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Compliance

q_iconQ’s strategic technology platform empowers compliance with the new Joint Commission accreditation standards for FPPE-OPPE as well as regulatory requirements for many of the HITECH meaningful use measures and for prevention of readmissions and limitations for hospital acquired conditions (HAC’s); but QualOptima offers the extraordinary opportunities to exceed compliance while gaining new benefits for optimal clinical, financial and operational outcomes.[/three_fourth]

 

The QualOptima Connectivity & Analytics System is the Complete Solution to Transform


Regulatory Compliance Solved by QualOptima

Compliance with Joint Commission Standards, Accountable Care Act regulations and new meaningful Use is a strategic imperative for healthcare organizations to thrive in this rapidly expanding and demanding environment. QualOptima is the first-to-market complete solution to go beyond what is required to strategically leverage healthcare analytics for the intentions behind the regulations.

Joint Commission Standards for Focused & Ongoing Professional Practice Evaluation (FPPE-OPPE), Accountable Care Act (ACA) transformation of the payment system to value-based reimbursement and value-driven care for Accountable Care Organizations (ACO’s), reimbursement restrictions for readmissions, hospital-acquired conditions (HAC’s) and specific conditions such as decubitus ulcers, and HITECH Act Meaningful Use requirements (especially in Phase III) are powerful examples of the rapidly increasing demands of healthcare decision-makers to comply with burgeoning regulations.

QualOptima is a strategic technology platform that exceeds compliance requirements for all these demands. Q’s unique expertise and experience solving clinical challenges for providers and payers as one of the two original pioneers of external peer review and the evolution of our software can provide true clinical and actionable insight to become your complete solution to compliance and beyond.


Transition from Peer Review to Performance Measurement (FPPE-OPPE) (v1.3)

Peer review remains a useful tool to study provider performance and patient outcomes to continuously improve quality of care and patient safety. However, electronic data collection, aggregation and analytics empowers healthcare organizations to evaluate clinical performance and outcomes with precise, defined metrics as required for FPPE-OPPE and evaluate care from existing clinical databases for patterns and trends rather than case-by-case in a standardized and objective framework. The past problems of labor-intensive, subjective and anecdotal review are solved by QualOptima.

The accreditation standards of the Joint Commission for focused and ongoing professional practice evaluation (FPPE-OPPE) create the urgent need to move from outdated methods of measuring clinical performance from clinical data (not billing codes), triggers to identify opportunities to improve, and rigorous proctoring. These standards coincide with the AMA’s Physician Collaborative for Performance Improvement (PCPI) adopting hundreds of precise metrics with defined numerators and denominators anticipating the rapid move to value-based purchasing. Existing methods from credentialing software and quality/risk management software will not suffice to comply with these inherent demands. Healthcare leaders and liability insurers are not yet fully aware of the ramification of negligent credentialing litigation that will drive rapid implementation of new technologies rather than prohibitive labor-intensive manual processes of the past.

QualOptima v1.3 combines traditional peer review software tools with electronic clinical performance measurement into a seamless, integrated FPPE-OPPE process. The QualOptima implementation of the InterSystems Ensemble interface engine creates a “second-generation” database from strategically mapped data elements for precise clinical data thousands of elements in all medical specialties. Natural language processing (NLP) tools in QualOptima machine read narrative text from discharge summaries, history & physical examinations, operative reports, and radiology and pathology reports to rapidly aggregate both structured and unstructured data into QualOptima’s unified Qualytx database. Q’s algorithms from over 35 years of clinical performance measurement embedded in the InterSystems DeepSee analytics and data display technology empowers each administrative and clinical quality & risk management, medical staff administrators and leadership, as well as each practitioner to evaluate clinical performance using individual patient risk factors and clinical variables to improve clinical, operational and financial outcomes.


Empower Outcomes & Performance Analytics with QualOptima (v1.7)

Q’s strategic technology platform and analytics for optimal clinical processes with metrics captured electronically across the healthcare enterprise empowers leadership for data-driven decisions for results-driven success. Q’s first-to-market clinical intelligence software is the complete solution for healthcare providers to comply with extensive regulations while improving clinical, financial and operational efficiencies and outcomes. Q is the proven and experienced clinical performance and outcome analytics and solutions company in American healthcare.

Healthcare decision makers find themselves in charge but not in control of the strategic imperative to measure clinical performance to rapidly improve clinical, operational and financial outcomes. The reason is that there has not been a software system to connect clinical data, available in existing vendor products (disparate databases), to the analytic tools essential to provide actionable insight for this strategic imperative. The metrics have been superficial and primarily linked to billing and revenue, and the available vendor products have relied on billing codes and not available patient clinical care and outcomes data. Organizations and their administrators and boards of trustees have been forced to rely on decisions to add extensive staffing for labor-intensive processes rather than electronic data collection and analytics capability. The organized medical staff, on primarily a voluntary basis and understandable biases, has been responsible for providing the healthcare organization with peer review data for quality and risk management functions, as well as for credentialing itself through the medical staff coordinator’s office.

QualOptima v1.7 implements the complete solution to the Joint Commission Standards for Focused & Ongoing Professional Practice Evaluation (FPPE-OPPE) for all three (3) essential components:

  • Measure clinical performance
  • Search for clinical “triggers” (formerly clinical indicators of sub-optima outcomes)
  • Proctor for current clinical competence

The inherent operational challenge presented by the Joint Commission FPPE-OPPE Standard is that it seems to transfer the operational function of assessing quality of care (traditionally a “quality management” function) and patient safety (traditionally a “risk management” function) to the medical staff coordinators’ functions combined with the traditional proctoring requirement. QualOptima v1.7 solves this inherent need with a common database that provides the tools for each operational function while dramatically improving available clinical data from disparate databases and analytics
The quality management function has traditionally relied upon peer review as the primary tool available to work with the organized medical staff. QualOptima transitions from the traditional system of clinical indicators to electronic triggers to identify sub-optimal outcomes for the additional tool for FPPE-OPPE:

  • Peer review

With the power of QualOptima’s interface engine (InterSystems Ensemble), the strategic imperative is solved with a unified database populated electronically from the total array of vendor databases as shown below:
qualytxVendorAgnosticDatabase

QualOptima v1.7 integrates these discreet process into a unified system of electronic data collection and aggregation. The metrics for proctoring are the same as the clinical performance metrics for these privileges. With the requirement to collect and evaluate clinical performance in each privilege for every credentialed practitioner at least twice per year, the same electronic data collection to grant a privilege is maintained in the FPPE-OPPE process, for example. It just makes sense! And if it seems like there will be too much resistance, the looming threat of negligent credentialing is the driver that will help providers and their insurers make the purchase decision.


Electronic Triggers to Identify Opportunities to Improve and for Risk Mitigation (v1.2)

Clinical performance monitoring to improve clinical quality, operational and financial outcomes must incorporate a system of “triggers” to comply with Joint Commission Standards for FPPE-OPPE. Ongoing Professional Practice Evaluation (OPPE) should include such a system to search for clinical indicators of sub-optimal outcomes that suggest patterns and trends of opportunities to improve care. OPPE should also convert to Focused Professional Practice Evaluation (FPPE) based on triggers (see Joint Commission Standards, Elements of Performance 5) that indicate the need for performance monitoring and can be clearly defined single incidents or evidence of a clinical practice trend. The performance criteria offer opportunities to read and learn from patient records and hospital documents and data to refine performance criteria into these triggers.

QualOptima harnesses the technology of the two (2) most powerful natural language processing (NLP) products in the world, including the InterSystems iKnow product pioneered and in extensive use in Europe. Q licenses and integrates two (2) very different technologies from proprietary licenses that comprise the technology of the Qtrigger application. Qtrigger machine reads narrative text using Boolean logic science for key words and phrases for rapid assimilation of triggers found in the text of discharge summaries, history & physical examinations, operative reports, and pathology and radiology reports for example. Comparative triggers can also be utilized for findings and events in outpatient records versus inpatient records, or operative diagnoses versus final pathological diagnoses, or Emergency Department versus subsequent Radiology Department interpretations of x-rays and other radiologic studies. A simple example of Q’s electronic triggers is to machine read for drug overdoses. Rather than search for clinical terms for “overdose”, Q’s technology reads for the drug Narcan used to reverse drug overdoses.
Qtrigger can machine read every electronic medical record in any healthcare organization in minutes. The Qtrigger application is a basic component of QualOptima v1.7 or can be licensed separately as QualOptima v1.2. Q’s extensive library of clinical indicators developed from over 35 years of external peer review and is embedded into the Qtrigger application for use as well as the ability to customize the application for user-specific triggers. In this new era of electronic records, it is simply impractical and illogical for healthcare organizations to rely upon labor intensive, manual medical record abstraction techniques of the past to implement an OPPE trigger process.


Electronic Proctoring for Credentialing Electronically Using Performance & Outcomes Metrics (v1.5)

“Proctoring” is the required process to evaluate the current clinical competence of practitioners to perform specific patient interventions or treat certain conditions. In American hospitals, proctoring is required of all physicians new to a hospital or on the medical staff and applying to perform a new clinical “privilege” by the Joint Commission Standards for Focused Professional Practice Evaluation (FPPE). Proctoring under FPPE is required in three (3) circumstances:

  1. New privileges – when the organization has no direct knowledge of a practitioner’s competence for a specific privilege (a) either at initial appointment to the medical staff and the practitioner is requesting clinical care privileges for the first time, or (b) when existing practitioners on the medical staff request a new privilege.
  2. Clinical care concerns – when Ongoing Professional Practice Evaluation (OPPE) data demonstrates clinical concerns regarding a practitioner’s competency, the medical staff process reverts to FPPE to conduct a focused review, previously known as “peer review” to proctor current clinical competence.
  3. Threshold reappointment criteria not met when an adequate volume of cases is not available to assess current competence.

QualOptima v1.5 is the Qproctoring application to electronically capture clinical data from existing databases, primarily the electronic medical record, and impose performance and outcomes metrics to evaluate current clinical competence. Q relies upon clinical performance measure sets from authoritative medical specialty organizations, supplemented by QualPRO panels of clinical experts and in collaboration with medical device companies for metrics. In the future, Qproctoring will also become an educational tool as well as performance and outcomes measurement tor the ultimate product potential.


Beyond Compliance – QualOptima (v2.0)


Early adopters of Q’s QualOptima Connectivity & Analytics Systems will discover that the database derived from the compliance applications provide ultimate enterprise management for their organization. After 35+ years of measuring clinical performance and outcomes in external peer review engagements, Q is uniquely positioned to market the QualOptima product to meet the needs of all constituents in the organization to achieve clinical, financial and operational efficiencies and outcomes.
qualoptima-analytics

Q’s first-to-market clinical intelligence software is the complete solution for healthcare providers, payers, employers, and insurance companies seeking to achieve optimal clinical, financial and operational outcomes. QualOptima empowers value-driven, patient-centered, personalized care focused on real-time and predictive patient management and patient safety, with optimal quality demonstrated by outcomes correlated with resource use and cost.