POPULATION REGISTRY PROCESSING

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4 Δεκ 2013 (πριν από 3 χρόνια και 14 μέρες)

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Providing
affordable s
olutions to
often expensive

Information Technol
o
gy

problems



POPULATION

REGISTRY
PROCESSING






Intelligent Healthcare


2800


28
th

Street, Suite 210, Santa Monica, CA 90405

www.intelHC.com

January 200
6

Disease Registry Processing


2

12/04/13



IntelHC Expertise

The

management team has 20 years of financial management and consulting
experience in the healthcare industry and 15 ye
ars of experience in the
information technology sector.


IntelHC currently maintains client healthcare data for analyses of services to
over
1
,
5
00,000 HMO enrollees. We service multiple clients and collect data
from multiple sources. Our clients inclu
de healthcare organizations of all sizes
and types, from small IPAs to large HMOs.



Organizational Chart











Paul Katz

Chief Executive Officer

DE

Srinath Sesham

Database Engineer

Katie Marker

Manage
r,
Production &
Reporting Services

Matt

Aghajanian

Database Operations

Ren Decena

Database Operations

Zara

Bukirin


Production Assistant

Fay
e

Jarow


Production Assistant

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3

Data Processing Responsibilities


CEO


CEO oversees and tracks

the production for each client’s:




Diabetes Disease Registry



Asthma Disease Registry



Cardiovascular Disease Registry


Maintains pharmacy and lab test
s
, and value data bases for each client, which
is used
in the

SQL processes
.



Manager, Product
ion

and Reporting Services


Maintains output data, reviews new data for reasonableness, oversees report
production
, conducts quality assurance for reporting accuracy, writes analysis
narrative. Maintains secure posting of clien
t reports on web site, and interacts
with client on standard reports, and special requests.



Database Engineer


Designs databases to achieve data uniformity across all clients. Processes data
conversion, and maintains multiple client databases from mul
tiple sources.
Validates completeness of data conversion into our system, including
communication and verification with client. Writes source code to generate
reports according to established criteria and specifications. The Database
Engineer processes
the disease and preventive care registries.


Database
Operations


The
operation
process
es

all of the data in SQL for each client database, and
tracks the completion of conversion processes.


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12/04/13



IntelHC’s Technologies


IntelHC's technolo
gy infrastructure is designed to:




Provide reliable and affordable services



Maintain the highest security possible of our clients' data



Present easy
-
to
-
use Web
-
access



Scale to meet the industry and our clients' changing needs


Our Servers operate on the
Microsoft Windows 2000 platform, providing fault
tolerance and low maintenance costs. Load balancing and Server clustering
needs are also accommodated through this platform.


We operate our Web Servers on the industry
-
standard Microsoft IIS. Our N
-
tier
ar
chitecture allows us to respond to changes in our clients' systems, analysis
and reporting needs. We are also able to adopt new technologies as they
become available to enhance IntelHC's services.


We use SQL Server 2000 for data warehousing and OLAP. Cli
ent data is both
on
,

and stored in
,

RAID 5 configuration with backups performed regularly and
stored off
-
site.


IntelHC employs the VeriSign digital certificate and SSL 128
-
bit encryption. We
also have secure database level login. IntelHC staff is trained

in handling the
confidentiality and sensitivity of client data.


All Servers and workstations are protected by Norton Virus Protection. It
protects email, instant messages, and other files by automatically removing
viruses, worms, and Trojan horses. A
utomatic LiveUpdate checks for updated
virus definitions and program updates from the Internet automatically.


Data Security

Healthcare data requires the highest level of security. At IntelHC, we have
implemented a security policy with measures focused on

our network,
applications that protect confidentiality and comply with Federal and State
regulations.
We use operating system and database security for user
authentication and usage monitoring. The following security policies are
enforced to protect dat
a confidentiality:


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12/04/13

5

1.

All IntelHC employees and affiliates sign confidentiality and disclosure
contracts.


2.

Any files sent utilizing email are PGP encrypted. Two keys or passwords
protect the data being transferred via FTP or the IntelHC web site.


3.


agrees not to use or further disclose Protected Health Information other
than as permitted or required by its HIPAA Agreement with its clients or as
required by Law. The standard HIPAA agreement
i
s posted on
our

web site
,
www.intelHC.
com
.


4.


agrees to ensure that any agent, including a subcontractor, to whom it
provides Protected Health Information received from, or created or received
by

on behalf of Covered Entity, agrees to the same rest
rictions and
conditions that apply through the HIPAA AGREEMENT to

with respect to
such information.


5.

SQL backs up each client
’s

database onto network vault
Server 7 weekly.
The files are then placed on a tape backup monthly. Ser
ver 7 contains only
SQL files to protect their integrity.


6.

On a monthly basis, all Servers are backed up on
hard

drives and stored
securely off
-
site.



7.

IntelHC utilizes Redundant Arrays (RAID) on each server to
insulate
against

hardware failures and data loss. The fundamental principle behind RAID

is
the use of multiple hard disk drives in an
array that behaves in most
respects like a single large, fast drive. The use of multiple drives allows the
resulting storage subsystem to have fault tolerance in the event of hardware
failure. Redundancy of computers is designed to keep our systems and
s
ervices operating with maximum capabilities and efficiency.









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12/04/13



Data Processing Flow Chart











































Data
Transmitted to
Inte
lHC

Encrypted data downloaded
off IntelHC FTP Site

Disk Received via Federal
Express, US Mail, etc.

Downloading of data
logged

Data
extracted
from disk or
FTP


Disk logged in and
locked in storage
cabinet

Step 1
-

Data Collection


Original Data
Sto
red on Server


Step 2

Data Loaded

Decryption
and
Validation

Decryption
and
Validation

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Step 2


Source Data Load

Member

Data

Provider
Data


Claims

Data

Encounter

Data

Enrollment

Data

Data
Loaded


Scrubbing


Linking

Duplicate
Checking



Symmetr
y
Tables


IHC

Rx

IHC

Specialty
Provider
Types

IHC

Health
Plans


IHC

Membership

Claim

Detail


IHC

Lab


IHC
Provider

IHC

Claim
Header


IHC

Enrollment

Reasonable Check
using Excel Pivot
Proof Tables and
other Q.A.


Symmetry


Step 3

IHC

Data Warehouse

Hos
pital

Data

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12/04/13






















RX Data Processing

Scr
ubbing


Linking IHC
Steps 1
-
6

IHC

Data Warehouse

RX Data

Source 1

.txt


RX Data

Source 2

.txt



RX Data

Source 3

.txt



RX Data

Source 4

.txt



RX Data

Source 5

.txt



RX Data

Source 6

.txt



Extract to
Client 1
New


Merge into
old stored
client data




Old

Client 1

.dbf


Linkage
Wiz

Tbl.
member



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Step 3
-

Da
ta Processing

IHC

Data Warehouse

Run Stored
Procedures

Childhood
Immunization

Diabetes

Registry


Asthma

Registry


Child
Immunization

.dbf

Asthma

.xls & .
dbf

Diabetes

.xls & .dbf


Step 4

Cervical

Cancer


Breast
Cancer


Cervical

.dbf

Mammogram

.dbf

Cardiovascular
Registry


Cardio

.xls & .dbf

IHC Regi
stry

Data Warehouse

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12/04/13






















Reports Stored on Web
Site Server


Data Processed and
Sorted


Web Reports
Created


IntelHC Client
Downloads
Reports

Step 4
-

Data Registry

Validation
and
Encryption

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Step 1: Data Collect
ion

Data is provided to IntelHC via data storage medium or FTP. Data is provided
from several sources to IntelHC. The types of data collected and stored include


patient demographics,

HMO member enrollment,

claims and encounters,

physician and other p
rovider information,

pharmacy, and

laboratory test results.


IntelHC works with its clients to determine a schedule when the periodic data
feeds are expected. If the files are not received when expected, IntelHC will
contact the client and remind them t
o send their data.



Disk Receiving Procedures

1.

Groups send data overnight via Federal Express or U.S. mail.

2.

Production Assistant signs for the disk and logs

it
in as received
.

3.

The disk is then stored
in a locked
c
abinet
.

4.

The Database Analyst copies the
data from the disk onto designated Server,
and returns the disk to the cabinet.


FTP Data Receiving Procedures

Our FTP site has user authentication, which uses Windows security. We also
use PGP encryption on all files prior to sending to the FTP site to p
revent
unauthorized viewing of data. This process protects data from access during
the entire transmission process and while the data resides on the FTP Server.
The IntelHC network operates behind multiple levels of secure firewalls. Client
data is proce
ssed and stored behind these firewalls. There is a firewall
dedicated to the web Server, as well as another firewall surrounding network
computers. The data receiving processes follows these steps:


1.

Access to our FTP site is password protected and encr
ypted by sending
source.

2.

User ID and passwords are required to log into the Server to upload
the data. Every month the passwords are changed. Windows
automatically prompts when to change the password.

3.

Data is sent IP to IP via FTP on FTP Server.

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12/04/13



4.

Client s
ends an email listing the files being sent.

5.

As soon as the file is transmitted from the source, they are removed
from the FTP site and saved behind the firewall.

6.

Files are decrypted and validated.

7.

Files are stored in directories by client name or from
pharmacy by
health

plan, study period and product, i.e., server

[number]:
\
[client
name]
\
[period]
\
Disease Registry.



RX Data

Data sorting and matching processes are utilized to identify members from
pharmacy data. This process is approximately 9
0
% compl
ete in identifying and
matching to member data. In addition, we also use a prob
abilistic

algorithms
program called Linkage
W
iz, which adds between
5 and
8
% additional
completeness. After the data is matched, it is added to the previous or old
d
atabase file for the client. If a client’s member code is missing we cannot link
to the table member, they are not counted into the registry system.


Pharmacy data from each of up to six health

plan sources per client is received

monthly
. The pharmacy da
ta is sent on different reporting cycles by each HMO.
Source data is converted and stored in dbase IV format. For example, most of
the HMOs send one data set for several clients. The source data is processed,
and individual dbase tables are created by c
lient for each health plan source.


i.e. “client[name]_rx_HMO[name]_200
5
Q2.dbf”


Each of these files is stored until that client’s data is processed. At that time,
each of the HMO new files are combined i.e. “client[name]_rx_new.dbf”, and
then linked

to the membership for that group. This table is added to the prior
accumulated prescription table (“client[name]_rx.dbf”)


The new pharmacy file with is linked to enrollment and membership data via a
multi
-
specification match. These files are linked by
matching the subscriber
number, health plan identification code, last name, first name, date of birth,
and sex. After these steps, the probabilistic software is used.




Lab Data Receiving Procedures:

Clients
receive data from laboratory service providers

and forward to

IntelHC

unprocessed. Data is provided as a text file, HL7 or other format, for each
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13

month of service processed. Each lab service provider codes the data
differently. The data receiving processes follows these steps:


1.

The data is sent t
o IntelHC client.


2.

The data is
copied onto
IntelHC

[designated] Server
.


3.

The information is converted into dbase, and using a lookup table specific
to each client and source, the lab tests needed for the registries are
extracted.


4.

Matching/linking to th
e membership data is then done for this extracted
data, and it is added to the prior client lab file.




Step 2: Data Storage

The Database Engineer oversees
,

processes and maintains data warehousing
and conversion. Currently there are 20 active client

databases split over three
Servers. Over 700 gigabytes of data is currently being managed. At least two
years of data is stored in the system for each client.


Servers work on dual Pentium processors with 4 gigabyte of RAM. Performance
is monitored by

Windows 2000 Performance Monitor and SQL 2000 profiler.


Preprocessing of Data

After data is received from the source, it is preprocessed and loaded into the
Data warehouse. Software is utilized to extract and integrate the source data
into the Registry

database tables.



Data Storag
e


Blue Shield & PacifiCare



Blue Shield data is received via CD. The files are copied off of the CD and
stored on the [designated] Server.


PacifiCare data is
received through an email attachment, locked to IHC’s PGP
lock key
. Files use a Julian date. To access the Server IntelHC staff must log
on. Data is stored separately for each client medical group.


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12/04/13



Step 3: Data Processing

The Database Engineer or Analys
t

process

data utilizing the following
procedures:



1.

Data is processed in SQL 2000 database.

2.

New source data is loaded using SQL or other software.

3.

Data is [currently] processed on Servers #4, #5, and #6.

4.

Data mapping is necessary for the first data l
oad from a client, or when
ever the source data changes.

5.

Data is loaded into database with IntelHC specific terms tracking count
source records and processed records.

6.

Quality Control procedures are taken at each step. Quality Control is
completed prior to

possessing any reports.

7.

Report proofs are run to compare previous quarters’ data to the new data
comparing patterns and trends.

8.

Report proofs are dynamically linked to the SQL database automatically
updating information with each data update.

9.

Reports are
available as tables in SQL.

10.

Source data is stored under the file tree “source”


The
Manager
,
Production

& Reporting Services assists with the data load &
verification by:

1.

Creates for new clients, and update for existing clients, tables

for provider
types and health plans, or any other look up reference table as needed to
convert the data into our standardized format.

2.

Uses the pivot/proof tables to check the data for consistency [by quarter &
pay status], complete [by plan & specialty]
, and appropriate to
commercial/senior enrollment data [per member per month cost &
utilization].


Symmetry
1

Program

IntelHC utilizes episode of care analysis tools from Symmetry
-
Health Data
Systems, including their Episode Treatment Groups (ETGs) and Ep
isode Risk


1

based on “Episode Treatment Groups”
, owned by Symmetry Health Data Systems, Inc.,
and used un
der a grant of license.

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15

Groups (ERGs). Symmetry is used to measure the severity of a patient
condition as another source of valuable data to include in the registries.



ETGs are illness
-
based classifications that identify episodes of care. An episode
is a series of
care services for a given patient for a given condition. For
example, a person being treated for a broken leg and for hypertension would be
classified into two distinct ETGs and receive a number of care services within
each, such as referrals, procedures a
nd medications. The ETGs are combined
into risk groups, which carry a risk factor. The risk factors for each patient are
added to a base demographic factor, to determine a risk score.


Population
Registries

After aggregating medical claims and en
counter data, reference laboratory test
values, and each health plan's pharmacy claims data, Intel
ligent Healthcare

creates
POPULATION
REGISTRIES for patients with diabetes, asthma and
cardiovascular disease for several California medical g
roups and one health
plan.


Risk scores are calculated for each patient in the disease registries

using
Symmetry Health's Episode Treatment Groups/Episode Risk Groups system.
Both retrospective and prospective risk scores are calculated from the system.
T
he prospective score is used to determine patient acuity for each patient in the
registry. Patients are segregated into quartiles based on their acuity relative to
the other patients in the registry. The patients with the highest acuity can then
be given h
igh priority for disease or case management by the medical director.




How Patients Are Identified and Included in
Population

Registries (i.e. diabetes
)


The creation of the registries follows the denominator technical specifications in
HEDIS and
Pay for Performance.


The registries, designed to improve the quality of care for targeted populations,
include all patients with the disease or condition regardless of their length of
time assigned to a physician or a medical group. The HEDIS or Pay fo
r
Performance score calculated from the registries includes only those patients
that meet the continuous enrollment requirement in the technical specifications.


The registry includes both dates and values for crucial interventions so as to
identify patien
ts who are either overdue for a monitoring intervention (such as
blood pressure, glycosylated hemoglobin, or lipids), or have a laboratory result
showing the need for further therapeutic intervention.

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12/04/13





Data in the diabetes registry can be categorized a
s:


1)

demographics,

2)

glycemic control [presence of glucose in the blood],

3)

coronary risk factors, and

4)

disease control data.


Examples of the data fields provided for these categories include:


Demographics:

age,

sex,

type of diabetes,

date of diagnosi
s,

payer, and

zip code.


Glycemic control:

HbA
1c

results


Coronary risk factors:

blood pressure,

lipids (total cholesterol, high
-
density lipoprotein [HDL], low
-
density
lipoprotein [LDL], triglycerides),

medications.


Micro vascular end organ diseas
e data:

micro albumin screening;

dilated retinal exam;

medications.

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Step 4: Client Reports


Monthly/
Bi
-
Monthly/
Quarterly Reports

The following
Report

examples

listed below are
some of the registries/reports
provided
to clients. These standardized reports
/databases

are modified

when
necessary

to meet specific client data issues and needs.


Disease Registries:


Patients with Diabetes (14 tables)


Patients with Asthma (11 tables)


Patients with Acute Cardiovascular Disease (7 tables)


Pay for Performance Progress “Patients by Provider” reports:


Patients with Diabetes


Patients with Asthma


Patients with Acute
& Chronic
Cardiovascular Disease


Cervical Cancer Screening


Breast Cance
r Screening


Childhood Immunizations


Chlamydia Screening


Children with Upper Respiratory Infection


Population
Registries


a.

The
Population
Registries are
separate and unique

databases by
population and by client
. Production involves a “refresh” of the
data, a check for formatting and design, verification that the data
shown on each table matches the table name and h
eadings, and
the data across tables balance. There is an “admin” worksheet in
each file which is updated quarterly with mega data specifics



Pay
-
for
-
Performance Progress Reports


The Patient by Provider reports use Crystal Report Writer software and a
predesigned template report. Production involves “setting location”
and
refreshing
to the current file. The
provider reports relating to the
population
registries are verified against the corresponding registry. The total group/client
scores on each report are checked for reasonableness.



Once the
registry
reports are ready they are printed t
o Adobe
. The CRW
template files
according to a formula
:

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12/04/13




b.

DR
_
[
Disease
]
_PatbyProv.rpt

or HEDIS_[
Population
]_PatbyProv.rpt


The respective data file
s

for each
registry

are:


a.

asthma_combined_members_ex.dbf

b.

card_combined_members_ex.dbf

c.

dm_combined_members_ex.dbf

d.

tbl_cervical_cancer_final.dbf

e.

tbl_mammogram_final.dbf

f.

tbl_chil
d_immuno_final.dbf

g.

tbl_chlamydia_final.dbf

h.

tbl_uri_final.dbf



Report Quality Assurance


The reports are reviewed by the
Manager
of
Production

& Reporting Services,
and the Chief Executive Officer. Once approved, they are locked usin
g PGP,
and posted to website for access by the client.




Report Modifications


For each new
month
/bi
-
monthly
/
quarter's work, there may be report design
changes based on client medical director requests. These are made at the
beginning of each
periods
work; comments throughout the
period
are saved in
and used for the following
period
. Design changes
first proofed against an
existing dataset
.




Client Report Access

Clients access reports over the we
b on our secure site. The client downloads
the reports as an Excel spreadsheet or Adobe print file. Clients must log in at
www.intelHC.com

under CLIENTS/LOG IN with their Username and Password.



Once the reports

have been processed, reviewed and PGP encrypted, they are
uploaded to the web site. Each uploaded report is tested for access and
security by IntelHC staff. The client then receives an email when the reports
available on the web site. The encryption us
es the client’s own PGP public key.
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19

A member of the client’s staff will then log into the web site to download their
reports.






















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12/04/13



Point of Care Reporting/Collection of Clinical Observations

Some physicians have access to their
popul
ation

registries on line through the Point of
Care
reporting

Tool. They can select
all, or specific, patients from their registries, and view
or print the current information. They can
also use the tool to
report clinical observatio
ns,
including blood pressure, height, weight, depression score, and aspirin use. The
physicians
are
able to update the information reported through the claims, pharmacy, and
laboratory data streams with more current
medical
chart information. Information

input by
physicians through the point of care system
is

incorporated into update
s

of
the registries.





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21

Appendix A

Pay for Performance Measurement Set

The Pay for Performance program was designed to evaluate the performance of
contracted physician gr
oups serving commercial HMO enrollees and develop
individual health plan quality bonus programs that will pay significant financial
incentives based on that performance. IntelHC utilizes the following
measurement sets to provide P4P reports to our clients
.


Condition

Measure Description

Childhood
Immunizations

The percentage of children who turned two years old during the
measurement year, who were continuously enrolled for 12
months immediately preceding their second birthday, who
received each of the fo
llowing:




four DTaP/DT or




three IPV/OPV or




one MMR or




three H influenza type B or




three hepatitis B or



one chicken pox vaccine

Breast Cancer
Screening

The percentage of women age 50 through 69

years who were
continuously enrolled for two years, and who had a mammogram.

Cervical Cancer
Screening

The percentage of women age 18 through 64 years who were
continuously enrolled for 3 years, and who received one or more
Pap tests.

Chlamydia Screen
ing
in Women

The percentage of women 16 through 25 years of age who were
identified as sexually active, who had at least one test for
chlamydia during the measurement year.

Asthma

The percentage of patients with persistent asthma continuously
enrolled for

two years and who received at least one dispensed
prescription for inhaled corticosteroids.
T
he measure should be
reported for each of three age stratifications:




5

9 year
-
olds




10

17 year
-
olds and




18


56 year
-
olds

C
oronary Artery
Disease

The percentage of patients age 18 through 75 years old as of
December 31 and who were discharged alive by Dec. 31 for
acute

myocardial infarction (AMI), coronary artery bypass graft
(CABG) or percutaneous transluminal coronary angiop
lasty

(PTCA)

or Ischemic Vascular Disease

and had evidence of LDL
-
C
controlled (<130 mg/dL; <100 mg/dL)
.

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12/04/13



Diabetes

The percentage of members with diabetes (Type 1 and Type 2)
age 18 through 75 years old continuously enrolled for one year,
and who

had evidence of Hemoglobin A1c (HbA1c) screening
,
HbA1c poorly controlled (>9%), LDL
-
C screening pe
r
formed, LDL
-
C

controlled (LDL<130 mg/dL), and LDL
-
C

controlled (LDL<100
mg/dL)
.

Children with URI

The percentage of children age 3 months to 18 years of
age who
during the intake period had a diagnosis of nonspecific URI

and
no inappropriate prescriptions.