MEANINGFUL USE FOR NYU CHAMPIONS
Leanthony Mathews, MSN, RN, [email protected]
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!
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It can be found at: http://bit.ly/NYUMUSURVEY
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