Performance Analytics Enhance Core Measures

Edited by Erin Harris, Editor, Health IT Outcomes

The Mankato Clinic’s new Web-based performance analytics tool helps funnel what would be an overwhelming amount of clinical data into a streamlined package that helps to identify core measures.

The Mankato Clinic is one of the largest physician- owned practices in Minnesota, with clinics in six communities across a 70-mile area. A multispeciality organization with approximately 140 providers, the Mankato Clinic features a mixture of family practice and specialty care. Tammy Kraetzner, director of knowledge management and performance improvement, was responsible for finding an analytics tool that extracts, organizes, and integrates business and clinical data from the existing EHR (electronic health record) to improve core measures and provide the Mankato Clinic’s quality team, care coordinators, and providers with information and functionality designed to increase productivity and quality of care.

Q: What challenges drove you to research/purchase a performance analytics solution?
Kraetzner: We face two challenges. First, we are moving from episodic care, where patients are treated sameday for various reasons, to population-based care. We are transitioning because we are adopting a proactive approach [as opposed to a reactive approach] to our patients’ health. In doing so, we had to define and monitor key areas of care in both chronic care and preventive care where we can use best practices and evidence-based medicine to identify gaps in care. To do so, we needed to find a data warehouse and a reporting tool that met our needs.

Second, we are publicly reported for a large number of best practice initiatives in Minnesota. As part of a state mandate, we have to report to the Minnesota Community Measurement Program. In addition, we must comply with the standards set forth by the Minnesota Community Measurement Program, Meaningful Use, and PQRS (Physician Quality Reporting System) Program.

We have other risk contracts that require us to report on patients’ progress as well as our own progress based on targets for different outcomes. It gets complex, and the nuances of each of these programs are slightly different. The monitoring aspect became very difficult.

In addition, we completed reports manually. It was paramount to implement a tool that allowed us to run reports, track and monitor all initiatives that have incremental variance, both internal and external, and allow our staff FTEs (full-time equivalents) to do other value-added tasks.

Q: What performance analytics solution did you choose and why?
Kraetzner: After evaluating several platforms, we selected Precision.BI: Quality Intelligence (QI) from Origin Healthcare Solutions as our performance analytics solution. We use the Web-based version of the solution, and it is located on our local server. Allscripts, our EHR vendor, introduced Origin to us. We also purchased Origin’s dashboard product, which is not yet in use (dashboards will be presented to Mankato’s administrative committees in the next month).

We use several aspects of the analytics tool. We perform general auditing and manipulating of the data in order to report it publicly or internally. We use Excel from time to time to add claims-level information, as we have not yet incorporated that function into Precision.BI. We will probably incorporate that function at some point in the future. We plan to take that process one step further by adding incremental fields and a copy of the workflow processes to access discrete data.

We currently use Origin to pull the reports for submission purposes. We are in the process of determining how to limit the intervention piece before we submit it to Minnesota Community Measurement or some of the other payor contracts. We also use the new tool to pull out reports that explain performance by clinic and department on certain conditions such as diabetes, vascular disease, asthma, depression, etc. This information is useful, because we need to know which areas within our clinic system are potentially struggling so that we meet both internal and external goals. Identifying the provider, clinic, or department by focus area (e.g. diabetes, asthma, vascular disease, etc.) that is not at a targeted performance level enables us to identify interventions, education efforts, and/or workflow changes to improve outcomes both for submission purposes and — even more importantly — for an individual patient’s longterm clinical outcome. Having patients come in for lab tests, exams, medication reconciliations, etc. based on evidence-based protocols increases the likelihood that they will develop more effective partnerships with their primary care providers and together improve their longterm clinical outcomes.

Right now most of the percentile reports Origin generates are sent out monthly. Once we put this data on the Web, it will be updated nightly so care coordinators, providers, and clinical managers will have access to real-time data they can act on.

Q: What are your core measures, and why are they important?
Kraetzner: We are focused on pinpointing the areas necessary to intercede for diabetes, vascular disease, asthma, and other conditions for which our patients are not receiving timely care. These are just some of the examples of the core measures. We benchmark core measures both internally and externally. MN Community Measurement, NCQA, (National Committee for Quality Assurance) and Meaningful Use are just a few organizations that have expectations as to what defines optimal care for certain chronic or preventive care conditions. We monitor our performance against these benchmarks to identify areas of improvement. The core measure areas identified above directly correlate with our focus areas for two reasons: large patient volumes, and/or areas where we can make a significant impact in improving clinical outcomes if evidence-based protocols are followed when appropriate.

The dashboards will allow our clinical staff to proactively call or contact patients when care is needed and intervene so that we can address their healthcare needs today rather than hoping they come in for the episodic care we are trying to transition away from.

Q: Who leverages the data analytics solution?
Kraetzner: Currently, our quality team and care coordinators use it, and it will soon be rolled out to our providers and additional clinical support staff.

The quality team leverages the tool to ensure data flows correctly. The care coordinators are responsible for managing our high-risk patients. Origin helps the care coordinators find and monitor the activity of those patients who are overdue for a visit, a test, etc. In addition, it is critical for our providers to easily search and find patients in need of some type of intervention. The EHR contains a great deal of information, but it cannot be easily queried so that next steps may be identified. Origin provides the search-and-find function that allows our providers to begin their outreach efforts.

Q: What benefits has the Mankato Clinic reaped since implementing the solution?
Kraetzner: We have a great deal of flexibility, which is necessary to define where each patient should be within the system. We no longer have to wait for a monthly report. Because data is updated daily, we are able to make real-time decisions.

The tool can also be used for any number of the initiatives that we undertake, such as population management, high-risk patient identification, care coordination, deriving individualized patient education material, pre-appointment planning — all of which help us identify the gaps in our own EHR. We can also use it to track trends in clinical and patient satisfaction performance and to compare our performance to internal and external benchmarks to uncover opportunities for improvement.

Finally, we now support the providers in a different manner than we have in the past. The EHR information is visible and accessible to them in a manner that fits their practice, not necessarily someone else’s interpretation of what they need to be monitoring and measuring.