They Might Be Right Lifespan Four hospitals, three med surg 1000 beds Half teaching, half private We’ve registered for year one Submitting the end of this month We think we’re okay for Stage Two
Our Approach Map the criteria to improvements that are evidence based for quality and safety If the criteria are not evidence based (?patient empowerment?) link them to something that is Present this as an incentive to do what we should do anyway Meet the criteria in a ‘meaningful’ way
Some Wrong Ways Duck and Cover One and Done Take the Money and Run
Duck and Cover Did you ever practice This is a good duck and cover at time to start! school?
It Really Stinks to Be You You were responsible for all clinical errors Now you’re responsible for the financial survival of your hospital as well A case can be made that the investment is too high, the return too low, and the penalties are tolerable Not a case you want to make
One and Done Some criteria for year one are measured by “do one” Orders Problems Home Meds Immunization submission Generate a report Etc.
One and Done Has This Problem: After year one we’re done Slammed short term solutions don’t get you to Stage 2 What happens year two if you can’t substantiate what you attested to?
Take the Money and Run It is possible that 2012 elections will produce big changes Health care reform gets undone HITECH gets unfunded If this happens, getting what you can year one is the goal… But if it doesn’t happen, then what…
Take the Money and Run If your hospital is sharing meaningful use money with the docs, you live in a different universe and should not be here Telling the clinicians that you’re doing this for the money for the hospital will not make them enthusiastic participants If you can’t make a case for improved quality and safety you have a steep hill to climb
One Approach – Seven Projects(Plus 3) Project #1 – Meeting Standards Project #2 – Electronically Collect Clinical Information Project #3 – Transitions of Care Project #4 – Quality Indicators Project #5 – Patient/Provider Access to Information Project #6 – Protecting Patient Information Project #7 – Communication and training
Standards “LOINC’d” lab and diagnostic imaging Both orders and results It is a lot of work None of it is rocket science (remind me to brag here) Problem List in SNOMED NLM subset ICD-9 crosswalk RxNorm is not ready for prime time
Electronic Clinical Documentation CPOE – no longer a question, is it? Nursing “LIP’s” (I really hate this expression) Home meds Two approaches Collect as data Use NLP Collect as data is more work but provides a great foundation for the future
Transitions of Care The CCD (or CCR) is the Holy Grail The more defined data you collect, the easier it is to build A discharge instruction process wins friends Med Rec does not, but a pharmacy profile from RxHub/Surescripts does
Quality Indicators Personal goal: chart abstraction will be a memory by the time I retire If orders, meds, nursing observations, results, discharge meds, and diagnosis are defined data, quality measures flow If not, NLP is not a full solution but it works
Patient Provider Access No evidence supporting patient access Make it a subset of provider access Good support for this… Provider access Registry/Repository XDS.b
Protect Patient Information Baked into all our systems… Yours, too?
Communication and Training Weekly messages from the CMO’s Many messages from the CEO’s All say: This is a quality and safety project
Plus 3 Technology Dragon has not been as popular as we thought IPads have been Certification Avoid self certification if you can – it is a quagmire Actualization Complicated but not impossible; don’t neglect the work to get the money….
ThanksQuestions? Reid Coleman firstname.lastname@example.org 401-444-6448 We share most everything