Healthcare quality improvement for meaningful use

Health Care Quality Improvement for Meaningful Use
Adrienne Mims, MD MPH
Medical Director for Medicare Quality Improvement
GMCF

Health Care Quality Improvement for Meaningful Use
AGENDA
What is meaningful use? Why is it relevant for TeleHealth?
The quality improvement process
Resources

Meaningful Use
The American Recovery and Reinvestment Act of 2009 authorizes the Centers for Medicare & Medicaid Services (CMS) to provide a reimbursement incentive for physician and hospital providers who are successful in becoming “meaningful users” of an electronic health record (EHR).

Meaningful Use is using certified EHR technology to…
• Improve quality, safety, efficiency, and reduce health disparities
• Engage patients and families in their health care
• Improve care coordination
• Improve population and public health
• All the while maintaining privacy and security
Relevant for TeleHealthcare?

Meaningful Use
Three components – Use of certified EHR
in a meaningful manner
for electronic exchange of health information to improve quality of health care
to submit clinical quality measures
Established 3 stages of meaningful use:
2011, 2013 and 2015

Meaningful Use
Stage 1 Objectives and Measures Reporting
Must complete:
15 core objectives
5 objectives out of 10 from menu set
6 total Clinical Quality Measures (out of 38)

Meaningful Use 15 Core Objectives
Computerized physician order entry
E-Prescribing
Report ambulatory clinical quality measures to CMS/States
Implement one clinical decision support rule
Provide patients with an electronic copy of their health information, upon request
Provide clinical summaries for patients for each office visit
Drug-drug and drug-allergy interaction checks
Record demographics

Meaningful Use 15 Core Objectives
Maintain an up-to-date problem list of current and active diagnoses
Maintain active medication list
Maintain active medication allergy list
Record and chart changes in vital signs
Record smoking status for patients 13 years or older
Capability to exchange key clinical information among providers of care and patient-authorized entities electronically
Protect electronic health information

Meaningful Use 5 out of 10 Menu Objectives
Incorporate clinical lab test results as structured data
Generate lists of patients by specific conditions
Send reminders to patients per patient preference for preventive/follow up care
Provide patients with timely electronic access to their health information
Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate

Meaningful Use 5 out of 10 Menu Objectives
Medication reconciliation
Summary of care record for each transition of care/referrals
Capability to submit electronic data to immunization registries/systems
Capability to provide electronic syndromic surveillance data to public health agencies
Drug-formulary checks

How can you evolve into a system of meaningful use?
A structured methodology is needed

Quality Improvement is a formal approach to the analysis of performance and systematic efforts to improve it.

Quality Improvement - Methods
FADE=focus, analyze, develop, execute, evaluate
PDSA=plan, do, study, act
Six Sigma=(define, measure, analyze, improve,
control)
CQI=Continuous Quality Improvement
TQM=Total Quality Management
Utilize an approach that matches employees and company’s culture.

Support for Quality Improvement
Leadership Team*
Executive sponsor
Project sponsor
Improvement leader
Design team
Additional stakeholders
* Upper management must be on board Realistic expectations of ROI

Did you develop a project charter or set definitive goals?
Examples:
Foster better communication between providers
Implement e-prescribing
Achieve meaningful use
Reduce 30-day readmission rate

Fundamental Questions for Improvement
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in an improvement?

To improve, you must
make changes.But…
Not all changes lead to improvement

Model for Improvement
What are we trying to accomplish?
Aim
How will we know a change is an improvement?
Measures
What change can we make that will result in Improvement?
Ideas
PLAN DO
ACT STUDY

Why an Aim Statement?
Answers and clarifies “What we are trying to accomplish?”
Creates a shared language to communicate the project to others.

Aim Statement
S =pecific
M = easureable
A= ttainable
R=elevant/realistic
T =imely

Defining the Measures
A good aim statement helps define the measures.
Measurement should not slow things down
Seek usefulness, not perfection
Use sampling
Use accessible measures (don’t wait for IT)

AIM Statement
To increase the number of patients with diabetes who have urine kidney tests performed from 25% to 50% by June 2011

Did you collect baseline measurement?
Measurement defines expectations and values
Evaluate compliance
Compare to benchmarks
Track improvements
Identify opportunities
Used by stakeholders
Improve care
Provider selection
Align incentives
Data drives decision making

Types of Data
Patient self-reported data
HRA
Productivity
Satisfaction surveys
Demographic
Plan design
Medical claims
Pharmacy claims
Laboratory data
Biometric screening
Disability data

Measure Caveats
Measure types
Structure:physical equipment and facilities
Process:how the system works/demonstrates compliance with the current process
Outcome:demonstrates the overall impact of the new process/the final product or results
Data collection is resource-intensive
Robust IT systems enable more efficient, timely reporting
Use of case studies to clarify through examples

“Data collection and analysis is a journey, one that must be taken carefully and with significant deliberation, but one that has the potential to bring great value”
~ Jan Berger, MD
Get buy-in and agreement across the organization
Create partnerships
Identify data sources
Convene a data summit
Collect and analyze data

What does our process look like?

Process Mapping
What are the steps that you would go through as a patient for an office visit in primary care?
Procedure
Identify who is involved in the process
Identify the starting and end points
Draw swim lines and post the steps in the process over time
Map the process using sticky notes
Use 2 words for the process (noun + verb)

What is the root of the problem?

Was a root cause analysis performed?

Pick one area to focus on for improvement at a time

PDSA Cycle for Process Improvement
PLAN
ACT
What changes are to be made?
Next cycle?
Objective
Questions and predictions
Plan to carry out the cycle (who, what, where, when)
Plan for data collection
DO
STUDY
Carry out the plan
Document the problems and unexpected observations
Begin analysis of the data
Complete the analysis of the data
Compare data to predictions
Summarize what is learned

PDSA Pitfalls
Plan, Plan, Plan, Panic
The Nike Model “Just do it”
The research model – Plan-do-study-publish
Neglecting to follow up on previous changes introduced (leaving out the “s”)
Piloting on a large scale – more than just a test
“Do” and “Act” are NOT a PDSA cycle

Was an action plan created?

How are projects steps tracked?

Were interim measures defined? If so, are they tracked on a dashboard?

What is the reporting mechanism for informing others of the project?
www.gmcf.org

Summary
Obtaining Meaningful Use certification is a goal that can be accomplished through a well-planned quality improvement process.

Resources
Get information, tip sheets and more at CMS’ official website for theEHR incentive programs: www.cms.gov/EHRIncentivePrograms
Learn about certification and certified EHRs, as well as other ONCprograms: http://healthit.hhs.gov
Learn about Georgia’s Regional Extension Center Institute for Healthcare Improvement: http://www.ihi.org/IHI/
GMCF – The Medicare Quality Improvement Organization for Georgia:
www.gmcf.org Adrienne.Mims@GMCF.org

This material was prepared by GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 9SOW-GA-PRV-11-03

Healthcare quality improvement for meaningful use

by Lloyd Sirmons on Mar 15, 2011

Accessibility

Upload Details

Usage Rights

1 Embed 345

Statistics

Healthcare quality improvement for meaningful use — Presentation Transcript