Finding the Data for APPs: How to Build and OPPE and FPPE Dashboard
Author Cassandra Bunker, MSN, CPNP-PC
Author Jill Gilliland, MBA
Editor Elizabeth Moran, MSN, RN, CPNP-PC
April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN
Associate Nursing Officer, Advanced Practice, Vanderbilt University Medical Center
Professor of Clinical Nursing, Vanderbilt University School of Nursing
Jennifer Quilty, DNP, APRN
Chief Clinical Officer – Orlando Health Medical Group
In 2008, “The Joint Commission (TJC) implemented a new standard mandating detailed evaluation of practitioners’ professional performance as part of the process of granting and maintaining practice privileges in a healthcare organization. Ongoing Professional Practice Evaluation (OPPE) is intended as a means of evaluating professional performance on an ongoing basis for three distinct reasons: 1) as part of the effort to monitor professional competency; 2) to identify areas for possible performance improvement by individual practitioners, and 3) to use objective data in decisions regarding continuance of practice privileges.
Once a provider has achieved practice privileges in a healthcare organization, The Joint Commission requires that performance data be collected and that the evaluation of providers is conducted at a frequency more than once per year. Evaluations completed annually or less are considered by the Joint Commission as “periodic,” not “ongoing.” To comply with this requirement, providers’ OPPE performance data should be evaluated every month, every three months, or every six months. “  The purpose of this is such that the Joint Commission receives ongoing transparency into the quality of care trends via Focused Professional Practice Evaluation (FPPE) feedback. According to Stanford Health, FPPE is ”a systematic process to ensure that there is sufficient information available to evaluate a practitioner’s professional competence. A focused review can be requested by the credentials committee,… or by the Service Chief. FPPE occurs:
- At the time of credentialing (initial FPPE)
- As a result of data evaluated during OPPE
- When additional data or reports indicate the need for a focused review of adverse events.”
OPPE and FPPE grant the organization the option to change privileges if the provider does not demonstrate competency to perform each privilege granted. The six general competencies of APPs are listed below, though the specifics of each will vary by specialty or specific procedure:
- Patient Care
- Medical/Clinical Knowledge
- Practice-based learning and improvement
- Interprofessional communication skills
- System-based practice
Historically, it was thought that there was not a good metric to measure Advanced Practice Provider (APP) quality. Rather, APP quality metrics were measured subjectively; a supervising physician was given a form to complete on whether or not the APP met the basic criteria in each category. Since the introduction of the electronic medical record (EMR), the ability to utilize chart review, case mix, procedures, and quality evaluated against clearly defined metrics. Now, the hurdle is to utilize the system to be most efficient for the hospital or clinic system as a whole.
April Kapu, Nurse Practitioner and Director of the Office of Advanced Practice Providers at Vanderbilt, and Jennifer Quilty, Nurse Practitioner and Chief Clinical Officer at Orlando Health Medical Group, discussed with us OPPEs for Advanced Practice Providers and specifically, using the Epic EMR to measure such metrics. April implemented EPIC over a year ago, whereas Jennifer is in the process of planning for an EPIC implementation. Jennifer’s focus was to learn how to build templates within Epic which capture the necessary data to match the six general competencies as established by the Joint Commission, with a long term goal of building unique templates for each specialty at Orlando Health Medical Group. The primary question of the discussion was: How do institutions that use the Epic EMR measure OPPEs for APPs?
Unsurprisingly, the recommendation for building a new system is to start small and focus on the six general competencies to meet the OPPE requirements. For phase I, April learned that keeping the templates broad to capture basic data was a better approach than trying to capture detailed data. This helped to build a simple reporting mechanism. Both Jennifer and April suggest using two profiles in EPIC to capture data for OPPE and FPPE. An OPPE profile for credentialed providers who do not require cosignature, and an FPPE profile where co-signature is required and the provider is being closely monitored. Phase II can move to more specific usage, such as capturing specialty-specific data and downloading information into reports and dashboards to track and monitor specific metrics.
Having one dedicated person whose role is to manage EPIC tracking is vital to success. Also having a lead APP onboard, who is fully aware of the responsibilities and duties of APPs, can be helpful since the ultimate goal is for the templates to be able to collect data on APP metrics. Furthermore, whereas the roles of physicians and nurses are generally well understood in terms of template building, APP template building is more challenging because of the variation in reporting and whether the care provided is attributed to the APP or the physician—especially when both the APP and physician see a patient so the APP bills incident-to. In this instance, it is helpful to build EPIC to identify the APP as either the service provider or billing provider. The profiles also need to eventually be set up by specialty with variations in templates for ortho, critical care, ambulatory specialties, etc. Ultimately, the goal is that templates are designed to capture unique procedures and competencies in order to provide data to measure the volume of specific activities, as well as to eventually benchmark the data appropriately.
RedCap is a commonly used program within Epic that tracks de-identified data. Team leads can use RedCap to check to see if OPPE is complete. Benefits of using RedCap also include sending auto emails for data entry requests, measuring continuing education, having various dashboards, and more. For example, a supervisor overseeing a unit can go into RedCap and make sure all APPs are up to date with their continuing education credits for the year prior to being audited. An email can then be sent to individuals who are not up to date with the criteria. RedCap can also create reports for the system as a whole. For example, RedCap can create reports on CAUTIs (catheter-associated urinary tract infections), which is not linked to a specific person, but to the system as a whole. The goal is to capture data and create reports to meet the requirements of OPPE and FPPE. By continuously evaluating providers against clearly defined metrics, institutions can ensure competencies are met in order to justify privileges granted.
Overall, learning from experienced users can help build the EMR system to meet the requirements for OPPE and FPPE. Both April and Jennifer agreed that open discussion with APPs at the forefront of the change is important to encourage buy-in and support for the process. Though the process can be overwhelming at the start, reaching out to other APPs leaders who have or also in the process of implementing OPPE and FPPE systems can provide support and information to make the process easier.
Melnic is happy to set up conversations for you with other APP leaders to help solve your most pressing challenges. Please contact firstname.lastname@example.org.
- What are OPPE and FPPE? Ongoing Professional Practice Evaluation (OPPE) Focused Professional Practice Evaluation (FPPE) http://webapps.cap.org/apps/docs/reference/oppe_fppe.pdf
- Harris, P., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde J. (2009) Research electronic data capture (redcap)–a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of biomedical informatics. 42(2), 377-81. Grant support from UL1 TR000445 from NCATS/NIH
has 6 years of pediatric nursing experience and two years as a nurse practitioner. She specializes in pediatric endocrinology, specifically type 1 diabetes. Cassandra graduated from the University of Detroit Mercy with my BSN, and from the University of Michigan with a Masters of Science in Nursing. In her free time, she enjoys running and crafting. This past year, she even ran her first full marathon!