Meaningful Use and Quality Measures and Healthstory

1. 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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3. 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 Session Objectives

4. 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. 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. Meaningful use and the EHR Facilitates the Transformation Hospital Centric To patient centric Patient Hospital eHealth Specialists Home Care Primary Care Primary Care Home care Specialists eHealth Hospitals Patient

7. Meaningful Use ≈ Data Reuse patient care quality reporting clinical decision support outcomes analysis research billing/claims adjudication Slide Courtesy of HealthStory

8. EMR Adoption Model (US) n=5217

9. 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. 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. 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. 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. 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. 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. Current Methods for Data Capture Direct data entry, physician Direct data entry, not physician Systemgenerated or interfaced data Unstructured Data Structured Data Dictation and Transcription Handwritten

16. 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. 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. EMR Use in Physician Practices Source: Texas Medical Association N=370, 4% response rate

19. EMR Use in Physician Practices 3 to 5 minutes / patient = 1 to 2 hours / day= 1 to 3 fewer patients / day Source: Texas Medical Association N=370, 4% response rate

20. 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. Meaningful Clinical Documents EHR Repository Disease, DF-00000 Metabolic Disease, D6-00000 Clinical Applications Disorder of carbohydrate metabolism, D6-50000 Disorder of glucose metabolism, D6-50100 HIM Applications Diabetes Mellitus, DB-61000 SNOMED CT Type 1, DB-61010 Neonatal, DB75110 Carpenter Syndrome, DB-02324 Insulin dependant type IA, DB-61020

22. 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. Current and Future Standards HL7 Implementation Guides Completed • History & Physical • Consultation • Operative Report • DICOM Imaging Reports • Discharge Summary • Procedure Note • Unstructured Documents Upcoming • Progress Notes (in HL7 ballot) • Billing and Reimbursement Requirements www.healthstory.com

24. Benefits of Health Story Project

25. Where You Can Find Me 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

26. 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