D.20 eQM Portal and Report User Guide, 36C25522R0052.pdf

ELECTRONIC QUALITY MEASURES (eQM) – Portal and Report User Guide

Office of Reporting, Analytics, Performance, Improvement & Deployment (RAPID-10EA) Performance Measurement

August 2017

D.20 eQM Portal and Report User Guide, 36C25522R0052

ELECTRONIC QUALITY MEASURES (eQM) – Portal and Report User Guide 2

Table of Contents Introduction to Electronic Measurement

The eQM Portal eQM Reports

Annual Progress Report

Available Measures by Year Report

Hospital Case Report

Organizational Performance Report

Patient Care Outlook Report

Excel Template for Cube Analysis

Dimensions

Connectivity Information

Scoring & Specifications

Selection Screen

Patient Result Detail Lists – Excluded, Passing or Failing Patient Lists

Patient Look up Pass or Fail

Information Tabs

Other Actions

Tabular View

Introduction to eMeasurement

Measure Roadmap eQM FAQs

Support

Office of Performance Measurement - Website

Educational Material

Help Desk

How to Request Data Access

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Introduction to Electronic Measurement As the nation’s largest integrated health care provider, supported by a world-class electronic health record (EHR) system, the Veterans Health Administration (VHA) is a recognized leader and pioneer of tools and techniques that enhance patient care. The Performance Measurement (PM) Office manages clinical quality measurement tools as well as the collection/reporting of core performance data for VHA, including the External Peer Review Program (EPRP) and Survey of Health Experiences of patients (SHEP).

Since the mid-1990’s VA has relied on EPRP to generate clinical performance measures using manual abstraction and sampling of individual medical records. The VA now has a robust electronic Health Record (EHR) based on facility based VistA systems (Veterans Health Information Systems and Technology Architecture) that include standardized patient information. The Vista data from all VHA facilities are pooled in the VHA Corporate Data Warehouse (CDW) providing a system resource with clinical information for all Veterans receiving care in the VHA. We are utilizing the CDW for electronic quality measurement –for nationwide, automated extraction of VHA electronic quality measures.

Electronic quality measurement provides significant benefit as it is an efficient and reliable mechanism to access clinical quality for all VHA patients. The PM Office has begun a process of migrating current EPRP based measures to electronic measures. The challenge is the availability of the standardized electronic data elements so that electronic quality measures can be calculated in a valid and reliable manner as is the case with EPRP based measures. The benefit is the calculation of measures for the entire Veteran population rather than estimating scores based on a sample of abstracted records. This information is updated daily so that management and front line staff can access current measure information to monitor how they are performing at all levels of the organization - including at the patient and provider level.

The eQM scores are updated daily and calculated differently than abstracted data.

The outpatient eQMs utilize a cumulative rate calculation (Fiscal Year (FY) will begin at 0%) for the full VHA-enrolled population; whereas, abstracted data is calculated for a sample of established VHA users who visit specified clinics during an EPRP review month. Inpatient eQMs are calculated based on inpatient discharges documented for a facility in the FY. Tools and reports have been created to assist end users with viewing and utilizing the data. *Note: although eQM data processing is on a daily update schedule, there are times due to various reasons where daily updates may be delayed. Significant delays will be communicated on the eQM portal.

http://www.ehealth.va.gov/VistA.asp https://vaww.eqm.cdw.portal.va.gov/Pages/default.aspx

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Interactive Algorithm (see Reports below)

The primary tool for interpreting measure results is the Interactive Algorithm. This interactive tool allows users to view (either in a graphic process flow diagram or in tabular format) a score calculation from the top of the VHA organization all the way down to an individual patient level score.

Graphical Process Flow View

Tabular View

This revolutionary tool allows users to see the details of every data element and decision point, while providing the measure requirements and the data source used (e.g. CDW).

The eQM platform also contains many reports to serve the individualized needs of all levels of data consumers - from Network Directors to front line providers and PACT team leaders. These reports provide data to help bridge the gap between organizational performance and individual patient metric qualifiers by providing both general and the granular-level data that can be incorporated into daily practice.

The eQM Portal provides regular status updates on the development and implementation of existing, new and upcoming electronic quality measures via the “Measure Roadmap.” Links to reports and educational materials are also provided on the portal home page.

https://vaww.app.dev.dwh.cdw.portal.va.gov/OABI_EQM/Prod/App/Launch.aspx?ResourceKey=IADashboard https://vaww.eqm.cdw.portal.va.gov/Pages/default-old.aspx https://vaww.eqm.cdw.portal.va.gov/Pages/roadmap.aspx

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The eQM Portal

There are five main components on the eQM Portal:

1. eQM Announcements - All announcements related to the eQM data program can be found in this section with date located to the right. Please read this section for details related to major updates and changes.

2. eQM Reports – This section lists all the current available reports.

3. Scoring & Specifications –This section contains links to scoring details of measures that may be found in both the Interactive Algorithm and electronic Technical Manual (eTM)

4. Getting to Know eMeasurement – Resources related to the electronic measurement program and status of the current set of electronic quality measures.

5. Support – Resources available to learn more about the eQM program, portal, and reports and data.

The items found in each of these sections are described in more detail in the remainder of this document.

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Report Footers

All reports include an ‘Executed by’ followed by user domain and date/time. This field represents the user who generated the report and the date/time it was generated.

The second date/time represents the ‘Report data generated.’ This is the date and time the data was last refreshed in the eQM system.

Layout:

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Annual Progress Report This report is displays a graphical representation of an organization’s/individual’s progress toward meeting the requirements of a measure. Results are available down to the Provider level (if you have the necessary security privileges). For specific details on an eQM’s numerator and denominator, please see the Interactive Algorithm.

Selections

Measure: One measure may be selected.

Evaluation Period: One selection is available.

VISN and Facility: One selection each available and viewable by any User Division, Team and Provider: Options are only available to users with proper security access.

Note: Please make selections left to right, top to bottom order.

Report Layout

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Available Measures by Year Report

This report is displays all the existing electronic Quality Measures that currently in production and their availability by fiscal year.

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Hospital Case Report This report includes only inpatient measures. It contains the case level breakout by Fiscal Year/month and is the same data found in the Interactive Algorithm.

Measure: One measure may be selected.

VISN and Facility: One selection each available and viewable by any User

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Organizational Performance Report

This is an “all-facility” report that displays progress toward meeting the requirements of a measure or set of measures.

Numeric scores are available down to the Division level.

Measure: Multiple measures may be selected.

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Patient Care Outlook Report

The Patient Care Outlook (PCO) displays key performance factors for eligible measures across a cohort of patients. The PCO contains three (3) views: summary, panel and patient.

Selections

VISN: One selection each available and viewable by any User Facility, Division, Team and Provider: Options are only available to users with proper security access.

Gender: Male, Female or All. Option is only available to users with proper security access.

Appointment: Selection results are based on any appointment in VHA. Options include ‘Ignore Appointment Status’ ‘Appointment Next Day’ ‘Appointment in Next 7 Days’ ‘Appointment in Next 30 Days’ ‘No Next Appointment Scheduled’ ‘Any Next Appointment Scheduled.’ Option is only available to users with proper security access.

Patient SSN List (Comma Separated): Options allows Users to enter full SSN into slicer and renders an individual report.

Option is only available to users with proper security access

The report renders a maximum of 100 patients in any view.

Summary View; Displays the most recent three years of data based on the selections in the filters. Measures that are applicable will have data displayed and measures which are grayed maybe be due to inactive for a given period not applicable in a given year. Users may hyperlink to the Interactive Algorithm (Alg) or Annual Progress Report (FYQTR).

Users may click on the measure name to directly link to the most recent specification in the electronic Technical Manual.

This view also includes benchmark data for national and facility for the most current two years. The denominator is displayed for each measure based on filter selections. Patients included in the Summary View are displayed on the left side of the report and users may select any patient for a Patient View. ‘Patient Mix based on Filter Selections’ is available on this view at the bottom of the report. It includes gender make-up, age distribution and the total number of patients based on the filter selection and of those patients the number eligible for at least one (1) measure.

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Panel View: Displays the filter selections for measures active in the current fiscal year. It includes all outpatient measures with a score and evidence including date found in the electronic data source for patients included in the measure population.

Patient View: Displays the most current measures scored for the individual patient over the past three (3) years.

Measures which are not passing are represented with a red ‘fail’ indicator. Measures which are ‘lower is better’ have an asterisk to alert users to lower is better as well as the ‘pass’ indicator is red. The most current two (2) years includes ‘Evidence and Evidence Date’ which displays data which is found to meet the measure. The Evidence field is only populated if the measure is in a ‘fail’ status. The ‘Score’ column may contain a Pass/Fail or in instances of median time based measures the ‘Score’ column may represent a time. Users may hyperlink out of the report to the Interactive Algorithm (for selected patient). The top of the report includes patient SSN, date of birth, age and gender. It is organized by outpatient measures followed by inpatient measures. At the bottom of the report is information regarding their primary care assignments including the division, team and provider found in PCMM Web/RPCMM. The start and

ELECTRONIC QUALITY MEASURES (eQM) – Portal and Report User Guide 13 end date of three most recent primary care providers. The last date the patient had a visit in the VHA as well as the patient’s next appointment, if available.

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Excel Template for Cube Analysis *Currently in Beta*

The eQM Excel Template for Cube Analysis contains aggregate information across several key dimensions of data and is designed for analytical scenarios only. Note that patient level data is not included, and users who require patient level must use one of eQM's canned reports.

Scope of Data: The cube contains the same measures (inpatient and outpatient) and time periods available in the eQM canned reports. Although patient data isn't available, patient demographics are, so users can slice/pivot by gender, age, etc.

Refresh Frequency: The cube is updated on the same schedule as the rest of the platform, typically nightly. To refresh the Excel pivot table, select the Data tab on the ribbon, and choose Refresh All.

Dimensions Evaluation Period: Defines the time period in which a measure analysis is performed. Typically this represents an entire year (outpatient), but some measures are naturally calculated quarterly (inpatient). For outpatient measures, Evaluation Period can be drilled down to the cumulative snapshot level (a point in time calculation, representing an annual measure calculation as of a specific day within the year). Keep in mind, showing outpatient measures down to the quarter is for PY comparison and consistency purposes and does not represent an actual quarter's worth of data.

Measure: Defines a clinical quality measure, such as c9h_ec. A measure can be selected either by its name, or through the category hierarchy which groups similar measures by subject area. Please note that aggregations at the category level are not support and will display a "N/A".

Organization: The organization dimension represents the VA organizational hierarchy from the National level all the way down to Teams and Providers. Patients are assigned to zero or more Providers through PCMM. If no assignment is found, they are assigned to a division based on visit frequency within the previous year. If multiple assignments are found, each providers (and associated ancestors like facility and VISN) are credited with the patient. The recommended method of navigating Organization is through the Primary Care hierarchy.

Patient Demographics: Represents common demographic attributes for patients (i.e. age and gender). Since the cube does not include patient data, this dimension should be used for patient focused analysis.

Population Criteria: Population Criteria is only applicable for measures whose specification stratifies the population when evaluating outcomes, or for measures that include multiple population definitions. Most measures do not use this dimension, but for those that do (i.e. DMS) use of this dimension is required only if further stratification is needed.

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The eQM Excel Template for Cube Analysis comes with 2 examples on how to create common reports with the eQM OLAP cube. These examples are located on separate worksheets shown as tabs in Excel – Organization Performance and Annual Progress reports. These examples are formatted to show how to create views similar to the Organization and Annual Progress reports located on the eQM platform in Reporting Services. These are suggested areas to start working with the Excel Template when building custom views for ad-hoc analytics.

Example from Annual Progress Report:

Connectivity Information This template is already connected to the eQM Cube and can be used for further customized analysis. However, if you want to create a new Excel connection, please follow these instructions.

1) In Excel, click on the Data ribbon; choose From Other Sources, then From Analysis Services

2) Enter the Server, Database, and Cube information below.

3) Click Next/Finish to complete the wizard.

4) Select a cell to insert the new Pivot Tables (i.e. $A$1)

Server: VHACDWSQL03

Database: OABI_EQM

Cube: eQM Analytics

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Scoring & Specifications

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Interactive Algorithm

This tool has been developed for users to walk through how each measure is evaluated, beginning with the Initial Patient Population (IPP) in the outpatient measures and Qualifying Encounters in the inpatient measures and all the steps involved with defining the denominator and numerator that results in the scoring of patients eligible for the measure.

The Interactive Algorithm can be adapted to show the current score calculation process, by measure, by organization level – including Team or Provider level (outpatient measures). For instance, a user can select a specific team in their facility, and be able to see how the measure includes/excludes patients throughout the scoring process, and ultimately see whether those patients passing or failing the measure.

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Interactive Algorithm (continued)

There are several tools and tips will assist you in understanding how to use the algorithm tool.

Selection Screen

To view any algorithm, both the actual measure of interest and the year of interest must be selected.

The next step in viewing the Interactive Algorithm is to select a specific population of interest which is defined by the VHA organization level. The outpatient measures within the Interactive Algorithm allow users, depending on security permission, the ability to drill down to patients within VISN, facility, division, team and provider panels. Inpatient measures do not drill down to provider panels. The slicer name which contains organizational hierarchy is ‘Hospital’ when viewing inpatient measures and Primary care VHA when viewing outpatient measures.

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Selection Screen

Once the organizational level is selected, the algorithm graphic will display in the adjacent screen to the left – with the numerator and denominators specific to that facility level selected.

Patient Result Detail Lists – Excluded, Passing or Failing Patient Lists

The algorithm tool provides a final drilldown list of patients who are a part of a result set (excluded, passing, failing etc.).

A detailed list of cases can be downloaded by clicking on a result symbol (circle) graphic, then clicking on the “Data” tab in the area below the filters. Lastly, select Drilldown and an Excel export will initiate. The resulting Excel file can be saved in a secure location in accordance with national and local security protocols.

Step 1: Click on the Pass or Fail circle Step 2: Click on the “Data” tab and select drilldown.

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Patient Look up Pass or Fail

Lastly, the tool provides a patient look-up feature, whereby the user may enter the patient SSN and see if the patient is currently passing or failing the measure.

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Information Tabs

General – Clicking on an element of the algorithm graphic will display the general label and/or meaning of that element.

Includes the specification of the data element.

Implementation – Displays information related to where the data is sourced electronically (i.e. CDW tables)

Value Sets – Displays information about data sets where available

Data – Provides drilldown actions where available.

Other Actions

Right Arrows – clicking on right arrows expands the content behind the box, providing more detail.

Down Arrow – clicking on down arrows hide the detail in the open detail box

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Tabular View Clicking on the Tabular tab will display the algorithm in a spreadsheet format. This provides more information in a text format.

Electronic Technical Manual (eTM)

This link takes the user to the online technical manual where measure details can be obtained. All the information related to measures, their definitions, rationale, references and scoring are located in the eTM.

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Getting to Know eMeasurement

Introduction to eMeasurement

This link opens a window that describes VHA’s current status in regard to electronic measurement. Some key concepts are discussed and general information about the eQM system is provided to give the user background on where VHA is and what the future of eMeasurement will look like.

Measure Roadmap

This document provides the most current information about eQMs in production, those under development as well as information about measures that have been retired. It includes hyperlinks to the eTM for each measure listed, if available. The measure links may include both eQM and External Peer Review program (EPRP) versions of the specifications.

eQM FAQs This link takes the user to a website listing eQM Frequently Asked Questions.

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Support

Office of Performance Measurement - Website Link to RAPID’s Performance Measurement website.

Educational Material Contains a set of education materials that explain the eMeasurement program in general and specifics on VHA’s eQM Portal, Tools and Reports.

Help Desk A link is supplied that when clicked on, will open a ticket on the eQM Help Desk.

How to Request Data Access Instructions for how to apply for access either local patient level access, or if a national quality specialist, access to the national databases.

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