OCHIN’s 2012 Learning Forum California Users Group Bi-Monthly Meeting Presentation

OCHIN’s 2012 Learning Forum

California Users Group

Bi-Monthly Meeting Presentation

Thursday, November 15th, 2012Meeting begins at 2:45 pm PST

Agenda2:45 Welcome and Introductions 2:50 CAIRS Project Update3:10 OSHPD Reporting Review3:25 CHDP Project Kick Off and Project Plan Review3:40 Site Visits and Dashboard Review3:50 New Year Revisions3:55 Accomplishments3:59 Adjourn

CAIR Immunization (IZ) Interface

Scope, Status, Challenges& Next Steps

1881 SW Naito Parkway • Portland OR 97201-5195 • Phone 503.943.2542 • Fax 503.943.2501 • Email: [email protected] • www.ochin.org

CAIR Immunization (IZ) Interface

• Project Scope– Unidirectional Interface

• IZ messages• Error reports• Yellow Card• Inventory Reports

– All California members• Workgroup of SME’s


CAIR IZ Interface Status

Completed Work– Interface Programming (HL7)– Error Reports– Automation– Basic Workflow

Documentation

In-Process Work– Scenario Testing– IZ Letter (Yellow Card)– Inventory Reports

• Immunizations Given• Flu Vaccines

– Training Plan– MU Attestation


CAIR – IZ Interface

• Challenges– HL7 is new to CAIR– Stable testing environment (at CAIR)– Maintaining resources among all stakeholders

(momentum)

• Implementation Date: 01-08-2013

OSHPD Reporting

California Primary Care Annual Utilization Report


OSHPD ReportingThe OSHPD reports contain descriptive information on services and encounters, staffing, capital expenditures, changes, operating costs, services offered and payment source information.•Demographics, Encounters, Clinical Services, and some financial reports are available to the OCHIN membership.


OSHPD – Comparing to UDSSimilarities with UDS:•Same definition of reportable encounters: Face-to-face visit with a health care professional, the professional is licensed, the professional exhibits independent judgment and the encounter is recorded in a patient chart.•Same reporting period 1/1 – 12/31.•Reports are due on 2/15.

Differences with UDS:•OSHPD reports are by site (OSHPD clinic license) as opposed to one report by organization like UDS (330 grant).•Different demographic, clinical services and payer source categories, in most cases the OSHPD categories are more detailed.


OSHPD – Groupers & Physical SitesOSHPD Specific Master File Groupers and OSHPD sites:•The OSHPD provider category is stored in Report Grouper 7 of the Epic Provider master file (Grouper 8 is used for UDS).•The OSHPD payor category is stored in Report Grouper 9 of the Epic payor master file.•Epic departments are mapped to OSHPD physical sites, OCHIN stores the department-OSHPD site crosswalk information in the custom X_CLARITY_PHYS_SITE Clarity table. This information is used to generate the reports by site.


OSHPD ReportingVisit Criteria Epic Master File - UDS

DesignationClarity Field Maintaine

d byPerforming Provider(provider who exercises independent professional judgment)

Determines whether the performing provider type on the visit is UDS reportable or not. (See appendix A of the UDS manual for a comprehensive list of provider types and their UDS designation)

UDS: Clarity_ser_view.Rpt_grp_eight

OSHPD:Clarity_ser_view.Rpt_grp_seven

Service Area

Department(Site/Location within the grantee’s scope of project)

Report grouper 1 must be set to either 'UDS Y’ or ‘UDS Y - School’ Clarity_dep.Rpt_grp_one OCHIN

Place of Service(Site/Location within the grantee’s scope of project)

Report grouper 2 must be set to 'UDS Y’ Clarity_pos.Rpt_grp_two OCHIN

Visit Program(Types of services)

The UDS flag in the OCHIN custom “UDS_Program” Clarity table must be set to 'UDS Y' Uds_programs.Uds OCHIN

Procedure Code(Types of services)

Report grouper 2 must be set to 'UDS Y’ on at least one procedure code posted against the visit. Clarit_eap.Rpt_grp_two OCHIN


OSHPD Reporting – Build Validation

It is crucial to validate the OSHPD/UDS build for your organization. Before running any OSHPD or UDS reports, you will need to run the “UDS Grouper Report for All Encounters in a Date Range”.•This report shows the current UDS designation for Departments, Places of Service and Providers, for all related encounters that took place within a user specified date range.•A list of current provider category types for UDS and OSHPD is included on the report, as well as the current UDS designation for Visit Program.


OSHPD – Sample Grouper Report


OSHPD – Grouper Report Cont.


OSHPD – OCHIN ReportsOSHPD reports are organized by sections:

Section 1: This section contains basic information about the clinic and the person completing the report. OCHIN doesn’t provide these reports.

Section 2: This section includes information on patient care services provided, information about languages spoken by patients and staff, and the composition of the clinic’s primary care providers. It also provides staffing level and volume of services delivered for each type of primary care practitioner at the clinic.


OSHPD – Section 2 ReportsClinic Services:

•This section includes information on patient care services provided, information about languages spoken by patients and staff, and the composition of the clinic’s primary care providers. It also provides staffing level and volume of services delivered for each type of primary care practitioner at the clinic.


OSHPD – Section 3 Reports

Patient Demographics:•This section reports an unduplicated count of all persons seen in the clinic during the report period by Race, Ethnicity, Federal Poverty Level, Age, Gender, Migrant/Seasonal worker status and Patient Coverage•This section also reports the number of patients served under episodic programs and the number of CHDP assessments, a patient could have more than one CHDP assessment during the year


OSHPD – Section 3 Reports Cont.





Encounters by Principal Diagnosis:•Total number of encounters by principal diagnosis, it must be equal to the total number of encounters in Encounters by Primary Care Provider (section 2, line 75, column 5), Encounters by Primary Services (section 5, line 45, column 1), FTE’s and Revenue and Utilization by Payer (section 6, line 1, column 19).•In the Epic diagnosis master file, Family Planning S-Codes are identified as those with the word “FAMPAC S CODES” in the Dx group: CLARITY_EDG.DX_GROUP = 'FAMPAC S CODES'





Encounters by Principal Service:•Report each medical encounter by CPT. Uses the “primary procedure code” to classify encounters. Does not report secondary or subsequent procedure codes, each encounter is to be counted only once.•Total encounters on line 45 must be the same as Encounters by Primary Care Provider (section 2, line 75, column 5), Encounters by Principal Diagnosis (section 4, line 25, column 1), FTE’s and Revenue and Utilization by Payer (section 6, line 1, column 19).•For visits with more than one procedure code OCHIN uses the CPT code on the first non-voided charge as the primary code.





Selected Procedures: This table includes data for selected CPT codes that are of particular interest. Unlike the previous table, the procedure codes listed in this table do not have to be the primary service code for that encounter.



Revenue and Utilization by Payer:•This section includes the encounters, gross revenues (charges), write-offs, and net patient revenue for each of the clinic’s payment sources.•The Report Grouper 9 in the Epic payor master file is used for the OSHPD payer source group. Please review list of payers for your clinics and let OCHIN know if any payors need to be reclassified.•Line 1, Columns 1 - 18: Encounters by Primary Payor (i.e. Medi-Medi Encounters are reported under Medicare)




OSHPD – Next Steps

The OSHPD suite of reports are not currently published to the Business Objects library as they require some form of customization for each organization that wants to use them.

If your organization would like to pursue getting these reports please have one of your Business Objects Report Designers submit a JIRA under the project of ‘REPORTING’.


Questions?

CHDP Project Team and Plan Review

Aryicka Frison, OCHINCalifornia Account Manager

Agenda• Project Plan Overview• Project Team• Training plan • Next Steps

Goals and Objectives

•Kick-off phase II planning activities.

•Achieve a shared understanding of the project, deliverables, timelines, roles, training, and communication plans.

•Create efficiencies of staff time and improve the documentation of required data in EpicCare and review of data in Resolute as it relates to the CHDP program.

Current CHDP State• The most recent development for this program from OCHIN was

in 2006• The current workflow for documentation has been recognized

and reported as very cumbersome• Some SAs have opted to continue to document on paper instead

of the designated workflow.• With the most recent upgrade to Epic’s version Summer, 2010 we

have additional functionality that can streamline the workflow

Opportunities• Phase I [in process]: Standardizing the Immunizations

– No longer the need for the distinction between standard immunizations and those affiliated with the CHDP program

– Supports the CAIRs implementation of the unidirectional interface

• Update all current well child smart sets to be functional– This is an interim fix until the completion of the project– List of all immunizations will be embedded for patients who are

behind at ANY level.

• Service Area Management of Smart Sets: – Train SAs to update and manage their own smart sets inclusive of labs

from their ‘preference lists’

Opportunities• Phase II [tentatively planned]: Streamline the Data Capture within

EpicCare– Data capture of all of the program requirements with use of a Smart

Form.– Expansion of CHDP Assessments to include those not currently listed

in current programming– Charges to flow the same as they do today, upon placing the order for

the procedure and/or administering charges will drop into encounter.

Project Scope and Team• Agree on design of Smart Form• Agree on exactly what data will be captured within the form• Agree on how billing staff will access clinical data for patient

visits

• Maria Vazquez- Santa Cruz• Carmen Aguila- Monterey County• Pamela Duncan-Placer County• Daniel Buchanan- Placer County• Gail Kuwahara- Open Door CHC • Tammy Flint- Open Door CHC• Marcy Chavez- Community Health Alliance of Pasadena

Stakeholders• OCHIN Project Development Team• Subject Matter Expert’s from your organizations

– Workgroup members

• Leadership from your organizations

Project Activities• Review of configuration options • Understand the benefits and constraints of each option• Consensus on deliverables and boundaries• Training preparation and delivery to staff on changes to

workflow• Assistance with testing prior to implementation.

Project Plan• Tentative Plan

– Mid March 2013• Gain consensus for project goals• Kick-Off workgroup call

– Early May 2013• Review configuration collectively• Schedule bi-weekly workgroup calls• Perform Gap Analysis (verify all required data is being collected and is

retrievable)• Begin testing if no revisions needed

– Early July 2013• Determine Go or No-go to begin training

– Implement new functionality by end of August 2013

Communication Plan

• Communication Considerations –Delivery (email, existing workgroups, etc.)–Frequency–Level/Depth of Communication

Conclusion• Next Steps

– Convene workgroup- Completed– Schedule Phase II Meeting– Determine and agree on configuration and data capture– Test– Review– Continue testing– Develop training materials– Train– Establish go-live date– Evaluate impact to operations

• Other Related Questions?

Site Visits and SA Dashboard Review


Summary

707 SW Washington Street Suite 1200 • Portland OR 97205 • Phone 503.943.2501 • Fax: 503.943.2501 • Email: [email protected] • www.ochin.org

• As part of OCHINs account management strategy, organization specific data will be reviewed with key staff every six months whether through a site visit or webinar.

• The information shared represents use of the OCHIN hosted software and its impact on day-to-day operations. This data will fundamentally support semi-annual objectives set during this review to uphold or advance your organization’s operations.

• While the forthcoming slides are conceptual, they do however reflect the idea of data we will review with key staff.

mailto:[email protected]

Summary of Dashboard Components• Basic Service Area Information and Tenure• Site Specialist and Development Milestones• No Show Rate and Number of Encounters• JIRA: Number Open, Closed and Average• Labs: Number Ordered, Errors and Error Rate• Revenue Cycle: Total Claims, Claim Error Rate through the

Clearinghouse and Accounts Receivable• Meaningful Use Milestones• PCHH Milestones• Workgroup Participation

Dashboard ComponentsBasic Information

Category MetricMember

Organization

Basics Project Manager: ***

Account/Engagement Manager: ***

SA #: ***

Go Live Type: PM & EHR

Annual Visits: 34,000

Tenure Go Live Date ***

# Days Live ***

# Weeks Live ***

Site Specialist DevelopmentCategory Metric ValueSite Specialist ***

Site Specialist Readiness Provider Master File No

To Date Trained Yes

Project Completed No

User Records Yes

Trained Yes

Project Completed Yes

Maintaining Preference Lists: Yes

Trained Yes

Project Completed n/a

Maintaining Fee Schedules: No

Trained Yes

Project Completed Yes

Web Utilities: Yes

Workstations Yes

Printers Yes

Order Transmittal w/s Adds No

Remote Access Yes

Dashboard Components

Appointments, Encounter & JIRA

Appointments No Show Rate 2287

[Date Range] Average Per Day 2094

Average Per Provider 91.6

Encounters # of Encounters: 2287

[Date Range] Closed Same Day or Day After: 2094

% Of Visits Closed On Same Day

or Day After: 91.6

Avg Days To Close: 0.5

Duplicate Patients: 53

Duplicate Patients (as % of

visits): 0.156%

JIRAs Tickets Opened 155

[Date Range] Tickets Closed 118

Tickets Still Open 37

Avg Tickets Opened Per Week 24.7

Labs, Claims & Claim Errors

Lab (EHR Only) Lab Orders: 935

[Date Range] Lab Errors : 11

Lab Error Rate : 1%

Revenue Management Total Claims: 4145

[Date Range] Total Charges $ 579,395.00

# Gateway EDI Claim Errors 36

$ Gateway EDI Claim Errors $ 5,364.00

% Of Gateway EDI Claim Errors 0.9%

# Payer Claim Errors 189

$ Payer Claim Errors $ 28,448.00

% Payer Claim Error 4.6%

Dashboard ComponentsA/R by Payer Class & Aged Totals A/R Aged w/o Self Pay & Avg. Days

AR by Payor Class %: Self Pay: -7.97%

Commercial: 65.14%

Family Planning:

Managed Medicaid 0.89%

Medicaid FFS: 6.72%

Medicare: 35.21%

Aged AR Total %: 0-30 days: 92.77%

31-60 days: -7.12%

61-90 days: 3.02%

91 and greater days: 11.34%

Aged AR w/o Self Pay %: 0-30 days: 84.14%

31-60 days: 4.67%

61-90 days: 2.80%

91 and greater days: 8.39%

Avg # of days in AR by Payor Class as of [insert date]: Self Pay: 31.78

Commercial: 35.15

Family Planning:

Managed Medicaid 29

Medicaid FFS: 48.97

Medicare: 21.98

Meaningful Use Dashboard Components


Year to Date Report This report card is based on EP's meeting MU Measures on a YTD basis, not 90 days90 days of meeting all measures can be analyzed via the Solutions "MU Provider Roster" Report

Meaningful Use Core Measures

# EP's Meeting

MU Measure

Total # EP's at SA

% Meeting YTD Measure

CPOE Medication Orders (by patient) 5 5 100.0%Maintain Active Problem List 7 8 87.5%E Prescribing (by prescription) 5 5 100.0%Maintain Active Medication List 7 8 87.5%Maintain Active Allergy List 7 8 87.5%Demographics 7 8 87.5%Record and Chart Vitals 7 8 87.5%Smoking Status 7 8 87.5%Provide Copy of e-Chart (w/in 3 days) 5 5 100.0%After Visit Summary (MyChart or Print) 7 8 87.5%




Meaningful Use Menu Set Measures

# EP's Meeting MU

Measure Total # EP's at SA% Meeting YTD

Measure

Structured Lab Results 8 8 100.0%

Electronic Access to Patient Record 7 8 87.5%

Patient Specific Education 7 8 87.5%

Transition of Care or Referral Summary 5 8 62.5%

YES/NO Attestation Measures

Drug-Drug and Drug-Allergy checks YES

Report quality measures to CMS YES

Launch/track one clinical decision support rule YES

Capability to exchange key clinical information YES

Security risk analysis

Generate lists of patients by specific conditions YES

Immunization Registries BY STATE





PCHH Dashboard Components


Placeholder


Committed to improving the health of the medically underserved through the best use of information and information technology.

QUESTIONS?

2013 Revisions


2013 Proposals

Do we need to meet on the same schedule? Currently bi-monthly3rd Thursday from 10 am -11:30 am

Best time for annual conference?Currently June

Volunteers to host this years conference?Last years host: Alliance Medical Center, Healdsburg, CA

SA specific meetings needed in conjunction with the collective?Tried this year, very little interest.

California Member Recognition

Presented by Aryicka Frison

Elite Club Accomplishment!Gateway EDI’s 99% Club [Error-Free Claims]Criteria•Submit at least 200 claims a month•Maximize their EDI rate for transactions•Utilize the Gateway EDI website•Demonstrate a low “AVG Days to File” rate•Be a member for at least 6-months

One of our own reached this status for the months of September & October 2012

Elite Club Accomplishment!

Santa Cruz County and Don Carlisle’s team for such an accomplishment!

Keep up the good work and keep sharing your practices with the other collaborative members. Together we’ll all reach such a status.

Next California Users Group Meeting

January 17th, 2013Please send agenda items and

volunteer to present!

Thank you, enjoy the rest of the learning forum’s informational

offerings!

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OCHIN’s 2012 Learning Forum California Users Group Bi-Monthly Meeting Presentation

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