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Meaningful use for NYU using Epic
1. MEANINGFUL USE
FOR NYU USING
EPIC
Presentation online at: http://bit.ly/NYUMUEPIC
2. 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
3. DISCLAIMER
• All characters, data,
examples that appearing
in this work are fictitious.
Any resemblance to real
persons, living or dead, is
purely coincidental.
4. SITUATION: POOR
ADOPTION OF H.I.T.
• US lags behind other in industry
sectors and developed countries.
6. ASSESSMENT: POOR
H.I.T.:
• Medical Errors
• Increased
healthcare cost
• Decreased quality
of care
• Increase
paperwork
7. • Increase the adoption of
the Electronic Medical
Record (EMR)
• Advance Health
Information
Technology(HIT)
8. 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
9. WHAT IS
MEANINGFUL USE?
• Meaningful Use (MU) =
Objective measures
that hospital report as a
result of HITECH act.
10. MEANINGFUL USE -
REPORT CARD
Hospital Reports on 21 Different
Objectives
13. MEANINGFUL USE:
THE RELIGION
• GIGO
• Adoption of
technology
• “Information
wants to be free”
14. 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!
15. INCENTIVE: IMPROVE
PATIENT CARE
o MU supports evidence based objectives to
improve patient outcome.
o MU supports patient-centric care that
engages patients and families
o MU helps reduce health disparities and
improve Population and Public Health
o MU improves care coordination
o DSS supports safe patient care
16. INCENTIVE: REVENUE
• $31 Billion Dollars available
for meaningful users of
electronic health systems.
• Hospital can receive
substantial income for
“meaningful use”
18. NEXT UP:
EXAMPLES
• Any Questions
before we
move to
examples?
19. 21 COMPONENTS OF
“MEANINGFUL USE”
• 1. Interoperability objectives
• 2. Objectives that measure clinical
use of EHR
20. 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
21. MU OBJECTIVES:
MEASURE CLINICAL USE
OF EHR
• Computerized Practitioner Order Entry
(CPOE)
• Record demographics
• Maintain active medication list
Every Patient
Encounter • Maintain active problem list
• *Maintain active Allergy list
• *Record smoking status for patients 13
years or older
• Medication Reconciliation
22. 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. Excess
length of stay, extra costs, and attributable mortality.
JAMA. 1997 Jan 22-29;277(4):301-6.
23. 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.
24. WORKFLOW TO MEET MU
OR ITEM
-Select No known allergies check box
-Select Mark as Reviewed.
-If patient leaves the hospital with no
data in the No known allergies measure
Fails.
26. EXAMPLE FINAL HOSPITAL
REPORT
Allergy
Objective
(80%):
Out of 1287
patients seen:
92% (passed)
8% (failed)
27. 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 than
nonsmokers and are at risk of more severe disease
Cleve Clin J Med. 2005 Oct;72(10):916-20.
28. WORKFLOW TO MEET MU
OR ITEM
-Select Tobacco use status of patient.
-If patient leaves the hospital Never Assessed measure
Fails. All other sections give credit. Including Unknown
If Ever Smoked.
30. END OF YEAR RESULTS FOR
SMOKING OBJECTIVE
Record Smoking
-End of the reporting
period
-For the entire Hospital
-Inpatient and ER
admissions
31. 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.
32. SOURCE READING
• Centers for Medicare & Medicaid Services
https://www.cms.gov
• The Meaningful Use Attestation Calculator
https://www.cms.gov/apps/ehr/
34. Thank you for your
Time!
This entire presentation can be found online at:
http://bit.ly/NYUMUEPIC
Editor's Notes
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