HEALTH INITIATIVES CONSULTING, INC. Maintaining Data Mapping in i2itracks

Transcription

1 HEALTH INITIATIVES CONSULTING, INC. Healthcare Transformation, Redesigned! Your Partner in Data Stewardship Maintaining Data Mapping in i2itracks Data Stewardship is a process of establishing and maintaining the validity and reliability of data used to drive your business. This document will help you maintain the appropriate data mapping in i2itracks, as part of your data stewardship process. Health center teams are encouraged to do an initial deep dive into all the data elements in i2itracks. After the initial comprehensive process, it is best practice to review and update data on a quarterly basis to include: 1. Linked Visit Types 2. Allergies 3. Educations 4. Immunizations 5. Medications 6. Problems 7. Procedures 8. Self-Management Goals 9. Treatment Plans 10. Other Profile Items 11. Labs 12. Custom Data Integrator (CDI) 7/12/17 Page 1 of 13

2 Allergies, Problems, and Medications are displayed in a patient s profile. Items with the i2i logo are Tracks profile items that are mapped and active. Items with the blue leaves are external items and come over as-is from the EHR. In general, it is best practice to enable only the patient profile items that you are currently using on a population level. If you determine that you need to add a new profile item, always click Show Disabled Items and check to see if the item exists in the disabled library. If it does, simply enable and map that item. As you complete mapping, already mapped data from the EHR/PM systems will disappear from the available library. If your search yields no results when you do your quarterly review, it means that no new items have been added to the EHR/PM libraries. If this result is unexpected the mapping should be reviewed for completeness. Linked Visit Types: ICD and CPT codes come from the Practice Management System. Linked Visit Types are a collection of CPT/ICD codes that all mean the same thing. They should be unique and specific to the concept that is mapped. Review all of the code mappings for the enabled Linked Visit Types during your initial Data Stewardship set-up process. Items that use Linked Visit Types are one of the only items in i2itracks that are not self-healing in the event of incorrect mapping. This means that if an ICD or CPT code is incorrectly mapped in a linked visit type that drives a Procedure, Education or Immunization and you identify that you can make the correction of future data by correcting the Linked Visit Type mapping. However, in order for historical Procedures, Educations or Immunizations to be removed, you must open a support case with i2i Population Health to have them remove the incorrect profile items that were populated by the linked visit type. Unless new codes are introduced, linked visit type mappings do not need to be maintained on a quarterly basis. pg. 2 HIC Maintaining Data Mapping in i2itracks 2017

3 In this example, all Procedure and Diagnosis codes mean a preventive care exam was done. There is an OR relationship between the Procedure and Diagnosis codes. Any one of the codes attributed to a patient will bring that patient up in search using this linked visit type. Patients do NOT need to have BOTH a mapped procedure AND Diagnosis code. Allergies: Review Allergy mapping (Setup > Patient Profile Items > Allergies) for all enabled allergies. Note that you only need to enable and map allergies that you are concerned with on a population basis, or allergies that are relevant for quality measures. Select the Allergy, and click Edit. Then in the new window, click Add to select from the External Allergy library. External Allergies are interfaced directly from your EHR (just like External Problems). Filter items based on your search criteria and select all that apply, then click OK. Repeat this search on a quarterly basis to identify mappings that need to be added, especially if there are new allergies being added to the EHR allergy library on a regular basis. Educations: Review Education mappings (Setup > Patient Profile Items > Educations) for all enabled Educations. pg. 3 HIC Maintaining Data Mapping in i2itracks 2017

4 Select the Education, and click Edit. You will note that Educations can be created through a Linked Visit Type. It is also helpful to put CDI in the description if this item is linked to Custom Data. Review the Custom Data mappings in the External Data Diagnostics tool (EDD). Verify that the alert schedule is still appropriate for the practice. External Data Diagnostics Tool (EDD): File > Tools > External Data Diagnostics Enter the name of the Profile Item in the search field as shown below. All mapped items will display with information that will be helpful in determining if the mapping is appropriate. You can also search with appropriate terms to identify potential data that are not currently mapped. Changing mapping in the Custom Data Integrator (CDI) is reviewed later in this document. Immunizations: Most immunizations are populated via hard-coded behind-the-scenes programming linking the EMR immunization table CVX codes to the Childhood Immunization elements in i2itracks. Childhood immunizations capture ALL immunizations, in spite of the nomenclature. Although immunizations can be mapped as part of the Profile Items using Linked Visit Types, best practice is to rely on Immunization Type mappings. Rarely there are immunization types entered into the EMR immunization table that are not associated with a CVX code. When this happens, these outliers must be mapped in Vaccine Type Mappings. Setup > Tracking > Childhood Immunizations > Vaccine Type Mappings pg. 4 HIC Maintaining Data Mapping in i2itracks 2017

5 Note how this FLU VACC QUADRAVALENT is not mapped. Select the unmapped item, click Map and find the related vaccine type to map to. If the specific vaccine type is not known, use the NOS version. If your organization does use the Immunization Profile Items then go to: Setup > Patient Profile Items > Immunizations > Select Immunization to Validate Go to the Vaccine Types tab and verify that all appropriate vaccine types are linked. Using this method will bring in immunizations administered at your clinic AND elsewhere that are documented in the EMR immunization template. Check the schedule to be sure it reflects current practice. Caution: Using a Linked Visit Type is NOT self-healing and can create duplicate immunizations based on the link to billing as well as the EMR immunization template. For each immunization, you can set custom schedules based on selected patient characteristics. If a patient does not meet the established schedule, you will see a notification on your Morning Huddle report. If you need to set a schedule that is more complicated than the standard schedule tool will allow, you can create a Protocol Search to display on the Morning Huddle report. Schedules for Childhood Immunizations are automatically loaded based off of the standard CDC guidelines. However, children of age for Childhood Immunizations must be added to Childhood Immunization Tracking in order for alerts to appear on the huddle report or patient visit summaries. Review each Immunization in your library on a quarterly basis. Medications: i2itracks automatically maps a specific set of medications and updates the mapping on a regular basis. The following i2itracks medications are automatically mapped: ACE Inhibitor, Unspecified (i2i) ADHD Medications AG Inhibitor, Unspecified (i2i) Amylin Agonists Anti-depressant, Unspecified (i2i) pg. 5 HIC Maintaining Data Mapping in i2itracks 2017 Antibiotic Antihypertensive Pharmacological Therapy Antithrombotic Therapy (NQF) (Note: Some aspirins may not map to this and may require manual update) ARB, Unspecified (i2i)

6 Aspirin (i2i) Asthma Controller Medication Asthma Rescue Medication Biguanides Contraceptives (NQF) Diabetes Medications (NQF) DPP 4 Inhibitors Glitazones, Unspecified (i2i) GLP 1 Analog (Byetta) Insulin (i2i) Lipid Lowerer (NQF) Meglitinides PCP Prophylaxis (Note: Bactrim and related medications are not auto-mapped and will need to be manually added as appropriate for your practice) Smoking Cessation (NQF) Sulfonylurea, Unspecified (i2i) Warfarin (NQF) (Note: Jantoven is not included auto-mapping and will need to be manually added as appropriate for your practice) Medications that are auto-mapped but not used by your practice can be disabled to remove them from the visible pick list. However they will continue to populate on the patient level based on their maping to EMR medications. DO NOT change the names of any of the auto-mapped medications as this will interfere with the appropriate function of the auto-map routine. If you need a medication that is not listed on the medication list, such as Hepatitis C Meds, it will need to be manually created and mapped. First, ensure that the medication is enabled (Setup > Patient Profile Items > Medications > Medications). Once it is enabled (or created), review the mapping (Setup > Patient Profile Items > Medications > Medication Mapping). Select the medication, and then Edit. If there are no medications listed, you will need to Add them manually. This is a labor intensive set-up process, but only needs to be maintained on a quarterly basis for enabled medications moving forward. First, search the medication library for the root word of the generic medication. In some EMRs the generic name is included with the brand name of the drug. If not, you ll also need to do a search for all the brand named drugs within the broader category. pg. 6 HIC Maintaining Data Mapping in i2itracks 2017

7 Select OK to add the medication mappings. On a quarterly basis, review the mapping for all medications that are NOT auto-mapped by doing a search for all the names that have already been mapped (this will identify if a new dosage was prescribed for the first time, for instance). Search for new medications in the class of medications that are being mapped. Is there a new brand name or generic that has been released recently that is now in use at your clinic? Problems: Review Problem mapping (Setup > Patient Profile Items > Problems) for all enabled problems. Note that you only need to enable and map problems that you are relevant to a population or for quality measures. You do not need to replicate your entire EHR problem list. Problems can be mapped to diagnosis codes, procedure codes, external problems, or custom data. If a problem is mapped to custom data (CDI) exclusively or in addition to External Problems, best practice is to write CDI Mapping in the Description to prevent confusion. It is best practice to map Problems to External Problems with or without CDI mappings as these are both self-healing and allow the problem in Tracks to resolve when the corresponding problem in the EMR is resolved. Any mapping changes in linked billing ICD codes will only change the problem attribution in i2itrakcs from that moment forward. As with Procedures, Immunizations or Educations that are created by linked visit types, past errors will need to be cleared by i2i Population Health by submitting a support ticket. pg. 7 HIC Maintaining Data Mapping in i2itracks 2017

8 The Related Profile Items tab in Problem setup is where you designate profile items of interest to patients that have that particular problem (e.g. comorbidities). These Related Profile Items will populate on the Patient Visit Summary for patients with the i2itracks problem(s), which is particularly useful if you are using a generic Preventive Care patient visit summary. This is a setup for the i2i Preventive Care Template Patient Visit Summary. Check the Include profile items that are related to the patient s problems radio button to have the visit summary personalize for each patient based on their i2itracks problems. Procedures: Review Procedure mappings (Setup > Patient Profile Items > Procedures) for all enabled Procedures. Select the Procedure, and click Edit. You will note that Procedures can be created through a Linked Visit Type. It is also helpful to put CDI in the description if this item is linked to Custom Data. Review the Custom Data mappings in the External Data Diagnostics tool (EDD). Verify that the alert schedule is still appropriate for the practice. See the CDI mapping section at the end of this document for more information on updating CDI mappings. pg. 8 HIC Maintaining Data Mapping in i2itracks 2017

9 Self-Management Goals, Treatment Plans and Other Profile Items: Setup > Patient Profile Items > Self Management Goals Setup > Patient Profile Items > Treatment Plans Setup > Patient Profile Items > Other Self-Management Goals, Treatment Plans and Other Profile Items can only be driven by the CDI. Review their mapping quarterly. See the CDI section in this document. Labs: Review lab mappings quarterly or when sudden shifts in report outcomes are observed. Labs can change result codes without your knowledge and EMR mappings can change. Either one of these events can change the lab result mapping needed in i2itracks. As with all data elements, only enable the Labs that you will be using to manage or report on the population. Labs are enabled and disabled in Labs. Once you have a clean list of labs that you will be using, lab mappings can be reviewed in Lab Mappings. Note: The other functions in this menu are legacy functions from a time before lab interfaces. These functions can be ignored. pg. 9 HIC Maintaining Data Mapping in i2itracks 2017

10 You will have a tab across the top for each of your lab sources. Labs need to be mapped separately under each tab. Prior to mapping it is a good practice to drill down on the various results in the External Data Diagnostics tool to validate appropriate results. Numeric results, like the HbA1c do not require additional steps beyond mapping the results codes. Qualitative and list values have additional mapping requirements. HIV screening is an example of a qualitative lab. HCV Fibrosis stage is an example of a list value. Use the Set button to map the results. Custom Data Integrator: Mapping for custom data occurs in the Custom Data Integrator (CDI). Items in the CDI are mapped on an as-needed basis. Depending on your EHR interface, you may have thousands of items in this library. You only need to maintain mappings (i.e. look for unmapped values) for items that have equivalent i2itracks items. Items that have unmapped values will be highlighted in red UNLESS the Ignore Unmapped Values radio button has been selected in the setup of that item. The selection of this radio button is indicated by a Yes in the Ignore Unmapped Values column of the CDI. pg. 10 HIC Maintaining Data Mapping in i2itracks 2017

11 If you identify an item in the CDI that needs to be mapped and an equivalent i2itracks item does not exist, the setup of that item can be done right from the CDI. For example, you might want to also map this item to a Procedure of Tobacco Use Assessment. Click on Add Another Mapping. Choose the Category of item that you want to create. Then click on Setup Items pg. 11 HIC Maintaining Data Mapping in i2itracks 2017

12 Then create the required data element. Remember to always check the disabled items before potentially creating a duplicate data element. Add CDI to the description for clarification. Once the item has been created you can map it. If you are creating a new Problem, you can map the External Diagnoses from the setup within the CDI, rather than having to go back through profile items setup when done in the CDI. When a new rule is added, you must determine how the rule will treat the EHR data. Other Profile Items that are numeric values will give you the following mapping options: Any date value (Use as event date Any numeric value As Is Any of the following values Any value When there are many text values, rules can be applied to simplify mapping maintenance. Validation should be thorough to be sure that the data is being interpreted appropriately. pg. 12 HIC Maintaining Data Mapping in i2itracks 2017

13 CDI Data Validation Depending on the EMR interface with i2itracks, there may not be a capability of drilling down on custom data in the External Data Diagnostics tool prior to mapping that data element. Prior to mapping something to production, when the data interpretation is not clear, you can map the data element to a Test List Value item in Other Profile Items. CDI mappings are self-healing. Once a mapping is cleared and auto-update has occurred (generally overnight for most installations of i2itracks) then the data that had been mapped to the i2itracks items is removed from the patient level. This allows you to repurpose any of the test list values for testing additional data elements. Simply edit the name of the item and map it to the data that you want to validate. Wait for auto-update and then you can drill down within the EDD or create searches and reports to validate the data. pg. 13 HIC Maintaining Data Mapping in i2itracks 2017