QualOptima For FPPE-OPPE
The Challenge to Transform Peer Review Processes to Performance Measurement
Quture (“Q”) was asked by Springhill Medical Center, Springhill, Louisiana, to advance the Company’s hospital peer review product for the new demands of performance and outcomes measurement. New regulatory mandates of Joint Commission Standards for Focused & Ongoing Professional Practice Evaluation (FPPE-OPPE), require hospitals to measure clinical performance and use peer review software as a tool that no longer satisfy the performance measurement requirements.
Simultaneously, customers and potential customers are facing other new compliance requirements from federal statutes and administrative rules. American health care is rapidly changing payment models to pay-for-performance transitioning to value-based purchasing, replacing fee-for-service based on billing codes. Delivery models are changing just as rapidly and from other federal regulations and administrative rules, such as Accountable Care Organizations (ACO’s) and patient engagement.
Software technology tools are expensive to license, so designing cost-effective solutions require innovative approaches to use cloud applications. Organized medicine and its medical specialty organizations are rapidly developing hundreds of clinical performance measure sets. Hospitals are not using these performance metrics in their credentialing processes, creating massive liability exposures from negligent credentialing litigation. So the requests from a customer paralleled Q’s endeavors to transform peer review processes to electronic performance measurement.
We had pioneered the first-to-market peer review software, and our development had focused on improving the interoperability of the product to electronically collect and integrate data from other existing sources of clinical data from other vendor products in hospitals. The challenge to transform the peer review software to electronic performance measurement software was consistent with our own vision for Q. We listened to the needs of a rural hospital customer and designed the innovations that have become QualOptima for FPPE-OPPE. Our external peer review engagements using our own software product had also given us insight into the value of a clinical performance and outcomes measurement database for analytics.
Problem Solved to Capturing Clinical Data from Existing Databases
The problem in healthcare information technology is well-known, because software vendors and especially electronic medical record (EMR) vendors resist access to their databases. The Assistant Administrator of Springhill Medical Center, Marilyn Mow, observed during a site visit that they could only access patient data in the hospital’s EMR for analytics rather than patient care for additional fees.
Working with hospital administrative and information technology staff, Q learned that the hospital receives a data run to report their core measure data to the Joint Commission. We were able to identify a work-around to collect electronic data from disparate databases without significant additional fees to other vendors.
Problem Solved for Potentially Prohibitive Costs for Software Application Licenses
Q selected the InterSystems’ interface engine Ensemble® as the superior product to capture and integrate data integration from any vendor’s electronic medical records and software into the InterSystems CACHÉ® object-oriented database. The InterSystems platform is aptly-suited to harness and support the power of Quture’s intellectual property. Through licensing arrangements and technology solutions, Q programmed remote cloud versions of QualOptima especially for smaller and rural hospitals like Springhill. Without this solution, about 1/3 of American hospitals would not be able to afford or operate our transformative new technology. Without Q’s electronic capability, existing labor-intensive, anecdotal, and vital quality and risk management processes would also be prohibitive for hospitals. Our software was developed to innovate solutions we have learned from our customers.
Problem Solved to Transform Peer Review to Performance Measurement
QualOptima is the first-to-market intelligence system that integrates the processes of clinical performance measurement with peer review. Most hospitals confuse old metrics used in other products and for different purposes with what is required to capture and analyze the precise metrics rapidly being developed by organized medicine to measure value. Q’s expertise and experience with peer review to identify root causes integrates its technology solution to use peer review as the drill-down solution to convert actionable insight to actionable wisdom.
- Evolution of Quture as a Healthcare Analytics Company