This document discusses process redesign for meaningful use objectives in healthcare. It begins by outlining the learning objectives of using software functionality and meaningful use criteria to inform process redesign in clinics. It then explains the 10 meaningful use objectives for eligible professionals, such as electronic prescribing, health information exchange, and public health reporting. For each objective, it summarizes the workflow impact, such as introducing new workflows or changing existing tasks. The document provides resources on the meaningful use specification sheets and criteria that providers must meet to receive incentives. Overall, it reviews using health IT functions to solve process problems and optimize clinical workflows in line with meaningful use objectives.
2015 Edition Proposed Rule Modifications to the ONC Health IT Certification ...Brian Ahier
Presentation to April 7, 2015 Health IT Policy Committee:
2015 Edition Proposed Rule Modifications to the ONC Health IT Certification Program and 2015 Edition Health IT Certification Criteria
Big Data and VistA Evolution, Theresa A. Cullen, MD, MSBrian Ahier
Presentation to Open Source Electronic Health Record Alliance (OSEHRA) Architecture Work Group by Theresa A. Cullen, MD, MS
Chief Medical Information Officer
Director, Health Informatics
Office of Informatics and Analytics
Veterans Health Administration
Department of Veterans Affairs
Stage 2 Meaningful Use brings more stringent requirements for the Stage 1 measures, a host of new measures, and a greater focus on clinical quality measures. In this instructive session, our expert faculty members review:
*The requirements and timeline for implementation of Stage 2 Meaningful Use
*The top five questions you need to ask to determine if your organization is ready for Stage 2
*The steps you can take to prepare your organization to successfully meet the Stage 2 requirements and get the most out of your EHR system
2015 Edition Proposed Rule Modifications to the ONC Health IT Certification ...Brian Ahier
Presentation to April 7, 2015 Health IT Policy Committee:
2015 Edition Proposed Rule Modifications to the ONC Health IT Certification Program and 2015 Edition Health IT Certification Criteria
Big Data and VistA Evolution, Theresa A. Cullen, MD, MSBrian Ahier
Presentation to Open Source Electronic Health Record Alliance (OSEHRA) Architecture Work Group by Theresa A. Cullen, MD, MS
Chief Medical Information Officer
Director, Health Informatics
Office of Informatics and Analytics
Veterans Health Administration
Department of Veterans Affairs
Stage 2 Meaningful Use brings more stringent requirements for the Stage 1 measures, a host of new measures, and a greater focus on clinical quality measures. In this instructive session, our expert faculty members review:
*The requirements and timeline for implementation of Stage 2 Meaningful Use
*The top five questions you need to ask to determine if your organization is ready for Stage 2
*The steps you can take to prepare your organization to successfully meet the Stage 2 requirements and get the most out of your EHR system
weems-Texas Medicaid Health Home Pilot Project Evaluation MethodsNASHP HealthPolicy
Leslie A. Weems, LMSW, Senior Policy Analyst and Project Manager, Medicaid/CHIP Division, Texas Health and Human Services Commission discusses Texas Medicaid Health Home Pilot Project Evaluation Methods at the New Tactics for Building Medical Homes in State Medicaid and CHIP Programs webinar
Selecting the Right Meaningful Use Criteria for Your Practice - October 25, 2010Cientis Technologies
Speaker: Peter Basch, MD, FACP, Medical Director, Ambulatory EHR and Health IT Policy, MedStar Health. He is a Senior Fellow with the Center for American Progress, practices general internal medicine in Washington, DC. Dr. Basch is an early adopter of electronic health records and e-prescribing.
Dr. Basch explained the Stage 1 Meaningful Use Criteria including the 15 Core Measures you must meet plus how to select the 5 Menu Measures that are most appropriate to your practice.
Purpose of the Webinar
1.Describe the process of developing an undergraduate MedRec IPE Event involving > 480 senior Medicine, Pharmacy and Nursing students;
2.Explain the logistics of conducting the event in multiple venues and urban/remote locations;
3.Discuss the successes and challenges of communicating MedRec patient safety concepts through this process; and
4.Describe future opportunities for enhancing undergraduate MedRec training in an interprofessional environment.
Watch the webinar recording: http://bit.ly/1fSqsqv
Meaningful Use Stage 2 and Health Information Exchange (HIE)MassEHealth
Transformational intent of Meaningful Use (MU) and the increased trend toward interoperability in MU Stage 2 (MU2); MU2 objectives with an HIE component and their MU2 measures; Approaches to achieving the transitions of care; Available public health registries and their current status and submission pathway; How to find a trading partner and best practices to engaging
CMS Core Measures Compliance: Best Practices for Data Collection, Analysis and Reporting
For many hospitals, the primary challenge with the core measure program is not achieving quality standards, but complying with the complex, time-consuming reporting process and staying current with constantly changing regulations.
Presentation: Improving the regulation of generic medicines in AustraliaTGA Australia
The registration system for generic prescription medicines has not been amended since the introduction of the Streamlined Submission Process in 2010 and assigns all generics the same target timeframe of 255 working days. Amendments to the generic medicine registration process are under discussion that could provide for flexibility for certain applications and better support the timely availability of high quality generic medicines and the sustainability of the Australian health system.
Slides from the Hielix Webinar discussing how achieving meaningful use in hospitals is more than just a technology upgrade. Full webinar is available on Vimeo (https://vimeo.com/user7074907)
Covering the results of our survey on the use and cost effectiveness of recruitment and retention tools, this presentation was given at the MRN\'s first Director\'s Dinner on October 28th. Comments are welcome.
MIPS APM for ACOs: A Hybrid Reimbursement ModelCitiusTech
CMS announced the Quality Payment Program (QPP) final rule in October 2017, stating how it plans to implement the clinician payment changes to QPP, mandated under the Medicare Access and CHIP Reauthorization (MACRA) act. The implementation of the MACRA act impacts different type of organizations, one such being the Accountable Care Organizations (ACOs). ACOs are evaluated for payments on the basis of quality care and the cost factors associated in achieving their quality goals. Post MACRA implementation, all clinicians will receive payments as per the MIPS (Merit based incentive payments) and Advanced APMs (Advanced alternative payment models). ACO’s can register as APM entities and are eligible to receive payments under Advanced APMs. There is a third category of APM entities which participate in Advanced APMs models but do not meet the threshold of payments and patients set by CMS. Such entities fall into a category that is straddling the line between APM and the MIPS track, called MIPS APM (partially qualifying APM participants). This document discusses about the reporting, scoring and payments for the MIPS APM entities
Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"
Luis Saldana, MD, MBA, FACEP
CMIO
Texas Health Resources
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
weems-Texas Medicaid Health Home Pilot Project Evaluation MethodsNASHP HealthPolicy
Leslie A. Weems, LMSW, Senior Policy Analyst and Project Manager, Medicaid/CHIP Division, Texas Health and Human Services Commission discusses Texas Medicaid Health Home Pilot Project Evaluation Methods at the New Tactics for Building Medical Homes in State Medicaid and CHIP Programs webinar
Selecting the Right Meaningful Use Criteria for Your Practice - October 25, 2010Cientis Technologies
Speaker: Peter Basch, MD, FACP, Medical Director, Ambulatory EHR and Health IT Policy, MedStar Health. He is a Senior Fellow with the Center for American Progress, practices general internal medicine in Washington, DC. Dr. Basch is an early adopter of electronic health records and e-prescribing.
Dr. Basch explained the Stage 1 Meaningful Use Criteria including the 15 Core Measures you must meet plus how to select the 5 Menu Measures that are most appropriate to your practice.
Purpose of the Webinar
1.Describe the process of developing an undergraduate MedRec IPE Event involving > 480 senior Medicine, Pharmacy and Nursing students;
2.Explain the logistics of conducting the event in multiple venues and urban/remote locations;
3.Discuss the successes and challenges of communicating MedRec patient safety concepts through this process; and
4.Describe future opportunities for enhancing undergraduate MedRec training in an interprofessional environment.
Watch the webinar recording: http://bit.ly/1fSqsqv
Meaningful Use Stage 2 and Health Information Exchange (HIE)MassEHealth
Transformational intent of Meaningful Use (MU) and the increased trend toward interoperability in MU Stage 2 (MU2); MU2 objectives with an HIE component and their MU2 measures; Approaches to achieving the transitions of care; Available public health registries and their current status and submission pathway; How to find a trading partner and best practices to engaging
CMS Core Measures Compliance: Best Practices for Data Collection, Analysis and Reporting
For many hospitals, the primary challenge with the core measure program is not achieving quality standards, but complying with the complex, time-consuming reporting process and staying current with constantly changing regulations.
Presentation: Improving the regulation of generic medicines in AustraliaTGA Australia
The registration system for generic prescription medicines has not been amended since the introduction of the Streamlined Submission Process in 2010 and assigns all generics the same target timeframe of 255 working days. Amendments to the generic medicine registration process are under discussion that could provide for flexibility for certain applications and better support the timely availability of high quality generic medicines and the sustainability of the Australian health system.
Slides from the Hielix Webinar discussing how achieving meaningful use in hospitals is more than just a technology upgrade. Full webinar is available on Vimeo (https://vimeo.com/user7074907)
Covering the results of our survey on the use and cost effectiveness of recruitment and retention tools, this presentation was given at the MRN\'s first Director\'s Dinner on October 28th. Comments are welcome.
MIPS APM for ACOs: A Hybrid Reimbursement ModelCitiusTech
CMS announced the Quality Payment Program (QPP) final rule in October 2017, stating how it plans to implement the clinician payment changes to QPP, mandated under the Medicare Access and CHIP Reauthorization (MACRA) act. The implementation of the MACRA act impacts different type of organizations, one such being the Accountable Care Organizations (ACOs). ACOs are evaluated for payments on the basis of quality care and the cost factors associated in achieving their quality goals. Post MACRA implementation, all clinicians will receive payments as per the MIPS (Merit based incentive payments) and Advanced APMs (Advanced alternative payment models). ACO’s can register as APM entities and are eligible to receive payments under Advanced APMs. There is a third category of APM entities which participate in Advanced APMs models but do not meet the threshold of payments and patients set by CMS. Such entities fall into a category that is straddling the line between APM and the MIPS track, called MIPS APM (partially qualifying APM participants). This document discusses about the reporting, scoring and payments for the MIPS APM entities
Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"
Luis Saldana, MD, MBA, FACEP
CMIO
Texas Health Resources
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
Presentation on payment reform and changing models given at 2016 Ziegler National Senior Living CFO Workshop, April 6-8, 2016 at The Sheraton New Orleans Hotel.
Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Thursday, April 21, 2016. During this webinar Model team members provided an overview of the model specifically for health IT vendors.
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http://innovation.cms.gov
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http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Unit VI Case StudyAnimal use in toxicity testing has long been .docxdickonsondorris
Unit VI: Case Study
Animal use in toxicity testing has long been a controversial issue; however, there can be benefits. Read “The Use of Animals in Research,” which is an article that can be retrieved from http://www.toxicology.org/pubs/docs/air/AIR_Final.pdf.
Evaluate the current policies outlined in the Position Statement on page 5 of the article. Use the SOT Guiding Principles in the Use of Animals in Toxicology to guide you in your analysis. Feel free to use additional information and avenues of information, including the textbook, to critically analyze this policy.
In addition, answer the following questions:
How do toxicologists determine which exposures may cause adverse health effects?
How does the information apply to what you are learning in the course?
What were the objectives of this toxicity testing?
What were the endpoints of this toxicity testing?
Finally, include whether or not you agree with the Society of Toxicology's position on animal testing.
Your Case Study assignment should be three to four pages in length. Use APA style guidelines in writing this assignment, following APA rules for formatting, quoting, paraphrasing, citing, and referencing.
Adventure Works Marketing Plan
Centralizing Medical Information To Improve Patient Care
(
Centralizing Medical Information To Improve patient Care
)
Contents
Centralizing Medical Information To Improve patient Care0
Contents1
History2
Executive Summary2
High-Level Functional Requirements:4
Project Charter4
Business Problem Statement5
Project Scope5
Budget and Schedule6
Strategy6
SWOT ANALYSIS6
Technology Constraints7
Project Documentation and Communication9
Project Organization and Staffing Approach9
Project Value Statement9
History
The Affordable Care Act law was passed to improve healthcare for its citizens in the United States by increasing the people that have health insurance and by decreasing healthcare cost. A benefactor to this law is the Medicare/Medicaid program which provides medical coverage to the poor, elderly and disabled individuals which is funded by the federal government. The Federal government covers funding for Medicare programs while it provides reimbursement funds for Medicaid programs provided by the states. (The National Federation Of Independent Business V Sebellius, Secretary Of Health And Human Services, 2012). The primary benefits of the Affordable Care Act Law are covering more consumers with improved quality of services while reducing healthcare cost, access to healthcare, and consumer protection. (ASPA, 2014) Centers For Medicare and Medicaid Services (CMS) manages both of these programs and by modernizing and strengthening the current system they will be lowering cost and providing quality care. Executive Summary
The Center for Medicare and Medicaid (CMS) is the federal office to organized the integration of Medicaid and Medicare services across multiple agencies nationwide. Its purpose is to improve access to services, ...
AAMI_HITECH MU: Impact on the Future of HC ITAmy Stowers
Relate the components of The HITECH Act and Meaningful Use to health management technology
Identify whether existing systems meet requirements
Communicate technology needs and request feedback from end users for a smooth transition
Implement best practices to move people and systems forward under these new requirements
Population Health Management: Enabling Accountable Care in Collaborative Prov...Salus One Ed
This document provides the reader information about population health management (PMH), how it relates to incentive payments for healthcare providers and their health insurance partners (commercial and government). See details about required transformation of care delivery methods, typical accountable care payment models, how to achieve incentives, partnerships between state government (public health) and community shared services needs and necessary technology and data to achieve it.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
1. Health Care Workflow Process
Improvement
Process Redesign
Lecture d
This material (Comp 10 Unit 6) was developed by Duke University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award
Number IU24OC000024. This material was updated by Normandale Community College, funded under
Award Number 90WT0003.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/
2. Process Redesign
Learning Objectives
• Use knowledge of common software
functionality and meaningful use
objectives to inform a process redesign for
a given clinic scenario
2
3. Process Redesign
Topics – Lecture d
• Objectives, skills and knowledge for
Process Redesign
• Matching common clinic system
functionality to solve process problems or
optimize existing clinical processes
• Process redesign for Meaningful Use
Objectives 1 through 10
3
4. 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.”
Source: (CMS EHR Meaningful Use Overview, n.d., para. 1)
4
6. Resources for this unit
• The Specification Sheets outline the
criteria an Eligible Professional or Eligible
Hospital must meet to achieve Meaningful
Use
• Links to the Table of Contents and
Specification Sheets are available on the
next slide
6
7. Links to Table of Contents
Eligible Professionals
https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Dow
nloads/2016_EPTableOfContents.pdf
Eligible Hospitals
https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Dow
nloads/2016_EHTableOfContents.pdf
7
8. Meaningful Use Objectives
• Two sets of objectives
– Eligible Professionals (10 objectives)
– Eligible Hospitals/Critical Access Hospitals
(CAH) (9 objectives)
• The criteria impact workflow
8
9. Eligible Professional
Objective 1
1. Protect Patient Health Information
• Protect electronic protected health information
(ePHI) created or maintained by the CEHRT
through the implementation of appropriate
technical capabilities.
Workflow Impact
• Organizations complete an annual security risk
assessment as part of compliance with
requirements under HIPAA.
9
10. Eligible Professional
Objective 2
2. Clinical Decision Support
• Use clinical decision support to improve
performance on high-priority health conditions.
Workflow Impact
• Decision tools, such as best practice alerts,
provide targeted guidance at various points
during the encounter.
• New workflow.
10
11. Eligible Professional
Objective 3
3. Computerized Provider Order Entry (CPOE)
• Use computerized provider order entry for medication,
laboratory, and radiology orders directly entered by any
licensed healthcare professional who can enter orders
into the medical record per state, local, and professional
guidelines.
Workflow Impact
• Role entering the order is determined by state, local and
professional guideline.
• New workflow for an existing task.
11
12. Eligible Professional
Objective 4
4. Electronic Prescribing (eRx)
• Generate and transmit permissible prescriptions
electronically (eRx).
Workflow Impact
• Role entering the order is determined by state,
local and professional guideline.
• Task sequence is specified by the Meaningful
Use Objective.
• New workflow for an existing task.
12
13. Eligible Professional
Objective 5
5. Health Information Exchange
• The EP who transitions their patient to another setting of
care or provider of care or refers their patient to another
provider of care provides a summary care record for
each transition of care or referral.
Workflow Impact
• When clinicians place orders for a referral, they can
specify the receiving provider and location.
• Summary of care documentation is electronically sent to
receiving provider or location.
• New workflow.
13
14. Eligible Professional
Objective 6
6. Patient-Specific Education
• Use clinically relevant information from CEHRT
to identify patient-specific education resources
and provide those resources to the patient.
Workflow Impact
• The EP identifies educational resources specific
to patients' needs.
• The EP provides these educational resources to
patients.
• New workflow for an existing task.
14
15. Eligible Professional
Objective 7
7. Medication Reconciliation
• The EP who receives a patient from another setting of
care or provider of care or believes an encounter is
relevant performs medication reconciliation.
Workflow Impact
• Process re-design takes advantage of the automation
that exists in CEHRT because the functionality assists
providers and facility staff in maintaining and reconciling
an up-to-date medication list.
• New workflow for an existing task.
15
16. Eligible Professional
Objective 8
8. Patient Electronic Access
• Provide patients the ability to view online, download, and
transmit their health information.
Workflow Impact
• The requirements include automating the release of
health information to an online portal, including lab
results and updates to medications and the problem list.
• Additionally, patients need the capability to download
and transmit their health information.
• New workflow.
16
17. Eligible Professional
Objective 9
9. Secure Electronic Message
• Use secure electronic messaging to
communicate with patients on relevant health
information.
Workflow Impact
• Provider initiated action and interactions with a
patient-authorized representative require secure
transmission.
• New workflow.
17
18. Eligible Professional
Objective 10
10. Public Health Reporting
• The EP is in active engagement with a public
health agency to submit electronic public health
data from CEHRT except where prohibited and
in accordance with applicable law and practice.
Workflow Impact
• The CEHRT provides many opportunities for
capturing health data through clinician workflows
involving patient care.
18
19. Process Redesign
Summary – Lecture d
• Eligible Provider and Hospital/Critical
access Hospital objectives
• Using the Table of Contents and
specification sheets for objectives
• Assessing possible workflow impact of
Meaningful Use Objectives
19
20. Process Redesign
References – Lecture d
References
CMS EHR Incentive Program
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html
Joint Commission: Using Medication Reconciliation
http://www.jointcommission.org/assets/1/18/sea_35.pdf
CMS EHR Incentive Program Eligible Providers Table of Contents. Retrieved from:
https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downloads/2016_EPTableOfContents.pdf
CMS EHR Incentive Program Eligible Hospitals Table of Contents. Retrieved from:
https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downloads/2016_EHTableOfContents.pdf
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21. Process Redesign
Lecture d
This material was developed by Duke
University, funded by the Department of
Health and Human Services, Office of the
National Coordinator for Health Information
Technology under Award Number
IU24OC000024. This material was updated
by Normandale Community College, funded
under Award Number 90WT0003.
21
Editor's Notes
Welcome to Health Care Workflow Process Improvement, Process Redesign, lecture d.
The objective for this lecture is to:
Use knowledge of common software functionality and meaningful use objectives to inform a Process Improvement for a given clinic scenario.
The topics covered in this Lecture d, Process Improvement, include:
Objectives, skills and knowledge for Process Improvement,
Matching common clinic system functionality to solve process problems or optimize existing clinical processes
Process Improvement for Meaningful Use.
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).
Meaningful Use has the same goals as Process Improvement in health care:
Improving quality and safety of care,
Enhancing the patient’s care experience,
Decreasing the cost of care, and
Making 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 began in 2011, continued through 2012 and 2013, and established baseline criteria for electronic data capture and information sharing within and between the Electronic Health Records, or EHR.
Stage 2 started in 2014 and then in October 2015, program requirements were streamlined, resulting in a Modified Stage 2 version.
Modified Stage 2 is applicable for reporting years 2015, 2016, and 2017.
Stage 3 begins as early as 2017 as optional, but required in 2018.
As the stages progress, the goals expand on Stage 1 baseline by leveraging health IT to focus use of certified EHR technology to support health information exchange and interoperability, advance quality measurement, and maximize clinical effectiveness and efficiencies.
Thus, Meaningful Use and Process Improvement are linked.
The Specification Sheets outline the criteria an Eligible Professional or Eligible Hospital must meet to achieve Meaningful Use
Links to the Table of Contents and Specification Sheets are available on the next slide
From the Table of Contents, clicking on the link for each objective opens the actual specification sheet for each objective. For each objective, the specification sheet contains a statement of the objective, detailed specification of the measure for the objective, exclusions for the objective if any exist, pertinent definitions, additional information, and frequently asked questions.
The links on the Meaningful Use Table of Contents allow you to view the detailed Specification Sheet for each Objective.
As described on the CMS Electronic Health Record Incentive Program website, there are two sets of objectives; one for Eligible Professionals (EPs) and another set for Eligible Hospitals.
For EPs, there are 10 objectives. For eligible hospitals and CAHs, there are 9 objectives.
We will cover the Meaningful Use Modified Stage 2 objectives for Eligible Professionals because these are most relevant to outpatient clinic settings. Upon review of both sets of objectives, you will notice all but one objective overlap between the objectives for Eligible Professionals and those for Hospital and CAH settings.
It is important to note that many of the criteria impact clinical workflow. The initial Stage 1 criteria achieved their intended benefit through changing processes for the better, through automation or through controls to catch or prevent errors, while subsequent Stages further support and advance these processes.
We will go through each criteria that impacts workflow and discuss for each, how achieving the Meaningful Use criteria will impact workflow analysis and Process Improvement. This unit specifically outlines Objectives 1 through 10 of Meaningful Use.
The first objective is to ensure that health information created or maintained by the CEHRT is protected.
The measure for Objective 1states 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 objective ultimately requires organizations to complete an annual security risk assessment, which was already part of compliance with requirements under Health Insurance Portability and Accountability Act (HIPAA).
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.
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 Clinical Decision Support objective requires use of decision support tools within the CEHRT to improve performance and improve outcomes for high-priority health conditions such as diabetes or asthma.
The objective also requires use of drug to drug or drug-to-allergy interaction checks.
Decision support tools, such as best practice alerts, provide targeted guidance at various points during the encounter. 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.
The next objective requires use computerized provider order entry for medication, laboratory, and radiology orders. The orders are directly entered by any licensed healthcare professional who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides.
There are two ways in which this objective 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 objective impacts clinical workflow is the task sequence. The order must be entered before action can be taken on the order. This is again because the benefit of CPOE just like Clinical 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 Improvement should assure that CPOE is implemented to meet these two stipulations.
Eligible provider objective four (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.
These prescribing related tasks are performed in clinics everywhere, but use of an EHR system to automate the routing of electronic prescriptions and prescription-related doctor-pharmacist communication drastically changed 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 ePrescribing workflow had to be incorporated into the existing clinic workflow and should be represented on flow diagrams.
Objective five (5) states that the EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral via Health Information Exchange.
CMS defines the Transition of Care as the movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory, specialty care practice, long-term care, home health, rehabilitation facility) to another. At a minimum this includes all transitions of care and referrals that are ordered by the EP.
When clinicians place orders for a referral, they can specify the receiving provider and location. Summary of care documentation is then sent to receiving provider or location electronically using certified technology.
Although many practices are accustomed to providing patients and referring or consulting providers with a copy of relevant clinical information in past workflow processes, it was 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 requires 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 is different than when done with copies of paper documents.
Objective six (6) states that clinicians use clinically relevant information from CEHRT to identify patient-specific education resources and provide those resources to the patient.
Educational resources or a topic area of resources are identified through logic built into certified EHR technology which evaluates information about the patient and suggests education resources that would be of value to the patient. Certified EHR technology is certified to use the patient's problem list, medication list, or laboratory test results to identify the patient-specific educational resources.
The EP may use these elements or may use additional elements within CEHRT to identify educational resources specific to patients' needs. The EP can then provide these educational resources to patients in a useful format for the patient (such as, electronic copy, printed copy, electronic link to source materials, through a patient portal or PHR).
For the next objective is number seven (7), the EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant performs medication reconciliation.
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.”
Health care facilities are required to perform medication reconciliation already, thus, it is not a new task to clinics. However, clinics previously used paper charts to maintain hardcopy list and were not able to benefit from automation such as adding prescriptions from orders or from records received via a Health Information Exchange (HIE).
Process re-design surrounding Medication Reconciliation takes advantage of the automation that exists in CEHRT because the functionality assists providers and facility staff in maintaining and reconciling an up-to-date medication list.
Provide patients online access to health information and the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP.
The requirements include automating the release of health information to an online portal, including lab results and updates to medications and the problem list. Additionally, patients need the capability to download and transmit their health information.
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.
Use secure electronic messaging to communicate with patients on relevant health information.
Secure Message is any electronic communication between a provider and patient that ensures only those parties can access the communication. This electronic message could be email or the electronic messaging function of a PHR, an online patient portal, or any other electronic means.
Provider initiated action and interactions with a patient-authorized representative, are acceptable for meeting this measure.
The EP is in active engagement with a public health agency to submit electronic public health data from CEHRT except where prohibited and in accordance with applicable law and practice.
The CEHRT provides many opportunities for capturing health data through clinician workflows involving patient care.
This slide concludes lecture d of Process Redesign.
In this lecture, we reviewed Meaningful Use modified Stage 2 criteria, covering all ten objectives required for Eligible Providers. At this point, you should be familiar with the Meaningful Use Table of Contents and how to access the specification sheets for each objective. In this lecture, we reviewed the possible workflow impacts of the Eligible Providers as they related to the objectives.
