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Why We Should Invest in Meaningful Use Guidelines: Patient Care Perspective

Why We Should Invest in Meaningful Use Guidelines: Patient Care Perspective. Ryan Kreinbring Joanne La Grange Melody Dungee. Presenters. Ryan Kreinbring, Chief Medical Officer Joanne LaGrange, Director of Operations Melody Dungee , Director of Implementations. Who Are We? .

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Why We Should Invest in Meaningful Use Guidelines: Patient Care Perspective

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  1. Why We Should Invest in Meaningful Use Guidelines:Patient Care Perspective Ryan Kreinbring Joanne La Grange Melody Dungee

  2. Presenters • Ryan Kreinbring, Chief Medical Officer • Joanne LaGrange, Director of Operations • Melody Dungee, Director of Implementations

  3. Who Are We? Northwestern Community Hospital located: Joliet, IL • Non-Profit Organization • 300 beds • 10 Clinics • Patient population: High Medicare/Medicaid • Competitors: Provena Covenant Medical Center and Silver Cross Hospital • EHR Adoption Level

  4. Competitive Landscape • Clinics not using the same EHR • ONLY Community hospital in area • Competitors are 2 Large IDN Networked hospitals (HCA and Tenet) • All Hospitals using different EHR vendors • High Medicare and Medicaid Population • Physicians are private, relationship has been strained

  5. Our Mission To provide safe, effective, patient-centered, timely, efficient and equitable patient care with an unparalleled passion and commitment to ensure the very best healthcare for the communities we serve.

  6. Agenda • Overview of where we are today • Discuss the benefits of 5 key impacts of Meaningful Use • Discuss the risks of implementing Meaningful Use • Conclusions and recommendations

  7. Hospitals Prepared to Meet Meaningful Use We Are HERE Source: iHealthBeat January 8, 2010

  8. Use CPOE (10%) Implement drug-drug, drug-allergy, drug-formulary checks (enabled) Maintain an up-to-date problem list of current and active diagnoses (80%) Maintain active medication list (80%) Maintain active medication allergy list (80%) Meaningful Use OverviewStage 1 Record demographics (80%) Record and chart changes in vital signs (80%) Record smoking status for patients 13 years old or older (80%) Incorporate clinical lab-test results into EHR as structured data (50%) Generate lists of patients by specific condition (1 list) Report hospital quality measures to CMS or the States (attestation/electronic) Implement 5 clinical decision support rules (5) Check insurance eligibility electronically (80%) Submit claims electronically (80%) Provide patients with an electronic copy of their health info (80%) Provide patients with an electronic copy of their discharge instructions (80%) Capability to exchange key clinical info (1 test) Perform meds reconciliation (80%) Provide summary care record (80%) Capability to submit electronic data to immunization registries (1 test) Capability to provide electronic submission of reportable lab results (1 test) Capability to provide electronic syndromic surveillance data (1 test) Protect electronic health information (security risk analysis)

  9. Use CPOE (10%) Implement drug-drug, drug-allergy, drug-formulary checks (enabled) Maintain an up-to-date problem list of current and active diagnoses (80%) Maintain active medication list (80%) Maintain active medication allergy list (80%) Key Impacts To Patient Care Record demographics (80%) Record and chart changes in vital signs (80%) Record smoking status for patients 13 years old or older (80%) Incorporate clinical lab-test results into EHR as structured data (50%) Generate lists of patients by specific condition (1 list) Report hospital quality measures to CMS or the States (attestation/electronic) Implement 5 clinical decision support rules (5) Check insurance eligibility electronically (80%) Submit claims electronically (80%) Provide patients with an electronic copy of their health info (80%) Provide patients with an electronic copy of their discharge instructions (80%) Capability to exchange key clinical info (1 test) Perform meds reconciliation (80%) Provide summary care record (80%) Capability to submit electronic data to immunization registries (1 test) Capability to provide electronic submission of reportable lab results (1 test) Capability to provide electronic syndromic surveillance data (1 test) Protect electronic health information (security risk analysis)

  10. CPOE > 10%...why? • NCH Plans a 2 “phase” rollout starting with ED only then moving housewide • Benefits Expected: • Reduced ADE • Standardization of Care • Improved Efficiency of Care Delivery • Eliminate Transcription Errors Safe Patient Centered Equitable Efficient Timely Safe

  11. Impacts to Stakeholders • Physicians – Bring the physician back to the front lines of the patient care decision process. Should increase the timeliness of order entry and improve TAT. Also will eliminate tedious back office steps for order signoff. • Hospital Staff – Real time order entry should make everyone's job easier anddecreaseTAT. Eliminate deciphering of any Physician communication, everything should be spelled out and clear. Remove time entering orders to focus on patient needs. • Patient – Increased interaction with Physicians. Assurance that orders placed are accurate and backed with decision support. Standards of care can be deployed so patients don’t fall through the cracks.

  12. Maintain Problem & Diagnosis List • Joint effort between Nursing and Providers to update and maintain • Benefits Expected: • Clear picture of patients health • Best Practice Care Planning • Improved Disease Management Reporting Patient Centered Effective Efficient Safe Effective

  13. Impacts to Stakeholders • Physicians – Allow the Physicians to actively manage patients life long problems and diagnosis with a clear picture of the patients overall health status. • Hospital Staff – Bridge the clinical gap between Physician documentation and nursing/ancillary documentation. Provide 1 place that’s managed collaboratively. • Patient – True patient centered listing across visits that will improve disease management. When every care provider is managing patients problems treatment and outcomes are tailored to patient needs.

  14. Maintain Active Medication & Allergy List • Nursing will gather medications and allergies list on admission, Physicians will perform medication reconciliation on discharge/admission/transfer of care. • Benefits Expected: • Eliminate Drug – Allergy Interactions • 100% compliance with Allergy documentation • Improve compliance with tracking patients home medications and feeds medication reconciliation process Safe Equitable Patient Centered

  15. Impacts to Stakeholders • Hospital Staff & Physicians– Provide discrete data in single location that crosses clinical disciplines. Allergies and medications entered will allow EMR to check for harmful interactions that will be caught before the order is even placed. Allows checks along the process where Physicians, Pharmacy, and Nursing will have visibility to potential interactions. • Patient – True patient centered listing that should substantially eliminate adverse drug events. This will substantially increase patient safety with regards to medication administration.

  16. Provide Patient Electronic Copy of Health Information • Upon discharge create Continuity of Care Document • Benefits Expected: • Provide patient clear picture of health • Build foundation for interoperability • Better care across patient venues Efficient Effective Patient Centered

  17. Impacts to Stakeholders • Hospital Staff & Physicians– Will provide the hospital with the foundation to explore expanded HIE opportunities. • Patient – Provide patients with clear picture of overall health picture. This should lead to better follow up care as well as empower patients to truly own their health.

  18. Perform Medication Reconciliation • Physician owned process carried out at Discharge/Admission/Transfer of care • Benefits Expected: • Provide all patients with Medication Reconciliation report • Improve compliance with Joint Commission medication reconciliation requirements Patient Centered Effective Equitable Safe

  19. Impacts to Stakeholders • Hospital Staff & Physicians– Physicians will perform on admission, transfer, and discharge. Will provide clear concise view at all times of patients active medication orders (as well as non active). • Patient – Provide the patient with clear guidance on to medications they should Start, Stop, Discontinue. Every visit will result in updated discharge medication reconciliation reports to every patient.

  20. What does this really mean? Ed Archer presents to ED with Shortness of Breath Triage Assessment • Past Visit Allergies Reviewed - allergy to Warfarin added • Notice Problem/Diagnosis documented of Pneumonia and High Blood Pressure • Online Nurse Protocols Initiated for Community Acquired Pneumonia – Triggered off patient history online

  21. What does this really mean? Order Entry (CPOE) at Bedside Physician Exam Best Practice Orders • Online documentation recommends orders based on Problems/Diagnosis list • Best Practice orders recommended that align with organization and national quality goals (smoking cessation, blood culture before first antibiotic, etc). • Decision support – Warafrin alert triggered off patient allergy

  22. What does this really mean? Orders, Medications, Problems, Allergies updated real-time Orders sent immediately Condition Improves, Discharge, follow up • All patients provided medication reconciliation report (start/stop/continue) • New prescriptions prescribed digitally • Mr Archer’s Meds changed - prescribed beta blocker and angiotension prescription cancelled • Mr Archer is provided electronic copy of care record that is also secure sent to PCP for follow up

  23. Risk 1: Visibility & Perception of NCH Quality Balanced Scorecard: • Market Performance/Customer Satisfaction • Internal Operations (Competitive service, quality, efficiency) • Associate Satisfaction & Ability to Adapt and Improve • Community aware of medical errors • $25M ONC Campaign – educate providers/public (March 2010) • To obtain approval of HIT adoption and MU • Consumer Partnership for eHealth (CPeH) consumer/employer survey results (March 2010) • MU is voluntary – capabilities exist in technology now • Harm from rapid MU deployment? “Already being harmed every day” • 50 Consumer & Employer Groups - HHS/CMS letter (April 2010) • Message: Retain MU - Do not defer • Wal-Mart, SEIU • Empowered Patient Coalition and Consumers Union's Safe Patient Project- Web site for patient surveys about their experiences with an adverse medical event

  24. Risk 1: Visibility & Perception of NCH Quality What is important to our customers? Substantial improvement in safety, access, communication and care coordination To Mitigate: • Approve proposed marketing budget increase • Improve & sustain transparency to demonstrate ACTION • Ongoing media campaign to promote NCH MU efforts • Campaigns directed to external providers • NCH Website - MU page for community • Maintain consistent themes: • Safe, effective, timely, patient-centered, efficient, equitable

  25. Risk 2: Automate Inefficiencies and NOT Improve Safety, Quality, Effectiveness or Coordinated Care Balanced Scorecard: • Internal Operations/Clinical & Administrative Quality • Ability to Adapt and Improve • Employee Satisfaction • MU not an implementation strategy! HIT is an enabler • Transformation requires workflow process redesign or we “automate inefficiencies” • Information must be meaningful and useful to have value • Processes to support patient-centered care is a change • Premier on MU, “Hastily implemented workflow changes could have the unintended consequence of adversely affecting quality of care rather than enhancing it.”

  26. Risk 2: Automate Inefficiencies and NOT Improve Safety, Quality, Effectiveness or Coordinated Care What is important to our customers? Six IOM aims: safe, effective, timely, patient-centered, efficient, equitable care To Mitigate: • Approve budget to engage a clinical workflow redesign consultant • Avoid costly customizations of EHR • Leverage Premier Healthcare Alliance HIT Collaborative • New Meaningful Use Best-Practices Library (April 2010) • Focus is expediting EHR implementation to qualify for MU incentives • Strategies for cultural change and communication

  27. Risk 3: CPOE May Not Be Safe Balanced Scorecard: • Internal Operations/Quality, Efficiency, Safety & Quality, Timeliness of Service, Patient Safety Index • Associate Satisfaction/Ability to Adapt, Improve, Implement Changes in Timely Manner • Market Performance/Market Share • Research: • Review of FDA reports links CPOE errors to Adverse Events • CPOE users overly confident about data accuracy & processing • Center for Patient Safety Research – analyzing CPOE factors contributing to medical errors & will classify errors • Message Overload - miss critical messages • Alerts, reminders & CDS to prevent errors • Physicians provide care at different hospitals • Learn multiple systems - different user interfaces • No consistent method to communicate with physicians at NCH!

  28. Risk 3: CPOE May Not Be Safe What is important to our customers? Six IOM aims: safe, effective, timely, patient-centered, efficient, equitable care To Mitigate: • Engage CPOE consultant • Invest in CMIO position (part-time) • Grant appropriate authority to CPOE Physician Advisory Committee • Budget/purchase Evidenced-Based Practice Order Sets • Consider mobile phone connectivity • Identify effective physician communication channel • Leverage Resources: • Institute for Safe Medication Practices human factors guidelines for CPOE • Content, format, protocols for managing RX approval, revisions updates • Premier MU Best Practices library

  29. Risk 4: To Much Too Soon? Sacrificing Safety by Rushing into MU in Year 1 Balanced Scorecard: • Internal Operations/Quality, Efficiency, Availability of Services, Measure of Safety & Quality, Timeliness of Service, Patient Safety Index • Market Performance & Customer Satisfaction/Associate Satisfaction, Ability to Adapt and Improve • AHA, Premier, other professional organization – YES • Care Coordination among diverse healthcare providers requires: • Standardization – coding, transmission, vocabulary, processes • Safe sequence of HIT efforts • Standardized coding – CDS Logic • Security – Patients with electronic copy of health information • Change Management – Education/Communication

  30. Risk 5: To Much Too Soon? Sacrificing Safety by Rushing into MU in Year 1 What is important to our customers? Six IOM aims: safe, effective, timely, patient-centered, efficient, equitable care To Mitigate • External consultant • Assess organizational readiness • Enterprise implementation strategy • Evaluate and plan sequence of HIT • Establish safe MU milestones • Strategies for quality; measuring, monitoring and reporting • Assess current application and use - adoption inventories

  31. Conclusions & Recommendations • Continued support for CPOE project and expand to other MU criteria • Move forward in pursuing meaningful use at a SAFE pace • Ensure project is clinically driven, NOT IT driven • Support for non-staff physicians to adopt MU • Approve budget requirements • External Consulting • CMIO Position • To meet needs of our customers and grow market share - Marketing campaigns to community and external providers Budget Requests

  32. References RECOVERY: Comprehensive Campaign for Communications and Education about Health Information Technology for Economic and Clinical Health (HITECH) Act. (March 24, 2010). https://www.fbo.gov/index?s=opportunity&mode=form&id=93ccf0f006ab28d8076dd69fc846f6ab&tab=core&_cview=1. Accessed April 14, 2010. Consumers weigh in on top 10 meaningful use arguments (March 8, 2010). Health IT News. Accessed April 14, 2010). http://www.healthcareitnews.com/news/consumers-weigh-top-10-meaningful-use-arguments. New Meaningful Use Best-Practices Library Helps Hospitals Effectively Implement HER to Improve the Health of Their Communities (April 6, 2010). Accessed April 14, 2010. http://emrdailynews.com/2010/04/06/new-meaningful-use-best-practices-library-helps-hospitals-effectively-implement-ehr-to-improve-the-health-of-their-communities. http://geekdoctor.blogspot.com/2010/01/do-it-yourself-board-presentation-of.html AHRQ Report: Health IT Adoption Could Lead to Gains in Care Quality (April 15, 2010). Accessed April 16,2010. http://www.ihealthbeat.org/articles/2010/4/15/ahrq-report-health-it-adoption-could-lead-to-gains-in-care-quality.aspx What Percentage of Hospitals Are Prepared To Demonstrate 'Meaningful Use' of EHRs? (January 8, 2010). Accessed April 16, 2010.http://www.ihealthbeat.org/data-points/2010/what-percentage-of-hospitals-are-prepared-to-demonstrate-meaningful-use-of-ehrs.aspx Consumers/Employers: Keep MU Strong (April 20, 2010). Health Data Management. Accessed April 20, 2010. http://www.healthdatamanagement.com/news/meaningful-use-comment-consumers-employers-40137-1.html?ET=healthdatamanagement:e1247:161947a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_042110. Review of FDA Reports Links CPOE Errors to Adverse Events (April 21, 2010) ihealthbeat. Accessed April 25, 2010.http://www.ihealthbeat.org/articles/2010/4/21/review-of-fda-reports-links-cpoe-errors-to-adverse-events.aspx ISMP Develops New Guidelines to Promote CPOE Standardization (March 15, 2010). Accesses April 25, 2010). http://www.ihealthbeat.org/articles/2010/3/15/ismp-develops-new-guidelines-to-promote-cpoe-standardization.aspx Researchers To Look at Medical Errors Related to Use of CPOE Tools (April 26, 2010). http://www.ihealthbeat.org/articles/2010/4/26/researchers-to-look-at-medical-errors-related-to-use-of-cpoe-tools.aspx New Web Site Invites Patients To Report on Adverse Medical Events (April 26, 2010). http://www.ihealthbeat.org/articles/2010/4/26/new-web-site-invites-patients-to-report-on-adverse-medical-events.aspx

  33. References RECOVERY: Comprehensive Campaign for Communications and Education about Health Information Technology for Economic and Clinical Health (HITECH) Act. (March 24, 2010). https://www.fbo.gov/index?s=opportunity&mode=form&id=93ccf0f006ab28d8076dd69fc846f6ab&tab=core&_cview=1. Accessed April 14, 2010. Consumers weigh in on top 10 meaningful use arguments (March 8, 2010). Health IT News. Accessed April 14, 2010). http://www.healthcareitnews.com/news/consumers-weigh-top-10-meaningful-use-arguments. New Meaningful Use Best-Practices Library Helps Hospitals Effectively Implement HER to Improve the Health of Their Communities (April 6, 2010). Accessed April 14, 2010. http://emrdailynews.com/2010/04/06/new-meaningful-use-best-practices-library-helps-hospitals-effectively-implement-ehr-to-improve-the-health-of-their-communities. http://geekdoctor.blogspot.com/2010/01/do-it-yourself-board-presentation-of.html AHRQ Report: Health IT Adoption Could Lead to Gains in Care Quality (April 15, 2010). Accessed April 16,2010. http://www.ihealthbeat.org/articles/2010/4/15/ahrq-report-health-it-adoption-could-lead-to-gains-in-care-quality.aspx What Percentage of Hospitals Are Prepared To Demonstrate 'Meaningful Use' of EHRs? (January 8, 2010). Accessed April 16, 2010.http://www.ihealthbeat.org/data-points/2010/what-percentage-of-hospitals-are-prepared-to-demonstrate-meaningful-use-of-ehrs.aspx Consumers/Employers: Keep MU Strong (April 20, 2010). Health Data Management. Accessed April 20, 2010. http://www.healthdatamanagement.com/news/meaningful-use-comment-consumers-employers-40137-1.html?ET=healthdatamanagement:e1247:161947a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_042110. Review of FDA Reports Links CPOE Errors to Adverse Events (April 21, 2010) ihealthbeat. Accessed April 25, 2010.http://www.ihealthbeat.org/articles/2010/4/21/review-of-fda-reports-links-cpoe-errors-to-adverse-events.aspx ISMP Develops New Guidelines to Promote CPOE Standardization (March 15, 2010). Accesses April 25, 2010). http://www.ihealthbeat.org/articles/2010/3/15/ismp-develops-new-guidelines-to-promote-cpoe-standardization.aspx Researchers To Look at Medical Errors Related to Use of CPOE Tools (April 26, 2010). http://www.ihealthbeat.org/articles/2010/4/26/researchers-to-look-at-medical-errors-related-to-use-of-cpoe-tools.aspx New Web Site Invites Patients To Report on Adverse Medical Events (April 26, 2010). http://www.ihealthbeat.org/articles/2010/4/26/new-web-site-invites-patients-to-report-on-adverse-medical-events.aspx

  34. Appendix B: HIMSS Hierarchy of EMR Adoption

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