Tips, Tricks, and Updates

The Explainer explains different parts of the Health Focus Registry and what it takes to present you with a clear and complete picture of patient care. New Explainers will appear on the 15th (or thereabouts) of each month. If you would like something explained, or need clarification, please let us know. Suggestions are welcome.

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December 2022

New and Improved PCMH Reports

“New” is often viewed warily. Do we need it and does it do what it’s supposed to do? “Improvements,” however, are always welcomed. Something that is working has been made better? Yes, please. Well, check out the PCMH reports. I’m sure

New

• PCMH – Pediatric ADD/ADHD Report
• PCMH – Pediatric Obesity Report

Improved

These Columns Are Now First in All Reports*

• PCP Provider Group
• PCP Name
• Patient Name
• Patient DOB
• Source

* You can still edit and reorder columns just like before.

Added Columns to PCMH – Asthma and COPD and PCMH – Congestive Heart Failure

• Medication Class
• Last Refill Date
• Refill Quantity

Added Columns to PCMH – Diabetes Report Only

• Urine Albumin (Date)
• Urine Albumin Result
• Albumin to Creatinine (Date)
• Albumin to Creatinine Result
• eGFR (Date)
• eGFR Result

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Introducing New Functionality: Incentive Reconciliation

Ever run into this? Health Focus shows that an incentivized patient is compliant but the payer says she’s not. Other than throwing up your hands, what else do you do? Well, we’ve put a gift under the metaphoric tree. You can now work out the patient status for each incentivized measure.

Unwrapping the Gift

In the screenshot below, the new incentivized measure’s status columns are explained.

1. The measure is met in Health Focus but the in the payer is unmet. See Incentive Status Details below for more, uh, details.
2. It’s eligible for supplemental reporting.
3. Its supplemental file has been sent on December 12, 2022 (YYYYMMDD format) and after the dash, the row number within the source. See Supplemental Status and Supplemental ID below.
4. If more than one file was sent, hover over the supplemental ID and the history appears.
5. It is compliant, despite what Incentive Status says. See Back Stop below for an explanation.
6. When it became compliant and what the result was.

Incentive Status Details

The Incentive Status setup

• The Health Focus icon is always on the left.
• The payer logo is to the right.

Met or Unmet Indicators

• Green circle with a “check” is met
• Red circle with an “X” is unmet

Met/Unmet Scenarios

1. unmet/unmet: neither source has the measure as compliant.
2. met/met: both sources have the measure as compliant.
3. unmet/met: HF has the measure as not compliant, but the payer does.
4. met/unmet: HF has the measure as compliant, but the payer doesn’t.

Most of the time, it is the fourth one, met/unmet. HF’s source has an encounter that meets the measure, but the payer source has yet to forward a confirmation.

Supplemental Eligibility and Supplemental IDs

The Supplemental Eligibility and Supplemental IDs columns give you more information about the compliance status. The Supplemental Eligibility column indicates whether or not it has been sent, and the ID number of the file that was sent.

The column tells you three things that are highlighted in the colored boxes:

• Red square: the file has not been
• Purple square: the file was sent and the supplemental ID indicates it was a “standard” file, which is accepted by the payer. In these cases, they were BCBS files.
• Green square: the file was sent but the supplemental ID was a “non-standard” file, which may not be accepted by the payer. In this case, it was a PPQC file. Other instances may have lab files.

The supplemental IDs are the date of the file (in YYYYMMDD format) and after the dash, the row number within the source.

The Backstop

What if the Incentive Status indicates that the Health Focus says it is unmet? But the payer says it is met? More often than not, the payer sent a treatment opportunity file saying that the patient has met the measure. We override the status and show a check in the Compliance indicating “met,” even though we don’t have evidence of service type or date.

This functionality is our “backstop. ” We may be missing documentation from direct clinical sources, but existing payer reporting closes the treatment opportunities gap. HF provides this backstop just in case there was a mistake.

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The “At Risk” Column in TCM and TOC

In order to meet a 2023 financial incentive for patients who are 18 years and older, who have had an ED visit, and has multiple high-risk chronic conditions, there has to be a follow-up service within seven days of the ED visit (8 total days).

In order to make it easier to identify “at risk” patients, Health Focus has a new column called At Risk. When there is an exclamation mark in this column, it shows that the patient is one of this population. There are two colors for the exclamation points. A blue one means that the patient is Blue Cross Blue Shield (BCBS) patient. A gray one means they are at risk, but not a BCBS patient.

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Have You Seen the HF Change Log?

The HealthFocus change log answers the question, what are those guys at HF doing other than fixing my issues? Well, it shows what we have been adding, updating, correcting, fixing, enabling, altering, consolidating, allowing, sorting, limiting, improving, fixing, reworking, re-ordering, reviewing, and removing. It’s like the change log is an open letter from us documenting how we are improving the tool.

When accessing the change log (Tools > Change Log) you’ll see that the page goes on and on, all the way back to ancient times. Luckily the newest entry is on top. A change log entry consists of the date when the changes were made “live”. The version number, which consists of a series of numbers connected by a period or “dot”  (which is what the cool kids say), uses the format of a major.minor.revision. So the 11/10/2022 version is pronounced: “seventeen dot five dot oh.” And the significance of each number is as follows:

• Major: changes or additions to the product that changes in functionality or significant improvements. 
• Minor: minor changes to the product, or improvements to a functionality
• Version: nominal changes like patches or bug fixes

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November 2022

Filtered Care Mgmt Incentive Tab: Smooth

The Care Management Incentive Dashboard can be used to perform a quick comparison of your incentive performance across three key payers: BCBSM, Priority Health Care Management, and Medicaid. But now you can now filter by practice. Now you can display a subset using criteria that show only the practice units or practice in which you are interested.

Note that filtering does not refresh the table; you are filtering only the items currently listed in the table. There are only two menus to choose from, Practice Unit and Practice Tag.

A desired result of filtering is so you can drill down to where the opportunity is for the provider and practices.

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Sometimes a Little Validation is Nice

In the Health Focus Registry, certain information is hand-entered, such as vitals. Now, we all “fat finger” or make typos when doing hand entry, especially when entering a dozen items at one time or when you’re pressed for time and needed elsewhere.

This is where Health Focus’s data entry validation comes in. It determines if what you typed in falls within the acceptable range of values. This is designed to grab your attention and alert you to review what you’ve entered.

Future Plans

This validation is just the beginning. When we told a client about this, he suggested being more aggressive. Perhaps do data verification, which means performing a check of the current data to ensure that it is accurate, consistent, and reflects its intended purpose.

If you have any thoughts about the value of both validation and verification, please let us know.

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How Issues Are Resolved

Health Focus’s issue resolution process helps you visualize and track who is resolving the issue, how they’re resolving it, and when they resolve it. Along with this, we have a database that helps us solve future issues better and faster.

The criteria are to make it simple, consistent, and open for two-way client/Health Focus communication and clarification opportunities. The result is our current process, detailed in the table below.  The columns’ definitions are below the table.

Step	Action	Bucket	Label	Progress
1.	The client identifies an issue and creates an issue request.	Requests	Added by SMPHO, Action Item, Email Request	Not Started
2.	HF processes the request and assigns staff. Notes the priority.	Acknowledge/Pending	No new label was added.	Not Started
3.	HF identifies the root cause and possible solutions. Development begins.	In Progress	Top Three, Global Priority	In Progress
4.	The solution has been decided on, and it’s being developed or in testing. After which, QA occurs.	Resolved	Resolution Pending	In Progress
5.	Solution pushed to production	Resolved	Confirm Resolution	In Progress
6.	Confirmation feedback is resolved.	Resolved		Completed

• Bucket: Where the ticket resides and the stage it is in the HF Workflow.
• Label: Categorization of the issue, denoting where it came from, its priority, and when a solution has been identified.
• Progress: Indicates whether work has started or the issue is resolved.

If you have any questions or comments, please do so.

A New Tool

Health Focus is in the process of acquiring a new tool to replace Microsoft Planner. We are targeting rollout at the beginning of the year.

When I came on board, one of my tasks was to codify Health Focus’s issue resolution process. Since HF had been going for a couple years, adapting it to standard process workflows was straightforward. However, we did not have a way for clients to create, track, and see the resolution of the issues HF was working on.

At that point, we felt that buying a tool was premature, given that the workflow was new. We would work on our processes first, and use Microsoft Planner which was already part of our MS 365 suite. We adapted it to our needs and now we have our requirements when we acquire a ticketing system. Stay Tuned!

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Understanding the “Batch”

The Health Focus Platform “refreshes” or updates your data every night. To do this, around 10:00 PM a series of software programs automatically kick off. These programs check to see if there are new records available and if there are, integrate the data and load it into the data warehouse. Existing data is reloaded as well.

Periodically, issues cause the batch to stop before it completes. If this occurs, we are notified, and we check the error logs, which describe the reason why it failed. For example, this may be due to permissions issues when looking to see if new records are available, handling errors such as abnormal incoming data, or errors when the validation rules are not conformed to. We zero in on the reason, fix it, and have the batch run again.

The term “batch” is an IT term for combining processes that take up a lot of the computer’s resources or computing power. Because it uses up computing power, it’s best to do it when you aren’t using Health Focus. When this happens, stop because you’re working too late!

Trivia

The term originated with mainframe computers when punched cards were the usual form of computer input and you put a batch of cards (one batch per program) in a box in the sequence that they were to be fed into the computer by the computer operator.

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1. 

   With SMPHO’s expertise and “want to” we have every confidence that you will get to that point, sooner than later!

2. 

   We were hoping to be able to do more with the files out here and create our own. Hopefully we…

3. 

   Is there a way to add to the bottom of the Status email that will show the files that were…

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October 2022

Changes to POC Last Value

Recently there has been concern about clarity on the POC form around the “Compliance” and “Last Value” columns. These two values are not necessarily linked. If you find the last value of “Completed” with an indication of non-compliance, this indicates that the service was completed on the date listed (Last Date). Occasionally a measure like the retinal eye exam, which has compliance spans impacted by negative or positive findings for retinopathy (negative: 2 yrs, positive: 1 yr), has the “Last Value” indicating completed but is non-compliant.

We’ve pushed our first round of changes to improve the mapping of external results to the available dropdown values for measures on the POC. For example, the code “Diabetic Eye Exam” parsed from the Touchworks instance is associated with values of:

• Eye Care Professional – Negative
• Eye Care Professional – Positive

This should make it easier to determine why a patient is listed as compliant or non-compliant given the last service date and result. Also, we’ve simplified how blood pressure values are displayed (removed the decimals). This should improve readability.

We will continue to incrementally push changes to how results are mapped. If there are any particular measures that stand out, please let me know and we’ll make sure to prioritize them.

Creating a Superuser

The role of “Superuser” is not someone who is really good with the Health Focus platform. Sure, that person may be a go-to resource or someone who knows a “trick” to make that one thing work. But the Superuser role can add/edit both practices and users. Compared to the Practice Admins role, which can only add/edit users within their own practice.

A superuser is a powerful role because they can go into all the practices, add users, and change or assign them roles. Having someone within your organization with this role can be very valuable. For example, if a user forgets their password the superuser can reset it.

The Morning Status Email

One of Health Focus’s features is that your data warehouse is refreshed every night. After it’s done, you are sent a status email that reports what files were added and what files were sent out. This article is going to explain the different parts of the email, so you can understand what happened.

The Data Refresh Process

Every night, including Saturday and Sunday, the data refresh occurs at a set time. It goes to all the identified sources and checks if there are files to upload. These files are added to and then processed in your warehouse. When complete, the status email is created and sent. The source files are never deleted but stored in an archive just in case it needs to be reviewed or reprocessed.

Decoding the Status Email

1) Inbound/Outbound Summary

The status email has two sections, inbound and outbound. Outbound is about files sent to payers and POs. Inbound is files from the payers, from a PO’s SFTP, and other sources.

2) Status Definitions

The summary bar sums up the status of all the files in the email. Each file line has the status indicated.

Status	Definition	Action
Success	The file was received, and processed, had a positive record count, and had no errors.	None needed.
Warning	Zero records were in the file. Generally, this is caused by “delta files” that have no updates for an existing patient.	Occasionally, we review the warnings when analyzing.
Failure	There was a problem during the loading process. Generally, this is because of changes in the file layout, the encoding within the file, and other document nuances.	The file will be reviewed that day to identify the problem. If there is an internal fix, we apply it. If the problem can only be fixed by the one who sent it, we will reach out to them. Once the problem is resolved, the file is uploaded when feasible. NOTE: Re-uploads could happen the same day or during the nightly refresh. A status email is sent after completion.
Stage	Files that have been flagged. These aren’t processed but stored in the warehouse. Generally, flagged files are for testing or quarantining.	Flagged files are often for updates or testing and are not used in production.

3) Inbound/Outbound Feed

Identifies the source of the files or where it is going.

4) Load ID

The Load ID is a unique number for that file, is a part of each record, and stays with it through every stage. It is valuable when we are doing analysis.

5) Record Count

The number of records processed in the file. 

6) Load Duration

How long it took to process the file, which is valuable when doing analysis.

7) Error Text Omitted

This text under the file name indicates that the error text has not been added to the status email. This is because the text used to troubleshoot could include Personal Identifying Information (PII), and the email may not be secure.

Questions

If there is a warning or failure, what next? 

These are reviewed each day and are used to identify the issue. If it is re-uploaded, it will be listed in the next status email. Note that the file is not deleted but stored in an archive.

If you have questions about specific file failures, create an issue in Planner.

I put a file to be uploaded but it doesn’t appear in the email. What happened?

The data loader grabs all the files in the PO SFTP folder. Files that are identified by the loader are processed and appear in the status email. Files that aren’t identified aren’t processed and the loader moves on to the next file. For example, the loader grabs ten files but only eight are recognized. The unrecognized two are archived. If you put a file in the SFTP and don’t see it on the status email, create an issue in Planner.

What is a “Global Priority”?

When we meet with you in our weekly meetings, we work on issues that, generally, are specific to your instance, such as missing or mislabeled patients or incorrect calculations. However, an issue you bring up may be due to an infrastructure problem that affects all. For example, at the end of the 2022 second quarter, we refactored the Athena loader because others were having similar problems too. 

The Health Focus Platform has a different “instance” for each client. An instance is a Health Focus interface that has data specific to that client. Your instance does not affect other clients because it uses only your data, which is stored separately from the others. 

This issue is labeled a “Global Priority,” which means that this tool-wide issue will be a primary focus for us and may need more eyes (and fingers) on it. The timeline may be long because a thorough root cause analysis and extensive coding and testing may be necessary. Also, Global Priority work causes a ripple effect on the timelines of other issues and projects, which may be delayed.

By giving it undivided attention, a Global Priority will often turn a problem into a strong point.  As they say, a problem is simply the opportunity to make things better.

Metabase: an Overview

Health Focus’s primary interface is the registry, and for the majority of you and your organization, that’s enough. However, for those of you who want to dig deeper into your data for more insights, we are making Metabase available.  

Metabase is an open-source business intelligence tool that lets you ask questions about your data and displays the answers in formats that make sense to you. Metabase is not a database or data warehouse, instead, it uses the HF data warehouse as the source. Don’t forget that our warehouse has integrated the data and processed it, via the financial and measure engines. 

But being handed the keys is no good if you don’t know how to drive. So, we’re kicking off a series of articles on Metabase, sourcing content from its website as well as other industry sources, and interpreting it to fit your needs. Please give suggestions on what areas to cover, or if a topic needs more detailing.

1. 

   With SMPHO’s expertise and “want to” we have every confidence that you will get to that point, sooner than later!

2. 

   We were hoping to be able to do more with the files out here and create our own. Hopefully we…

3. 

   Is there a way to add to the bottom of the Status email that will show the files that were…

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