Meaningful Use And Quality

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  • Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality.http://www.healthcareitnews.com/news/healthcare-it-chief-takes-meaning-meaningfulARRA HITECH Act and Meaningful Use brief overview
  • Complete patient record (the health story) in the center and all types of secondary uses coming from it Define notion of primary data and then secondary dataA critical, foundational component of MU is interoperability specifications, because they support data reuse and data aggregation.
  • http://www.himssanalytics.org/docs/HA_EMRAM_Overview_ENG.pdf
  • http://www.ehealthnews.eu/industry/2269-emram-award-winners-announced
  • Use of Electronic Health Records in U.S. Hospitals, New England Journal of Medicine, April 2009http://content.nejm.org/cgi/content/full/NEJMsa0900592Responses from 3,049 acute care hospitals in the U.S.
  • http://www.nuance.com/healthcare/physician-study/
  • What do physicians like about their EMRs? The OUTPUT. For the most part, physicians like using information in the EMR once it has been entered. (Note that electronic charting in this context refers to having access to notes electronically, not the actual act of charting)From sources other than this survey, we have seen the following EMR benefits noted:Finding and Retrieving NotesDoing RefillsFaxing Off PrescriptionsLooking Up Test ResultsDoing CalculationsDrug InteractionsMaking AppointmentsGenerating RemindersLooking Up ICD9s
  • What do physicians hate about their EMRs? The INPUT. For the most part, physicians dislike the user interfaces that slow down their ability to enter patient visit notes. We are starting to hear a common theme among physicians, that EMRs reduce their productivity considerably: it is taking from 3 to 5 minutes more per patient for visit documentation, which over the course of a workday translates to 1 to 3 fewer patients per day, or getting home 1 to 2 hours later. ( A recent survey by MGMA [March 2010, n=439] found that two thirds of respondents expected a PERMANENT decline in productivity with meaningful use, and fully one third expected declines of 10% or more). From sources other than this survey, we have seen the following EMR drawbacks noted:Dictating- Poor or NoneDocumenting an EncounterRestrictive TemplatesDirect Entry ErrorsComputer-generated NotesFaxing/Sending NotesReceiving NotesAutofeaturesElectronic ExchangeAccuracy DeclinesMalpractice Unknowns
  • Health Story members share the vision that all of the clinical information required for good patient care, administration, reporting and research will be readily available electronically, including information from narrative documents.Other key points:Active for three years (founded 2007 by AHIMA, AHDI, Alschuler, MTIA, M*Modal) Associate Charter Agreement: HL7Elected executive committee from member organizations provide direction- Members support project with active participation and annual membership dues
  • Why are we here today?
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  • Meaningful Use And Quality

    1. 1. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Meaningful Use and Quality Measures and Healthstory Nick van Terheyden, MD Chief Medical Information Officer, Nuance Executive Committee, Healthstory Project Board of Directors, MTIA October 16, 2010
    2. 2. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Plant Administration Pharmacy $1,433 Food services Lab $3,233 About that BillRadiology $1,290 Cardiology $3,943 Billing Intensive Care $17,664 Operating Room $36,127 Meet Gerard Donovan…. ... and his 150 medical staff...
    3. 3. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Session Objectives At the end of this session you will:  Understand the underlying principles of Meaningful Use (MU) and the broad intentions of the program  Identify key Quality Measures and their source in the clinical encounter  Be familiar with the goals and document standards of the Health Story Project  Recognize how these initiatives are working together to accelerate EMR adoption and can help guide successful healthcare reform  Get to know your Simultaneous Translators
    4. 4. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD What is Meaningful Use? “Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety and quality.” “HIT is the means, but not the end. Getting an EHR up and running in health care is not the main objective behind the incentives provided by the federal government under ARRA. Improving Health is. Promoting health care reform is. David Blumenthal, MD National Coordinator for HIT Slide Courtesy of HealthStory
    5. 5. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Meaningful Use EHR Goals  Improve quality, safety, efficiency, and reduce health disparities  Engage patients and families  Improve care coordination  Improve population and public health  Ensure adequate privacy and security protections for personal health information  Largely aimed at driving healthcare organizations to collect and report on quality and safety metrics
    6. 6. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Meaningful use and the EHR Facilitates the Transformation Hospital Centric To patient centric
    7. 7. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Meaningful Use ≈ Data Reuse patient care billing/claims adjudication research quality reporting clinical decision support outcomes analysis Slide Courtesy of HealthStory
    8. 8. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD EMR Adoption Model (US) 0.8% 2.6% 3.2% 9.7% 50.2% 15.5% 6.8% 11.2% n=5217
    9. 9. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD 3 European Hospitals Awarded Stage 6 Oct 1, 2010  Odense University Hospital, Denmark (DK)  The University Hospitals of Geneva (HUG)  ISMETT Hospital The Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT) Sicily, Italy
    10. 10. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Meaningful Use: Core Set  Vital signs – structured data (>50%)  Problem List (1 entry for >80%)  Active Medication List (1 entry for >80%)  Smoking status (>50%)  Drug/Drug and Drug/Allergy Checking  e-Prescribing (>40%)  CPOE for medication (1 medication >30%)  Medication Allergy (1 entry >80%)  Patient Demographics (>50%)  Electronic Exchange (1 test exchange)  One clinical decision support rule  Implement privacy and security  Report Clinical quality Measures through attestation in 2011  Generate Electronic Summary (>50% within 3 days)  Provide e-copy to patients (>50% within 3 days)
    11. 11. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Meaningful Use – Menu Set  Medication Reconciliation (>50% of transitions of care)  Drug Formulary Checks (one internal or external formulary check)  Incorporate Labs as Structured Data (>40%)  Patients specific education (>10%)  Generate Lists of Patients by Condition  Summary of Care record (>50%)  Electronic Immunization Reporting (1 test submission)  Electronic syndrome surveillance (1 test submission)  Record Advance Directives (Hosp >50%)  Electronic submission of lab data (Hosp 1 test submission)  Patient Reminders for Preventative/f/u care (EP >20%)  Provide Patients with electronic access to Health Record (EP >105 within 4 days)
    12. 12. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Quality Reporting Measures  Reporting Hospital Quality Data for Annual Payment Update  Acute myocardial infarction (AMI), Children’s asthma care (CAC), Heart failure (HF), Surgical care improvement project (SCIP), Pneumonia (PN), Hospital outpatient measures (HOP), Pregnancy and related conditions (PR), Venous thromboembolism (VTE), Hospital-based inpatient psychiatric services (HBIPS), Stroke (STK)  The Joint Commissions Core Measures  Acute myocardial infarction (AMI), Children’s asthma care (CAC), Heart failure (HF), Surgical care improvement project (SCIP), Pneumonia (PN), Hospital outpatient measures (HOP), Perinatal Care (PC) – replaced Pregnancy Related, Venous thromboembolism (VTE), Hospital-based inpatient psychiatric services (HBIPS), Stroke (STK)  Physician Quality Reporting Initiative (PQRI)  216 individual quality measures in the 2010 PQRI Program (this increases every year)
    13. 13. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Core Measures Acute Myocardial Infarction  AMI-1 Aspirin at Arrival 1  AMI-2 Aspirin Prescribed at Discharge 1  AMI-3 ACEI or ARB for LVSD 1  AMI-4 Adult Smoking Cessation Advice/Counseling 2  AMI-5 Beta-Blocker Prescribed at Discharge 1  AMI-6 Beta-Blocker at Arrival 1  AMI-7 Median Time to Fibrinolysis  AMI-7a Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival 2  AMI-8 Median Time to Primary PCI  AMI-8a Timing of Receipt of Primary Percutaneous Coronary Intervention (PCI) 2  AMI-9 Inpatient Mortality
    14. 14. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD PQRI – Measure Groups  Diabetes Mellitus  Chronic Kidney Disease  Preventive Care  Rheumatoid Arthritis  Peri-operative Care  Back Pain  Hepatitis C  Heart Failure  Coronary Artery Disease  Ischemic Vascular Disease  HIV/AIDS  Community Acquired Pneumonia CAD Oral Antiplatelet Therapy Prescribed for Patients with CAD Inquiry Regarding Tobacco Use (Preventive Care and Screening) Advising Smokers and Tobacco Users to Quit (Preventive Care and Screening) Symptom and Activity Assessment Drug Therapy for Lowering LDL-Cholesterol IVD Inquiry Regarding Tobacco Use (Preventive Care and Screening) Advising Smokers and Tobacco Users to Quit (Preventive Care and Screening) Blood Pressure Management Control Complete Lipid Profile Low Density Lipoprotein (LDL-C) Control Use of Aspirin or Another Antithrombotic
    15. 15. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Unstructured Data Structured Data Dictation and Transcription System generated or interfaced data Direct data entry, not physician Direct data entry, physician Handwritten Current Methods for Data Capture
    16. 16. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Perceived Barriers to Adoption Major Perceived Barriers to Adoption of Electronic Health Records (EHRs) among Hospitals with Electronic- Records Systems as Compared with Hospitals without Systems. Hospitals with electronic-records systems include hospitals with a comprehensive electronic-records system and those with a basic electronic-records system that includes functionalities for physicians' notes and nursing assessments. P<0.01 for all comparisons except physicians' resistance (P=0.20). IT denotes information technology, and ROI return on investment.
    17. 17. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Survey Conducted with 1,000 Physicians  • 67% cited time associated with reliance on keyboard and mouse to document within an EHR as a major hurdle for adoption  • 97% selected narrative over structured data entry as the more valuable documentation method to treating patients  • 96% expressed concern that they may lose the patient’s unique story with transition to point-and- click EHRs  MDs resist point and click
    18. 18. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD EMR Use in Physician Practices Source: Texas Medical Association N=370, 4% response rate
    19. 19. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD EMR Use in Physician Practices Source: Texas Medical Association N=370, 4% response rate 3 to 5 minutes / patient = 1 to 2 hours / day = 1 to 3 fewer patients / day
    20. 20. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Health Story Project  Vision: Comprehensive electronic clinical records that tell a patient’s complete health story.  Who We Are: A non profit alliance of healthcare vendors, providers and associations  Mission: Pool resources to develop data standards through HL7 for flow of information between common types of healthcare documents and EHR systems  Goals: Bridge the gap between the narrative documents and structured data
    21. 21. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Narrative Text Structured Documents Extracted, Coded Discrete Data Elements EHR Repository HIM Applications Clinical Applications SNOMED CT Disease, DF- 00000 Metabolic Disease, D6- 00000 Disorder of glucose metabolism, D6-50100 Diabetes Mellitus, DB- 61000 Type 1, DB- 61010 Insulin dependant type IA, DB-61020 Neonatal, DB75110 Carpenter Syndrome, DB-02324 Disorder of carbohydrate metabolism, D6-50000 Meaningful Clinical Documents
    22. 22. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Meaningful Clinical Documents vs. Text  Structured and encoded clinical content enables…  pre-signature alerts,  decision support,  best documentation practices,  multiple output formats,  multi-media reporting,  data mining  Implements HL7 CDA4CDT standard compliant document types  Increases quality of documentation
    23. 23. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Current and Future Standards HL7 Implementation Guides Completed  History & Physical  Consultation  Operative Report  DICOM Imaging Reports  Discharge Summary (in publication) Upcoming  Procedure Note (focus on Endoscopy Report)  CDA with unstructured body  Billing and Reimbursement Requirements  Progress Notes w w w . h e a l t h s t o r y. c o m
    24. 24. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Benefits of Health Story Project Benefit Value Retains patient story Maintains primary role of documentation to clearly describe and communicate what is going on with patient. Preserves physician time for clinical care Makes efficient use of physician time by enabling choice of documentation methods Supports meaningful use Implements HL7 CDA document standards for electronic exchange of clinical information (Patient Summary Record) Enables dual use of information Structured narrative enables better outcomes reporting, data mining, and decision support Collaborative approach Developed by a broad array of providers, vendors and IT organizations Balloted process supports harmonization Better documentation Supports better coding, DRG optimization = better reimbursement
    25. 25. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD What Health Story Offers You  Allows providers to choose preferred workflow and documentation methods  Increases the value and usability of narrative documents  Accelerates the implementation of interoperable electronic health records  Allows intelligent and meaningful reuse of information  Provides on-ramp to EMR system adoption  pre-populate EMR with structured documents  integrate legacy documents
    26. 26. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Nick van Terheyden, MD Chief Medical Information Officer, Nuance Communications Twitter http://twitter.com/drnic1 Technorati http://technorati.com/people/technorati/nvt1 Voice of the Doctor http://drvoice.blogspot.com/ MyBlogLog http://www.mybloglog.com/buzz/members/nvt LinkedIn http://www.linkedin.com/in/nickvt Plaxo http://nvt.myplaxo.com FaceBook http://profile.to/drnick Digg http://digg.com/users/nvt1 Delicious http://delicious.com/nvt1 E-Mail nvt@nuance.com, drnick@nuance.com, drnic1@gmail.com GrandCentral (301) 355-0877 Where You Can Find Me
    27. 27. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD Meaningful Use and Quality Measures and Healthstory Nick van Terheyden, MD Chief Medical Information Officer, Nuance Executive Committee, Healthstory Project Board of Directors, MTIA October 16, 2010

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