g., Common Well, eHealth Exchange, Carequality)

Other (Please Specify)

Question #37 Skip this question if you answered (e) to Question #4.

Can you use existing FHIR® Profiles that EHRs and other systems may already be producing (for example, FHIR® US Core)?

1. Yes No Data Mapping Question #38 Skip this question if you answered (e) to Question #4.

The following three questions assess the completeness and accuracy of your internal EHR data to determine if you can rely on your EHR to report FHIR®-based quality data to an external organization.

Note: Internal data mapping is critical to ensure accuracy, consistency, and integration of data as it moves from your internal Health IT systems to external systems. One way to ensure data integrity is to ensure all data is properly mapped to the appropriate code systems.

Question #38a What percentage of medications from orders, dispenses, and administrations are mapped to either RxNorm or National Drug Codes (NDC)?

1. 0%–25% 26%–50% 51%–70% 71%–80% 80%–90% 90%–100% Question #38b What percentage of diagnoses entered in visits or admissions are mapped to the most recently implemented version of International Classification of Diseases (ICD) codes?

1. 0%–25% 26%–50% 51%–70% 71%–80% 80%–90% 90%–100% Question #38c What percentage of lab tests and results are mapped to LOINC codes?

1. 0%–25% 26%–50% 51%–70% 71%–80% 80%–90% 90%–100%

Acronyms and Definitions

Appendix A – Survey Script Decision Tree Figure 2 identifies the question logic and specific Foundational and Technical questions used to assign respondents to Technical Readiness Tiers 0, 1, 2, and 3. Foundational, Technical, Administrative, and Operational Readiness questions are equally important and necessary to provide a holistic view of the organization’s readiness to transition their systems and infrastructure to access, share, and use data for quality improvement.

Figure 2. Survey Script Decision Tree (Detailed View) Appendix B – Question List by Category Table 6. Question List by Category Categories / Question #

General and Foundational Questions

Precedent to #s13, 15, 16, 25, 27, 37

Organizational Structure Questions

Resource Availability Questions

Operational Readiness Questions

Technical Readiness Questions

Architecture

Infrastructure

Dependent on #s3, 4

Data Submission Process

Dependent on #4

Appendix C – ONC Certification Criteria Table 7 presents the applicable Health IT capabilities and corresponding ONC certification criteria. Meeting all certification criteria (when more than one is specified) is not necessary but encouraged.

Table 7. ONC Certification Criteria

§170.315(b)(2) Promoting Interoperability

§170.315(g)(7) §170.315(g)(8) §170.315(g)(9) §170.315(g)(10) Promoting Interoperability

§170.315(f)(7) Promoting Interoperability

§170.315(c)(2) §170.315(c)(3)(i) and (ii) §170.315(c)(4) (optional) Promoting Interoperability

§ 170.315(a)(14) ONC Base EHR

§ 170.315(g)(7) § 170.315(g)(10) § 170.315(g)(9) § 170.315(h)(1) § 170.315(h)(2) ONC Base EHR

Appendix D – Readiness Assessment Methodology and QIO Use Case Background and Purpose The Readiness Assessment is an online questionnaire for providers to assess their readiness to transition systems and infrastructure to access, share, and use data for quality improvement. The Readiness Assessment is designed to be easy to understand, broadly applicable, and useful for collecting actionable responses to support design of interventions.

An important purpose of the survey is to ensure that providers in underserved areas can use modern information technology (IT) systems for data collection and advanced analytics to improve quality of care and health outcomes. While originally intended to support providers in underserved areas, the survey is applicable for all providers and does not specifically target an underserved population (either Health Professional Shortage Area (HPSA), A Medically Underserved Area (MUA), or Medically Underserved Population (MUP). QIOs can administer the survey to any provider.

The scope of the Readiness Assessment includes general, administrative, resource availability, operational, and technical questions, which encompass the many organizational factors that can influence development of a quality improvement and technological infrastructure. The array of questions contributes to a holistic assessment of a provider’s capability to transition systems and infrastructure for quality improvement. The Readiness Assessment categorizes the questions as follows:

General and Foundational. Includes points of contact and basic infrastructure for participating in quality measure capture and transmission.

Organizational Structure. Includes culture, leadership, operational staffing, and barriers to developing technological infrastructure.

Resource Availability. Includes quality improvement and technology staffing as well as in-house technological capability.

Operational Readiness. Includes operational assessments and analyses to help the provider build an appropriate technological infrastructure.

Technical Readiness. Includes identification of technological capabilities to support transition to access, share, and use data for quality improvement. This category includes the software, hardware, technological workflows, system architecture, technological infrastructure, data submission processes, and data mapping that support quality improvement activities.

The Technical Readiness questions include questions whose answers associate a Technical Readiness Tier to respondents for measurement over the 5-year assessment period. The answers to these questions allow QIOs to:

Measure and track progress across Tiers over time Identify skill sets needed to support providers Help allocate resources to support technical assistance and interventions Group providers to create standardized interventions Table 8 details the provider characteristics associated with each Technical Readiness Tier.

Table 8.Provider Characteristics for Technical Readiness Tier

In-scope questions for the Readiness Assessment include any topics that support QIO technical assistance or interventions such as technological, administrative, operational, or resource areas of provider operations. Out-of-scope topics include information likely to be currently available to QIOs such as provider or clinician demographics (e.g., location, tax identification number, and size of practice.) and patient demographics (e.g., age and insurances).

Once the final survey is drafted and available, CMS teams will develop a final survey in an online tool. QIOs will then administer the assessment to providers and clinicians, assess results, support development of improvement / intervention plans, and track progress.

If a provider determines they do not have sufficient internet speed or bandwidth to support survey administration, the QIO will work with the provider to consider how to administer the Readiness Assessment using other methods.[footnoteRef:2] [2: In the Readiness Assessment survey, Question #2 asks respondents about internet speed: “Does your organization have sufficient internet connectivity to support operations?” We considered using “broadband” and specific megabits per second (Mbps) speeds in the question to understand provider internet capability. The term “broadband,” however, is vague and defined differently by local, state, and federal agencies. In addition, entities and agencies vary in internet speed (Mbps) to achieve various levels of data exchange across geographies. Accordingly, QIOs and respondents likely will have a different understanding of the term “broadband” and respondents may not consistently measure internet speed with standardized tools. The survey therefore does not inquire about “broadband” specifically but asks respondents about the capability of internet to support operations as a proxy for their understanding of internet capability. Question #2 is not solely responsible for assigning respondents to a specific Technical Readiness Tier; rather, it is one of three questions that assess a base level of capability for Tiers 0 and 1.]

5-Year Assessment Period CMS plans to administer the Readiness Assessment survey at…