T ECHNOLOGY : M EANINGFUL USE , M EANINGFUL COMMUNICATION L IZ F - PDF document

T ECHNOLOGY : M EANINGFUL USE , M EANINGFUL COMMUNICATION L IZ F AGAN, MD, F ACE P HE AT HE R ST IRNWE IS, RN Date ME ANINGF UL USE • 1999 Institute o f Me dic ine ’ s “T o E rr is Huma n: Building a Sa fe r He a lth Syste m” – With this pub lic a tio n, o rg a niza tio ns b e g a n the initia l pro c e sse s o f a ddre ssing a nd pla nning initia l pro c e sse s o f a ddre ssing a nd pla nning fo r imple me nta tio n o f IT syste ms to he lp minimize the risk o f e rro rs re duc e c o sts a nd impro ve pa tie nt c a re • 2001 Institute o f Me dic ine ’ s “Cro ssing the Qua lity Cha sm, A Ne w He a lth Syste m fo r the 21 st Ce ntury” Page 2 ME ANINGF UL USE 2009--T he Ame ric a n Re c o ve ry a nd Re inve stme nt Ac t. Me dic a re a nd Me dic a id E HR inc e ntive pro g ra ms pro vide a fina nc ia l inc e ntive fo r the me a ning ful use o f c e rtifie d E HR te c hno lo g y to a c hie ve he a lth a nd g y e ffic ie nc y g o a ls. By putting into a c tio n a nd me a ning fully using a n E HR syste m, pro vide rs will re a p b e ne fits b e yo nd fina nc ia l inc e ntive s–suc h a s re duc tio n in e rro rs, a va ila b ility o f re c o rds a nd da ta , re minde rs a nd a le rts, c linic a l de c isio n suppo rt, a nd e -pre sc rib ing / re fill a uto ma tio n. Page 3 1

W HATIS "M E UL U SE ”? ANINGF • T he use o f a c e rtifie d E HR in a me a ning ful ma nne r, suc h a s e -pre sc rib ing . • T he use o f c e rtifie d E HR te c hno lo g y fo r e le c tro nic e xc ha ng e o f he a lth info rma tio n to impro ve q ua lity o f g p q y he a lth c a re . • T he use o f c e rtifie d E HR te c hno lo g y to sub mit c linic a l q ua lity a nd o the r me a sure s. • Simply put, "me a ning ful use " me a ns pro vide rs ne e d to sho w the y're using c e rtifie d E HR te c hno lo g y in wa ys tha t c a n b e me a sure d sig nific a ntly in q ua lity a nd in q ua ntity. Page 4 WHAT ARE T HE CRIT E RIA F OR ME ANINGF UL USE ? • The criteria for meaningful use will be staged in three steps over the course of the next five years. • Stage 1 (2011 and 2012) sets the baseline for electronic data capture and information sharing. l i d d i f i h i • Stage 2 (expected to be implemented in 2013) and Stage 3 (expected to be implemented in 2015) will continue to expand on this baseline and be developed through future rule making. • Me a ning ful use info rma tio n pa c ke ts in b a c k. Page 5 H OW DO I M E T M E UL U SE R S ? E ANINGF E QUIRE ME NT • Adopte d: Ac q uire d a nd insta lle d c e rtifie d E HR te c hno lo g y. (F o r e xa mple , c a n sho w e vide nc e o f insta lla tio n.) • Imple me nte d: Be g a n using c e rtifie d E g g HR te c hno lo g y. g y p (F o r e xa mple , pro vide sta ff tra ining o r da ta e ntry o f pa tie nt de mo g ra phic info rma tio n into E HR.) • ade d: E xpa nde d e xisting te c hno lo g y to me e t Upgr c e rtific a tio n re q uire me nts. (F o r e xa mple , upg ra de to c e rtifie d E HR te c hno lo g y o r a dd ne w func tio na lity to me e t the de finitio n o f c e rtifie d E HR te c hno lo g y.) Page 6 2

H OW DO I M E T M E UL U SE R S ? E ANINGF E QUIRE ME NT • In it’ s fina l rule da te d July 13, CMS inc lude d CPOE in its c o re se t o f me a ning ful use o b je c tive s. • “CPOE is a fo unda tio na l e le me nt in ma ny o f the o the r o b je c tive s o f me a ning ful use , inc luding j g , g e xc ha ng e o f info rma tio n a nd c linic a l de c isio n suppo rt” • F o r e lig ib le ho spita ls a nd c ritic a l a c c e ss ho spita ls (CAHs), the re a re a to ta l o f 24 me a ning ful use o b je c tive s. T o q ua lify fo r a n inc e ntive pa yme nt, 19 o f the se 24 o b je c tive s must b e me t, inc luding : Page 7 M E UL U SE S PE ION S HE ANINGF CIF ICAT E T S • 14 re q uire d c o re o b je c tive s—AND.. • 5 me nu se t o b je c tive s (c ho se n fro m a list o f 10) • E a c h she e t c o ve rs a sing le e lig ib le pro fe ssio na l c o re o r me nu se t o b je c tive : – Me e ting the me a sure fo r e a c h o b je c tive – Ho w to c a lc ula te the nume ra to r a nd de no mina to r fo r e a c h o b je c tive – Ho w to q ua lify fo r a n e xc lusio n to a n o b je c tive – In-de pth de finitio ns o f te rms tha t c la rify o b je c tive re q uire me nts – Re q uire me nts fo r a tte sting to e a c h me a sure Page 8 Inc e ntive T ime line Page 9 3

B E NE F IT S OF ME ANINGF UL USE • 52 physic ia ns + Sta ff a t 26 pra c tic e s with E HR in pla c e fo r a t le a st 2 ye a rs we re surve ye d b y Ce nte r fo r Studying He a lth Syste m Cha ng e – Imme dia te a c c e ss to E MR da ta e na b le d the m to fo c us o n the pa tie nt ra the r tha n g a the ring info rma tio n fro m a va rie ty the pa tie nt ra the r tha n g a the ring info rma tio n fro m a va rie ty o f pa pe r so urc e s during visits – E a se o f a c c e ss e nric he d pa tie nt e duc a tio n during visit – Sho wing pa tie nts po rtio ns o f the ir re c o rds c o uld fa c ilita te mo re a c c ura te do c ume nta tio n a nd jo int de c isio n ma king • Struc ture d/ Co de d Da ta is se a rc ha b le Can EMRs Lead to a Failure to Communicate? HealthLeaders Media, April 29,2010. Janice Simmons. Page 10 C ASE E XAMPL E • Ne w Pa tie nt is b ro ug ht b a c k fo r b e dside tria g e trig g e ring “pt ne e ds to b e se e n” ic o n. – Ic o n no te d b y physic ia n who re vie ws no te s, e xa mine s pt a sking CC fo c use d q ue stio ns p g q fo llo we d b y CPOE • Nurse no te s/ c a rrie s o ut o rde rs o n pa tie nt – Pro vide r no te s o rde r c o mple tio n a nd re c he c ks pt, e xpla ins re sults/ disc ha rg e pla n o f c a re —the n trig g e rs ic o n fo r d/ c • Nurse se e s ic o n a nd d/ c pt with Rx/ instruc tio ns. Page 11 C ASE E XAMPL E DISCUSSION • Pt re c e ive d time ly c a re fro m b o th nurse a nd pro vide r, BUT …….. • Nurse a nd Pro vide r ha d no inte rpe rso na l N d P id h d i t l c o mmunic a tio n re g a rding the pa tie nt. Do e s tha t ma tte r? ........ . • Page 12 4

C OMMUNICAT ION CONCE RNS WIT H E HR • Pro vide rs will re ly o n E MR fo r info rma tio n g a the ring a t the e xpe nse o f re a l time c o mmunic a tio n with pa tie nts a nd o the r c a re pro vide rs • T he we a lth o f da ta a va ila b le c a n lull c linic ia ns into b e lie ving the y ha ve a ll the info rma tio n ne e de d c a using the m to c o mmunic a te le ss with the ir pa tie nts » Electronic Medical Records and Communication with Patients and Other Clinicians: Are we Talking Less? Issue Brief No. 131 April 2010 O’Malley, Cohen, Grossman. Page 13 C OMMUNICAT ION CONCE RNS WIT H E HR • E HRs ha ve e na b le d so me c linic ia ns to e ng a g e le ss with pa tie nts b e c a use so muc h mo re info rma tio n is a va ila b le b e fo re se e ing the pa tie nt the pa tie nt – “…..My c o nc e rn no w is tha t we ’ re liste ning le ss b e c a use we ha ve mo re info rma tio n whe n we wa lk into the ro o m, a nd its no t a ll trustwo rthy” – “ T his is g re a t, I use d the E MR, a nd wa s a b le to write the no te s b e fo re I e ve n we nt into the ro o m” – E le c tro nic Me dic a l Re c o rd s a nd Co mmunic a tio n with Pa tie nts a nd Othe r Clinic ia ns: Are we T a lking L e ss? Issue Brie f No . 131 April 2010 O’ Ma lle y, Co he n, Gro ssma n. Page 14 C ASE R E PORT • 38 yo WM c o mpla ins o f “flu-like sympto ms” fo r o ne we e k— inc luding sub je c tive fe ve r, dry c o ug h a nd pa in with de e p b re a thing . • 98.6 97 18 145/ 90 100% sa t o n RA • • PMH/ PSH a re ne g a tive 1 ppd o c c a sio na l e to h de nie s PMH/ PSH a re ne g a tive , 1 ppd, o c c a sio na l e to h, de nie s drug use • URI te mpla te c ho se n a nd do c ume nte d o n b y tria g e nurse • Physic ia n e xa mine s pt, a sks fo c use d q ue stio ns, c o mple te s URI te mpla te c he c kb o xe s a nd d/ c pt with sympto ma tic the ra py. • Pt wa s fo und de a d b y spo use whe n she c a me ho me fro m wo rk Page 15 5