To Improve Outcomes & Clinical Efficiency

Transcription

1 To Improve Outcomes & Clinical Efficiency 1

2 New England Home Care Conference & Trade Show June 6, 2013 Carolyn J Humphrey, RN, MS, FAAN President, CJ Humphrey Associates Louisville, Kentucky cjhumphrey@bellsouth.net 2

3 Four National Trends Evidence based Clinical Practices Clinical Decision Support Systems Electronic Health Record (EHR) & Information Technology (IT) national events are impacting providers and professionals Importance of standardization to support patientcentered care and care giver communication and collaboration 3

4 Today s Objectives Identify how current evidence based practice (EBP) concepts apply to homecare & hospice clinical practice. Describe how meaningful use standards impact current and future EMR requirements. 4

5 Today s Objectives Recognize how a Clinical Documentation System (EMR) incorporating a Clinical Decision Support System (CDS)can help: Streamline workflow Increase clinical accuracy & productivity Support the use & adherence to EBP Increase clinician satisfaction & improve retention Improve patient t outcomes Maximize agency resources Position the organization for opportunities 5

6 Take Home An update of current EBP & EMR terms & concepts to use as a framework for your further analysis Specific examples of how clinical software at the Pointof care can support several organizational departments and goals Creative approaches to maximize your IT Investment & increase efficiencies in your agency 6

7 How current evidence based practice (EBP) concepts apply to homecare & hospice clinical practice 7

8 An EBP Refresher Evidence based practice is a problem solving approach to health care that incorporates the conscientious use of current best evidence from well designed studies, a clinician s expertise, and patient values and preferences. Fineout Overhold, Melynk, 2005 All three of these key components must be present for All three of these key components must be present for evidence based practice to be effective. 8

9 Fineout Overholt, el al, 2005 The EBP Paradigm 9

10 Why EBP? Status of America's Health Care 30% of healthcare spending $750 Billion for ineffective or redundant care. BC/BS % of acute care and 56% of chronic care conformed to the medical literature. McGlynn, 2003 Patients have a 50% chance of receiving the most advisable care RWJ, ,000 people die each year from preventable medical errors Nat Ac Press,

11 Why EBP? National, State & Local Perspective Helps decrease variability across clinicians & providers Supports accurate & comparable benchmarking Helps achieve efficient & effective patient outcomes Helps decrease costs Meets accreditation & licensure standards Helps decrease adverse events Can positively affect HH Compare Scores 11

12 Why EBP? Positioning your Organization NOW! Basing practice & care on evidence is integrated into the Affordable Care Act (ACA). ACOs are required to promote evidence based medicine and coordinate care through using it. Focus on achieving patient centered outcomes rather than just delivering care & paying per visit. 12

13 Clinical Perspective Why EBP? Research studies show that using EBP helps leads to: Higher quality care Improved patient outcomes Reduced costs, and Greater nurse satisfaction than traditional approaches to care. 13

14 Clinicians Perspective Why NOT EBP? Lack of knowledge. Wasn t included in their nursing education. Lack computer & Internet search skills. Too difficult or too time consuming. 14

15 Why NOT EBP? Regulations! Regulations were never meant to tell clinicians how to practice. Increasingly, agencies will be licensed on their use of best practice. Using evidence based clinical practices does not conflict with bi being compliant and licensed, and if it does, everyone in the agency should know the procedure to move the issue forward. 15

16 Doctor s Orders! Why NOT EBP! Clinicians develop their skilled Plan of Care in conjunction with physician orders. Agency policies & procedures should support EBP. Physicians should be open to EBP questions. 16

17 Knowledge Statistics, Evidence and Mistakes is the enemy of disease The third revolution in healthcare will be driven by knowledge, technology and patients. Sir Mur Gray, Chief Knowledge Officer of Britain's National Health Service 17

18 Meaningful Use The set of CMS defined standards that governs the use of EHRs & allows eligible providers to earn incentive payments by meeting specific criteria. The goal of meaningful use is to promote the spread of electronic health records to improve health care in the United States. t 18

19 Benefits of Meaningful Use Complete and accurate information EHRs allow providers to know more about their patients & their health history prior to office visits, having the needed information to deliver the best possible care. Better access to information EHRs supply providers with greater information access to diagnose problems earlier and improve patient outcomes. Information is easily shared among providers leading to better care coordination. Patient empowerment EHRs can empower patients to be active in their own and their family s health by receiving and sharing their records and information securely over the Internet. 19

20 Meaningful Use CPOE (for Medications) Clinical Decision Support Drug to Drug and Drug to Calculate and transmit Allergy interaction checks CMS quality measures Demographics, gender, Electronic copy of health race, ethnicity, DOB, records preliminary cause of death Problem List Medication list Medications allergy list Vital Signs Electronic copy of discharge instructions Clinical Summaries Exchange key clinical information Privacy and Security 20

21 Right Information to the Right person in the Right format through the Right channel at the Right time 21

22 CH2 Clinical Decision Support CH1 Is a sophisticated HIT component doesn t stand alone Common features Knowledge based (dx, drug interactions, guides) Rules & relationships that combine knowledge with patient specific information Communication mechanism that provides relevant information back to the clinician i i as care is delivered. d Berner,

23 Slide 22 CH1 CH2 does this help clarify? See also the sentence I wrote in the notes below to elaborate on this 1st bullet. Carolyn Humphrey, 5/17/2013 Revised slide Carolyn Humphrey, 5/17/2013

24 CH3 Clinical Decision Support Can lower costs impacts numerous departments Improve efficiency assists the clinician Reduce patient inconvenience information transfer May do all these simultaneously 23

25 Slide 23 CH3 revised slide Carolyn Humphrey, 5/17/2013

26 Benefits of a Clinical Documentation System that incorporates Clinical Decision Support 24

27 Benefits of an EMR with CDS Streamlines Workflow Information must be filtered, organized and presented to support current workflow, allowing the clinician to make an informed decision quickly and take action. Provides a variety of tools to enhance decision making in the clinical workflow. Tools can include computerized alerts and reminders for both the care provider & patients. 25

28 Benefits of an EMR with CDS Helps Increase Clinical Accuracy & Productivity Respects training & practice patterns. Plan reminders no need to write things down; Alerts, visit schedules, etc. Provides information when clinicians are unsure; Can hover over areas for reminders EBP, tips, etc. Presents EBP alternatives to support decision making Corrects clinician errors; Like spell check, EBP reminders, etc. 26

29 Benefits of an EMR with CDS Supports the use and adherence to EBP Includes clinical guidelines; condition specific order sets; focused patient data reports & summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools. 27

30 Benefits of an EMR with CDS Helps Increase Clinician Satisfaction & Improve Retention Intelligent workflow reduces reliance on taking notes. Address the information overload clinicians face Provides support for completing complex protocols Research has shown by alerting & then recommending EBP, a significant improvement occurs in adhering to guidelines. 28

31 Benefits of an EMR with CDS Helps Improve Patient Outcomes Include personalized assessments & care plans Avoid multi physician, multi pharmacy use Provide interdisciplinary POC Focus on patient s complete health & well being Provide support for self management, including Provide support for self management, including telehealth 29

32 Benefits of an EMR with CDS Helps Maximize Agency Resources Dynamic comprehensive assessment using standard language = accurate & consistent documentation. Required documents for billing result from the assessment & care planning process. Queues up documents for review based on clinical variation and deviation from EBP Supports exception based review = Reduced time spend auditing and reviewing all clinical documentation. 30

33 Benefits of an EMR with CDS Helps Position the Organization for Opportunities Provides holistic view of patient care. Efficient sharing with other providers and payers. Identifies those at risk for high utilization Evidence based practice guidelines Improved efficiency, cost benefit, provider & patient satisfaction Transition to appropriate level of care 31

34 Lt Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done? Florence Nightingale Notes on Nursing: What it is and What it is Not 32

35 What You re Doing & Questions 33

36 References Abrahamson, K. A., Fox, R. L., Doebbeling, B. N., (2012). Facilitators and barriers to clinical practice guidelines use among nurses. American Journal of Nursing 112(7), Berner, E. S., (2009). Clinical decision support systems: State of the Art. AHRQ Publication No EF Rockville, Maryland: Agency for Healthcare Research and Quality. Blue Cross/Blue Shield (2012). Building tomorrow s healthcare system: The pathway to high quality, affordable care in America. bcbs/health reform/pathway.pdf Buerhaus, P.I., DesRoches, C., Applebaumn, S., Hess, R., Norman, L.D., Donelan, K. (2012). Are nurses ready for health care reform? A decade of survey research. Journal of Nursing Economics, 30(6),

37 References Carrington, J. M. (2012). The usefulness of nursing languages to communicate a clinical event. CIN: Computers, Informatics, Nursing, 30(2), Cipriano, P. F. (2011). The future of nursing and health IT: The quality elixir. Nursing Economics, 29(5), 282 and Fineout Overholt, E., Melnyk, B, and Schultz, A. (2005). Transforming health care from the inside out: Advancing evidence based practice in the 21 st century. Journal of Professional Nursing 21(6), ; 35

38 References Health IT.gov Clinical Decision Support. How To Guides (5) for Clinical Decision Support (CDS) Implementation. researchersp// /p implementers/cds implementation Harrison, R. L., Lyerla, F. (2012). Using nursing clinical decision support systems to achieve meaningful use. CIN: Computers, Informatics, Nursing, 30(7): Kohn, L. T., Corrigan, J. M., Donaldson, M. S. (2009). To Err is Human: Building a Safer Health System. The National Academies Press: Washington, D.C. 36

39 References League, K., Christenbery, T., Sandlin, V. (2012). Increasing nurses access to evidence through a Webbased resource. Journal of Nursing Administration, 42(11), McGlynn, E. A., et al. The quality of health care delivered to adults in the United States. New England Journal of Medicine 348, Robert Wood Foundation (2010). Quality & equality in U. S. Health Care: A message handbook. 37