HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker...
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Transcript of HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker...
![Page 1: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/1.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
QualityNet ExchangeQualityNet Exchange
Dennis StrickerDirector, Information Systems GroupOffice of Clinical Standards and QualityCenters for Medicare & Medicaid Services
![Page 2: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/2.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Quality Improvement OrganizationsQuality Improvement Organizations
• 53 Contractors for quality improvement for Medicare program
• Multiple parties and settings involved
• Privacy data extensively used
![Page 3: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/3.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
End Stage Renal Disease NetworksEnd Stage Renal Disease Networks
• Only disease-specific way to become a Medicare beneficiary
• Three separate (soon consolidated into one) systems determine Medicare eligibility
• Privacy data historically collected via paper forms
![Page 4: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/4.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
QIOs/ESRDs - Business NeedQIOs/ESRDs - Business Need
• Improve service to customers
• Streamline business processes
• Standardize data collection and information sharing across 50 States, DC, PR and VI
• Adhere to Congressional Mandates– GPEA– HIPAA
![Page 5: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/5.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
QIOs/ESRDs - ChallengesQIOs/ESRDs - Challenges
• Implement an “end-to-end” trust model that scales across the country
• Authenticate users in a G to B environment
• Collect and securely transmit and store clinical & privacy data over the internet
• Limit access to data based on “need-to-know”
• Auditing that involves users and administrators
![Page 6: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/6.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
QIOs/ESRDs - Program ObjectivesQIOs/ESRDs - Program Objectives
• Identification – Ensure user is who they say they are
• Authentication – Ensure user is authorized to use system
• Access Control – Limit access to data based on “need-to-know”
![Page 7: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/7.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
QIOs/ESRDs – Technologies UsedQIOs/ESRDs – Technologies Used
• PKI (Public Key Infrastructure) – Identity authentication and digital signatures
• Portals - Personalized for each user based on user role
• CKM® (Constructive Key Management®) – Confidentiality, tokens, credentials, and role-based access control to data using encryption
![Page 8: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/8.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
PKI,CKM, Oracle and Notary PKI,CKM, Oracle and Notary ProofingProofing
• CMS, through contractor support, provides Notary in-person-proofing at the customer level
• CKM has been integrated into the QualityNet web applications for role-based authorization and protection of data in transit and at rest
• Oracle database rules along with CKM credentials (roles) are used to enforce confidentiality and “need-to-know” access
![Page 9: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/9.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
QIOs/ESRDs - BenefitsQIOs/ESRDs - Benefits
• Real Time Reporting
• Faster access to better information
• Eliminate/reduce paper forms
• Facilitate quality improvement at the provider level
• Protection of data in transit and at rest
• Access control to data based on “need-to-know”
• Digital Signatures
![Page 10: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/10.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Security Features-Security Features- Identifying Users Identifying Users
• Digital Certificate –
• Identity authentication
• Digital signatures
• Bi-directional SSL connection
• User Token
• Tiny, safeguarded file
• Password protected
• User information – Credentials, Roles
• Store the digital certificate
![Page 11: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/11.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Registration to QualityNet ExchangeRegistration to QualityNet Exchange
• Registration to QualityNet Exchange site where designated administrators use digital certificates to sign-off on users for access and roles
• Users receive a CKM token, digital certificate, CKM encryption access role, and database role
Current process : :
![Page 12: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/12.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Authentication to QualityNet Authentication to QualityNet Exchange Exchange
• Users must have these components for authentication to QualityNet Exchange– x509 certificate for bi-directional
(verification of user and web server) 128 bit SSL to QualityNet Exchange
– Pass the Certification Revocation List (CRL)– CKM token– QualityNet Exchange Database ID
• Users login into QualityNet Exchange web application that seamlessly verifies all security components through a single sign-on
![Page 13: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/13.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Auditing QualityNet Exchange Auditing QualityNet Exchange • Logging of all user activities• Everyone is part of auditing the system• Auditing reports filtered by:
– Individuals can track what they have done
– Designated QualityNet security administrators can track activity of their users
– CMS and the CMS contractor can track user activity across QualityNet Exchange
![Page 14: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/14.jpg)
Clinical Warehouse - Data FlowClinical Warehouse - Data Flow
ProvidersProviders CDACsCDACsQIOsQIOs
QIO Clinical QIO Clinical WarehouseWarehouse
VendorsVendors
DataData
![Page 15: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/15.jpg)
Clinical Warehouse - Data FlowClinical Warehouse - Data Flow
ProvidersProviders
QIOsQIOs CMSCMS
QIO Clinical QIO Clinical WarehouseWarehouse
•Clinical indicatorsClinical indicators
•Provider specificProvider specific
•State aggregatesState aggregates
•Quality Quality improvement improvement
reportsreports
•Aggregate reportsAggregate reports
•State & national State & national indicatorsindicators
•Comparisons to Comparisons to state and national state and national
normsnorms
•Immediate Immediate feedback reportsfeedback reports
InformationInformation
InformationInformation InformationInformation
![Page 16: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/16.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
ESRDFacility
CROWN OverviewCROWN OverviewSSA
ESRDNetwork
QualityNeteXchange
Secure WebUpload &Download
(soft tokens withencryption key&
digital certificates)
CMS
HL7XMLHL7XML
Init
ial
Da
tab
as
e S
etu
p
Pa
tie
nt
Tra
ns
fer
Co
rre
cti
on
s /
Up
da
tes
Beneficiary Demographics+ Part A Enrollment
ESRD coverage Periods
Export
Import
Extract
ExportImport
Load
Replicate
Report
FileExchange
Legacy Migration
Fe
ed
ba
ck
/ S
tatu
s
PaperForms
Transplant Event& follow up data
Deaths, transplant failures,
missing transplants
Claims Data
View
File Exchange
Feedback /AccretionsC onsolidated
R enal
O perations
W eb-enabled
N etwork
Internet
![Page 17: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/17.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Data CollectionData Collection
• Abstraction tools
• File import according to specifications
![Page 18: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/18.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Functionality - File ExchangeFunctionality - File Exchange
• Secure distribution channel for any file
• Safe transfer of confidential or private data
• Encryption is transparent to users
• Files are encrypted at rest and in transit
• Monitoring activity in real-time by user (who, what, when and how often)
![Page 19: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/19.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Information Dissemination Information Dissemination
• Immediate feedback reports
• Aggregate data reports
• Aggregate reports posted by QIOs
• Quality improvement progress by providers
![Page 20: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/20.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Users View Users View
![Page 21: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/21.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Users View Users View
![Page 22: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/22.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Users View Users View
![Page 23: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/23.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Users View Users View
![Page 24: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/24.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Users View Users View
![Page 25: HCQ P MEDICARES HEALTH CARE QUALITY IMPROVEMENT PROGRAM QualityNet Exchange Dennis Stricker Director, Information Systems Group Office of Clinical Standards.](https://reader036.fdocuments.net/reader036/viewer/2022070305/5513f68b55034646298b6303/html5/thumbnails/25.jpg)
HCQ PMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAMMEDICARE’S HEALTH CARE QUALITY IMPROVEMENT PROGRAM
Users View Users View