Assignment Application Adoption of New Technology SystemsAs a nu.docx
Meaningful use review slide share
1. Institute of Medicine (IOM)
6 Quality Areas for Health care
1. Safe
2. Effective
3. Efficient
4. Timely
5. Patient centered
6. Equitable
(Institution on Medicine, 2001)
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2. EHR Meaningful Use
• Term coined by the framers of the 2009
American Recovery & Reinvestment Act (ARRA)
• Addresses five national health policy priorities
1. Improve quality, safety and efficiency and reduce health disparities
2. Engage patients and families
3. Improve health care coordination
4. Improve population and public health
5. Ensure adequate privacy and security protections for personal health
information (PHI)
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3. Meaningful Use
• Qualified EHR - an electronic record of health-
related information that:
• Includes patient demographic and clinical health
information
• Has the capacity to:
−Provide clinical decision support
−Support physician order entry
−Capture and query information relevant to health care quality
−Exchange electronic health information with, and integrate such
information from, other sources
(Department of Health and Human Services, 2010)
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4. Meaningful Use
Stage 1
• Lays the groundwork for a planned secure
nationwide health information network
• Establishes minimal functionality for Certified
EHR Technology
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5.
6. EP CO 1 Workflow Impact
“The order must be entered by someone who could exercise
clinical judgment in the case that the entry generates any alerts
about possible interactions or other clinical decision support aides.
This necessitates that the CPOE occurs when the order first
becomes part of the patient’s medical record and before any
action can be taken on the order.”
Workflow Impact:
• Role entering the order is determined by state, local and
professional guideline.
• Task sequence is specified by the Meaningful Use Objective
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7. EP CO 2
Drug-drug and drug-allergy interaction checks:
“Implement drug-drug and drug-allergy
interaction checks.”
Workflow Impact:
• Task sequence and timing is implied by the
Meaningful Use Objective
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8.
9. EP CO 3
Problem list:
“Maintain an up-to-date problem list of current
and active diagnoses.”
Workflow Impact:
• Addition of a new reconciliation and
documentation task
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10.
11. EP CO 4
ePrescribing (eRx)
“Generate and transmit permissible
prescriptions electronically”
Workflow Impact:
• New workflow for an existing task
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12.
13. EP CO 5
Medication list
“Maintain an active medication list”
Workflow Impact:
• New workflow for an existing task
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14.
15. EP CO 6
Medication allergy list
“Maintain an active medication allergy list”
Workflow Impact:
• Possible new workflow for an existing task
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16.
17. EP CO 7
Demographics
“Record all of the following demographics:
(A)Preferred language
(B)Gender.
(C) Race.
(D) Ethnicity.
(E) Date of birth.”
Workflow Impact:
• Minimal
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18.
19. EP CO 8
Changes in vital signs
“Record and chart changes in all of the following vital
signs:
(A) Height.
(B) Weight.
(C) Blood pressure.
(D) Calculate and display body mass index (BMI).
(E) Plot and display growth charts for children 2-20 years, including BMI”
Workflow Impact:
• Changes existing tasks
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20.
21. EP CO 9
Smoking status
“Record smoking status for patients 13 years or
older”
Workflow Impact:
• Possible changes to an existing task
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22.
23. EP CO 10
Clinical quality measures
“Report ambulatory clinical quality measures to
CMS or, in the case of Medicaid EPs, the States.”
Workflow Impact:
• Changes to an existing administrative task
Requirements and electronic specifications for ambulatory clinical quality measures can be found at:
http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPage
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24.
25. What are CQMs? Any of a number of measures which measure
various aspects of clinical care. Some of them are process
measures – things like “what percentage of my diabetic patients
had an LDL-cholesterol level drawn?” Some of them are more
endpoint measures – “what percentage of my diabetics have LDL-
cholesterol levels less that 100?”
26.
27. 3 CORE CQMs or Alternate CORE CQMs
Plus 3 Additional CQMs
28. EP CO 11
Clinical decision support
“Implement one clinical decision support rule relevant to
specialty or high clinical priority along with the ability to
track compliance with that rule.”
Workflow Impact:
• Possible new task
• Changes to an existing leadership and technical task
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29.
30. EP CO 12
Providing patients an electronic copy of their health
information
“Provide patients with an electronic copy of their health
information (including diagnostics test results, problem
list, medication lists, medication allergies) upon request.”
Workflow Impact:
• Changes to an existing administrative task
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31.
32. EP CO 13
Clinical summaries
“Provide clinical summaries for patients for each office
visit.”
Workflow Impact:
• Probable new task
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33.
34. EP CO 14
Exchange key clinical information
“Capability to exchange key clinical information (for
example, problem list, medication list, allergies, and
diagnostic test results), among providers of care and
patient authorized entities electronically.”
Workflow Impact:
• Probable new task
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35.
36. EP CO 15
Protect electronic health information
“Protect electronic health information created or
maintained by the certified EHR technology through the
implementation of appropriate technical capabilities.”
Workflow Impact:
• Probable new tasks, and
• New workflow for existing tasks
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37.
38. Meaningful Use
“The Medicare and Medicaid EHR Incentive Programs
provide a financial incentive for the "meaningful use" of
certified EHR technology to achieve health and
efficiency goals. By putting into action and meaningfully
using an EHR system, providers will reap benefits
beyond financial incentives–such as reduction in errors,
availability of records and data, reminders and alerts,
clinical decision support, and e-prescribing/refill
automation.” (CMS EHR Meaningful Use Overview, n.d., para. 1)
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39. Meaningful Use Stages
Stage 3 – 2015
Stage 2 – 2013
Stage 1 – 2011
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Crossing the Quality Chasm provided six aims and simple rules for redesign of health care. They are:Care should be safe, as safe for patients in their health care facilities as in their homes. The science and evidence behind health care should be applied and served as the standard in the delivery of care. Care and service should be cost effective and waste should be removed from the system. Patients should experience no waits or delays in receiving service. The system of care should revolve around the patient, respect patient preferences, and put the patient in control. Unequal treatment should be a fact of the past; disparities in care should be eradicated. (Institute of Medicine, 2001)Importantly, increasing the quality of care is our goal. Implementing technology is a way to achieve this goal.
“Meaningful Use” of EHRs is used to collectively describe those criteria established by the American Recovery and Reinvestment Act or ARRA to qualify health care providers for the electronic health record incentives to be provided. The purpose of these incentives is to encourage the greater health care community to implement EHRs. The expectation is that the coordinated adoption of EHR use across health care providers will address the five established national health policy priorities. The Health Information Technology for Economic and Clinical Health (HITECH) Act incentives and assistance program seeks to improve . . . the performance of the U.S. health care system through “meaningful use” of EHRs to achieve five national health care goals: Improve quality, safety and efficiency and reduce health disparities,Engage patients and families,Improve health care coordination,Improve population and public health, andEnsure adequate privacy and security protections for personal health information (PHI).
A Qualified EHR (Department of Health and Human Services, 2010) is defined as an electronic record of health-related information on an individual that: Includes patient demographic and clinical health information, such as medical history and problem lists; andHas the capacity to: provide clinical decision supportsupport physician order entrycapture and query information relevant to health care quality and exchange electronic health information with, and integrate such information from, other sourcesAn EHR Module is defined in the Final Rule to mean “any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary” (Institute of Medicine, 2001).
Stage 1 of the Meaningful Use requirements lay the groundwork for what is planned to become a secure nationwide health information network with the purpose of improving the quality and safety of patient care and increasing the efficiency of the health care delivery system.The Final Rule, i.e., 42 CFR Parts 412, 413, 422, and 495, defines Certified EHR Technology (Department of Health and Human Services, 2010) as: A complete EHR that meets the requirements included in the definition of a Qualified EHR and has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary; orA combination of EHR Modules in which each constituent EHR Module of the combination has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary, and the resultant combination also meets the requirements included in the definition of a Qualified EHR. An EHR Module is defined in the Final Rule to mean “any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary” (Department of Health and Human Services, 2010).
The specification sheet for EP CO 1 states, “The order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This necessitates that the CPOE occurs when the order first becomes part of the patient’s medical record and before any action can be taken on the order” (Eligible Professional Meaningful Use Core Measures Measure 1 of 15, CPOE for Medication Orders. 2010).There are two ways in which this CO impacts workflow. The first is that the role entering the order is determined by state, local and professional guideline, i.e., a qualified clinician who can take clinical action based on any system generated decision support, e.g., alerts for contraindications or drug-drug interactions. The second way in which the CO impacts clinical workflow is that the CO specifies the task sequence. The order must be entered before action can be taken on the order. This is again because the benefit of CPOE and Decision Support comes from use of the computer system to scan the accessible health data for the patient, and available knowledge-bases, e.g., lists of contraindications, and interactions, for potential problems. Thus, process redesign should assure that CPOE is implemented to meet these two stipulations.
Eligible provider core objective 2, “Implement drug-drug and drug-allergy interaction checks” impacts clinic workflow by the implied task sequence, i.e., the drug-drug and drug-allergy clinical decision support should run during order entry so that the clinician can resolve the alert (Eligible Professional Meaningful Use Core Measures Measure 2 of 15, Drug Interaction Checks. 2010). Further, the decision support logic should run and trigger any alerts before action is to be taken on the order. Preferably, the alerts would occur while the clinician is on the order entry screen within a few seconds of order submission, or as part of an order preview or screening process prior to actual submission or finalization of the order. This gives the clinician the opportunity to make changes immediately and while they are working with the patient and have the case current in their mind.
Eligible provider core objective 3, “Maintain an up-to-date problem list of current and active diagnoses”, impacts the actual tasks that are performed in the clinic as well as system functionality that may be required and clinic workflow (Eligible Professional Meaningful Use Core Measures Measure 3 of 15, Maintain Problem List. 2010). To maintain a problem list, systems may have functionality to add diagnoses manually from clinical assessments, from claims (billing), or from data received via a Health Information Exchange (HIE). The Meaningful Use requirement to maintain an up-to-date problem list implies that clinicians or extenders will at some point have to review existing problems and remove ones that are no longer present, e.g., a past episode of bronchitis for which the patient was treated and from which the patient recovered, and add new problems – sort of like medication reconciliation. This management of the problem list is something that clinicians have always done mentally for problems relevant to the reason for current visit, during the encounter. With the Meaningful Use requirement to maintain the problem list, the actual documentation and reconciliation aspect, will represent a new task for many practices. This new task will have to be incorporated into the clinical workflow, discussed with practice providers and staff, and should be represented on flow diagrams.
Eligible provider core objective 4, “Generate and transmit permissible prescriptions electronically,” changes the workflow of the existing task of writing prescriptions, including new scripts for refills and responding to pharmacy questions (Eligible Professional Meaningful Use Core Measures Measure 4 of 15, e-Prescribing (eRx). 2010). These prescribing related tasks are performed in clinics every where, but use of an EHR system to automate the routing of electronic prescriptions and prescription-related doctor-pharmacist communication drastically changes the task. Instead of handwriting a prescription, the provider will enter the information into their EHR along with the address or other identifying information for the patient’s pharmacy. The system, through a network of intermediaries, transmits the prescription to the pharmacy system where it is received electronically and can be submitted to the insurance company, and ultimately filled. This new ePrescribing workflow will have to be incorporated into the existing clinic workflow, discussed with practice providers and staff, and should be represented on flow diagrams.
Eligible provider core objective 5, “Maintain an active medication list,” changes the workflow for an existing task, medication reconciliation (Eligible Professional Meaningful Use Core Measures Measure 5 of 15, Active Medication List. 2010).The Joint Commission defines Medication Reconciliation as, “… the process of comparing a patient's medication orders to all of the medications that the patient has been taking”. The Joint Commission goes on to state that, “This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care. This process comprises five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and to the patient” (Sentinel Event Alert, Using medication reconciliation to prevent errors. 2006).Health care facilities are required to perform medication reconciliation already, thus, it is not a new task to clinics. However, clinics using paper charts are maintaining a hardcopy list and are not able to benefit from automation such as adding prescriptions from orders or from records received via a Health Information Exchange (HIE). Health care facilities already using an EHR may have varying degrees of automation available based on the system functionality, e.g., the full spectrum from a screen where medications can be entered with no decision support for comparison and no ability to update the list based on new orders or other data, to a system that adds new medications for approval by a provider and suggests old PRN (as needed) medications and completed prescriptions for removal. Process re-design surrounding ePrescribing should take advantage of the automation that exists because the functionality assists providers and facility staff in maintaining an up-to-date medication list.
Eligible provider core objective 6, “Maintain an active medication allergy list,” may change the workflow for the existing task, of confirming medication allergies and soliciting new medication allergies (Eligible Professional Meaningful Use Core Measures Measure 6 of 15, Medication Allergy List. 2010). At outpatient visits, or upon encounters with new providers in inpatient settings, patients are asked if they have any medication allergies, and if so, what type of reaction they had if any. EHR systems that meet Meaningful Use will provide a place to record, update and delete medication allergies. Advanced systems may require providers to acknowledge that the medication allergies have been reviewed, or may suggest such review upon entry of treatments commonly given for reactions to medications following recent administration, for example, Benadryl –used to treat allergic reactions, or Narcan, used to reverse the effects of narcotics. Further, advanced systems will use the patient’s medication allergy list for decision support to alert the provider if he or she prescribes a medication to which the patient has a documented allergy.Process re-design surrounding medication allergy solicitation and documentation should take advantage of the automation that exists because the functionality assists providers and facility staff in maintaining an up-to-date medication list.
Eligible provider core objective 7, “Record all of the following demographics: (A) Preferred language. (B) Gender. (C) Race. (D) Ethnicity. (E) Date of birth” (Eligible Professional Meaningful Use Core Measures Measure 7 of 15, Record Demographics. 2010).Has minimal impact on workflow because most facilities already record this information and maintain it electronically. Implementation of a new EHR system that includes practice management functionality may change the time point of recording these, may include patient completed information, and may change the format in which they are recorded, for example, use of United States Government Office of Management and Budget (OMB) standard race and ethnicity data elements if these are not already used in the facility.
Eligible provider core objective 8, “Record and chart changes in all of the following vital signs:(A) Height.(B) Weight.(C) Blood pressure.(D) Calculate and display body mass index (BMI).(E) Plot and display growth charts for children 2-20 years, including BMI” (Eligible Professional Meaningful Use Core Measures Measure 8 of 15, Record Vital Signs. 2010).Impacts clinic workflow by changing existing tasks. Practices for which height, weight and blood pressure are relevant already measure and record them, however, they may not already do so electronically. Implementation of a new EHR system may change the time point of recording and may change the format in which they are recorded.With certified EHR technology, these parameters can be recorded electronically, and may also be received electronically, e.g., from a health information exchange. As stated in the specification sheet for core objective 8, “The only information required to be inputted by the provider is the height, weight, and blood pressure of the patient. The certified EHR technology will calculate BMI and the growth chart if applicable to patient based on age” (CMS, 2010c). With certified EHR technology, information use is also impacted. For example, when the system calculates the BMI, and relevant percentiles and charts the information over time, i.e., displays it in graphical form, this additional information is available to the provider during the encounter, thus, it can be used to trigger decision support, e.g., alerts for high or low BMI, and for use in clinical decision making.
Eligible provider core objective 9, “Record smoking status for patients 13 years or older” (Eligible Professional Meaningful Use Core Measures Measure 9 of 15, Record Smoking Status. 2010). Impacts clinical workflow through possible changes to the existing task of recording smoking status in patients 13 years of age or older. The recommendation and practice of recording smoking status in patients 13 years or older pre-dated the Meaningful Use criteria, so many practices will already have a routine habit of soliciting smoking status. However, most likely not all of them record it in structured data as required by core objective 9. Further changes to workflow may include receiving this information via patient completed forms through a patient portal, and computer assisted follow-up on the information during the visit, e.g., for patients under a certain age, a decision support rule may prompt the provider to solicit or confirm smoking status because a parent unaware of the adolescent's smoking may have completed the form. Thus, EHR technologies broaden the possibilities for information capture and for information use, both of which should impact clinic workflow for the better. The specification sheet for core objective 9 also adds that if smoking status is “already in the medical record available through certified EHR technology, an inquiry does not need to be made every time a provider sees a patient 13 years old or older”. The specification sheet goes on to say that, “the frequency of updating this information is left to the provider and guidance is provided already from several sources in the medical community” (Eligible Professional Meaningful Use Core Measures Measure 9 of 15, Record Smoking Status. 2010).
Eligible provider core objective 10, “Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States” (Eligible Professional Meaningful Use Core Measures Measure 10 of 15, Clinical Quality Measures (CQMs). 2010). This objective is different from core objectives 1-9 because it involves reporting aggregate quality improvement data rather than collection, display or use of data for an individual patient encounter. Core objective 10, therefore does not impact the clinical workflow during patient encounters, it instead impacts the administrative task of reporting quality measure data to CMS. Instead of collecting quality measures data manually via medical record abstraction, or redundantly be entering the information into a separate system, data for reporting clinical quality measures can be obtained from the EHR and reported directly from the EHR.Forty-four CMS clinical quality measures are specified at the link on the slide. The CMS Quality Measures website states that, “EPs must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures. A maximum of 9 measures would be reported if the EP needed to attest to the 3 required core, the three alternate core, and the 3 additional measures” (Electronic Specifications, Eligible Professionals (EPs). n.d.). Up to 3 alternate quality measures are to be reported if the denominator on any of the core quality measures is zero. For the complete set of clinical quality measures and specifications for their reporting, visit the link provided on the slide.
Eligible provider core objective 11, “Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule,” changes leadership and technical tasks because practice leadership will need to decide which clinical decision support rules warrant implementing for their practice and population (Eligible Professional Meaningful Use Core Measures Measure 11 of 15, Clinical Decision Support Rule. 2010). Technical tasks are impacted because the rules need to be written and added to the system along with the necessary system configuration to use the rule to trigger alerts and to track compliance with the rule. Clinical workflow during patient encounters will be impacted if use of clinical decision support via the EHR is new to the practice. With clinical decision support enabled, the EHR will trigger alerts based on the clinical decision support rules, for example, a warning that the patient has not received a screening test that is recommended by clinical care guidelines. This impacts clinical workflow because in order for the clinical decision support to have an impact, the data must be entered during the encounter, the rule must run during the encounter, and the alert must be rendered during the encounter, or at minimum before an order is carried out, so that the provider can make a change if needed. Importantly, drug-drug and drug-allergy interaction rules cannot be used to meet this objective.
Eligible provider core objective 12, “Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request,” changes the existing administrative task of providing patients, “with all of the health information they have available” as described in the HIPAA Privacy Rule, 45 CFR 164.524 (Eligible Professional Meaningful Use Core Measures Measure 12 of 15, Electronic Copy of Health Information. 2010). Most facilities have processes and forms that are used for a patient to request a copy of their health information. Prior to widespread use of EHRs and patient portals, patient health records were copied and provided in paper form to patients and providers. With certified EHR technology, patient health information can now be provided electronically. Thus, new workflow will need to be developed possibly enabling patients to authenticate to an electronic system, e.g., patients with a user ID and password to the patient portal for a practice, and electronically request and receive a copy of their health information. This new workflow will be most efficient for the practice if the practice can fill the request by electronically selecting information or whole encounters to be provided.
Eligible provider core objective 13, “Provide clinical summaries for patients for each office visit.” means that a written summary must be provided electronically or in paper if the patient requests (Eligible Professional Meaningful Use Core Measures Measure 13 of 15, Clinical Summaries. 2011). The CMS specification sheet for core objective 13 defines clinical summary as, “an after-visit summary that provides a patient with relevant and actionable information and instructions containing the patient name, provider’s office contact information, date and location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other instructions based on clinical discussions that took place during the office visit, any updates to a problem list, immunizations or medications administered during the visit, summary of topics covered/considered during visit, time and location of next appointment/testing if scheduled, or a recommended appointment time if not scheduled, list of other appointments and tests that the patient needs to schedule with contact information, recommended patient decision aids, laboratory and other diagnostic test orders, test/laboratory results (if received before 24 hours after visit), and symptoms” (Eligible Professional Meaningful Use Core Measures Measure 13 of 15, Clinical Summaries. 2011). The additional information section of the specification sheet for core objective 13 goes on to say that, the EP must include all of the items listed in the above definition “that can be populated into the clinical summary by certified EHR technology”. And, that “If the EP's certified EHR technology cannot populate all of these fields, then at a minimum the EP must provide in a clinical summary the data elements for which all EHR technology is certified for the purposes of this program” and lists the following: Problem ListDiagnostic Test Results o Medication ListMedication Allergy List”(Eligible Professional Meaningful Use Core Measures Measure 13 of 15, Clinical Summaries. 2011).Core objective 13 impacts clinic workflow by possibly adding a new task. For example, although many practices are accustomed to providing patients a copy of a superbill, most existing superbills do not include the data elements listed in the core objective 13 definition of clinical summary. Some of the required information may require additional things to be documented in the EHR to populate the clinical summary – thus, this objective may require additional documentation tasks as well as the additional task of actually generating the clinical summary and providing it the patient.
Eligible provider core objective 14, “Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically” (Eligible Professional Meaningful Use Core Measures Measure 14 of 15, Electronic Exchange of Clinical Information. 2010). The measure for core objective 14 states that the criterion for a practice being able to attest to this objective is that they have, “Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information” (Eligible Professional Meaningful Use Core Measures Measure 14 of 15, Electronic Exchange of Clinical Information. 2010). The Specification sheet further states that “key clinical information” is up to the provider, depending on what is clinically relevant, and states that, “a minimum set of information is identified in the HIT Standards and Criteria rule at 45 CFR 170.304(i), and is generally outlined in this objective as: problem list, medication list, medication allergies, and diagnostic test results” (Eligible Professional Meaningful Use Core Measures Measure 14 of 15, Electronic Exchange of Clinical Information. 2010). Core objective 14 impacts clinic workflow by possibly adding a new task. For example, although many practices are accustomed to providing patients and referring or consulting providers with a copy of relevant clinical information, today, it is usually in paper form or in proprietary electronic formats, e.g., images from a commercial device requiring a special image viewing software. Thus, this objective may require the additional task of generating the electronic clinical information, or selecting the relevant information from the EHR so that the system can generate a standards-based data transmission. In addition, the workflow of selecting the information and generating the transmission will be different than when done with copies of paper documents.
Eligible provider core objective 15, “Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities” Eligible Professional Meaningful Use Core Measures Measure 15 of 15, Protect Electronic Health Information. 2010). The measure for core objective 15 states that to attest to the objective, the practice must have undertaken a formal risk management process, i.e., conducted or reviewed the results of a security risk analysis of their systems according to 45 CFR 164.308(a)(1) and must have implemented security updates as necessary and corrected identified security deficiencies. The specification sheet states that a security update may include, “updated software for certified EHR technology to be implemented as soon as available, changes in workflow processes or storage methods, or any other necessary corrective action that needs to take place in order to eliminate the security deficiency or deficiencies identified in the risk analysis”Eligible Professional Meaningful Use Core Measures Measure 15 of 15, Protect Electronic Health Information. 2010). Protecting health information can impact workflow in many ways. First, controlled access to health information will require physical security, i.e., lockable doors, maybe badge access, and situating screens where they are viewable by the patient being treated and not viewable by others. Many technical controls on EHR systems may include use of an identifying token to log onto the system, or use of a userID and password. Thus, providers and staff will have to log on to the system. Further security measures such as session time-outs for periods of inactivity may require providers and staff to “lock” workstations or to log back in after time out. Other managerial workflow impacts may include processes for setting up new accounts on the system and for removing access when providers and staff leave the organization. Changes to workflow due to the need to protect health information should be considered along with process redesign because security measures will impact how and when providers and staff access health information throughout their day. If not considered and planned with other workflow changes, security measures can impede providers, staff and patient access to information in a timely manner.
“The Medicare and Medicaid EHR Incentive Programs provide a financial incentive for the “Meaningful Use" (MU) of certified EHR technology to achieve health and efficiency goals. By putting into action and meaningfully using an EHR system, providers will reap benefits beyond financial incentives–such as reduction in errors, availability of records and data, reminders and alerts, clinical decision support, and e-prescribing/refill automation” (CMS EHR Meaningful Use Overview, n.d., para. 1).i.e., Meaningful Use has the same goals as process redesign in health care:Improving quality and safety of care,Enhancing the patient’s care experience,Decreasing the cost of care, andMaking clinic processes more efficient.The Centers for Medicare & Medicaid Services (CMS) website quoted and listed on the slide, provides resources with more information about Meaningful Use as well as a CMS EHR Meaningful Use Criteria Summary, and Meaningful Use Objectives.
Meaningful Use is being rolled out in stages. Stage 1 (2011and 2012) baseline criteria for electronic data capture and information sharing Stage 2 (expected in 2013) and Stage 3 (expected in 2015) will expand on this baseline. Stage 1 meaningful use objectives impact clinic workflow. Stage 2 objectives will be focused on leveraging health IT to advance clinical process. Thus, Meaningful Use and process redesign are inextricably linked.Only Stage 1 criteria are available as of the writing of this material; only Stage 1 can be covered here. More information can be found on the CMS link from the previous slide about stages 2 and 3 as it becomes available.
