Real World Test Plan 2022 Results

General Information

Developer Name: Claimpower, Inc

Product Name: Claimpower Mobile EMR

Version Number: 6.1

Certified Health IT Product List (CHPL) ID(s): 15.04.04.1238.Clai.06.01.1.200427        

Developer Real World Testing Page URL: https://claimpower.com/real-world-test-plan/

Standards Update

Question Answer
Standard (and Version) 1) USCDI v3 Standards
2) CMS Implementation Guide for Quality Reporting Document Architecture: Category III; Eligible Clinicians and Eligible Professionals Programs; Implementation Guide for 2021 (Available 3/12/2021)
Updated Certification Criteria and Associated Product Claimpower V 6.1
Updated Certification Criteria:
§ 170.315(c)(3) – Clinical quality measures (CQMs) — report
Health IT Module CHPL ID 15.04.04.1238.Clai.06.01.1.200427
Method Used for Standard Update SVAP, Drummond Attestation
Date of ONC ACB Notification September 30th, 2022 (Target Date)
Date of Customer Notification October 15th, 2022 (Target Date)
USCDI updated certification criteria (and USCDI version) USCDI v3
Updated Certification Criteria:
§ 170.315(b)(1) Transitions of care;
§ 170.315(b)(2) Clinical information reconciliation and incorporation;
§ 170.315(e)(1) View, download, and transmit to 3rd party;
§ 170.315(f)(5) Transmission to public health agencies—electronic case reporting;
§ 170.315(g)(6) Consolidated CDA creation performance; and/or
§ 170.315(g)(9) Application access—all data request
§ 170.315(b)(9) Care plan;
§ 170.315(g)(6) Consolidated CDA creation performance; and/or
§ 170.315(b)(7) Security tags – summary of care – send and/ or
§170.315(b)(8) Security tags – summary of care – receive on access—all data request
§170.315(b)(3) Electronic prescribing

 

TCM Management [CP-TCM]

Justification

One of our clients is involved in several Transitional Care Management Programs. We will support them with our Real-World Testing plan. As part of this program, patients are tracked for a 30-day period post-discharge. This test plan will ensure we can import data from partner hospital Epic systems and streamline the administrative tasks necessary for this program.

 

User Stories

  • For each of their patients, we will send a Discharge Summary and C-CDA from their partner hospital’s Epic.
  • We will import this data into our system. Both demographic details and medication lists will be reconciled
  • All medications will be ePrescribed through our system
  • When a patient completes their 30 days, we will export an updated C-CDA

 

Associated Certification Criteria

  • 170.315(b)(1) – Transitions of Care
  • 170.315(b)(2) – Clinical information reconciliation and incorporation
  • 170.315(b)(3) – Electronic Prescribing
  • 170.315(b)(6) – Data Export*

Measures

  • Count of patients in TCM program we import data for in a 30-day period. This metric will give a total count of the discharge summaries and C-CDA’s we import data for
  • %Of patients in the TCM program we import data for in a 30-day period. This ratio will track how often this import is used. The denominator will be the count of patients enrolled in the TCM program, the numerator how many we import discharge summaries and C-CDA’s for.
  • Count of patients enrolled in the TCM programs that we send prescriptions for in a 30-day period.
  • % of patients in the TCM program we send ePrescriptions for in the measured 30-day period. This ratio will track the % of patients in the TCM program who had medications ePrescribed. The denominator will be a distinct count of patients enrolled in the program, the numerator a distinct count of patients who had an ePrescription sent
  • Count of patients enrolled in the TCM programs that we complete the data export for in a 30-day period.
  • %Of patients in the TCM program we export data for in a 30-day period.

Expected Outcomes

For each measure, we expect that we will have more than 10 qualifying patients in a 30 day period and that each of our ratios will be above 70%.

Schedule of Key Milestones

  • February 28, 2022. Finalize coordination with Epic to receive Discharge Summaries and C-CDA files
  • March 1st – March 31 2022. Gather data
  • April 30th, 2022: Complete report summarizing data  

Changes to Original Plan

  • Despite many requests to varying levels of management at our partner hospital, we were not able to setup an automated C-CDA import. The option to export C-CDAs was also not exposed to the userid we were provided to access Epic.
  • We attempted to work out a flat file exchange with the hospital so we could get basic patient demographic information in an automated manner. Our team built a utility to bulk import the provided data. The hospital was unable to provide us with an accurate select of patients that had an Ortho surgery and were referred to this program. This resulted in many irrelevant patients imported into our EMR, mass confusion. We worked with Epic to setup a custom order for patients that were referred to this program, however, the hospital was unable to send us patients that had this order.
  • After months of meetings and dead ends with the hospital IT, we reverted to a manual data entry process to create the patients in Claimpower.
  • The hospital did not want the C-CDA files back, however, we still tested our ability to export C-CDA files.

 

Summary of Key Testing Methods and Key Findings

As detailed in our milestones, we took a one-month sample of our work in this program for our Real-World Test Plan. Here is the data:

Measure Numerator Denominator Outcome%
Patients imported 3.1.22 – 3.31.22 0 via C-CDA 8 total patients 0%
Patients prescriptions sent for 3.1.22 – 3.31.22 8 patients with prescriptions sent 8 total patients 100%
Patients with C-CDAs exported 8 patients with C-CDAs exported 8 total patients 100%

 

While we were disappointed that we were not able to automate the data exchange with the hospital, we are excited to continue to support these Post-Acute programs. In the past year, we helped our client setup 4 other similar programs. Given the continued focus of these programs, we are hopeful we will one day get a C-CDA export from Epic. We shall not give up!

New Client – CQM Data Import [CP-CQM]

Justification

We are blessed to have gained a few EMR clients during the pandemic. We will use this Real World Test Plan to assist them with their quality reporting. We will accomplish this by:

  • Auditing the CQMs we already have setup for them and ensure we are generating compliant QRDAs for them by importing this data to the QPP portal.
  • Conducting trainings for our new clients to ensure they are comfortable using our reporting website to track their CQM scores.
  • As some of our clients switched to our EMR in the middle of 2021, we will import the CQM data from their old EMR systems.

Associated Certification Criteria

  • 170.315(c)(1) – Clinical quality measures (CQMs) — record and export
  • 170.315(c)(2) – Clinical quality measures (CQMs) — import and calculate
  • 170.315(c)(3) – Clinical quality measures (CQMs) — report

Metrics

  1. Count of how many QRDA files uploaded to the QPP portal
  2. Count of how many clients we import CQM data for

Expected Outcomes

Our target is to import at least one set of QRDA files to the QPP portal. Due to COVID-19, many of our clients have already requested we file MIPS reporting exclusions for them.

We received a lot of pushback from our clients’ previous EMR systems as we brought them into ours. So much so, we file an Information Blocking ONC complaint against CureMD, who requested an unreasonable amount of money ($14,000) to give us a data export. Unfortunately, after many follow ups, we still have not received a response from the ONC on our complaint. This behavior was consistent with our other EMR transitions. Given the challenges in working with other EMRs, our target is to complete the QRDA import for one client.

Schedule of Key Milestones

  • December 31st, 2021- Receive QRDA data files from our new clients’ old EMRs. Complete trainings to ensure clients are comfortable pulling reports
  • January 31st, 2022– Complete QRDA import
  • February 28th, 2022– Upload files to QPP portal

 

Changes to Original Plan

We brought 10+ clients in the past year and completed EMR data imports for many of them. A consistent trend is tremendous difficulty in getting data exports from legacy EMR systems. From unreasonable costs to data export “experts” who could only speak in Urdu, we battled many vendors for our clients’ data. As a result, we were not able to import any QRDA files from a legacy EMR system. We’ve adopted a policy of not charging our departing clients for their data exports.

Summary of Key Testing Methods and Key Findings

We have two clients that are enrolled in Primary Care First who required us to upload their data to CMS via a QRDA file. We did this successfully. We will continue to ask for QRDA files as we bring on new clients.

 

Patient Portal [CP-PP]

Justification

Many patients seen by our providers use our patient portal to gain access to their health information. We will track their usage with this Real-World Test plan. We will implement site tracking on our patient portal to see how many patients use the portal.

User Stories

  • We will track a count of how many patients log into the portal to see how many view their information.
  • We will track a count of how many patients download their data.
  • Finally, we will track a count of how many patients transmit their information to another party.

Metrics

  1. %Of Patients who view their info = Count of unique patients logged in/ #of Patients who have patient portal enabled in a 30 day period
  2. Count of how many patients download their data in a 30-day period
  3. Count of patients who transmit their information to another party in a 30-day period

Expected Outcomes

Given the large patient population that already has access to the portal, we anticipate that 5% of them will login within a 30-day period. We expect that 10% of these patients will download and transmit their data.

Associated Certification Criteria

View, download, and transmit to 3rd party” criterion in § 170.315(e)(1)

Schedule of Key Milestones

  • August 30th, 2022– Complete the implementation of site tracking across the patient portal
  • September 1st, 2022- Begin collection of patient portal data
  • September 30th, 2022- Complete data collection

Changes to Original Plan

There were no changes to the real-world test plan we created.

Summary of Key Testing Methods and Key Findings

As outlined in our plan, we completed data collection to track how many patients had access to the patient portal from 9/1/22 – 9/30/22. Here is a summary of the data:

Patients Logged-In Login% Data Downloaded/Transmitted Download/Transmit%
507 14 2.76% 3 21.43%

Our percentage of patients logged in was below our initial 10% projection. We will work with our providers to improve the workflows they use to refer patients over to the portal. We also plan to do more to optimize this site for mobile. We were pleased to see that of these patients who logged, 21.43% of them were able to download/ transmit their data.

 

Immunization Registry [CP-IR]

Justification

We’ve enrolled several of our providers with the New Jersey Immunization Registry. We will track their usage with this Real World Test plan. New Jersey automatically enrolls all patients born after January 1, 1998 into the Immunization Registry. Over a 30 day period, we will track how many of these patients we send immunizations to the registry for. We will also track how many of these patients we are able to pull back the immunization history and forecast for. We will make our sample period during flu shot season so we can track maximum immunization data.

 

User Stories

  • As a user enters a vaccine into our system, we will automatically send this data to the registry
  • A user will have the option to pull immunization registry data back and have it display on their screen

Metrics

  1. Count of patients born after 1/1/1998 who have their vaccine information sent to registry/ count of patients born after 1/1/1998 vaccinated over a 30-day period.
  2. Count of patients born after 1/1/1998 who we successfully pull vaccine information for/ count of patients born after 1/1/1998 who information is requested for over a 30-day period.

Expected Outcomes

We expect at least 80% of patients vaccinated will have their information successfully transmitted to the registry and that at least 80% of the requests from the registry of vaccination information will be successful.

Schedule of Key Milestones

  • August 30th, 2022– Complete registration of any remaining clients to the vaccination registry.
  • September 1st, 2022- Begin collection of vaccination data.
  • September 30th, 2022- Complete data collection

Associated Certification Criteria

The public health criteria in § 170.315(f)

  • 170.315(f)(1) – Transmission to immunization registries
  • 170.315(f)(2) – Transmission to public health agencies — syndromic surveillance

 

Changes to Original Plan

Bottlenecks in the registry sign-up process combined with complications arising from COVID-19 made it so only one of our clients were signed up with the immunization registry.

 

Summary of Key Testing Methods and Key Findings

We succeeded in collecting data on registry transmissions during he measurement period. We exceeded our 80% target for successful transmissions.

Patients Vaccinated Patients Sent to Registry Transmission%
172 141 81.98%

 

Deepscribe [CP-DPS]

Justification

At our client’s request, we completed an integration with an AI power charting vendor. This vendor connects to our API to pull relevant patient information and then pushes back documentation from the visit. Much of the information exchanged follows the data standards of 2015 Edition CCDS. The ability to exchange a subset of this data validates that we can meet this requirement. For our Real-World Test plan, we will gather data on this for a 30-day period.

User Stories

  • A user should be able to view all patients checked in under the Claimpower platform in the Deepscribe platform for a given date range.
  • Documentation from the patient’s visit should automatically come back into Claimpower.
  • The data exchange is logged.

Metrics

Number of patients data is transmitted for/ total number of patients checked in over a 30-day period.

Expected Outcomes

We expect that 100% of the patients checked in will successfully transmit to the Deepscribe platform and that 100% of the patients in the Deepscribe platform will have their chart data sent back to Claimpower.

Schedule of Key Milestones

  • January 1st, 2022– Begin data collection.
  • January 31st, 2022- Complete data collection.
  • The application programming interface criteria in § 170.315(g)(7) through (g)(9)
    • 170.315(g)(7) – Application access — patient selection
    • 170.315(g)(8) – Application access — data category request
    • 170.315(g)(9) – Application access – all data request

 

Changes to Original Plan

There were no changes to our original test plan.

 

Summary of Key Testing Methods and Key Findings

We collected the data below from 1/1/22 – 1/31/22:

Patients Checked-In Patients Sent to Deepscribe Transmission%
349 349 1

As predicted 100% of checked-in patients were transmitted to Deepscribe from 1/1/22 – 1/31/22.

 

Direct Project [CP-DPO]

Justification

A few of our clients are enrolled with EMR Direct to exchange information with other providers. For our Real-World Test plan, we will track their utilization of this for a 30 day period. Many of our clients have told us that they are unable to find direct email addresses for other providers they work with. We will assist them in creating a list of all the specialists they work with and reaching out to them for their secure email addresses.

User Stories

A user should be able to use EMR Direct to exchange a patient’s health information with another provider.

Expected Outcomes

Given the troubles our clients have previously communicated to us with finding specialists Direct Email addresses, our target is to complete this exchange for at least 1 patient.

Metrics

Count of patients who have their information exchanged using EMR Direct.

  • The transport methods and other protocols criteria in § 170.315(h)
    • 170.315(h)(1) – Direct Project

Changes to Original Plan

There were no changes to the original test plan. Our clients continue to be disinterested in this technology.

 

Summary of Key Testing Methods and Key Findings

We completed this exchange for one patient.

 

Care Settings

Our EMR is built and marketed to small individual practitioners. None of the offices we work with has more than 5-6 doctors using our EMR. Our client base is primarily internal medicine, with a few cardiologists, psychiatrists, and one infectious disease client. Given the commonality of their size, the needs of each practice are homogenous, so we are only testing for the “Small Individual Practitioner” care setting.

 

This Real World Testing plan is complete with all required elements, including measures that address all certification criteria and care settings. All information in this plan is up to date and fully addresses the health IT developer’s Real World Testing requirements.

Authorized Representative Name: Rohan Thadani

Authorized Representative Email: rohan@claimpower.org

Authorized Representative Phone: 201-982-3661

Date: 2/11/23