QualOptima Professional Practice Application Version 1.3
Performance & Outcomes Measurement with Peer Review
QualOptima Version 1.3 integrates clinical performance and outcomes measurement with Q’s enhanced peer review tool for single case review. Measuring clinical performance for FPPE-OPPE requires the electronic data capture technology of our interface engine. Q recommends that healthcare organizations who elect to begin with v1.3 use the common data platform and data collection tools as the first step to transition to healthcare data science methods for quality, risk and credentialing functions.
Transitioning to clinical performance measurement begins with collecting and analyzing large data sets with precise analytics using defined numerators and denominators data implementing standardized metrics published by specialty-specific medical organizations. QualOptima converts peer review to a structured process, no longer subjective and anecdotal. Peer review then becomes a drill-down technology that fits with v1.3 tools into new organizational outcomes processes.
The features of the PPE Application include:
Electronically Capture Existing Clinical Data from Disparate Databases
Q embeds its extensive clinical content, with defined specialty-specific numerators and denominators, into QualOptima’s intelligence system for its proprietary analytics anticipating the needs of each constituent in the organization. The threshold minimum data for collection begins with the performance measures portfolio now published by organized medicine, which includes:
- Measurement sets in 47 clinical areas and preventive care
- More than 300 individual measures
- Clinically relevant means for tracking variations in care
Q’s Clinical Metrics Library enables the organization and its clinicians to select the performance and outcomes measures by medical specialty or clinical service. QualOptima is designed to improve clinical processes of care and exceeds the limited core measures and existing quality indicators moving to integrated performance measurement with outcomes analytics.
Electronically capture patient and physician demographics with billing codes
QualOptima collects patient demographics essential to pattern and trend analysis as well as patient-specific risk factors. QualOptima does not rely on “risk adjustment”, rather directly risk stratification for diagnosis and treatment analytics as well as for provider analytics. Technology to identify relationships which are not apparent with manual processes and other software is a feature of QualOptima.
While QualOptima uses existing clinical data primarily, billing codes and data analytics from administrative data augment processes such as determining complication rates or comparative data with other organizations. Even in peer review processes, having the denominator for analysis is essential in most pattern and trend analyses.
Transform quality, risk and credential processes with a common data platform
The traditional healthcare organization has evolved with separate functions and often software product for quality management, risk management, credentialing and medical staff functions. The common data platform of QualOptima crossing these boundaries and providing analytics tools are essential to move to these functions playing a pivotal key role in transitioning to value-driven outcomes. Patient safety is an integral function of the aggregated Qualytx database and analytics, just as it patient safety is an integral component of quality and outcomes.
While the requirements of FPPE-OPPE to demonstrate current clinical competence are credentialing functions, data collection and analysis must be performed by quality and risk management professionals. Standards to collect and analyze practitioner performance at least twice annually in every clinical privilege, even with core credentialing, requires the electronic data collection and analytics tools of QualOptima. The navigation and permissions programmed in QualOptima allow each organization to use the intelligence system of the common data platform and analytics that matches how they work.
Next Steps to Value-Driven Outcomes
As healthcare organizations transition to performance and outcomes based payment, and as value-driven results of care become the goal of quality and patient safety initiatives, the technology of the tools you use must be equal to the tasks inherent in organizational process changes. Limited data samples and limitations of calculating rates without the sophistication of looking beneath the surface are no longer viable choices for traditional functions and processes of quality, risk, credentialing and medical staff. C-level management urgently need the analytics of strategically implemented next steps to health data science with technology.
QualOptima versions are designed to either begin with the end technology necessary for the next steps of this transition or to begin with QualOptima v1.3 for performance and outcomes measurement with drill-down capability with the most robust peer review software, then adding triggers with v1.2 and proctoring technology with v1.5 to benefit from the total v1.7 suite of products.
Performance Metrics w/Clinical Variables for Optimal Clinical Processes
Clinical process improvement requires analytics to reveal variance, not only in magnitude but with the technology to rapidly analyze massive data relationships. QualOptima collects clinical variables in all dimensions of performance and outcomes metrics, correlated with personalized risk factors.
In organizations dealing with the perception that “my patients are sicker,” risk adjustment tools will not suffice. First, if there are risk stratification methods available for lowering risk or adjusting treatment protocols, the technology for assessment is critical to optimal clinical processes. If perception is not reality, scientific methods of analytics are essential to review of sub-optimal outcomes.
Solutions Require Root Cause Analysis
The technology, analytics and even the peer review processes of QualOptima embed root cause analysis. Q has been engaged for over 35 years to identify potential solutions to sub-optimal outcomes, not simply to collect and display data. The experience of clinical performance analysis and deriving alternative solutions differentiate QualOptima from tools based on technology without insight into how to move back-stream with data through analytics to identify root causes.
Enhance the Single Case Review Process
QualOptima technology has evolved from our first-to-market electronic peer review product in the 1990’s and from extensive peer review engagements for 35+ years. We have learned from every engagement, in almost every medical specialty in hundreds of hospitals, physician organizations, HMO’s and medical malpractice companies and self-insured systems. Our single case review software has improved from use by not only our physicians but from our own use of the product in external peer reviews and use by our licensed clients.
QualOptima is different from other software systems because Q electronically collects clinical data, not billing data, using precise clinical metrics and knows:
- What data to collect
- Where that data resides in different vendor databases
- The significance of analytics to provide actionable insight for solutions (not collecting data for the sake of data collection and analysis)
- Displaying complex clinical information and its financial significance uniquely understandable to clinicians, administrators, and laymen
Peer review, which has been the traditional tool of quality management, remains anticipated by the FPPE-OPPE Standards but as a tool and not a regulated standard. QualOptima integrates the processes of measuring clinical performance from aggregated data with Q’s analytics for pattern and trend evaluation while integrating peer review for single case drill-down to assess perceptions from aggregate data and root causes for solutions. As anticipated by the Joint Commission FPPE-OPPE Standards, QualOptima functionality permits remote peer review, both to facilitate local reviews and external peer review.
QualOptima is committed to licensing QualOptma to healthcare organizations that truly learn from experience and set specific goals to achieve optimal clinical, operational and financial outcomes. There are instances where focused review can become punitive, but the process must be scientific and the data and actionable insight must be scientifically derived. Single case review is just as important to analyze how and why exceptionally optimal outcomes are achieved to break down the variables to replicate in other lower-performing clinical processes.
Involving the Medical Staff in Collaborative Process Improvement
Physicians and clinical practitioners will usually respond favorably to accurate and insightful information. Engaging them in optimal clinical processes, coordinated with requirements of value-driven payment, are empowered with QualOptima.
The QualOptima common data platform can empower the Medical Staff, departments, service lines, and leadership in their processes.
Additional QualOptima Versions for All 3 Requirements of FPPE-OPPE
QualOptima creates a common database from existing data collected electronically for the other two (2) requirements of FPPE-OPPE – triggers and proctoring. QualOptima v1.7 is licensed with all three (3) of these applications.
- QualOptima v1.7 – FPPE-OPPE
QualOptima v1.2 can be licensed for triggers, which are also used as clinical indicators for peer review and pattern and trend analysis.
- QualOptima v1.2 – Qtriggers
The analytics of machine reading and learning from these technology tools is available in QualOptima v2.0.
- QualOptima v2.0
The third requirement of FPPE-OPPE is proctoring physicians and other clinical practitioners, which is available electronically in QualOptima v1.5.
- QualOptima v1.5 – Qproctor
Transition to real-time predictive modeling for patient management
The Clinical Trial of QualOptima at the University of Miami, Jackson Memorial Hospital, demonstrates how the technology is used for patient management through predictive modeling. First, for example, patients with temperature variation or significant post-operative nausea and vomiting can alert for specific post-operative protocols. Second, data analysis of use of antiemetic medications peri-operatively can be analyzed for dosage, sequencing and combination for better outcomes in specific risk patient populations.
Analytics from the Qualytx database and QualOptima’s robust and powerful clinical intelligence system is designed to transition learning organizations from evidence-based to experience-based knowledge and actionable wisdom.