Health Care Quality Improvement for Meaningful Use<br />Adrienne Mims, MD MPH<br />Medical Director for Medicare Quality I...
Health Care Quality Improvement for Meaningful Use<br />AGENDA<br />What is meaningful use? Why is it relevant for TeleHea...
Meaningful Use<br />The American Recovery and Reinvestment Act of 2009 authorizes the Centers for Medicare & Medicaid Serv...
Meaningful Use is using certified EHR technology to…<br />•  Improve quality, safety, efficiency, and reduce health dispar...
Meaningful Use<br />Three components – Use of certified EHR<br />in a meaningful manner<br />for electronic exchange of he...
Meaningful Use<br />Stage 1 Objectives and Measures Reporting<br />Must complete: <br /><ul><li>15 core objectives
 5 objectives out of 10 from menu set
 6 total Clinical Quality Measures (out of 38)</li></li></ul><li>Meaningful Use 15 Core Objectives<br />Computerized physi...
Meaningful Use 15 Core Objectives<br />Maintain an up-to-date problem list of  current and active diagnoses<br />Maintain ...
Meaningful Use 5 out of 10 Menu Objectives<br />Incorporate clinical lab test results as structured data<br />Generate lis...
Meaningful Use 5 out of 10 Menu Objectives<br />Medication reconciliation<br />Summary of care record for each transition ...
How can you evolve into a system of meaningful use?<br />A structured methodology is needed<br />
Quality Improvement is a formal approach to the analysis of performance and systematic efforts to improve it. <br />
Quality Improvement - Methods<br />FADE=focus, analyze, develop, execute, evaluate<br />PDSA=plan, do, study, act<br />Six...
Support for Quality Improvement<br />Leadership Team*<br /><ul><li>Executive sponsor
Project sponsor
Improvement leader</li></ul>Design team<br />Additional stakeholders<br />* Upper management must be on board Realistic ex...
Did you develop a project charter or set definitive goals?<br />Examples:<br />Foster better communication between provide...
Fundamental Questions for Improvement<br />What are we trying to accomplish?<br />How will we know that a change is an imp...
To improve, you must <br />make changes.But…<br />Not all changes lead to improvement<br />
Model for Improvement<br />What are we trying to accomplish?<br />Aim<br />How will we know a change is an improvement?<br...
Why an Aim Statement?<br />Answers and clarifies “What we are trying to accomplish?”<br />Creates a shared language to com...
Aim Statement<br />S =pecific<br />M = easureable<br />A= ttainable<br />R=elevant/realistic<br />T  =imely<br />
Defining the Measures<br />A good aim statement helps define the measures.<br />Measurement should not slow things down<br...
AIM Statement<br />   To increase the number of patients with diabetes who have urine kidney tests performed from 25% to 5...
Did you collect baseline measurement?<br />Measurement defines expectations and values<br />Evaluate compliance <br /><ul>...
Track improvements
Identify opportunities</li></ul>Used by stakeholders<br /><ul><li>Improve care
Provider selection
Align incentives</li></ul>Data drives decision making<br />
Types of Data <br />Patient self-reported data<br /><ul><li>HRA
Productivity
Satisfaction surveys</li></ul>Demographic <br />Plan design<br />Medical claims<br />Pharmacy claims<br />Laboratory data<...
Measure Caveats <br />Measure types <br /><ul><li>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</li></ul>Data collection is resour...
“Data collection and analysis is a journey, one that must be taken carefully and with significant deliberation, but one th...
Create partnerships
Identify data sources
Convene a data summit
Collect and analyze data</li></li></ul><li>What does our process look like?<br />
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Healthcare quality improvement for meaningful use

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Healthcare quality improvement for meaningful use

  1. 1. Health Care Quality Improvement for Meaningful Use<br />Adrienne Mims, MD MPH<br />Medical Director for Medicare Quality Improvement<br />GMCF<br />
  2. 2. Health Care Quality Improvement for Meaningful Use<br />AGENDA<br />What is meaningful use? Why is it relevant for TeleHealth?<br />The quality improvement process<br />Resources<br />
  3. 3. Meaningful Use<br />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). <br />
  4. 4. Meaningful Use is using certified EHR technology to…<br />• Improve quality, safety, efficiency, and reduce health disparities<br />• Engage patients and families in their health care<br />• Improve care coordination<br />• Improve population and public health<br />• All the while maintaining privacy and security<br />Relevant for TeleHealthcare?<br />
  5. 5. Meaningful Use<br />Three components – Use of certified EHR<br />in a meaningful manner<br />for electronic exchange of health information to improve quality of health care<br />to submit clinical quality measures<br />Established 3 stages of meaningful use: <br />2011, 2013 and 2015<br />
  6. 6. Meaningful Use<br />Stage 1 Objectives and Measures Reporting<br />Must complete: <br /><ul><li>15 core objectives
  7. 7. 5 objectives out of 10 from menu set
  8. 8. 6 total Clinical Quality Measures (out of 38)</li></li></ul><li>Meaningful Use 15 Core Objectives<br />Computerized physician order entry<br />E-Prescribing<br />Report ambulatory clinical quality measures to CMS/States<br />Implement one clinical decision support rule<br />Provide patients with an electronic copy of their health information, upon request<br />Provide clinical summaries for patients for each office visit<br />Drug-drug and drug-allergy interaction checks<br />Record demographics<br />
  9. 9. Meaningful Use 15 Core Objectives<br />Maintain an up-to-date problem list of current and active diagnoses<br />Maintain active medication list<br />Maintain active medication allergy list<br />Record and chart changes in vital signs<br />Record smoking status for patients 13 years or older<br />Capability to exchange key clinical information among providers of care and patient-authorized entities electronically<br />Protect electronic health information <br />
  10. 10. Meaningful Use 5 out of 10 Menu Objectives<br />Incorporate clinical lab test results as structured data<br />Generate lists of patients by specific conditions<br />Send reminders to patients per patient preference for preventive/follow up care<br />Provide patients with timely electronic access to their health information<br />Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate<br />
  11. 11. Meaningful Use 5 out of 10 Menu Objectives<br />Medication reconciliation<br />Summary of care record for each transition of care/referrals<br />Capability to submit electronic data to immunization registries/systems<br />Capability to provide electronic syndromic surveillance data to public health agencies<br />Drug-formulary checks<br />
  12. 12. How can you evolve into a system of meaningful use?<br />A structured methodology is needed<br />
  13. 13. Quality Improvement is a formal approach to the analysis of performance and systematic efforts to improve it. <br />
  14. 14. Quality Improvement - Methods<br />FADE=focus, analyze, develop, execute, evaluate<br />PDSA=plan, do, study, act<br />Six Sigma=(define, measure, analyze, improve, <br /> control)<br />CQI=Continuous Quality Improvement <br />TQM=Total Quality Management <br />Utilize an approach that matches employees and company’s culture.<br />
  15. 15. Support for Quality Improvement<br />Leadership Team*<br /><ul><li>Executive sponsor
  16. 16. Project sponsor
  17. 17. Improvement leader</li></ul>Design team<br />Additional stakeholders<br />* Upper management must be on board Realistic expectations of ROI<br />
  18. 18. Did you develop a project charter or set definitive goals?<br />Examples:<br />Foster better communication between providers<br />Implement e-prescribing<br />Achieve meaningful use<br />Reduce 30-day readmission rate<br />
  19. 19. Fundamental Questions for Improvement<br />What are we trying to accomplish?<br />How will we know that a change is an improvement?<br />What changes can we make that will result in an improvement?<br />
  20. 20. To improve, you must <br />make changes.But…<br />Not all changes lead to improvement<br />
  21. 21. Model for Improvement<br />What are we trying to accomplish?<br />Aim<br />How will we know a change is an improvement?<br />Measures<br />What change can we make that will result in Improvement?<br />Ideas<br /> PLAN DO<br /> ACT STUDY<br />
  22. 22. Why an Aim Statement?<br />Answers and clarifies “What we are trying to accomplish?”<br />Creates a shared language to communicate the project to others.<br />
  23. 23. Aim Statement<br />S =pecific<br />M = easureable<br />A= ttainable<br />R=elevant/realistic<br />T =imely<br />
  24. 24. Defining the Measures<br />A good aim statement helps define the measures.<br />Measurement should not slow things down<br />Seek usefulness, not perfection<br />Use sampling<br />Use accessible measures (don’t wait for IT)<br />
  25. 25. AIM Statement<br /> To increase the number of patients with diabetes who have urine kidney tests performed from 25% to 50% by June 2011<br />
  26. 26. Did you collect baseline measurement?<br />Measurement defines expectations and values<br />Evaluate compliance <br /><ul><li>Compare to benchmarks
  27. 27. Track improvements
  28. 28. Identify opportunities</li></ul>Used by stakeholders<br /><ul><li>Improve care
  29. 29. Provider selection
  30. 30. Align incentives</li></ul>Data drives decision making<br />
  31. 31. Types of Data <br />Patient self-reported data<br /><ul><li>HRA
  32. 32. Productivity
  33. 33. Satisfaction surveys</li></ul>Demographic <br />Plan design<br />Medical claims<br />Pharmacy claims<br />Laboratory data<br />Biometric screening<br />Disability data<br />
  34. 34. Measure Caveats <br />Measure types <br /><ul><li>Structure:physical equipment and facilities
  35. 35. Process:how the system works/demonstrates compliance with the current process
  36. 36. Outcome:demonstrates the overall impact of the new process/the final product or results</li></ul>Data collection is resource-intensive<br />Robust IT systems enable more efficient, timely reporting<br />Use of case studies to clarify through examples<br />
  37. 37. “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”<br />~ Jan Berger, MD<br /><ul><li>Get buy-in and agreement across the organization
  38. 38. Create partnerships
  39. 39. Identify data sources
  40. 40. Convene a data summit
  41. 41. Collect and analyze data</li></li></ul><li>What does our process look like?<br />
  42. 42.
  43. 43. Process Mapping<br /><ul><li>What are the steps that you would go through as a patient for an office visit in primary care?
  44. 44. Procedure
  45. 45. Identify who is involved in the process
  46. 46. Identify the starting and end points
  47. 47. Draw swim lines and post the steps in the process over time
  48. 48. Map the process using sticky notes
  49. 49. Use 2 words for the process (noun + verb)</li></li></ul><li>
  50. 50. What is the root of the problem?<br />
  51. 51. Was a root cause analysis performed?<br />
  52. 52. Pick one area to focus on for improvement at a time<br />
  53. 53. PDSA Cycle for Process Improvement<br />PLAN<br />ACT<br />What changes are to be made?<br />Next cycle?<br />Objective<br />Questions and predictions<br />Plan to carry out the cycle (who, what, where, when)<br />Plan for data collection<br />DO<br />STUDY<br /><ul><li>Carry out the plan
  54. 54. Document the problems and unexpected observations
  55. 55. Begin analysis of the data
  56. 56. Complete the analysis of the data
  57. 57. Compare data to predictions
  58. 58. Summarize what is learned</li></li></ul><li>PDSA Pitfalls<br />Plan, Plan, Plan, Panic<br />The Nike Model “Just do it”<br />The research model – Plan-do-study-publish<br />Neglecting to follow up on previous changes introduced (leaving out the “s”)<br />Piloting on a large scale – more than just a test<br />“Do” and “Act” are NOT a PDSA cycle<br />
  59. 59. Was an action plan created?  <br />
  60. 60. How are projects steps tracked?<br />
  61. 61. Were interim measures defined?  If so, are they tracked on a dashboard?<br />
  62. 62. What is the reporting mechanism for informing others of the project?<br />www.gmcf.org<br />
  63. 63. Summary<br /> Obtaining Meaningful Use certification is a goal that can be accomplished through a well-planned quality improvement process.<br />
  64. 64. Resources<br />Get information, tip sheets and more at CMS’ official website for theEHR incentive programs: www.cms.gov/EHRIncentivePrograms<br />Learn about certification and certified EHRs, as well as other ONCprograms: http://healthit.hhs.gov<br />Learn about Georgia’s Regional Extension Center Institute for Healthcare Improvement: http://www.ihi.org/IHI/<br />GMCF – The Medicare Quality Improvement Organization for Georgia:<br />www.gmcf.org Adrienne.Mims@GMCF.org<br />
  65. 65. 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<br />

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