System and method for analyzing, collecting, and tracking quality data across a vast healthcare provider network

• US 8,428,966 B2
• Filed: 04/08/2011
• Issued: 04/23/2013
• Est. Priority Date: 02/25/2009
• Status: Active Grant

• Current Assignee: Greenway Health LLC (Greenway Medical Technologies Incorporated)
• Original Assignee: Greenway Medical Technologies Incorporated
• Inventors: Green, W. Thomas III, Ingram, James T., Samples, Johnathan, Schulenburg, Gregory H., Colquitt, Jason, Felt, Steve
• Primary Examiner(s): Morgan, Robert
• Assistant Examiner(s): KANAAN, MAROUN P
• Application Number:
  US13/082,717
• Publication Number:
  US 20110246224A1
• Time in Patent Office: 746 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof

Abstract

A system and method for gathering quality data for a plurality of healthcare providers over an extended computer network is disclosed. The system and method comprise an enhanced services server in electronic data communication with a plurality of Electronic Health Record (EHR) systems via a network connection, the plurality of EHR systems being configured to capture patient data for a plurality of patients at the plurality of healthcare providers'"'"' sites during a plurality of encounters with each of the plurality of patients, and the enhanced services server being built on the same architecture as the plurality of EHR systems. Electronic quality of care forms are retrieved from one or more form managers via the network connection and a plurality of fields in each of the electronic quality of care forms are automatically populated using the patient data captured by the plurality of EHR systems. The completed electronic quality of care forms are then automatically transmitted to one or more form receivers via the network connection, the one or more form receivers being one or more organizations that process quality of care data to qualify healthcare providers for at least one of certifications, accreditations, and monetary incentives.

Claims

1. A system for gathering quality data for a plurality of healthcare providers over an extended computer network, the system comprising:

a plurality of Electronic Health Record (EHR) systems that are built on the same architecture and configured to capture patient data for a plurality of patients at the plurality of healthcare providers'"'"' sites during a plurality of encounters with each of the plurality of patients, said plurality of EHR systems being configured to capture and transmit the patient data in a common data format that specifies information to be collected and a format for the information to be collected; and

an enhanced services server built on the same architecture as the plurality of EHR systems and that is in electronic data communication with the plurality of EHR systems via a network connection and configured to transmit and receive the patient data in the common data format, the enhanced services server including;

form retrieval functionality configured to retrieve electronic quality of care forms in the common data format from one or more form managers via the network connection, each of the electronic quality of care forms having a plurality of fields to be completed with quality of care data obtained from the patient data captured by the plurality of EHR systems, and the one or more form managers being one or more organizations responsible for maintaining forms used by healthcare providers to qualify for at least one of certifications, accreditations, and monetary incentives; and

form filler functionality configured to fill in the plurality of fields in each of the electronic quality of care forms using the quality of care data in the common data format, each of the quality of care forms being completed for a single healthcare provider from among the plurality of healthcare providers and for a single patient from among the plurality of patients, and the patient data filled in the plurality of fields being from a plurality of encounters with that single patient,

wherein each of the electronic quality of care forms is automatically transmitted to one or more form receivers via the network connection after its plurality of fields are filled in, the one or more form receivers being one or more organizations that process quality of care data to qualify healthcare providers for at least one of certifications, accreditations, and monetary incentives.

2. The system of claim 1, wherein the enhanced services server is configured to archive the quality of care data from the electronic quality of care forms on a central database after the plurality of fields are filled in, aggregate the quality of care data from the electronic quality of care forms based on user-defined criteria, and provide a comparison of one or more of the plurality of healthcare providers to one or more other of the plurality of healthcare providers based on that quality of care data.

3. The system of claim 2, wherein the enhanced services server aggregates the quality of care data based on at least one of healthcare provider site, healthcare provider specialty, size of healthcare provider practice, and geographic region.

4. The system of claim 2, wherein the enhanced services server is further configured to analyze the quality of care data aggregated for each of the plurality of healthcare providers and determine at least one of quality indicators, effectiveness measures, qualifying certifications, qualifying accreditations, and qualifying monetary incentives for each of the plurality of healthcare providers.

5. The system of claim 4, wherein

the quality indicators are Agency for Healthcare Research and Quality (AHRQ) quality indicators that indicate measures of health care quality for each of the plurality of healthcare providers;

the effectiveness measures are Healthcare Effectiveness Data and Information Set (HEDIS) measures that indicate measures of performance for each of the plurality of healthcare providers;

the qualifying certifications are Medical Group Management Association (MGMA) certifications for which each of the plurality of healthcare providers qualify;

the accreditations are National Committee for Quality Assurance (NCQA) accreditations for which each of the plurality of healthcare providers qualify; and

the monetary incentives are based on CMS initiatives for which each of the plurality of healthcare providers qualify.

6. The system of claim 2, wherein the quality of care data is aggregated using a sequential filtering process that implements a plurality of steps corresponding to a plurality user-defined criteria input into the enhanced services server.

7. The system of claim 2, further comprising a research system that is built on the same architecture as the enhanced services server and the plurality of EHR systems and that is in electronic data communication with the enhanced services server and the plurality of EHR systems via the network connection, wherein the enhanced services server is configured to receive input from a researcher to establish the specific quality of care data with which to base the comparison of one or more of the plurality of healthcare providers to one or more other of the plurality of healthcare providers.

8. The system of claim 2, further comprising a research system that is maintained by a researcher and built on a different architecture than the enhanced services server and the plurality of the EHR systems, the research system being interfaced with at least the enhanced services server via an interoperability engine at the enhanced services server.

9. The system of claim 1, wherein the enhanced services server is configured to automatically retrieve electronic quality of care forms, fill in the plurality of fields in each of the electronic quality of care forms, and transmit each of the quality of care forms with its fields filled in to one or more form receivers in regular intervals as required to qualify for at least one of certifications, accreditations, and monetary incentives.

10. The system of claim 1, wherein the one or more form managers and the one or more form receivers are a single entity and the enhanced services server is interfaced with that single entity via an interoperability engine at the enhanced services server.

11. A method for gathering quality data for a plurality of healthcare providers over an extended computer network, the method comprising the steps of:

placing an enhanced services server in electronic data communication with a plurality of Electronic Health Record (EHR) systems via a network connection, the plurality of EHR systems being configured to capture patient data for a plurality of patients at the plurality of healthcare providers'"'"' sites during a plurality of encounters with each of the plurality of patients, and the enhanced services server being built on the same architecture as the plurality of EHR systems, said plurality of EHR systems being configured to capture and transmit the patient data in a common data format that specifies information to be collected and a format for the information to be collected, said enhanced services server being configured to transmit and receive the patient data in the common data format;

retrieving electronic quality of care forms in the common data format from one or more form managers via the network connection, each of the electronic quality of care forms having a plurality of fields to be completed with patient data, and the one or more form managers being one or more organizations responsible for maintaining forms used by healthcare providers to qualify for at least one of certifications, accreditations, and monetary incentives;

filling in the plurality of fields in each of the electronic quality of care forms using quality of care data in the common data format obtained from the patient data captured by the plurality of EHR systems, each of the electronic quality of care forms being completed for a single healthcare provider from among the plurality of healthcare providers and for a single patient from among the plurality of patients, and the quality of care data being filled in the plurality of fields being from a plurality of encounters with that single patient; and

automatically transmitting each of the electronic quality of care forms to one or more form receivers via the network connection after its plurality of fields are filled in, the one or more form receivers being one or more organizations that process quality of care data to qualify healthcare providers for at least one of certifications, accreditations, and monetary incentives.

12. The method of claim 11, further comprising the steps of:

archiving the quality of care data from the electronic quality of care forms on a central database after their plurality of fields are filled in;

aggregating the quality of care data from the electronic quality of care forms based on user-defined criteria; and

providing a comparison of one or more of the plurality of healthcare providers to one or more other of the plurality of healthcare providers based on the quality of care data represented in the electronic quality of care forms.

13. The method of claim 12, wherein the step of aggregating the quality of care data is based on at least one of healthcare provider site, healthcare provider specialty, size of healthcare provider practice, and geographic region.

14. The method of claim 12, further comprising the steps of:

analyzing the quality of care data aggregated for each of the plurality of healthcare providers; and

determining at least one of quality indicators, effectiveness measures, qualifying certifications, qualifying accreditations, and qualifying monetary incentives for each of the plurality of healthcare providers.

15. The method of claim 14, wherein the quality indicators are Agency for Healthcare Research and Quality (AHRQ) quality indicators that indicate measures of health care quality for each of the plurality of healthcare providers;

the effectiveness measures are Healthcare Effectiveness Data and Information Set (HEDIS) measures that indicate measures of performance for each of the plurality of healthcare providers;

the qualifying certifications are Medical Group Management Association (MGMA) certifications for which each of the plurality of healthcare providers qualify;

the accreditations are National Committee for Quality Assurance (NCQA) accreditations for which each of the plurality of healthcare providers qualify; and

the monetary incentives are based on CMS initiatives for which each of the plurality of healthcare providers qualify.

16. The method of claim 12, wherein the step of aggregating the quality of care data is implemented using a sequential filtering process in a plurality of steps corresponding to a plurality user-defined criteria input into the enhanced services server.

17. The method of claim 12, further comprising the step of placing a research system in electronic data communication with the enhanced services server and the plurality of EHR systems via the network connection, the research system being built on the same architecture as the enhanced services server and the plurality of EHR systems, and the enhanced services server being configured to receive input from a researcher at the research system to establish the specific quality of care data with which to base the comparison of one or more of the plurality of healthcare providers to one or more other of the plurality of healthcare providers.

18. The method of claim 12, further comprising the step of interfacing a research system with at least the enhanced services server via an interoperability engine at the enhanced services server, the research system being maintained by a researcher and built on a different architecture than the enhanced services server and the plurality of the EHR systems, and the enhanced services server being configured to receive input from a researcher at the research system to establish the specific quality of care data with which to base the comparison of one or more of the plurality of healthcare providers to one or more other of the plurality of healthcare providers.

19. The method of claim 11, wherein the enhanced services server performs the steps of automatically retrieving electronic quality of care forms, filling in the plurality of fields in each of the electronic quality of care forms, and transmitting each of the quality of care forms with its fields filled in to one or more form receivers in regular intervals as required to qualify for at least one of certifications, accreditations, and monetary incentives.

20. The method of claim 11, wherein the one or more form managers and the one or more form receivers are a single entity and the enhanced services server is interfaced with that single entity via an interoperability engine at the enhanced services server.

21. A system for gathering quality data for a plurality of healthcare providers over an extended computer network, the system comprising:

an enhanced services server built on the same architecture as a plurality of Electronic Health Record (EHR) systems and that is in electronic data communication with the plurality of EHR systems via a network connection, the plurality of EHR systems being configured to capture patient data for a plurality of patients at the plurality of healthcare providers'"'"' sites during a plurality of encounters with each of the plurality of patients, said plurality of EHR systems being configured to capture and transmit the patient data in a common data format that specifies information to be collected and a format for the information to be collected, and the enhanced services server being configured to transmit and receive the patient data in the common data format and including;

form retrieval functionality configured to retrieve electronic quality of care forms in the common data format from one or more form managers via the network connection, each of the electronic quality of care forms having a plurality of fields to be completed with quality of care data obtained from the patient data captured by the plurality of EHR systems, and the one or more form managers being one or more organizations responsible for maintaining forms used by healthcare providers to qualify for at least one of certifications, accreditations, and monetary incentives; and

form filler functionality configured to fill in the plurality of fields in each of the electronic quality of care forms using the quality of care data in the common data format, each of the quality of care forms being completed for a single healthcare provider from among the plurality of healthcare providers and for a single patient from among the plurality of patients, and the patient data filled in the plurality of fields being from a plurality of encounters with that single patient,

wherein each of the electronic quality of care forms is automatically transmitted to one or more form receivers via the network connection after its plurality of fields are filled in, the one or more form receivers being one or more organizations that process quality of care data to qualify healthcare providers for at least one of certifications, accreditations, and monetary incentives.

22. The system of claim 21, wherein the enhanced services server is configured to archive the quality of care data from the electronic quality of care forms on a central database after the plurality of fields are filled in, aggregate the quality of care data from the electronic quality of care forms based on user-defined criteria, and provide a comparison of one or more of the plurality of healthcare providers to one or more other of the plurality of healthcare providers based on that quality of care data.

23. The system of claim 22, wherein the enhanced services server aggregates the quality of care data based on at least one of healthcare provider site, healthcare provider specialty, size of healthcare provider practice, and geographic region.

24. The system of claim 22, wherein the enhanced services server is further configured to analyze the quality of care data aggregated for each of the plurality of healthcare providers and determine at least one of quality indicators, effectiveness measures, qualifying certifications, qualifying accreditations, and qualifying monetary incentives for each of the plurality of healthcare providers.

25. The system of claim 24, wherein

the quality indicators are Agency for Healthcare Research and Quality (AHRQ) quality indicators that indicate measures of health care quality for each of the plurality of healthcare providers;

the effectiveness measures are Healthcare Effectiveness Data and Information Set (HEDIS) measures that indicate measures of performance for each of the plurality of healthcare providers;

the qualifying certifications are Medical Group Management Association (MGMA) certifications for which each of the plurality of healthcare providers qualify;

the accreditations are National Committee for Quality Assurance (NCQA) accreditations for which each of the plurality of healthcare providers qualify; and

the monetary incentives are based on CMS initiatives for which each of the plurality of healthcare providers qualify.

26. The system of claim 22, wherein the quality of care data is aggregated using a sequential filtering process that implements a plurality of steps corresponding to a plurality user-defined criteria input into the enhanced services server.

27. The system of claim 22, further comprising a research system that is built on the same architecture as the enhanced services server and the plurality of EHR systems and that is in electronic data communication with the enhanced services server and the plurality of EHR systems via the network connection, wherein the enhanced services server is configured to receive input from a researcher to establish the specific quality of care data with which to base the comparison of one or more of the plurality of healthcare providers to one or more other of the plurality of healthcare providers.

28. The system of claim 22, further comprising a research system that is maintained by a researcher and built on a different architecture than the enhanced services server and the plurality of the EHR systems, the research system being interfaced with at least the enhanced services server via an interoperability engine at the enhanced services server.

29. The system of claim 21, wherein the enhanced services server is configured to automatically retrieve electronic quality of care forms, fill in the plurality of fields in each of the electronic quality of care forms, and transmit each of the quality of care forms with its fields filled in to one or more form receivers in regular intervals as required to qualify for at least one of certifications, accreditations, and monetary incentives.

30. The system of claim 21, wherein the one or more form managers and the one or more form receivers are a single entity and the enhanced services server is interfaced with that single entity via an interoperability engine at the enhanced services server.