Health Information Technology( HIT ): framework management of health information across computerized systems Includes: -Electronic Medical Record ( EMR ) -Computerized Provider Order Entry (CPOE) - Secure health information Exchange and its secure exchange between consumers, providers, government and quality entities, and insurers. Patient
-Paper is cheap
Poor transfer of information outside of hospital
Improve health care quality; Prevent medical errors; Reduce health care costs; Increase administrative efficiencies Decrease paperwork; and Expand access to affordable care.
MU attestation is a report showing that an EH or EP is using a certified EHR technology to meet all the MU objectives. The system must compute and produce the report and can be audited at any time.
‘ meaningful use,’ of HIT we recognize that better healthcare does not come solely from the adoption of technology itself, but through the exchange and use health information to best inform clinical decisions at the point of care. Not on paper on a clipboard or in someone pocket or head.
Noble / Tradition / First do no harm
1. Objectives that measure clinical use of EHR : Measure use of Use of certified EHR in a meaningful manner (e.g., e-prescribing, CPOE). 2. Interoperability objectives: Use of EHR technology for electronic exchange of health information to improve quality of health care and public health. (Immunization, EMR to other institution ) 3. Objectives that show improved Quality Care of patients: Use of EHR technology to submit clinical quality measures (CQM) (Stroke, ED throughput).
To send the data, it must be structured. Write information in the write place. Information in notes or on paper can not be transmitted or used for DSS.
Smokers who quit after myocardial infarction lower their risk of death (compared with ongoing smokers) by up to 40%. Combined results from 12 studies with 2 to 10 years of follow up indicate that one life is saved for every 13 patients who can stop smoking (29).
-Abstracted and integrated the MU elements into the workflow. -Workflows-Utilize NYU approved best practice Epic workflows. -Always document “as it happens” -Work with your leadership to idenitfy key paper documents and confirm that they are on the crosswalk process for inclusion in Epic
Meaningful use for NYU using Epic
MEANINGFUL USE FOR NYU USING EPICPresentation online at: http://bit.ly/NYUMUEPIC
AGENDA• Welcome o 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
DISCLAIMER • All characters, data, examples that appearingin this work are fictitious. Any resemblance to realpersons, living or dead, is purely coincidental.
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)
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
MEANINGFUL USE: THE RELIGION • GIGO • Adoption of technology • “Information wants to be free”
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 CAREo MU supports evidence based objectives to improve patient outcome.o MU supports patient-centric care that engages patients and familieso MU helps reduce health disparities and improve Population and Public Healtho MU improves care coordinationo 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
MU OBJECTIVES: MEASURE CLINICAL USE OF EHR • Computerized Practitioner Order Entry (CPOE) • Record demographics • Maintain active medication listEvery Patient Encounter • Maintain active problem list • *Maintain active Allergy list • *Record smoking status for patients 13 years or older • Medication Reconciliation
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. Excesslength 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.
WORKFLOW TO MEET MU OR ITEM-Select No known allergies check box-Select Mark as Reviewed.-If patient leaves the hospital with nodata in the No known allergies measureFails.
EXAMPLE FINAL HOSPITAL REPORTAllergyObjective(80%):Out of 1287patients 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 thannonsmokers and are at risk of more severe diseaseCleve 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 measureFails. All other sections give credit. Including UnknownIf Ever Smoked.
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 & Mark as reviewed• Key: Utilize reports / Best Practice Advisories – Reports and Advisories are your friend.
SOURCE READING• Centers for Medicare & Medicaid Services https://www.cms.gov• The Meaningful Use Attestation Calculator https://www.cms.gov/apps/ehr/