CMIO Summit 2011 | Reid Coleman


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CMIO Summit 2011 | Reid Coleman

  1. 1. MU: The Right Way, TheWrong Way… and BreakingThrough the ConfusionReid W Coleman MD FACPMIO, Lifespan
  2. 2. Disclaimer!!! Presentation title provided by conference organizers It assumes I know the right way!!?? My title would have been…
  3. 3. A CMIO Looks At MU: TheView From Under The Bus
  4. 4. 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
  5. 5. 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
  6. 6. Some Wrong Ways Duck and Cover One and Done Take the Money and Run
  7. 7. Duck and Cover Did you ever practice  This is a good duck and cover at time to start! school?
  8. 8. 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
  9. 9. One and Done Some criteria for year one are measured by “do one”  Orders  Problems  Home Meds  Immunization submission  Generate a report  Etc.
  10. 10. 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?
  11. 11. 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…
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. Protect Patient Information Baked into all our systems… Yours, too?
  20. 20. Communication and Training Weekly messages from the CMO’s Many messages from the CEO’s All say: This is a quality and safety project
  21. 21. 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….
  22. 22. ThanksQuestions? Reid Coleman   401-444-6448 We share most everything