EMR Meaningful Use : Current Status
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1 EMR Meaningful Use : Current Status Capital Hill Briefing: HITECH Implementation Status: Meaningful Use, Standards, Certification, State Assistance Efforts, and Regional Extension Centers C. Martin Harris, M.D. Chief Information Officer, Cleveland Clinic Executive Director, ecleveland Clinic
2 American Reinvestment and Recovery Act HIT Directives Secretary, Health and Human Services Framework (HIT Adoption, Quality Management, and Interoperability) HIT Policy Committee HIT Standards Committee Definition of Meaningful Use Measures Definition Standards Definition
3 Stimulus-related (Funding) HIT-related Programs Definition of Meaningful Use
4 ehealth Services Providers Patients MyPractice: Electronic Electronic Medical Medical Record Record System System MyPractice Community MyChart: Your Your Personal Personal Health Health Connection MyConsult: Your Your First First Choice Choice for for a Second Second Opinion Opinion eanalytics and and Research: Research Research Standardization Dr.Connect: Improved Improved Communication; Improved Improved Care Care VirtualVisit: Patient/Physician Interaction Interaction Globally Globally MyMonitoring: Ongoing Ongoing Condition Condition Reporting Reporting from from Home Home
5 Electronic Medical Record Ambulatory Functionality Messaging Schedule Results Documentation Physician Order Entry Best Practice Alerts Inpatient Functionality Inpatient census All results Medication administration record Vital signs and I&O Documentation Computerized Physician Order Entry (CPOE)
6 ehealth Services Providers Patients MyPractice: Electronic Electronic Medical Medical Record Record System System MyPractice Community MyChart: MyChart: Your Your Personal Personal Health Health Connection Connection MyConsult: Your Your First First Choice Choice for for a Second Second Opinion Opinion eanalytics and and Research: Research Research Standardization Dr.Connect: Improved Improved Communication; Improved Improved Care Care VirtualVisit: Patient/Physician Interaction Interaction Globally Globally MyMonitoring: Ongoing Ongoing Condition Condition Reporting Reporting from from Home Home
7 MyChart Patient Services View medical information View health reminders View schedule Appointment request Prescription renewal request
8 ehealth Services Providers Patients MyPractice: Electronic Electronic Medical Medical Record Record System System MyPractice Community MyChart: Your Your Personal Personal Health Health Connection MyConsult: Your Your First First Choice Choice for for a Second Second Opinion Opinion eanalytics and and Research: Research Research Standardization Dr.Connect: Improved Improved Communication; Improved Improved Care Care VirtualVisit: Patient/Physician Interaction Interaction Globally Globally MyMonitoring: Ongoing Ongoing Condition Condition Reporting Reporting from from Home Home
9 eenabled Chronic Care Management Model
10 eenabled Chronic Care Management Model Connectivity
11 eenabled Chronic Care Management Model Connectivity MyChart
12 Dear Patient, I recommend the following: Begin spironolactone 25mg once daily. I sent this as a secure eprescription to your preferred pharmacy. Stop Norvasc (amlodipine), but do not discard. Decrease potassium to 20mEq once daily Stop by the lab for blood potassium test 2-3 weeks after making these changes. Message me if you have additional questions.
13 ehealth Services Providers Patients MyPractice: Electronic Electronic Medical Medical Record Record System System MyPractice Community MyChart: Your Your Personal Personal Health Health Connection MyConsult: Your Your First First Choice Choice for for a Second Second Opinion Opinion eanalytics and and Research: Research Research Standardization Dr.Connect: Improved Improved Communication; Improved Improved Care Care VirtualVisit: Patient/Physician Interaction Interaction Globally Globally MyMonitoring: Ongoing Ongoing Condition Condition Reporting Reporting from from Home Home
14 Connectivity / Interoperability MyPractice Community database pre-loaded with: 100+ million data elements Insurance information for all major payors MyPractice Community connected to: Laboratories Cleveland Clinic Health System Quest Diagnostics Retail Pharmacies Acme CVS Giant Eagle RITE AID Sam s Club Walgreens Wal Mart Transcription Companies MedQuist Precis Premier Spheris Cymed Chase
15 H Ashtabula County Medical Center.. H FHC Euclid Hospital MyChart Patients in Patients: MyPractice: 233, Million Willoughby Hills. (Electronic Medical Record System) Family Health Center.. H Huron Hospital H Hillcrest Hospital.. H Cleveland Clinic. FHC Lakewood Hospital Elyria Family FHC.. H H..... FHC Health Center Westlake Family. South Pointe Lutheran Hospital.... Beachwood Family FHC Health Center Hospital. Health and Surgery Center H H Lakewood FHC Family Health Marymount Hospital FHC Center Lorain Family Health. H Solon Family Cleveland.. And. Surgery Center Fairview Hospital Florida Independence Family Health Center FHC FHC Health Center Clinic FHC FHC Chagrin Falls Family FHC FHC Health Center... Strongsville Family Health and Surgery Center. Brunswick Family Wooster Family. Health Center... Health Center
16 Process to Achieve Meaningful Use Objectives Operating Model Use CPOE for all order types including medications [OP, IP] Implement drug-drug, drug-allergy, drug-formulary checks [OP, IP] Maintain an up-to-date problem list [OP, IP] Generate and transmit permissible prescriptions electronically (erx) [OP] Maintain active medication list [OP, IP] Maintain active medication allergy list [OP, IP] Record primary language, insurance type, gender, race, ethnicity [OP, IP] Record vital signs including height, weight, blood pressure [OP, IP] Incorporate lab-test results into EHR [OP, IP] Generate lists of patients by specific condition to use for quality improvement, reduction of disparities, and outreach [OP] Send reminders to patients per patient preference for preventive / follow up care [OP, IP]
![Record primary language, insurance type, gender, race, ethnicity [OP, IP] Record vital signs including height, weight, blood pressure [OP, IP] Incorporate lab-test results into EHR [OP, IP] Generate](/docs-images/44/14018377/images/page_16.jpg "lists of patients by specific condition to use for quality improvement, reduction of disparities, and outreach [OP] Send reminders to patients per patient preference for preventive / follow up care")
17 1. Independent Physician s Office 4. Cleveland Clinic Inpatient Meaningful Use Operating Model 2. Independent commercial pharmacy, labs, and patient at home 3. Cleveland Clinic Ambulatory sites
18 Physician: Scheduled Patient Arrives 01:00 PM B :23 PM EST PATIENT Closed Comp 6 MONTHS FOLLOW 01:20 PM R. 20 1:23 PM EST PATIENT Closed Comp HOSP FOLLOW UP 01:40 PM A. 20 1:09 PM EST PATIENT Closed Sch FOLLOW UP 02:00 PM N. 20 1:11 PM EST PATIENT Closed Arr 4 MONTH FOLLOW UP 02:20 PM L. 20 1:50 PM EST PATIENT Closed Comp 4 MONTH FOLLOW UP 02:40 PM P. 20 1:50 PM EST PATIENT Closed Comp 6 MONTH FOLLOW UP 03:00 PM W. 20 2:28 PM NEW/ESTAB Closed Arr PHYSICAL 03:20 PM B. 20 3:54 PM EST PATIENT Closed Sch 4 MONTH FOLLOW UP 03:40 PM C. 20 3:29 PM EST PATIENT Closed Sch 4 WEEK FOLLOW UP 04:00 PM S. 20 3:40 PM EST PATIENT Closed Comp ONE MONTH FOLLOW UP 04:20 PM A. 20 4:17 PM NEW/ESTAB Closed Arr HOSP FOLLOW UP 04:40 PM M. 20 4:28 PM EST PATIENT Closed Comp SIX MONTHS FOLLOW UP, MD, MD, MD, MD, MD
19 MA/LPN/RN After rooming the patient, the office staff confirms pharmacy benefits
20 MA/LPN/RN Recently ordered/refilled medications reviewed during medication reconciliation process
21 Physician: Best Practice alert reminder to assess screening tests based on Health Maintenance List
22 Physician: Reviews Summary showing Problem List and Medication List
23 Physician: Confirms Penicillin Allergy
24 Physician: Completes History and Physical and Writes a Note
25 Physician: Orders a Laboratory Test Hospital and Commercial Laboratories
26 Physician: Reviews Test Result Final
27 Physician: Medication Information Presented Upon Ordering as a Part of e-prescribing. If the Medication is Non-formulary, the System Automatically Presents Alternative
28 Physician: After completing the visit documentation, follow-up can be scheduled and a summary of the visit can be routed to other providers, if indicated Specialist
29 Physician: At the end of the visit, an After Visit Summary is printed and presented to the patient
30 Process to Achieve Meaningful Use Objectives Use CPOE for all order types including medications [OP, IP] Implement drug-drug, drug-allergy, drug-formulary checks [OP, IP] Maintain an up-to-date problem list [OP, IP] Generate and transmit permissible prescriptions electronically (erx) [OP] Maintain active medication list [OP, IP] Maintain active medication allergy list [OP, IP] Record primary language, insurance type, gender, race, ethnicity [OP, IP] Record vital signs including height, weight, blood pressure [OP, IP] Incorporate lab-test results into EHR [OP, IP] Generate lists of patients by specific condition to use for quality improvement, reduction of disparities, and outreach [OP] Send reminders to patients per patient preference for preventive / follow up care [OP, IP] Operating Model The ultimate vision is one in which all patients are fully engaged in their healthcare, providers have real-time access to all medical information and tools to help ensure the quality and safety of the care provided while also affording improved access and elimination of health care disparities. Meaningful Use: A Definition Recommendations from the Meaningful Use Workgroup to the Health IT Policy Committee June 16, 2009
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