M EANINGFUL U SE FOR  NYU C HAMPIONS           Leanthony Mathews, MSN, RN, CNML                          LEANTHONY.MATHEWS...
A GENDA•   Welcome    o   Review of agenda and goals for the session•   History of Meaningful Use•   Define Meaningful Use...
S ITUATION : P OOR    ADOPTION OF H.I.T.• US lags behind other in industry  sectors and developed countries.
B ACKGROUND :     R EASONS Cost Software Quality and  Usability Standards
A SSESSMENT: P OOR      H.I.T.:     • Medical Errors     • Increased       healthcare cost     • Decreased quality       o...
• Increase the adoption of  the Electronic Medical  Record (EMR)• Advance Health  Information  Technology(HIT)
S OLUTION : HITECH        A CT  • Signed into Law Feb 17,2009 by    President Obama with a Goal by    2015 to:    o   redu...
W HAT IS M EANINGFUL                   U SE?• Meaningful Use (MU) =  Objective measures  that hospital report as a  result...
M EANINGFUL U SE -         R EPORT C ARDHospital Reports on 21 Different                     Objectives
E XAMPLE F INAL H OSPITAL                 R EPORT
M EANINGFUL U SE:                        T HE RELIGION                       • GIGO                       • Adoption of   ...
W HY CHANGE ?    •    Voluntary program and you attest to being a                           MU.•       I don’t need an EHR...
I NCENTIVE : I MPROVE                    PATIENT C AREo   MU supports evidence based objectives to    improve patient outc...
I NCENTIVE : R EVENUE• $31 Billion Dollars available  for meaningful users of  electronic health systems.• Hospital can re...
I NCENTIVE : N ON U SE                 P ENALTY• Penalties start in  2015
N EXT   UP :   E XAMPLES• Any Questions  before we  move to  examples?
21 C OMPONENTS OF      “M EANINGFUL U SE ”• 1. Interoperability objectives• 2. Objectives that measure clinical  use of EHR
MU O BJECTIVES : MEASURE                                        INTEROPERABILITY Homework:   Currently, what clinical  inf...
MU O BJECTIVES : MEASURE                   CLINICAL USE OF EHR                 •   Computerized Practitioner Order Entry  ...
MU R ULE : A LLERGY L IST                 • Objective :Maintain active                   medication allergy list.         ...
W ORKFLOW TO MEET MU OR                                               ITEM                             -Patient admitted u...
W ORKFLOW TO MEET MU OR                                          ITEM-Select No known allergies check box-Select Mark as R...
R ECORD A LLERGY OBJECTIVE
E XAMPLE F INAL H OSPITAL                                  R EPORTAllergyObjective(80%):Out of 1287patients seen:92% (pass...
MU R ULE : S MOKING S TATUS          • Objective :Record smoking            status for patients 13 years old            or...
W ORKFLOW TO MEET MU OR                                               ITEM   -Select Tobacco use status of patient.-If pat...
R ECORD S MOKING O BJECTIVE
E ND OF YEAR R ESULTS FOR      S MOKING O BJECTIVE    Record Smoking-End of the reportingperiod-For the entire Hospital-In...
K EY TAKEAWAYS•   Key: Start with education of users on correct    workflow – Minimize Work Around•   Key: Real Time Docum...
S OURCE          READING•   Centers for Medicare & Medicaid Services    https://www.cms.gov•   The Meaningful Use Attestat...
M EANINGFUL U SE :• Questions?
H OMEWORK•   Currently, what clinical information about your    patient to do you constantly struggle locating in    the p...
Thank you for your                            Time!This entire presentation can be found online at:   http://bit.ly/NYUMU2...
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Meaningful use for NYU champions

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MU presentation I presented tot he champions.
Survey after presentation is at: http://bit.ly/NYUMUSURVEY

For more details I can be reached at:
leanthonyrn@gmail.com

or LinkedIN

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  • Health Information Technology(HIT): framework management of health information across computerized systemsIncludes: -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 efficienciesDecrease paperwork; andExpand 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 champions

    1. 1. M EANINGFUL U SE FOR NYU C HAMPIONS Leanthony Mathews, MSN, RN, CNML LEANTHONY.MATHEWS@NYUMC.ORGPresentation online at: http://bit.ly/NYUMUSLIDES
    2. 2. A GENDA• 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
    3. 3. S ITUATION : P OOR ADOPTION OF H.I.T.• US lags behind other in industry sectors and developed countries.
    4. 4. B ACKGROUND : R EASONS Cost Software Quality and Usability Standards
    5. 5. A SSESSMENT: P OOR H.I.T.: • Medical Errors • Increased healthcare cost • Decreased quality of care • Increase paperwork
    6. 6. • Increase the adoption of the Electronic Medical Record (EMR)• Advance Health Information Technology(HIT)
    7. 7. S OLUTION : HITECH A CT • 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
    8. 8. W HAT IS M EANINGFUL U SE?• Meaningful Use (MU) = Objective measures that hospital report as a result of HITECH act.
    9. 9. M EANINGFUL U SE - R EPORT C ARDHospital Reports on 21 Different Objectives
    10. 10. E XAMPLE F INAL H OSPITAL R EPORT
    11. 11. M EANINGFUL U SE: T HE RELIGION • GIGO • Adoption of technologyHomework: What one paper • “Informationdocument in your department do wants to be free”you feel Epic will have problems making electronic?
    12. 12. W HY 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!
    13. 13. I NCENTIVE : I MPROVE PATIENT C AREo 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
    14. 14. I NCENTIVE : R EVENUE• $31 Billion Dollars available for meaningful users of electronic health systems.• Hospital can receive substantial income for “meaningful use”
    15. 15. I NCENTIVE : N ON U SE P ENALTY• Penalties start in 2015
    16. 16. N EXT UP : E XAMPLES• Any Questions before we move to examples?
    17. 17. 21 C OMPONENTS OF “M EANINGFUL U SE ”• 1. Interoperability objectives• 2. Objectives that measure clinical use of EHR
    18. 18. MU O BJECTIVES : MEASURE INTEROPERABILITY Homework: Currently, what clinical information about your patient do • Report hospital quality measures to CMS (Stoke, ED you throughput) constantly struggle • Exchange clinical information with other institutionslocating in thepatient chart? • Submit electronic data to immunization registries
    19. 19. MU O BJECTIVES : MEASURE CLINICAL USE OF EHR • Computerized Practitioner Order Entry (CPOE) • Record demographics • Maintain active medication listEvery Patient Encounter • Maintain active problem list Homework: • *Maintain active Allergy list Currently, which one • *Record smoking status for patients 13 Clinical MUMeasure does years or older your unit struggle to • Medication Reconciliation complete?
    20. 20. MU R ULE : A LLERGY L IST • 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.
    21. 21. W ORKFLOW TO MEET MU OR ITEM -Patient admitted using Admission Navigator in Epic. -During your admission suggested workflow you Homework: Describe one will come to the allergies clinical section. workflow youare concernedthat Epic EHRwill struggle to capture,specific to your department?
    22. 22. W ORKFLOW 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.
    23. 23. R ECORD A LLERGY OBJECTIVE
    24. 24. E XAMPLE F INAL H OSPITAL R EPORTAllergyObjective(80%):Out of 1287patients seen:92% (passed)8% (failed)
    25. 25. MU R ULE : S MOKING S TATUS • 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. Smokersare 2 to 3 times more likely to get pneumonia thannonsmokers and are at risk of more severe disease CleveClin J Med. 2005 Oct;72(10):916-20.
    26. 26. W ORKFLOW 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.
    27. 27. R ECORD S MOKING O BJECTIVE
    28. 28. E ND OF YEAR R ESULTS FOR S MOKING O BJECTIVE Record Smoking-End of the reportingperiod-For the entire Hospital-Inpatient and ERadmissions
    29. 29. K EY TAKEAWAYS• Key: Start with education of users on correct workflow – Minimize Work Around• Key: Real Time Documentation - Minimize Batch Documentation• Key: Utilize reports / Best Practice Advisories – Reports and Advisories are your friend.• Key: Standard data capture. Put information in correct electric place - Paper is going away.
    30. 30. S OURCE READING• Centers for Medicare & Medicaid Services https://www.cms.gov• The Meaningful Use Attestation Calculator https://www.cms.gov/apps/ehr/
    31. 31. M EANINGFUL U SE :• Questions?
    32. 32. H OMEWORK• Currently, what clinical information about your patient to do you constantly struggle locating in the patient chart?• What one paper document in your department do you feel Epic will have problems making electronic?• Currently, which one Clinical MU Measure does your unit struggle to complete?• Describe one clinical workflow you are concerned that Epic EHR will struggle to capture, specific to your department?
    33. 33. Thank you for your Time!This entire presentation can be found online at: http://bit.ly/NYUMU2012Please take 5 minutes to complete the Survey about MU in you area: It can be found at: http://bit.ly/NYUMUSURVEY

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