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EHR-peds
- 1. EHRs & Care Management: Mandates& Opportunities MICHAELNEWELL, RN, MSN PRESIDENT LIFESPAN CAREMANAGEMENT Personal Healthcare Concierge Service www.LifeSpanCM.com Presented to Case Management Department Children’s Hospital of Philadelphia
- 2. Objectives •Describe the criticalcomponents of the Electronic Heath Record Evolution •Explain how “Meaningful Use” will enhance the standard of medical care as Electronic health records are implemented •Describe How Case Managers can use these innovations to improve transitions of care and avoid adverse events. Personal Healthcare Concierge Service www.LifeSpanCM.com © Copyright 2010. LifeSpan Care Management, LLC. All rights reserved.
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- 4. Willem Einthoven firstdemonstrated electrical heart conduction using an electrocardiograph in 1906, winning the Nobel Prize for this invention in 1924
- 6. What does thedata mean?
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- 16. Who • Office ofthe National Coordinator (ONC) for Health Information Technology • Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009 • $20B Funded by the American Recovery and Reinvestment Act of 2009 (ARRA)
- 17. What + Where •Primary Care Providers taking Medicare offered $44,000 each to purchase and use an EMR • Eligible providers for Medicaid may apply for up to $63,750 per clinician • A base payment of $2 million for eligible hospitals and critical access hospitals, depending on certain criteria • All must show “Meaningful Use”
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- 19. Clinical Information System(s) Business Process System(s) = EMR +PHR =EHR + Clinical Decision Support Outcomes Care coordination Client satisfaction Errors Costs
- 20. MU • Updates toface sheet • New diagnoses get free text box to enable details • Once appropriate details about the diagnosis or problem are recorded, such as quality, duration, timing, and complicating factors, the provider clicks a box marked “add to the problem list.”
- 21. MU-2 • Medication reconciliation •Summary of encounter provided to patient at time of discharge, including: – Chief complaint/reason for visit – Findings/diagnosis – Plan of Care – Meds, diagnostics, treatments ordered • Notification of care transitions to pertinent providers • Summary of care at transition points
- 22. Population Health Management Defined as: •Intensive care management for individuals at the highest level of risk • Personal health management for those at lower levels of predicted health risk
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- 24. HIE solutions • Achievinghealth goals through health information exchange • Improving long-term and post-acute care transitions • Consumer-mediated information exchange • Enabling enhanced query for patient care • Fostering distributed population-level analytics
- 25. HIE To-Do List •Create and implement up-to-date privacy and security requirements for HIE • Coordinate with Medicaid and state public health programs to establish an integrated approach • Monitor and track meaningful use HIE capabilities in their state
- 26. Summary Of CareRecord • Patient name. • Referring or transitioning provider's name and office contact information (EP only). • Procedures. • Encounter diagnosis • Immunizations. • Laboratory test results. • Vital signs (height, weight, blood pressure, BMI). • Smoking status. • Functional status, including activities of daily living, cognitive and disability status
- 27. SoC list… • Demographicinformation (preferred language, sex, race, ethnicity, date of birth). • Care plan field, including goals and instructions. • Care team including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider. • Reason for referral • Current problem list (EPs may also include historical problems at their discretion). • Current medication list, and • Current medication allergy list.
- 28. SoC List… • ProblemList – At a minimum a list of current, active and historical diagnoses. The EP is not limited to just include diagnoses on the problem list. • Active/current medication list – A list of medications that a given patient is currently taking. • Active/current medication allergy list – A list of medications to which a given patient has known allergies & any exaggerated immune response or reaction to substances that are generally not harmful. • Care Plan …
- 29. PoC The structure usedto define the management actions for the various conditions, problems, or issues. A care plan must include at a minimum the following components: • problem (the focus of the care plan), • goal (the target outcome) and any • instructions that the provider has given to the patient. A goal is a defined target or measure to be achieved in the process of patient care (an expected outcome).
- 30. Functional Independence Measures (FIM--WeeFIM) Self-Care •Grooming • Bathing • Dressing Upper • Eating • Dressing Lower • Toileting – Sphincter Control • Bladder Management • Bowel Management Motor – Transfers • Chair, Wheelchair • Toilet • Tub, Shower – Locomotion • Walk, Wheelchair • Stairs COGNITIVE • Comprehension • Expression • Social Interaction • Problem Solving • Memory
- 31. FIM Decision Tree 7:Complete Independence Client completes activity without help, assistive device, in a reasonable time and without safety concerns 6: Modified Independence Needs more time or assist device 5: Supervision Needs set-up, cueing or contact guarding 4: Minimal Assistance Completes 75-100% of task 3: Moderate Assist Completes 50-75% of task 2: Maximal Assist Completes 25-50% of task 1: Total Assist Completes little or none by self
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- 34. MOS SF-36 • Self/phone/interviewadministered in 10 minutes • Uses Likert scale, acute, chronic & disease- specific versions • Correlates .70 to .80 with actual health exams • Discriminates stages, severity of disease and moderate size treatment effects
- 35. SF-36 Health Domains •General health perceptions • Physical functioning • Role limitations due to physical and emotional problems • Social functioning • Pain • Emotional well-being • Vitality • Changes in health HSQ adds 3 question depression screener
- 36. Working with HSQData 0 20 40 60 80 100 Phys FuncR ole/Phys PainM ntlH lthR ole-Em ot Soc Fx VitalG en H lth Baseline 2nd Visit 1st F/U Adj Norms
- 37. Clinical Quality Measures •Appropriate testing for children with Pharyngitis • Weight assessment & counseling for nutrition & physical activity for children & adolescents • Use of appropriate medication for Asthma • Childhood immunization status • Preventive care & screening: influenza immunization • HA1c test for pediatric patients • Appropriate Tx for children with URIs • ADHD: f/u care for children prescribed ADHD meds • Children who had dental decay or cavities • +HIV testing f/u
- 38. Goals for the U.S.Healthcare System As per the Institute of Medicine of the National Academy of Science
- 39. A Continuously LearningSystem
- 41. References: Best Care atLower Cost: The Path to Continuously Learning Health Care in America (2102) Mark Smith, Robert Saunders, Leigh Stuckhardt, J. Michael McGinnis, Editors; Committee on the Learning Health Care System in America; Institute of Medicine, National Academies Press, Washington DC. Blumenthal, D., Tavenner, M. (2010). The “Meaningful Use” Regulation for Electronic Health Records. The New England Journal of Medicine, 363, 501-504. Halamka, John D. (2009). Making Smart Investments in Health Information Technology: Core Principles. Health Affairs. 385-289. DOI: 10.1377/hlthaff.28.2.w385 McBride, S., Delaney, J. Tietze, M. (2012). Health Information Technology and Nursing. American Journal of Nursing. 112;8. 36-42. DOI: 10.1097/01.NAJ.0000418095.31317.1b http://www.cms.gov/regulations-and- guidance/legislation/ehrincentiveprograms/stage_2.html