ToC+-+Success+Metrics+Consensus+Page

include component="page" wikiName="siframework" page="TOC Header" **Sub-Workgroup Links:**


 * The ToC Success Metrics Workgroup achieved consensus on the matrix on November 8th, 2011. Please reference the Success Metrics Wiki Page to access the final product. **

1. On the tab labeled "Process-Patient", in the Patients column (for Metrics Questions) #2 - the first 3 items refer to "an HIE" and in the second set of items, two of the items read "a HIE". Just to be consistent, these two should be changed to "an HIE". 2. On the Overview tab - for #3 - Outcomes - this statement does not closely match the **Outcome tab** that only refers to hospital readmissions as the desired outcome for the success metrics. Also, I am in agreement with David Tao's comments below. || 2) For the questions about support of CDA vs consolidated CCD vs CCD, I would consider changing the question formatting if an electronic form is used (to minimize free text entry) to the following: Please indicate which, if any, of the following standards you support (CDA, consolidated CCD, CCD) with a radio button/check box next to each selection. 3) Though I feel the success metrics document can move forward, I strongly agree with David Tao/Siemen's voting comments (regarding specifying/referencing standards being measured). || Correct type on Outcomes tab in the Hypothesis section pertaining to readmissions Minor suggestion - whenever we address denominators and numerators, can we list the numerators on top and the denominators on bottom? It just seems more intuitive (to me anyway). || Adoption: agree with metrics. In IMPACT we look at the following stages, each of which represents one part of adoption: building capability, increasing use (more staff using it) and increasing effective use (more staff usingit 100% of the time to 100% capability). Progress along each axis can be measured and progress on all axes define an area that can be used to assess progress towards all three goals (please see Adoption ppt on Wiki) Process: Provider. In general the results of "satisfaction" surveys are not sufficiently consistent to be actionable. Rather than ask if senders or receivers of health informationo are satisfied with the amount, timing or content, ask instead what they had to do in order to work around any defect in the process. A defect can be too much or too little information, too early or too late, unclear format, duplicated or conflicting information. Asking what the receiver had to do (eg: nothing extra because the transition was perfect, reconcile conflicting data elements by call the sender or checking in the EHR, etc) is specific to the process and represents their experience rather than their opinion. Since one can record a time measure with the question ("how much time did it take to ...) it is possible to assign a cost to the work arounds thereby giving a measure of efficiency as well. A similar approach can be taken with the senders. What did they have to do to comply with the requirements? Were there required elements which are of little value? Conversely, were there any essential elements that were not required in the opinion of the sender. This results in actionable data that also leads to continuous improvement of the process and gives a measure of the efficiency of the process. Process: Patient. Same comments as above. Ask the patient what they had to do (or not do) based on what they receive from their provider. Outcome. Readmission reduction is a worthy goal but it is not a clean metric given all of the factors that contribute to or mitigate against them. Other potential measures include total cost of care, utilization of services, unscheduled return to the emergency deprartment. Analysis of these measures in more discrete groups of high risk patients (CHF, oncology, end stage organ failure, behavioral health) might more clearly show the impact of HIE on reducing costs and utilization. Readmission reduction is a tough metric and may not move even if HIE is effective. Other metics: we might want to consider adding "Improved Efficiency" as an important outcome measure by itself because it represent one way to remove costs from health care without affecting services. HIE should be a major tool for achieving improved efficiency. Asking senders and receivers what they had to do to make up for a defect in the transition of care is one way to measure "non-value added work", effectively a measure of efficiency. || === (Major) **Adoption** metrics should better define the three levels of document: ToC Consolidated CDA, "Constrained CCD" and CCD. Each needs more precision. 1. ToC Consolidated CDA as specified in (IG to be written) 2. "Constrained CCD" is not understood by most of the audience if not defined, so it needs to be defined. 3. Suggest "Stage 1 MU CCD" instead of just CCD, because CCD by itself is nebulous, and no certified EHR can get away with just a CCD -- MU 1 C32 is a set of constraints on it. Since CCR is not in the ToC recommendation, it should not be listed. (Minor) Adoption metrics for HISP/HIE, Vendors, and Providers. Currently says "how many clinicians are using the system?" I suggest it just say **"How many users are using the system for clinical information exchange ?"** since clinicians may have administrative staff who use the system to assist them (and that should be OK), and also just using "the system" (e.g., the EHR) is not enough: we want them to be using it for information exchange. (Minor) For **Outcome** Metrics, there should be a metric for closed loop ambulatory referrals, corresponding to that ToC Use Case. Readmissions is fine as a metric for the Hospital Discharge Use Case, but that was not the only UC. Can change to Yes if the Major comment is addressed. || Alliance for Nursing Informatics, AMIA - Nursing Informatics WG ||  ||   ||
 * **Name** || **Organization** || **Endorsement (yes/no)** || **If No, what can be done to make it Yes?** ||
 * John Quinn || Accenture ||  ||   ||
 * J. Michael Fitzmaurice || Agency for Healthcare Research and Quality || Yes || Comment with concurrence: I would like to have seen a metric that measures the degree to which the use case workgroup met the requirements for fully describing the data elements to the satisfaction of the users. However, I see that that would be more an internal metric rather than a metric measuring external use and satisfaction. I support David Tao's, Susan Campbell's, and Leslie Hall's comments (not that this is an election!). I just was not wise enough tosee it from their points of view. ||
 * Harry Rhodes || AHIMA ||  ||   ||
 * Robin A. Barnes || Agency for Healthcare Research and Quality(AHRQ) ||  ||   ||
 * Derrick Evans || Allscripts ||  ||   ||
 * Emma Jones || Allscripts ||  ||   ||
 * Ken McCaslin || American Clinical Laboratory Association (ACLA) ||  ||   ||
 * Anne Diamond || American College of Obstetricians and Gynecologists (ACOG) ||  ||   ||
 * James Scroggs || American College of Obstetricians and Gynecologists (ACOG) ||  ||   ||
 * Thomson Kuhn || American College of Physicians (ACP) ||  ||   ||
 * Denise Maxwell-Downing || AORN (Association of periOperative Registered Nurses), IHE ||  ||   ||
 * Seonho Kim || ApeniMED (formerly MEDNET) ||  ||   ||
 * Greg Chittim || Arcadia Solutions ||  ||   ||
 * Mary Lynam || Argus Health Systems ||  ||   ||
 * Coletta Dorado || AZZLY ||  ||   ||
 * Jeffrey Ice || AZZLY ||  ||   ||
 * Tara Jacquet || BH&A Ins. Services ||  ||   ||
 * Sriram Bharadwaj || Business Strategix Inc ||  ||   ||
 * David Lenhart || Cal eConnect ||  ||   ||
 * Susan E. Campbell || Care Management Professionals || yes, with minor change to patient metrics || Most patients will not know what an HIE is and many won't know what a PHR is. So it might be better to use standard English. For example: ask if the patient has allowed his/her information to be used electronically for evaluation of his/her care providers' effective exchange of information. Ask the patient if s/he received information about a visit in digital format like a CD, flash drive or other electronic method. ||
 * Paula Gwyn || CareTech Solutions ||  ||   ||
 * Gary Dickinson || CentriHealth ||  ||   ||
 * Greg Turner || CGI ||  ||   ||
 * Justin Austin || Clopton Clinic ||  ||   ||
 * Terri Skalabrin || Colorado Regional Health Information Organization (CORHIO) ||  ||   ||
 * Michael L. Glickman || Computer Network Architects, Inc. ||  ||   ||
 * Dr John Haughton || Covisint ||  ||   ||
 * Rachelle Blake, PA, MHA || CTG Healthcare Solutions / Omni Micro Solutions; HIMSS Advocacy and Public Comment Workgroup ||  ||   ||
 * Dalana Ostlie || Deaconess Medical Center ||  ||   ||
 * Chris Doucette || Deloitte ||  ||   ||
 * Randolph Sanks, MBA || Deloitte (Health and Life Sciences) ||  ||   ||
 * David Parker, MD || Department of Defense/Evolvent Technologies ||  ||   ||
 * Mike Lincoln || Department of Veterans Affairs ||  ||   ||
 * Patricia Greim || Department of Veterans Affairs ||  ||   ||
 * Sarah Maulden || Department of Veterans Affairs ||  ||   ||
 * You-Ying Whipple || Department of Veterans Affairs ||  ||   ||
 * Catherine Hoang || Department of Veterans Affairs ||  ||   ||
 * Holly Miller || Department of Veterans Affairs ||  ||   ||
 * Srini Krishnamoorthy || Discoverture Health Solutions ||  ||   ||
 * Carl Farmis || Discoverture Health Solutions ||  ||   ||
 * Tom Dawson || Dispersive Medical ||  ||   ||
 * Stephen Hufnagle || DoD Military Health System ||  ||   ||
 * Jim Hansen || Dossia Consortium ||  ||   ||
 * Elliot B. Sloane, PhD || Drexel University School of Biomedical Engineering //Center for Healthcare Information Research and Policy (CHIRP)// ||  ||   ||
 * Kyle Meadors || Drummond Group Inc. ||  ||   ||
 * Hari Ramachandran || Enable Healthcare Inc ||  ||   ||
 * Rahul Dewan || Enable Healthcare Inc ||  ||   ||
 * Peter DeVault || Epic ||  ||   ||
 * Vassil Peytchev || Epic ||  ||   ||
 * Thomas Giannulli MD, MS || Epocrates ||  ||   ||
 * Larry Garber, MD || Fallon Clinic/SAFEHealth ||  ||   ||
 * Joel Amoussou || FEI Systems on behalf of SAMHSA ||  ||   ||
 * Ken Lord || FireStar Software, Inc ||  ||   ||
 * Mark Eisen || FireStar Software, Inc ||  ||   ||
 * John B. Williams || Garden State Health Systems Inc / Health-ISP.com ||  ||   ||
 * John Moehrke || GE Healthcare ||  ||   ||
 * Keith W. Boone || GE Healthcare ||  ||   ||
 * Ruth Berge || GE Healthcare ||  ||   ||
 * Patricia MacTaggart || George Washington University ||  ||   ||
 * Mark Braunstein, MD || Georgia Institute of Technology || Yes ||  ||
 * Philip Lamson || Georgia Institute of Technology Enterprise Innovation Institute || Yes ||  ||
 * Steve Rushing || Georgia Institute of Technology || Yes ||  ||
 * Brian Ahier || Gorge Health Connect, Inc. ||  ||   ||
 * Gregory L. Smith || Greg Smith and Associates (KHIN, KHIE) || Yes ||  ||
 * Susan Johnston || GSI Health ||  ||   ||
 * Thompson H. Boyd, III, M.D. || Hahnemann University Hospital ||  ||   ||
 * Joan Duke || Health Care Information Consultants, LLC || yes ||  ||
 * Durwin Day || Health Care Service Corporation ||  ||   ||
 * Jaime Estrada || Health Information Network of Arizona ||  ||   ||
 * Lindsey Hoggle || Health Project Partners, LLC || Yes ||  ||
 * Teresa M. Mota, BSN, RN || Healthcentric Advisors || Yes, with comments incorporated as stated by Susan, Leslie, Farrant, Cyndalynn and David. ||  ||
 * Amy Walker || HealthIT Plus, a business division of QSSI ||  ||   ||
 * Simpson William || Healthland ||  ||   ||
 * Adrian Gropper || HealthURL ||  ||   ||
 * Leslie Kelly Hall || Healthwise || yes with concerns || I am concerned because during transitions of care, patients have the highest opportunity to influence care. However this is largely dependent upon their understanding of their current health status, that they are informed about choices when preference sensitive care exist, and have an opportunity to provide their choices prior to transition. All of this is dependent upon patient education and knowledge and their ability to influence the clinician. Patient specific education with access to records would help. ||
 * Susan Nedza MD || HealthyCircles, LLC. || yes ||  ||
 * Jennie Harvell || HHS ||  ||   ||
 * < Anna Poker ||< HHS/HRSA ||>  ||>   ||
 * Louise V. Fryer, RN, MS, PMP || Highmark Blue Cross Blue Shield ||  ||   ||
 * Penny Probst || Highmark Blue Cross Blue Shield ||  ||   ||
 * Joyce Sensmeier || HIMSS ||  ||   ||
 * Audrey Dickerson || HIMSS and IHE/PCC technical representative ||  ||   ||
 * Sandra Schafer || Holon Solutions ||  ||   ||
 * Mary Moewe || Iatric Systems ||  ||   ||
 * David Cheng || IBM ||  ||   ||
 * Aaron Stranahan || ICA ||  ||   ||
 * Adora Bruce || ICA ||  ||   ||
 * Mayuri Patel || ICA || Yes || Sorry for the late comments on the spreadsheet:
 * Tim Dunnington || ICA ||  ||   ||
 * Michael J. McCoy, MD || IHE PCC, ACOG, Catholic Health East || Yes ||  ||
 * Scott Serich || IJIS Institute ||  ||   ||
 * Farrant Sakaguchi || Independent/University of Utah Dept of Biomedical Informatics || Yes, but please note comments. || 1) I agree with Cyndalynn Tilley's comment about putting numerators above denominators.
 * Rosa Aleman || Independent Registered Nurse working as a Women Health Educator in Family Planning and Foreign Medical Graduate ||  ||   ||
 * John Donnelly || IntePro Solutions, IHE || Yes ||  ||
 * Cyndalynn Tilley || Intermountain Healthcare || Yes with minor edits || I also agree with others that the acronyms should be explained rather than used not only for patients, but also providers since not all are technologically inclined.
 * Laura Heermann Langford || Intermountain Healthcare ||  ||   ||
 * Amber Broadwater || Dynamik Care ||  ||   ||
 * David E. Clark || IRIS Partners, LLP ||  ||   ||
 * Larry Wolf || Kindred Healthcare ||  ||   ||
 * Sajid Ahmed || L.A. Care Health Plan – HITEC-LA ||  ||   ||
 * Jeff Bloemker || Lewis And Clark Information Exchange ||  ||   ||
 * Amy Knopp || Mayo Clinic ||  ||   ||
 * Corey Spears || McKesson ||  ||   ||
 * Holly Miller, MD, MBA || MedAllies || Yes ||  ||
 * Mark Bamberg || MedFX ||  ||   ||
 * Eric Heflin || Medicity ||  ||   ||
 * Luann Whittenburg || Medicomp System, Inc. || Yes || Recommend inclusion of Restorative Care (Allied Health/Home Health) in Clinical Organizations examples: "Provider Practices / Hospitals / LTC consistent with TOC Use Case. ||
 * Fred Buhr || Metasteward LLC || Yes ||  ||
 * Paul Edge || Microsoft Corp ||  ||   ||
 * Konda Mullapudi || Misys Open Source Solutions (MOSS) LLC. ||  ||   ||
 * John Odden || My Direct HISP ||  ||   ||
 * Latoya Thomas || National Associationn for Home Care & Hospice/Home Care Technology Association of America ||  ||   ||
 * Rick A. Moore || National Committee for Quality Assurance (NCQA) ||  ||   ||
 * Stephen Beller || National Health Data Systems || Yes ||  ||
 * Lynne Gilbertson || NCPDP ||  ||   ||
 * Teresa Strickland || NCPDP ||  ||   ||
 * John Klimek R.Ph. || NCPDP ||  ||   ||
 * Annamarie Saarinen || Newborn Coalition || YES ||  ||
 * Tom Foley || NextEnt, LLC ||  ||   ||
 * Robert Barker || NextGen Healthcare ||  ||   ||
 * Steven Saitsky || NextGen Healthcare ||  ||   ||
 * Russell B. Leftwich, MD || Office of eHealth Initiatives, State of Tennessee || yes || wrt other comments, this is about ToC Success Metrics; other Stage I MU criteria would be out of scope and not a metric for ToC ||
 * Kimberly Tooles || Onyx Home Health Care, LLC. ||  ||   ||
 * Lola McCune || Onyx Home Health Care, LLC. ||  ||   ||
 * Robert Worden || Open Mapping Software ||  ||   ||
 * Lin Wan || OptumInsight ||  ||   ||
 * K.D. Pool, MD || OZ Systems || Yes ||  ||
 * Terrance O'Malley, MD || Partners Healthcare || Yes with comments || This is directionally correct but I believe some shift in emphasis and a change in the evaluation processes and targets are in order.
 * C John Torontow MD MPH || Piedmont Health Services ||  ||   ||
 * Elaine A. Blechman || SmartPHR.com; U. Colorado || YES ||  ||
 * Thomas P. Caruso || Quantal Semantics, Inc. ||  ||   ||
 * Freida Hall || Quest Diagnostics, Inc. ||  ||   ||
 * Bob DeAnna || Recursion Software ||  ||   ||
 * Will Ross || Redwood MedNet ||  ||   ||
 * Charles Hewitt || Rhode Island Quality Institute ||  ||   ||
 * Gary Christensen || Rhode Island Quality Institute ||  ||   ||
 * Todd Treiber || Sage Healthcare ||  ||   ||
 * Lane Chambers || SAIC ||  ||   ||
 * Vera Blanc || Sandlot ||  ||   ||
 * Eugene Fievitz || IMS Health ||  ||   ||
 * Sherry Selover || Selover Company ||  ||   ||
 * Ernest Grove || SHAPE HITECH, LLC ||  ||   ||
 * Lester Keeper Jr. || SHAPE HITECH, LLC ||  ||   ||
 * David Tao || Siemens || YES || NOV. 8th, I changed the "No" vote to YES, as a result of the satisfactory resolution of my comments on the ToC Success Metrics WG call.
 * Doug Pratt || Siemens ||  ||   ||
 * Lorre Pacheco || Sunquest Information Systems ||  ||   ||
 * Mark T. Palen, PMP, CPHIMS || System Administrative Services, L.L.C. || Yes || Yes, and I agree with the acronym technological explanation for the providers. ||
 * Ollie B. Gray || Telemedicine Advance Technology Research Center/Department of the Army ||  ||   ||
 * Betty Levine || Telemedicine Advance Technology Research Center/Department of the Army ||  ||   ||
 * Sri Koka || Techsant Technologies || Yes ||  ||
 * Mara Robertson || Tennessee Primary Care Association (TPCA) ||  ||   ||
 * Michael R. Lardiere || The National Council ||  ||   ||
 * Virginia Lorenzi || The NewYorkPresbyterian Hospital ||  ||   ||
 * Lori Harrington || Thomas Reuters - Healthcare ||  ||   ||
 * Philip DePalo || Towson University ||  ||   ||
 * Yeong-Tae Song || Towson University ||  ||   ||
 * Gregory L. Alexander PhD, MHA, MIS, RN || University of Missouri,
 * Rob Lecker || Vecna Technologies ||  ||   ||
 * Michael Meyer || WellPoint ||  ||   ||
 * Theresa (Terry) M. Hearn || WellPoint ||  ||   ||
 * Albert Llanes || ZyDoc ||  ||   ||
 * Matthew Bouchard || ZyDoc ||  ||   ||

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