J.3_List_of_IT_Systems_Narrative.docx

Attachment J.3- List of Information Technology Systems

HHSM-500-2014-RFP-QIN-QIO

Systems / Tools from the QIN-QIO SoW Health Care Quality Information Systems (HCQIS) (formerly known as HCQIS – Standard Data Processing Systems)- The Health Care Quality Information Systems (HCQIS), implemented in 1997, supports the Quality Improvement Organization (QIO) Program and Centers for Medicare & Medicaid Services (CMS) community. Prior to HCQIS, each QIO was responsible for developing solutions to meet the management and reporting requirements of the Statement of Work (SoW). Besides the obvious inefficiencies of redundant systems and costs, each QIO had different competencies during that period. Since the inception of HCQIS, the functions of HCQIS have encompassed support, standardization and development of data, software and standards for the QIO community. HCQIS continues to rapidly evolve with innovative technology to meet the challenges of supporting and interfacing directly with the QIO community and surrounding healthcare industry.

Quality Improvement Organization System Tools QIONet - The QIONet is an Intranet site that provides centralized communications among QIOs and CMS leaders related to all operational aspects of the QIOs' Scope of Work, as well as the Health Care Quality Information Systems (HCQIS) that supports it. This site is only available to users on HCQIS computers within the HCQIS Wide Area Network.

The goal of the QIONet is to provide the tools, functionality and information that will assist in the management and improvement of QIO/CMS programs. QIONet contains HCQIS memos, Transmission of Policy (TOPS) memos, forms, user guides, access to WebEx training videos and resources, technical information such as data dictionaries and data models and access to subscribe to Lyris ListServe.

Posting of content on QIONet is managed by a CMS contractor.

Case Review Information System (CRIS) - CRIS allows QIOs to track medical records within their organization and record online case review results for Diagnostic Related Groups (DRG), Quality, Utilization, Beneficiary Complaint, Hospital Issued Notice of Noncoverage, and EMTALA. The timeliness of review by QIO staff is tracked through reports generated from CRIS. The CRIS Helpline module allows QIOs to record and track their Medicare beneficiary Helpline activities.

CRIS utilizes claims and beneficiary data stored in the HCQIS warehouse. CRIS also utilizes provider, practitioner, Medicare Advantage Plan, Medicare Administrative Contractor and Prescription Drug Plan data stored in the Program Resource System application on an HCQIS database. When monthly claims are received from CMS, records meeting criteria for selection as a Higher Weighted Diagnosis Group are identified and loaded to the CRIS application.

The Quality Management and Review System (QMARS)- is a commercial off-the-shelf (COTS) web-based application that can be easily configured to track medical case review performed by the Quality Improvement Organizations (QIOs). It was necessary to design a case review system that fully meets CMS’ needs as defined in Part B of Title XI of the Social Security Act as amended by the Peer Review Improvement Act of 1982 and 42 CFR Part 475 – 480 because the old system was not web-based, which does not comply with the Center for Medicare and Medicaid’s (CMS’s) technical reference architecture (TRA).

QIOs are private, mostly not-for-profit organizations, which are staffed by professionals, mostly doctors and other health care professionals, who are trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. They will use the QMARS application to track these medical reviews in a timely manner, which in turn will be measured by CMS through QMARS reports.

Deliverable and Data Submission Tool (DDST) - The DDST is a Web application developed for the Quality Improvement Organization (QIO) 10th Statement of Work. DDST will allow QIOs to upload their deliverables and to track other required information. It will permit the applicable Contracting Officers Technical Representative (COTR) to acknowledge, reject or approve the QIO submitted deliverables.

National Healthcare Safety Network (NHSN) - A secure, internet-based surveillance system that integrates patient and healthcare personnel safety surveillance systems managed by the Division of Healthcare Quality Promotion (DHQP) at Centers for Disease Control (CDC). NHSN has the capacity for healthcare facilities to share data in a timely manner between healthcare facilities (e.g., a multihospital system) or with other entities (e.g., public health agencies or quality improvement organizations).

The NHSN is the data source for the Healthcare Associated Infections (HAI) measures. The National Coordinating Center downloads data for the measures, performs analysis and the results are loaded to the Deliverable and Data Submission Tool (DDST) for measure reports.

Collaboration Tool - The Collaboration Tool is used to support health centers in maximizing opportunities to collaborate with other health care safety net providers.

The HRSA Patient Safety and Clinical Pharmacy Services (PSPC) module provides data for the adverse drug events (ADE) measure. The data is extracted from HRSA PSPC by the National Coordinating Center (NCC) and loaded to the Deliverable and Data Submission Tool for measure reporting.

Data Repository – The proposed data repository will assist the NCC’s in monitoring trends and performing business analytics. This tool configuration and implementation have yet to be finalized.

Minimum Data Set (MDS) - is part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems. jRAVEN is the data entry software, which Nursing Homes and Swing Bed providers may use to collect and maintain the MDS 3.0 assessment, resident and facility data and create the MDS 3.0 submission files for subsequent submission to the appropriate state and/or national data repository The Quality Improvement and Evaluation System (QIES) contractor downloads Pressure Ulcer and Physical Restraint nursing home data for the Healthcare Acquired Conditions (HAC) measures. The data is provided to the National Coordinating Center (NCC) for analysis and analytic results are loaded to the Deliverable and Data Submission Tool for measure reports.

Program Resource System (PRS) - PRS is the storage area for all physician, health service provider, and beneficiary, Medicare Advantage (MA), Prescription Drug Plan (PDP), and Medicate Administrative Contractor (MAC) information for every state. It is considered the center of the QualityNet data system because other applications link to PRS as a data source. QIOs have the ability and responsibility to update fields in PRS to keep it as current as possible.

Data received monthly from CMS is loaded to PRS. The files include individual physician and group physician data from PECOS; health service provider from CASPER; Medicare Advantage and Prescription Drug Plan from HPMS. Medicare Administrative Contractor records are added to the database by the CMS contractor when a new MAC is identified.

Administrative Warehouses (HCQIS HSE) - The HCQIS HSE claims warehouse is used for collection, storage, processing and reporting to include Inpatient (IP) and Ambulatory Surgical Center Outpatient/Part B (ASC OP/PTB) claims data received from CMS. The information is used by Quality Improvement Organizations (QIOs) for ad hoc research and analysis requests for their assigned states and by the Case Review Information System (CRIS) product for medical case reviews. Designated QIO staff has roles to access the claims data via ad hoc tools.

Two TAP files, an Ambulatory Surgical Center Outpatient/Part B (ASC.OP/PTB) claims file, and an Inpatient (IP) claims file, are received monthly from CMS. Reference code files, received annually from CMS, are also used as input to this processing. Data is split into several files for processing, and loaded to the HCQIS HSE claims warehouse database.

HCQIS HSE claims data is stored for 42 months. A monthly roll off process determines the records to be removed from the database, based on specific date checks and other criteria. Claims utilized in case review (CRIS) are not rolled off.

Administrative Warehouses - Health Account Joint Information (HAJI) Part A and Part B - Monthly load processing begins when CMS has created the monthly HAJI Part A and Part B claims TAP file, and made it available on the CMS ENDEVOR mainframe. It is a copy of the source data from the NCH (National Claims History) database for CMS. The file is normally created on the 15th of the month. HCQIS Production Support backs up the monthly tape, and then executes the COBOL procedures to prepare the files for HCQIS. HCQIS Production Support backs up the HCQIS network HAJI warehouse server directory and uses SCP to transfer the HAJI files to the HCQIS HAJI server directory. Record counts and byte counts are verified for all files. After verification is complete, the SQL*Loader processing loads the HAJI Claims files from the HAJI warehouse server directory to tables on the HAJI Administrative Warehouse database. After the load processing has completed, record counts are again verified, comparing NDM counts to counts from the SQL*Loader processes. Final action processing determines the most recent activity for all claims.

The following types of claims used by HAJI:

· Part A:

· Inpatient (IP)

· Swing Bed/Skilled Nursing Facility (SNF)

· Outpatient (OP)

· Home Health Agency (HHA)

· Hospice (HPSC)

· Part B:

· Carrier (physician/supplier) QIOs do not have direct access to the HAJI data. Requests for ad hoc data must be submitted via the module in Remedy.

Administrative Warehouses (EDB) – Monthly load processing begins when CMS has created the beneficiary enrollment data on their mainframe. Processing of the data is similar to HCQIS HSE claims and HAJI Part A and Part B claims.

Access to Medicare enrollment information is necessary for the proper functioning of the Part A and Part B databases in order to associate claims with beneficiaries. However, no enrollment information is stored in the Admin Warehouse as it pertains to Part A and Part B. Therefore, those databases must access the Enrollment Database, which is located on the HCQIS Claims Warehouse, for enrollment information.

Designated QIO staff has roles to access the claims data via ad hoc tools.

Administrative Warehouses (Prescription Drug – Part D) - Monthly Part D Claims load processing begins when CMS has created the Part D claims file, and made it available on their mainframe. HCQIS Production Support backs up the Part D Claims File and executes the COBOL processing to prepare the file for HCQIS processing, then NDMs the file down to the HCQIS Network Claims Warehouse Server. Record counts and byte counts are verified. Once the files are placed on the database server, they become visible to the load programs via the external table definitions within Oracle. Analytical data integrity checks are performed on the Part D claims data. After data integrity checks are completed, and approved by CMS if applicable, HCQIS Production Support executes the monthly load package to add/update the claims data to multiple tables on the Administrative Warehouse Part D Claims database. The monthly process also includes final action processing.

QIOs do not have direct access to the Part D data. Requests for ad hoc data must be submitted via the module in Remedy.

Program Progress Reports - The Program Progress Reports (PPR) application is designed to allow CMS, QIOs, and CDACs to run and view reports from data entered on the centralized national database via the HCQIS applications (CRIS, CATS, PRS, and the QIO Clinical Warehouse.) The PPR provides a user-friendly interface for QIOs, CDAC, and CMS to request, view, and print reports. The Reports section is used to request reports by selecting a report ID, entering retrieval criteria, and submitting the report to run in the background without tying up the user’s computer. The Folders section is used to view, print, save, and export completed reports.

The PPR application is accessed from the QIOnet under Dashboard/ Reports | Program Progress |Program Progress Reports.

Financial Information and Vouchering System (FIVS) – FIVS is a vouchering system utilized by QIOs to record data regarding labor costs associated with Case Reviews and to submit their monthly vouchers.

Enterprise Tools Used by QIO and Hospital Reporting Online Access Request System (OARS) - OARS provides Security Administrators with a web-based tool to enter, update and manage user accounts and application security online. OARS utilize the secure pages of QualityNet, My QualityNet, for gathering user account information and access roles. Once entered and approved, user account information and roles are replicated to the appropriate security systems by polling procedures that run on the production databases. The polling procedures contain the business logic required to translate selections on the My QualityNet screens into the required security table entries and application database roles. Consolidation of all user account and access information in a single location provides data for management reports that provide a consolidated view of application access for individuals within an organization.

ListServe- ListServe is a method used to create and maintain point of contact (POC) lists. The POC lists can be used to distribute HCQIS memos, TOPS and National Coordinating Centers (NCC) documentation and to facilitate additional communication activities. ListServe provides QIO, CMS and CDAC users the ability to subscribe to any of the open HCQIS POC lists. There is no limit on the number of users per organization who may subscribe to the open POC lists.

It is necessary to restrict some of the POC lists. Members of the restricted POC lists will be maintained by CMS or HCQIS staff, depending on the specific lists. Members of the restricted POC lists are subject to approval by the list administrator (specified CMS or HCQIS staff). Notify Only and Discussion lists have been created for each POC group. Notify Only lists will allow members to receive all HCQIS memos, TOPS and NCC documentation sent to the list, but not all messages generated by discussion from the members. Discussion lists will allow members to participate in discussions with other members of the list. Users may subscribe to either the Notify Only or the Discussion lists or both.

QualityNet - The purpose of QualityNet is to improve the quality of care for Medicare beneficiaries through increased efficiencies in information exchange.

QualityNet.org is the public website that provides general information, resources and tools to the communities (Hospitals, Physician Offices, Nursing Homes, ASCs etc.).

Users sign in to the secure, non-public functions of QualityNet from the public QualityNet.org website. Upon signing into the secure area of QualityNet, My QualityNet, registered QualityNet users can access several secure functions depending on the roles they have been assigned. Examples of these functions include Vendor Authorization, Report Authorization, Online Pledging, Population and Sampling, etc.

QualityNet Navigation Framework - Users of the stakeholder communication portal (aka QualityNet Navigation Framework) need access to vetted healthcare quality improvement news, resources and data reporting tools and applications, and an easy way to access the HCQIS applications that they have permissions to use. The stakeholder communication portal allows users to log into the secure personal web portal and see the links for the HCQIS applications that they can use.

The stakeholder communication portal includes the following functions:

Access healthcare quality improvement news and resources Users can access program specific healthcare quality improvement news and resources.

Access secure area of Stakeholder Communication Portal (Secure Personal Web Portal) Users can log in and out of the secure area of the Stakeholder Communication Portal (Secure Personal Web Portal).

Accessing HCQIS Applications Authenticated users can see the My Tasks area of the Secure Personal Web Portal and can click on links to applications that they have permission to use. These links are based on roles provided in the User Role Management System.

Viewing Alerts and News Users can view Alerts and News from the Secure Personal Web Portal page.

Providing Consistent Navigation The Navigational Framework provides a common header and footer that are used in HCQIS applications so users can navigate from the applications back to the Secure Personal Web Portal as well as accessing information in the common headers and footers.

QualityNet File Exchange - File Exchange provides secure, real-time communications and data exchange between two or more organizations, including hospitals, Quality Improvement Organizations (QIOs), Performance Measurement Systems (PMS)/vendors, CDACs, CMS and other facilities as directed by CMS.

Question and Answer Tool – The Question and Answer Tool is used by the QIO and Hospital Reporting (IQR and OQR) programs. The tool allows users to submit questions relevant to their work. The tool includes workflow to allow Individuals designated as Subject Matter Experts (SME) to receive email notification when a question is submitted to their assigned category. When the SME has completed entry of a response, notification goes to the Publisher who reviews the response and publishes the response. The tool is hosted by RightNow Technologies

For questions related to the QIO 10th SoW contract or operations of the SoW, the QIOs submit those questions directly to the CMS central point of contact.

QualityNet Identity Management System (QIMS) – QIMS provides an Identity and access management system integrated with a two factor solution (currently Anakam). QIMS ensures secure, distributed, and consistent account management, and authentication services for applications requiring multifactor authentication. These services are provided in a consistent, repeatable, and highly secure method. The current applications that use QIMS are CRMIS, QMARS, QIO DDST, CROWNWeb and ESRD QIP.

Hospital Reporting System Tools – Inpatient (IQR) and Outpatient (OQR) Clinical Data Abstraction Center (CDAC) - The CDAC provides services in support of the Quality Improvement Program and other special projects, such as other affiliated agencies (i.e., End Stage Renal Disease, Medicare Patient Safety Monitoring System, etc.), as deemed by the Center for Clinical Standards and Quality (CCSQ) that includes, managing an accurate, reliable, efficient and cost-effective clinical data abstraction, validation, adjudication and entry operation that continually meets CMS's objectives and provides support to the QIOs as appropriate.

Depending upon the requirements of the specific program, cases submitted to the QIO Clinical Warehouse are randomly selected for abstraction, validation and adjudication. Medical records are requested from the provider and provided to the CDAC in specified timeframes.

CMS Abstraction & Reporting Tool (CART) - CART is an application for providers, QIOs, and other organization interested in collecting quality improvement regarding the following topics:

1. Inpatient – 8 topics: AMI, HF, PN, SCIP, ED (Emergency Department Throughput), IMM (Global Immunization), STK (Stroke), VTE (Venous Thromboembolism).

2. Outpatient – 6 topics: AMI, CP (chest pain), Surgery, ED Throughput (Emergency Department Throughput), Pain Management, Stroke Through data collection retrospective analyses and real-time reporting, CART enables hospitals to comprehensively evaluate and manage quality improvement efforts.

This tool was designed and developed by CMS in collaboration with the Joint Commission and QIOs. The quality indicators tracked through CART are applicable for both the Medicare National Priority topics and TJC accreditation. CART can be downloaded from QualityNet (http://www.qualitynet.org).

Vendor Authorization - Vendor Authorization, accessed through “My QualityNet” at www.qualitynet.org, allows providers to authorize data vendors to submit data on the provider’s behalf to the clinical warehouses to support program initiatives.

Report Authorization - Report Authorization, accessed through “My QualityNet” at www.qualitynet.org, allows third-party vendors and healthcare systems to request authorization to view identified reports available to individual providers. Also allows hospitals to approve pending requests.

Secure Data Exchange (SDX) - The purpose of is to improve the quality of care for Medicare beneficiaries through increased efficiencies in information exchange. File Exchange accomplishes this goal by providing secure, real-time communications and data exchange between two or more organizations, including hospitals, Quality Improvement Organizations (QIOs), Performance Measurement Systems (PMS)/vendors, CDACs, CMS, physician offices, and other facilities as directed by CMS.

Structural/Web-Based Measures Tool This online tool allows hospital representatives to enter measure data online.

· Structural Measures – Measures to describe healthcare environment

· Web-based measures – Aggregate quality measure data Note: this tool is also used by ASCQR and IPFQR programs.

Ambulatory Surgical Center Quality Reporting Program (ASCQR): The ASCQR program is a newly developed quality reporting program beginning with payment determination year 2014. Via the Hospital Quality Reporting (HQR) system, the ASCQR program collects ASC claims data and ASC procedural data in effort to calculate payment information and provide reports for feedback/submission purposes.

Prospective Payment System (PPS)- Exempt Cancer Hospital Quality Reporting Program (PCHQR): The PCHQR program is a newly developed quality reporting program beginning with fiscal year 2014. Via the Hospital Quality Reporting (HQR) system, the PCHQR program collects patient and registry data to provide reports for feedback and public reporting purposes.

Inpatient Psychiatric Facility Quality Reporting Program (IPFQR): The IPFQR program is a newly developed quality reporting program beginning with payment determination year 2014. Via the Hospital Quality Reporting (HQR) system, the IPFQR program collects IPF patient data in effort to calculate payment information, provide reports for feedback/submission and public reporting purposes.

Hospital Reporting System Tools – Hospital Value-Based Purchasing (VBP) VBP Performance Scoring - This process uses hospital inpatient quality reporting (HIQR) program data to calculate eligible hospitals’ VBP baseline scores, and total performance scores (TPS). Hospitals that meet or exceed performance standards will be rewarded based on their TPS scores, and held-back base-operating DRG payment amount.

Hospital Reporting System Tools – Inpatient (IQR) Secure Data Exchange (SDX) - The purpose of is to improve the quality of care for Medicare beneficiaries through increased efficiencies in information exchange. File Exchange accomplishes this goal by providing secure, real-time communications and data exchange between two or more organizations, including hospitals, Quality Improvement Organizations (QIOs), Performance Measurement Systems (PMS)/vendors, CDACs, CMS, physician offices, and other facilities as directed by CMS.

HCAHPS Online Data Collection Tool - The CAHPS Hospital Survey (HCAHPS) is a public domain survey of patients’ perspectives of the quality of hospital care. The purpose of HCAHPS is to provide a standardized survey instrument and data collection methodology. This standardized instrument allows patients' perspectives on the quality of care to be compared fairly and reliably across participating hospitals nationally. The results of the HCAHPS survey are publicly reported on Hospital Compare.

My QualityNet provides the ability for secure data transmission of HCAHPS data files in the XML format or submission via the HCAHPS Online Data Entry Tool. An HCAHPS data warehouse accepts, stores, and reports on data being submitted through My QualityNet. The HCAHPS Online Data Entry Tool is designed to provide the option to enter one single survey at a time, primarily for hospitals that do not contract with a vendor. The online tool is an alternative to converting data files into the XML format. HCAHPS addresses eight areas of hospital care:

• Communication with nurses

• Communication with physicians

• Cleanliness and quietness of the environment

• Responsiveness of hospital staff

• Pain control

• Communication about medicines

• Discharge information

• About Patient

• Overall rating

HCAHPS Warehouse and Import Processor - The HCAPHS warehouse processes and stores patient satisfaction surveys submitted by providers or external contractors.

Notice of Participation- Notice of Participation, accessed through “My QualityNet” at www.qualitynet.org, allows providers to pledge on-line their participation (or non-participation) in the Reporting Hospital Quality Data for Annual Payment Update (IQR) program initiative.

Inpatient Measure Designation - The Measure Designation application, accessed through “My QualityNet” at www.qualitynet.org, allows a provider or their contracted vendor to designate the measures they will be submitting to the QIO Clinical Warehouse for a given reporting period.

Measure Suppression- The Measure Suppression application, accessed through “My QualityNet” at www.qualitynet.org, allows providers to designate applicable measures that they wish to suppress from public reporting on Hospital Compare.

Data Accuracy and Completeness Acknowledgment (DACA) - The Data Accuracy and Completeness Acknowledgement, accessed through “My QualityNet” at www.qualitynet.org, allows provider representatives to attest to the completeness and accuracy of annually data submissions to the QIO Inpatient Clinical Warehouse, as a requirement of the Hospital IQR program.

Hospital Inpatient Public Reporting Final File- The Hospital Public Reporting Final file is a quarterly creation of the final file for the same measures indicated on the preview report as well as Medicare volume, children’s asthma care measures, veteran’s hospital clinical process of case measures, and hospital value based purchasing measures. The final file data is posted on Hospital Compare website.

Hospital Data Validation Processing – IQR: The hospital data validation processing allows for quarterly updates, as needed, for the data validation sample selection and data processing for the random cases selected for validation from the QIO Clinical Warehouse to support IQR.

Hospital Inpatient Public Reporting Preview- The Hospital Public Reporting Preview file is a quarterly report for the inpatient clinical process measures, outcome measures, AHRQ measures, HAI measures, HCAHPS measures, Hospital-wide Readmission and structural measures.

APU Dashboard - This dashboard provides visual representation for hospital representatives to review their program compliance for the current payment year. It summarizes current hospital status per APU element. Users can drill down to view details and corresponding report data.

Hospital Reporting System Tools – Outpatient (OQR) Notice of Participation (NOP) - Outpatient Pledging, accessed through “My QualityNet” at www.qualitynet.org, allows providers to pledge on-line their participation (or non-participation) in the Hospital Outpatient Quality Data Reporting Program (OQR) initiative.

Outpatient Population & Sampling - The Population and Sampling application, accessed through “My QualityNet” at www.qualitynet.org, allows a provider or their contracted vendor to enter outpatient population and sampling data of Medicare and Non-Medicare patients that meet the inclusion criteria for each of the measure sets.

Clinical Warehouse and Import Processor - The Clinical Warehouse is a data repository that has enterprise-wide use and impact. The quality data is utilized to support multiple initiatives.

Hospital Outpatient Public Reporting Final File - The Hospital Public Reporting Final file is a quarterly creation of the final file for the clinical process measure data. The final file contains clinical measures, OIE and structural measures which are posted on Hospital Compare website.

Hospital Data Validation Processing – OQR: The hospital data validation processing allows for quarterly updates, as needed, for the data validation sample selection and data processing for the random cases selected for validation from the QIO Clinical Warehouse to support OPPS.

Hospital Outpatient Public Reporting Preview- The Hospital Public Reporting Preview file is a quarterly report for the outpatient clinical process measures, Outpatient Imaging Efficiency measures, and structural measures.

Physician Quality Reporting System Tools Physician Quality Reporting System (PQRS) - (includes eRx information although this is a separate program) Analyzes beneficiary and claims based data needed for measure and payment calculation, processing, and report generation.

Eligible professionals and groups (GPROs) are able to:

1. Report measures through a choice of methods – claims, registry, EHR (direct and via a data submission vendor, and group web interface) GPROs are more limited in their submission methods. No Web Interface for eRx. For 2013 small GPROs must submit via Registry, Medium and Large can do Registry or the Web Interface.

1. Limited Registration –for Groups to indicate their submission method - WI, Registry or if they were opting for Admin claims and for individual EPs to select Admin claims if so desired

1. Receive payment and/or payment adjustment for PQRS incentive; eRx; Meaningful Use (when submitting through the EHR Pilot); Maintenance of Certification

1. Request an informal review of their incentive eligibility Individuals Authorized Access to the CMS Computer Services (IACS) – IACS is used by the PQRS program. It is an identity management system that provides the means for users needing access to CMS applications to:

· Identify themselves

· Apply for and receive login credentials in the form of a User Identifier (User ID) and Password

· Apply for and receive approval a role to access the required system(s).

PQRS Portal- the PQRS Portal is the PQRS users’ entrance into PQRS services.

PECOS Interface- PECOS using the Provider Data Exchange (PDE) is for the purpose of collecting key data elements of user information for eligible Medicare professionals.

PQRS Reports Distribution System (RDS) - This system’s primary purpose is to enable program participants to monitor their program participation and clinical performance data as well as obtain information concerning the incentive payments they have earned. The users go through the Reporting Portlet to request their feedback reports.

Submission Portlet (PQRS) - The Submission Portlet allows the secure exchange of data and interoperability eligible professionals, data submission vendors and CMS.

Submission Report Portlet - A submission report Portlet allows the exchange of submission reports between eligible professionals, registries, data submission vendors and CMS. It is the Submission Application within the PQRS Portal GPRO Web Interface- the GPRO interface is open to authorized GPROs for completion of ACO and PQRS group measure data for a pre-determined sample of their Medicare beneficiaries.

QualityNet Roles Management System (QRMS).- This repository stores PQRS application specific attributes data from multiple sources. The data is used by the Portal for user authorization and to populate feedback reports for the Reports contractor.

PQRS CREW Database- The PQRS CREW (claims, registry, EHR warehouse) database is a repository that stores clinical measures data submitted through various methods. Stores aggregate data for registry, GPRO and some EHR reporting methods. The data is used for payment calculation and report generation.

PQRS Measures Engine – The PQRS Measures Engine performs measure calculations for claims and some EHR submission methods.

Submission Integration Engine- the Submission Integration Engine is responsible for processing uploaded XML/HL7 and other data files received from the PQRS Portal. It validates the data.

Payment Integration Module- The purpose of the Payment Integration Module (PIM) is to determine the methods by which a NPI/ TIN is incentive eligible, and calculate one incentive amount. The Payment Integration Module will also generate the Center for Drug and Health Plan Choices (CPC) payment file and the Office of Research, Development, and Information (ORDI) payment data. These files will provide different CMS entities with PQRS incentive results beneficial to their separate initiatives. It also processes payment incentive information after the measures engine completes.

Measure Applicability Validation (MAV) - A module will validate that a sufficient number of applicable measures reported through the individual claims reporting method have been reported by eligible professionals via claims. As well as validating PQRS measures information after the Measures Engine completes.

Reporting Integration Module- The purpose of the Reporting Integration Module is to combine PQRS results in order to produce the data needed to create these reports. It loads valid patient measures information after the validation process Measures Groups Module (MGM)- The Measures Groups Module (MGM) determines incentive eligibility for NPI/TINs submitting claims-based Measures Groups. Results from this module are sent to the Payment Integration Module. It validates measures group information after the Measures Engine completes.

HITECH

The functional purpose of the project is to provide the ability to receive EHR data from participant hospitals and report successful submitters to both the NLR and the IQR system for payment determination. The system focuses on the following key components:

Receipt of QRDA Category-I files Process, verify, and store data from received QRDA Category-I files Process and calculate eCQMs received in QRDA Category-I format, based on the HQMF standard (Future capability in next release HQR 6.0) Identification of successful hospital by CCN (CMS Certification Number) for MU and IQR payment determinations