Health quality measures systems and methods

• US 8,924,229 B2
• Filed: 03/10/2010
• Issued: 12/30/2014
• Est. Priority Date: 03/11/2009
• Status: Active Grant

• Current Assignee: NXGN Management, LLC. (NextGen Healthcare, Inc.)
• Original Assignee: QSI Management, LLC (NextGen Healthcare, Inc.)
• Inventors: George, Jibu, Rosenberger, Bryan, Jarvis, Charlie
• Primary Examiner(s): PAULS, JOHN A
• Application Number:
  US12/721,043
• Publication Number:
  US 20100235192A1
• Time in Patent Office: 1,756 Days
• Field of Search: 705/2, 705/3, 709/246, 707/200
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/0639 Performance analysis of employees; Performance analysis of enterprise or organisation operations
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

Systems and methods of exchanging Healthcare Quality Measures (HQM) are disclosed. Healthcare providers can define one or more HQMs by constructing expressions using an expression builder according to a funding organization'"'"'s requirements. Once a measure is derived, it can be converted to a common HQM data format and exchanged with the organization via an intermediary HQM service. The HQM data can then be converted into the organization'"'"'s proprietary format. Thus, HQM data exchanges among providers and organizations are simplified.

Claims

1. A method of reporting a health quality measure (HQM), the method comprising:

providing, for a plurality of healthcare providers, access to an HQM service, comprising at least one computer, that is coupled to a first funding organization and a second funding organization, the HQM service configured to receive, from each of the plurality of healthcare providers, patient data in a proprietary format corresponding to the healthcare provider and convert the received patient data from the proprietary format to a common HQM data format;

providing a healthcare provider interface coupled to the HQM service computer;

allowing each of the plurality of healthcare providers to use the healthcare provider interface to define a first mathematical expression that uses at least some of the patient data corresponding to the healthcare provider for computing a first HQM according to requirements of the first funding organization;

deriving, by the HQM service, the first HQM for each of the plurality of healthcare providers based on the patient data corresponding to the healthcare provider and the first mathematical expression defined by the healthcare provider;

upon request by the first funding organization, generating, by the HQM service computer, a first HQM report having the derived first HQM, where the report is automatically formatted according to requirements of the first funding organization; and

automatically sending, by the HQM service computer, the generated first HQM report to the first funding organization.

2. The method of claim 1, wherein the step of allowing each of the plurality of providers to define the first mathematical expression for computing the first HQM includes authenticating the provider with respect to the HQM service.

3. The method of claim 1, wherein the step of deriving the first HQM is conducted by an HQM agent that is a client-side software application configured to operate on a second computer at the provider'"'"'s site.

4. The method of claim 1, wherein the first mathematical expression for computing the first HQM comprises a numerator and a denominator, wherein the step of deriving the first HQM includes calculating a numerator representing a number of encounters in the patient data that satisfy the selection criteria of the numerator portion, and calculating a denominator representing a number of encounters in the patient data that satisfy the selection criteria of the denominator portion.

5. The method of claim 4, further comprising calculating the first HQM as a ratio of the numerator to the denominator.

6. The method of claim 1, further comprising using the HQM service computer to generate a plurality of lists containing encounter data entries obtained from the patient data where each of the entries represents an encounter that satisfies individual selection criterion of the selection criteria from at least one of the numerator portion and the denominator portion.

7. The method of claim 6, wherein the first HQM comprises at least some of the plurality of lists.

8. The method of claim 1, wherein the step of allowing the provider to define the first mathematical expression for computing the first HQM includes allowing the provider to drag and drop elements of selection criteria within the provider interface to form the first HQM.

9. The method of claim 1, further comprising:

allowing each of the plurality of healthcare providers to use the healthcare provider interface to define a second mathematical expression that uses at least some of the patient data corresponding to the healthcare provider for computing a second HQM according to requirements of the second funding organization;

deriving, by the HQM service, the second HQM for each of the plurality of healthcare providers based on the patient data corresponding to the healthcare provider and the second mathematical expression defined by the healthcare provider;

upon request by the second funding organization, generating, by the HQM service computer, a second HQM report having the derived second HQM, wherein the report is automatically formatted according to requirements of the second funding organization; and

automatically sending an the generated second HQM report having the second HQM to a second funding organization.

10. A healthcare quality measure (HQM) analysis engine comprising a computer, the engine further comprising:

an HQM database storing HQM data in a common HQM data format where the HQM data represents patient data obtained from a plurality of healthcare providers, the patient data from each of the plurality of healthcare providers is in a proprietary data format corresponding to the healthcare provider;

a network interface communicatively coupled to the plurality of healthcare providers via a packet switched network and configured to allow each of the plurality of healthcare providers to define a mathematical expression that uses at least some of the HQM data corresponding to the healthcare provider for computing an HQM according to requirements of a first funding organization and store the encounter data mathematical expression in the HQM database;

an HQM analysis module configured to derive a measure for each of the plurality of healthcare providers based on the HQM data corresponding to the healthcare provider and the mathematical expression defined by the healthcare provider;

a HQM reporting module configured to generate, for the first funding organization, an HQM report based on the derived measures of the healthcare providers, where the generated report is automatically formatted according to requirements of the first funding organization; and

an organization interface communicatively coupled to the plurality of healthcare organizations via a network and configured to present the generated HQM reports to the first funding organization via the network.

11. The engine of claim 10, wherein the HQM analysis module is further configured to generate one or more lists containing entries representing patient data from the HQM data corresponding to HQM selection criteria, wherein the lists are stored within the HQM database.

12. The engine of claim 10, further comprising a list processing module configured to merge two or more lists into a single list according to one or more selection criterion of the HQM selection criteria.

13. The engine of claim 10, wherein the HQM database stores one or more measure requirements from the first funding organization.

14. The engine of claim 10, further comprising an HQM data lock module configured to restrict access to a remote healthcare provider'"'"'s patient data.