end stage renal disease (esrd) hcfa/medicare/esrdpage.htm

Implementing HCFA’s ESRD E-Reporting with HL7 v3 XML Implementing HCFA’s ESRD E-Reporting with HL7 v3 XML Cleveland, May 22-26, 2000Cleveland, May 22-26, 2000

© 1997-2000 Meta Integration Technology, Inc.

www.metaintegration.comwww.hcfa.gov

End Stage Renal Disease (ESRD)http://www.hcfa.gov/medicare/esrdpage.htmhttp://www.hcfa.gov/quality/qlty%2D5d.htm

Standard Information Management System (SIMS)http://www.simsproject.com

http://www.esrdnetwork6.org

Vital Information Systemto Improve Outcomes in Nephrology (VISION)

HCFA / ESRD E-Reporting based on HL7 v3 XML Technology

XML based Data Collection / ETL Toolsoon http://www.metaintegration.net/HCFA

Contacts @ HCFA Contacts @ Meta IntegrationCyrus Karimian [email protected] Bill Le Clair [email protected] Stricker [email protected] Christian Bremeau [email protected]




HCFA ESRD Network SOWBackground

HCFA ESRD Network SOWBackground

• The Statement of Work (SOW) delineates the activities to be conducted by each End Stage Renal Disease (ESRD) Network Organization (Network) to meet the requirements of section 1881(c) of the Social Security Act; the Health Care Financing Administration's (HCA's) Health Care Quality Improvement Program (HCQIP); and other directives related to improving the quality of care of patients with ESRD.

• The statute, regulations, the ESRD Network Organizations manual, and other HCFA instructions provide additional detail concerning Network functions, activities, and responsibilities.




HCFA ESRD Network SOWGoals

HCFA ESRD Network SOWGoals

• Improve the quality of health care services and quality of life for ESRD beneficiaries;

• Improve data reliability, validity, and reporting among ESRD providers/facilities, Networks and HCFA (or other appropriate agency);

• Establish and improve partnerships and cooperative activities among and between the ESRD Networks, Peer Review Organizations (PROs), State Survey Agencies, ESRD providers/facilities, ESRD facility owners, and professional groups.




HCFA ESRD Network SOWInformation ManagementHCFA ESRD Network SOWInformation Management

• The Network shall be required to utilize theStandard Information Management System (SIMS)to support Network data processing, information management and reporting contractual requirements to HCFA.

• HCFA is redesigning the current Renal Beneficiary and Utilization System (REBUS).

• The new system will be named the Renal Management Information System (REMIS).

• The Network shall be required to utilize REBUS or REMIS as directed by HCFA.




HCFA / ESRD / SIMSResponsibilities

HCFA / ESRD / SIMSResponsibilities

• The Network's responsibilities for data processing, information management and reporting are: – To have sufficient system capacity with the appropriate computer

hardware and software to carry out its contractual responsibilities;

– To effectively manage the collection, validation, storage and use of data, including data provided by HCFA, for review, profiling, pattern analysis, and sharing with the HCFA RO and State Survey Agency for use in its ESRD Medicare survey and certification activities;

– To ensure timely and accurate reporting by the providers/facilities;

– To maintain an ESRD patient and facility database and ensure the integrity and accuracy of the databases; and

– To ensure the quality and accuracy of the data submitted to HCFA for inclusion in the ESRD Program Management and Medical Information System (PMMIS) and the United States Renal Data System (USRDS).




HCFA / ESRD / SIMS System Capacity

HCFA / ESRD / SIMS System Capacity

• The Network shall maintain a system that provides the capacity to meet its contractual responsibilities for data collection, validation, entry, retrieval, profiling, analysis, and reporting, and for electronic data interchange. The system, at a minimum, shall utilize and consist of the following: – SIMS software, and program documentation, for the entry and transmission of the

HCFA ESRD forms described in section C.5.E.; – HCFA approved software for the entry and transmission of clinical performance

measures described in section C.2.C.; – Internet enabled electronic mail capability compatible with HCFA, including the

ability to send and receive attachments; – Dial-in capability for connection to REBUS and HCFA compatible web browser

access for connection to REMIS; – Office automation software compatible with the HCFA standard;– HCFA supplied or other statistical software for data analysis and profile analysis

including profiling patients and facilities by county to facilitate disaster planning and other studies;

– Provisions for disaster recovery of the databases and data system; and– Sufficient hardware to run the above software applications.




HCFA / ESRD / SIMSDatabase Management

HCFA / ESRD / SIMSDatabase Management

• The Network shall maintain a patient database containing the minimum/ critical data elements listed in the Draft ESRD Network Organizations Manual instructions. The Network shall perform the following tasks related to its patient database:

– The Networks shall consistently update the SIMS central repository based on data received from the providers/facilities. HCFA will receive a data feed from the SIMS central repository on a regularly scheduled basis to obtain an update of the Networks‘ patient data for REBUS/REMIS.

– Upon notification from HCFA either by hardcopy or electronically through REBUS/REMIS, update the Network's patient database with valid changes to important data elements (e.g., beneficiary name, date of birth, Health Insurance Claim Number (HICN) and Beneficiary Identification Code (BIC)).

• Through SIMS, the Network shall also maintain a facility database containing the minimum data elements listed in the Draft ESRD Network Organizations Manual instructions. HCFA has the capacity to create data files and labels, and to verify data for the national listing, directly from the SIMS system. HCFA will give the Networks two weeks notice prior to taking these actions so that Networks can properly schedule their system updates for the date the file is created.




HCFA / ESRD / SIMSCollection, Validation & Maintenance of HCFA ESRD

Forms (Introduction)


Forms (Introduction)

• The Network shall obtain completed HCFA ESRD forms from each ESRD provider/facility in the Network area. The Network will also include all voluntarily submitted forms from the non-Medicare Department of Veterans Affairs (DVA) facilities, and other institutions such as prisons and nursing homes. These forms contain patient specific information necessary for the operation of the national ESRD program. The HCFA ESRD forms and their facility computer generated equivalents include the following:– HCFA-2728-U4 - ESRD Medical Evidence Report Medicare Entitlement and/or

Patient Registration (completed on each incident ESRD patient);

– HCFA-2744 - ESRD Facility Survey (completed annually);

– HCFA-2746 - ESRD Death Notification (or computerized facility generated Death Notification form) (completed within 30 days of the date of death);

– HCFA-820 - In-Center Hemodialysis (HD) Clinical Performance Measures Data Collection Form; and

– HCFA-821 - Peritoneal Dialysis (PD) Clinical Performance Measures Data Collection Form.





Forms (VISION)


Forms (VISION)

• It is anticipated the:Vital Information System to Improve Outcomes in Nephrology (VISION) project will be rolled out during this contract period, with National Implementation slated for the first quarter of calendar year 2001. However, until such time as the HCFA requires electronic reporting from all dialysis facilities for all patients, it will be on a voluntary basis. At that time, the Networks will be responsible for validating the data from the facilities.

• Monitoring the accuracy and completeness of reports, and the validation of facility-level patient data are critical roles in assuring the integrity of the patient tracking system. Similarly, capturing data forms on all incident cases requires a mechanism for cross-checking so facilities can query and detect unreported forms. As VISION is implemented, the activities specified below will need to be retained in a format that is consistent with migration from hardcopy to electronic reporting.




HCFA / ESRD / SIMSCollection, Validation & Maintenance of HCFA

ESRD Forms (Activities)

HCFA / ESRD / SIMSCollection, Validation & Maintenance of HCFA

ESRD Forms (Activities)

• The Network shall conduct activities to ensure that the data required on the forms are collected, completed, and validated in accordance with Draft ESRD Network Organizations Manual instructions, and the ESRD Program Instruction Manual for Renal Providers. These activities include the following: – Review forms received for accuracy and completeness and return to the

provider/facility (or otherwise query the provider/facility) for correction or completion of those forms with missing or inaccurate data.

– Receive and process the ESRD Medical Evidence Report, Medicare Entitlement and/or Patient Registration form (HCFA-2728-U4).

– Process and transmit the information on HCFA-2728 and HCFA-2746 forms directly to the HCFA Data Center via SIMS.

– Process and transmit the information on the HCFA-2744 form directly to the HCFA Data Center via SIMS by the fifth working day in April.

– Transmit corrections on the HCFA-2744 form by hard copy or through SIMS by the third Friday in May.

– Maintain a file of all HCFA ESRD hardcopy forms that are processed for at least two years.




HCFA / ESRD Data FlowThe big picture…

HCFA / ESRD Data FlowThe big picture…

In-Center Hemodialysis (HD)Clinical Performance Measures Data

CollectionForm 2000, Form HCFA-820

Peritoneal Dialysis (PD)Clinical Performance Measures Data

CollectionForm 2000 Form HCFA-821

ESRD Beneficiary Selection(Home Patients Only)

Form HCFA-382

ESRD Medical Information System

Facility SurveyPart One: Dialysis

Part Two: Kidney TransplantsForm HCFA-2744

ESRD Medical Evidence ReportMedicare Entitlement And/Or Patient

RegistrationForm HCFA-2728-U3

Dialysis Facility (DF)Clinical Performance Measures Data

CollectionForm 2000 Form HCFA-???

Patient DeathForm HCFA-2746

PatientSpecific Information

Form SIMS-???

FacilitySpecific Information

Form SIMS-???

Social SecurityAdministration

(SSA)

Health CareFinancing

Administration(HCFA)

End StageRenal Disease

(ESRD)Facility


(ESRD)Facility


(ESRD)Facility

Transforming the ESRD Reporting Process to HCFA

from Paper Forms to HL7 v3 XML based E-reporting




Network #20

…

HCFA / ESRD Data FlowThe SIMS front end

HCFA / ESRD Data FlowThe SIMS front end

HCFA-2744

HCFA-2728-U3

HCFA-2746


(ESRD)Facility


(ESRD)Facility


(ESRD)Facility

OvernightUpdates

…

Network #02

Network #01

Health Care Financing Administration (HCFA)


(ESRD)Facility


(ESRD)Facility


(ESRD)Facility


(ESRD)Facility


(ESRD)Facility


(ESRD)Facility

ReportingHCFA

(Paper)Forms

MS SQL Server Databases

Replication

SIMS Networks(geographically

distributed)

IBM Model 2.04 Databases




HCFA / ESRD Data FlowInside HCFA Today…

HCFA / ESRD Data FlowInside HCFA Today…


IBM Model 2.04

IBM Model 2.04

MS SQLServer

Social SecurityAdministration

(SSA)





HCFA / ESRD Data FlowInside HCFA Tomorrow…HCFA / ESRD Data Flow

Inside HCFA Tomorrow…

IBM Model 2.04

IBM Model 2.04

Oracle 8i

Oracle Business Intelligence (BI) &

Knowledge Management (KM) Solutions:Data Warehousing

Data MiningOLAP

AuxiliaryESRDSpecializedDatabases

Very limited and primitive had-hocquery and reports on the IBM mainframe(no need for legacy software migration,

replaced by Oracle BI & KM tools: DW, DM, OLAP).

Legacy Migration ETL

UpdatesETL

Updates ETL




HCFA / ESRD Data FlowLong Term Objective…HCFA / ESRD Data FlowLong Term Objective…


(ESRD)Facility



MS SQL Server RDBMS ?Data Extraction, Transformation & Load (ETL)Electronic Data Interchange (EDI)

over Secure Internet (based on XML)

Do they havea database ?

Is HL7 v3XML Ready ?

Are they connectedon internet / dialups ?

How about the securityof the medical information ?




HCFA / ESRD Data FlowThe VISION Data Collection Tool

(Vital Information System to Improve Outcomes in Nephrology)

HCFA / ESRD Data FlowThe VISION Data Collection Tool

(Vital Information System to Improve Outcomes in Nephrology)


(ESRD)Facility

VISION Data Collection Tool(Windows Standalone Utility)

HCFA-2744HCFA-2728-U3 HCFA-2746

Graphical User Interface(GUI)

(Windows Visual Basic)


(Windows Visual Basic)


(Windows MFC Visual Basic)

MS Access DB

•Manual Entries of HCFA Forms•Automatic Import (ETL from ESRD Facility Database)•Automatic Export (ETL to HCFA SIMS)•Form Editing, Browsing, Queries, Printing, etc.



MS SQL Server RDBMS ?ETL ETL




HCFA / ESRD Data FlowETL #1 & 2 : VISION Import/Export of

HL7 v3 XML “Based” HCFA Documents

HCFA / ESRD Data FlowETL #1 & 2 : VISION Import/Export of


VISION Data Collection Tool(Windows Standalone Utility)

HL7 v3 XML based

HCFA -2744

HL7 v3 XML based

HCFA-2728-U3

HL7 v3 XML based

HCFA -2746


(Windows Visual Basic)Graphical User Interface

(GUI)(Windows Visual Basic)Graphical User Interface

(GUI)(Windows MFC Visual Basic)

MS Access DB

Data Movement Component



Meta Integration Works Data Extraction,Transformation

|& Load (ETL)

Generation & Maintenance of theData Movement Components

(C++ based, Windows Plug&Play)

Import

Export

Import

Export

XML Files






HCFA / ESRD Data FlowETL #3 : HCFA / SIMS Import of


HCFA / ESRD Data FlowETL #3 : HCFA / SIMS Import of


HL7 v3 XML based

HCFA -2744

HL7 v3 XML based

HCFA-2728-U3

HL7 v3 XML based

HCFA -2746

MS SQLServer



|& Load (ETL)



Import

Import

XML Files

Data Movement ComponentImport





(ESRD)Facility

HCFA / ESRD Data FlowETL #4, 5, … : ESRD Facility Export of


HCFA / ESRD Data FlowETL #4, 5, … : ESRD Facility Export of


HL7 v3 XML based

HCFA -2744

HL7 v3 XML based

HCFA-2728-U3

HL7 v3 XML based

HCFA -2746

Any RDBMSvia ODBC



|& Load (ETL)



Export

Export

XML Files

Data Movement ComponentExport




HCFA / ESRD Data FlowGenerating Data Movement Components HL7 v3 XML “based” HCFA Documents

HCFA / ESRD Data FlowGenerating Data Movement Components HL7 v3 XML “based” HCFA Documents

HL7 v3 XMLbased

HCFA-2728-U3

MS Access DB


|& Load (ETL)

HL7 v3 XML DTDbased

HCFA-2728-U3 (step 2) Model Mapper

(step 1) Model Converter (Import Bridges)

(step 3) Data Bridge Builder

HCFA-2728 HL7 v3 XML to VISIONData Movement Component

ME

TA

DA

TA

LE

VE

LD

AT

AL

EV

EL

Database SchemaLogical Model (ERwin, Rose, etc.)

Physical Model (DDL)




Network #20

Network #19

…

HCFA / ESRD Data FlowIntroducing VISION phase 1

HCFA / ESRD Data FlowIntroducing VISION phase 1


(ESRD)Facility


(ESRD)Facility


(ESRD)Facility

…

Network #02

Network #01Health Care Financing Administration (HCFA)


(ESRD)Facility


(ESRD)Facility


(ESRD)Facility


(ESRD)Facility


(ESRD)Facility


(ESRD)Facility

ConventionalReporting

HCFA(Paper)Forms

VISIONData Collection

Tool(Windows

StandaloneUtility)

HCFA-2744

HCFA-2728-U3

HCFA-2746

E-Reporting

“HyperShip”Secured

TransportU.S. Postal

OfficeCertified !




DomainInformation Models

(DIM)

HarmonizationProcess

ReferenceInformation Model

(RIM)

Refined MessageInformation Model

(R-MIM)

HL7 v2.x(Encoding-

Rules 7) ER7

HL7 v3.x(XML DTD)Messages

HL7 DevelopmentEnvironment

HL7 DevelopmentEnvironment

The HL7 Development Environment is composed of:•A repository called “RIM” implemented on Microsoft Access

•Represents the master copy of all HL7 metadata,•Contains RIM tables as well as R-MIM, HMD, more?•Can be populated from Rational Rose(with referential integrity, and version management))•But contains more information than in Rose?•Can export to Rose

•A toolset called “RoseTree” implemented with Visual Basic

HierarchicalMessage

Descriptions(HMD)

Message Object Diagram

Interaction Model

Message Object DiagramMessage Object Diagram

Interaction ModelInteraction Model

Unused?




HL7 v3 XML “Based” HCFA DocumentsDocument/Message Construction

HL7 v3 XML “Based” HCFA DocumentsDocument/Message Construction

• Goal– Build HL7 XML documents/messages for HCFA forms

– Use Message Development Framework Version 3.2 April 1999

– Use RoseTree

– RIM095 with no modifications

– Use standard coding schemes• LOINC codes (Logical Observation Identifiers, Names and Codes ) for

identifying laboratory and clinical observations.

• ICD-9 (International Classification of Diseases)

– Fortunate that USAM 2.4 (Unified Service Action Model) existed




HL7 v3 XML “Based” HCFA Documents Current Message Choices

HL7 v3 XML “Based” HCFA Documents Current Message Choices

• What about the current documents– Patient Record Architecture Framework

• Not enough RIM information

• Not all the information seems to be in the RIM (i.e.,Clinical_Document_Header with Patient relationship)

• Closest to what we need but timeliness is an issue

– Could not find other documents dealing with documents




HL7 v3 XML “Based” HCFA Documents Classes Used

HL7 v3 XML “Based” HCFA Documents Classes Used

Clinical_document(1) Clinical_document_header(1) Authentication(0..1) Healthcare_document_authenticator(1) Person(1..n)

Person_name(1) Service(0..n) Target(0..n) Material(1)

Master_patient_service_location(1) Dependent_Service(1..n)

Service(1) Healthcare_provider_organization(1) Master_patient_service_location(1)

Patient(1) Person(1) Person_name(1) Employee(0..n)

Person_Employment(0..n) Administrative_patient_death(1)

Master_patient_service_location (from previous box) Patient(1)… Patient_Encounter(0..n) Service(0..n) Target(0..n) Material(0..1) Master_patient_service_location(0..1) Dependent_Service(0..n)

Service(1..n) Consent(1) Consent.Actor(1) Consent.Witness(0..1) Master_healthcare_benefit_product(0..1) Insurer(0..1)

Organization(1) Material(0..n) (Statistical) Target(0..n) Service(0..n) (statistical)

Service is an Observation, Procedure, Condition_node, Medication, or Supply




HL7 v3 XML “Based” HCFA Documents Status

HL7 v3 XML “Based” HCFA Documents Status

• Lessons learned– The RIM is fairly complete – found no needs create new

relationships or to create new attributes

– It is sometimes hard to choose a path when several paths are possible and valid (Services for example)

– Yes/No questions require interpretation

– Members of HL7 are very cooperative

• Waiting on– Statistics – not yet defined

• Used Xeena tool from IBM (free validating XML editing tool)