MEANINGFUL USE FOR NYU CHAMPIONS

Leanthony Mathews, MSN, RN, CNMLLEANTHONY.MATHEWS@NYUMC.ORG

Presentation online at: http://bit.ly/NYUMUSLIDES

AGENDA

• Welcomeo Review of agenda and goals for the session

• History of Meaningful Use• Define Meaningful Use• Demo Epic Workflow MU Allergy objective• Demo Epic Workflow MU Smoking objective • Review Key Points• Answer questions• Next Steps

o Review homework

SITUATION: POOR ADOPTION OF H.I.T.• US lags behind other in industry

sectors and developed countries.

BACKGROUND: REASONS

Cost Software Quality and

Usability Standards

ASSESSMENT: POOR H.I.T.:

• Medical Errors

• Increased healthcare cost

• Decreased quality of care

• Increase paperwork

• Increase the adoption of the Electronic Medical Record (EMR)

• Advance Health Information Technology(HIT)

Recommendation: National HIT

SOLUTION: HITECH ACT• Signed into Law Feb 17,2009 by

President Obama with a Goal by 2015 to:

o reduce the -cost of care

o Improve patient-health centered care

o Enhance patient safety

o Improve population care

WHAT IS MEANINGFUL

USE?• Meaningful Use (MU) =

Objective measures that hospital report as a result of HITECH act.

MEANINGFUL USE - REPORT

CARDHospital Reports on 21 Different

Objectives

EXAMPLE FINAL HOSPITAL REPORT

MEANINGFUL USE: THE RELIGION

• GIGO• Adoption of

technology• “Information

wants to be free”

Homework: What one paper

document in your department do

you feel Epic will have problems

making electronic?

WHY CHANGE?

• Voluntary program and you attest to being a MU.

• I don’t need an EHR to be a good clinician?

• Where do I find time to learn a new system?

• How do I find time to see patients and enter my own data?

• It will slow me down?

• It so uncaring and not patient friendly.

• I like paper records!

INCENTIVE: IMPROVE PATIENT CARE

o MU supports evidence based objectives to improve patient outcome.

o MU supports patient-centric care that engages patients and families

o MU helps reduce health disparities and improve Population and Public Health

o MU improves care coordination

o DSS supports safe patient care

INCENTIVE: REVENUE

• $31 Billion Dollars available for meaningful users of electronic health systems.

• Hospital can receive substantial income for “meaningful use”

INCENTIVE: NON USE PENALTY

• Penalties start in 2015

NEXT UP: EXAMPLES

• Any Questions before we move to examples?

21 COMPONENTS OF “MEANINGFUL USE”

• 1. Interoperability objectives

• 2. Objectives that measure clinical use of EHR

MU OBJECTIVES: MEASURE INTEROPERABILITY

• Report hospital quality measures to CMS (Stoke, ED throughput)

• Exchange clinical information with other institutions

• Submit electronic data to immunization registries

Homework: Currently,

what clinical information about your patient do

you constantly struggle

locating in the patient chart?

MU OBJECTIVES: MEASURE CLINICAL USE OF EHR

• Computerized Practitioner Order Entry (CPOE)

• Record demographics

• Maintain active medication list

• Maintain active problem list

• *Maintain active Allergy list

• *Record smoking status for patients 13 years or older

• Medication Reconciliation

Every Patient Encounter

Homework: Currently, which one Clinical MU

Measure does your unit

struggle to complete?

MU RULE: ALLERGY LIST

• Objective :Maintain active medication allergy list.

• Measure : More than 80 percent of all unique patients admitted to the eligible hospital’s have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data.Evidence:

Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997 Jan 22-29;277(4):301-6.

WORKFLOW TO MEET MU OR ITEM

-Patient admitted using Admission Navigator in Epic.-During your admission suggested workflow you will come to the allergies section.

Homework: Describe one

clinical workflow you

are concerned that Epic EHR will struggle to

capture, specific to your department?

WORKFLOW TO MEET MU OR ITEM

-If patient leaves the hospital with no data in the No known allergies measure Fails.

-Select No known allergies check box-Select Mark as Reviewed.

RECORD ALLERGY OBJECTIVE

EXAMPLE FINAL HOSPITAL REPORT

Allergy Objective (80%):

Out of 1287 patients seen:92% (passed)

8% (failed)

MU RULE: SMOKING STATUS

• Objective :Record smoking status for patients 13 years old or older.

• Measure : More than 50 percent of all unique patients 13 years old or older or admitted to the eligible hospital’s inpatient or emergency department have smoking status recorded as structured data.

Evidence: Smoking cessation counseling should be provided. Smokers are 2 to 3 times more likely to get pneumonia than nonsmokers and are at risk of more severe disease Cleve Clin J Med. 2005 Oct;72(10):916-20.

WORKFLOW TO MEET MU OR ITEM

-Select Tobacco use status of patient.

-If patient leaves the hospital Never Assessed measure Fails. All other sections give credit. Including Unknown If Ever Smoked.

RECORD SMOKING OBJECTIVE

END OF YEAR RESULTS FOR SMOKING OBJECTIVE

Record Smoking

-End of the reporting period-For the entire Hospital-Inpatient and ER admissions

KEY TAKEAWAYS

• Key: Start with education of users on correct workflow – Minimize Work Around

• Key: Real Time Documentation - Minimize Batch Documentation

• Key: Utilize reports / Best Practice Advisories – Reports and Advisories are your friend.

• Key: Standard data capture. Put information in correct electric place - Paper is going away.

SOURCE READING

• Centers for Medicare & Medicaid Services https://www.cms.gov

• The Meaningful Use Attestation Calculator https://www.cms.gov/apps/ehr/

MEANINGFUL USE:

• Questions?

HOMEWORK

• Currently, what clinical information about your patient to do you constantly struggle locating in the patient chart?

• What one paper document in your department do you feel Epic will have problems making electronic?

• Currently, which one Clinical MU Measure does your unit struggle to complete?

• Describe one clinical workflow you are concerned that Epic EHR will struggle to capture, specific to your department?

This entire presentation can be found online at:

http://bit.ly/NYUMU2012

Thank you for your Time!

Please take 5 minutes to complete the Survey about MU in you area:

It can be found at: http://bit.ly/NYUMUSURVEY