QualVal consultation facilitates achieving optimal operational outcomes by transforming existing organizational structures with knowledge from the integrated analytics of health data science. The QualOptima common data platform crosses the traditional boundaries with data for analytics available with tools specific to those silos but not confined by those silos. QualVal is the right decision for providers who commit to become true learning organizations.
Joint Commission Standards for Focused & Ongoing Professional Practice Evaluation (FPPE-OPPE) require extensive changes in quality and risk management and credentialing operations. Peer review requirements have been removed, replaced by performance measurement, with peer review now a tool in that process to drill down into clinical validation and root cause determinations. In the required ACGME framework of medical/clinical knowledge, patient care, interpersonal skills communication, practice-based learning, professionalism, system-based practice, old measures using administrative data must be replace with defined clinical measures with defined numerators and denominators publish by organized medicine. Manual methods of data abstraction must be replaced with technology to capture this data from existing disparate databases.
Use of “triggers” to identify potential suboptimal outcomes is the second FPPE-OPPE that requires technology rather than manual data abstraction operations. Machine reading with learning functionality is the logical solution provided by QualOptima (see). Proctoring new privileges for demonstration of current clinical competence completes the three (3) essential tools used for FPPE-OPPE compliance.
- Clinical Trial Results
- QualOptima Clinical Trial at the University of Miami/Jackson Memorial Hospital
- QualOptima v1.2
- Professional Practice Application v1.2: Triggers, Clinical Indicators and Big Data Analytics
- QualOptima v1.5
- Professional Practice Application v1.5: Proctoring for Competence with Expert Learning Simulation
Transforming Quality/Risk Management & Credentialing w/Health Data Science
QualOptima v1 products with all three (3) requirements of FPPE-OPPE for performance measurement with peer review tools, triggers and proctoring are provided for compliance with Joint Commission Standards. However, the technology of QualOptima in its most robust version 2.0 provides health data science will transform quality & risk management operations with credentialing to achieve optimal clinical and financial outcomes. QualVal consultation works with existing operations resources first to comply with FPPE-OPPE then institute the new health data science actionable insights that meet the urgent needs of our clients for their strategic imperatives of optimal outcomes.
- Optimal Clinical Outcomes
- QualOptima Clinical Intelligence System Version 2.0: Connectivity & Analytics Platform
QualPRO External Peer Review
The QualPRO peer review tool in QualOptima v1.3, v1.7 and v2.0 permit remote medical record review for specialized experts in each medical specialty to evaluate the care, treatment and outcomes in its unparalleled structured explicit format. In situations where there are economic conflicts, no practitioner in that specialty or performing the involved procedure, or in highly sensitive or significant liability risk reviews, the expert clinical panels of QualPRO are available for external peer review of single/similar cases or for external peer review engagements of departments or services. QualPRO technology both provides a superior external peer review and at significantly lower costs than QualVal competitors.
Systems to Proctor Practitioners
QualOptima v1.2, which is included in v1.7 and v2.0, is the technology to use electronic data for proctoring practitioners, focused not only on measuring current clinical competence but educational with simulation technologies. QualPRO expert proctors are often the same clinical experts working with medical device manufacturers and academicians that develop the metrics and learning functionality of the QualOptima Proctoring Application. Remote proctoring functionality permits optimal external resources when needed by providers or panels of payers.
Provider Branding with Patient-Centered Care & Optimal Outcomes
Hospitals are estimated to spend approximately $700 billion annually on advertising, but with only less than 20% focused on creating a brand. Billboards taut decreased ER waiting times, really measured in how long it takes to put a patient gurney against a wall number. At the same time, advertising “best hospitals” in many surveys are beginning to face analysis of outcomes such as recent findings of “Fivefold Variation in Obstetrical Complications Among US Hospitals,” Glance et al., Health Affairs 33(8): 1330 (August 2014) capable of dividing hospitals into high, medium and low-performing organizations.
QualVal with QualOptima consults with hospitals that market to payers and patients based on actual clinical outcomes, as well as cost in value-based analytics. With the individualized risk and fitness factors embedded into the QualOptima technology, when a patient transitions from in-patient or emergency care, their outcomes and treatment modalities are immediately available for marketing based on loyalty from clinical knowledge of them as individuals. QualVal consulting with empowering technology focuses on thriving in the new health care environment with branding becoming tied to optimal outcomes and individualized care as an immediate strategic imperative for hospitals.
Performance-Based Physician Contracting
Hospitals often contract many clinical services to outside physician staffing vendors or individual physicians contracting services for emergency medicine, anesthesiology, radiology, laboratory/pathology, acute care surgery, or hospitalists. While most of these groups market themselves on performance, the metrics are usually efficiency, compliance and financial measures. QualVal all too often has often consults with clients who have no data from these vendors regarding clinical outcomes, clinical performance measures, complications and adverse events, and their own internal peer review data is not even disclosed. QualVal Solutions implements contractual agreements with explicit clinical performance and outcomes metrics specified in contractual agreements and capable of integration into the QualOptima database for analytics and contractual incentives and disincentives.
External Clinical Auditing
The QualVal Clinical Audit Service provides Boards of Trustees with standardized and objective information to evaluate clinical outcomes and quality of the processes of the health care organization, including outside clinical vendors. The goal is to provide consistently reliable, high quality, error-free health care with analysis of overuse, underuse and misuse. This critical service is designed to meet the challenges to Boards as recently stated in a white paper from the University HealthSystem Consortium: “The recently enacted Sarbanes/Oxley Act and the increased awareness of medical error challenges a hospital’s Board to become responsibly involved in investigating and improving the quality of care delivered within their organization.” Clinical audit further focuses on measuring performance as progress toward milestones in strategic plans.
These QualVal consulting services further provide insight and understanding to lay boards of the significance and actionable information in measuring clinical performance and outcomes. Until now, hospital boards have only received clinical quality information through quality, risk and credentialing processes – always filtered through the Medical Staff. As clinical performance and outcomes data is presented to lay boards and even C-level administration, QualVal consultation on the interpretation and use of that knowledge is an invaluable resource from external sources – just as boards rely on external financial audits.