EHRs, Quality Measurement, and the Foundation for a Learning Health System Rosemary Kennedy, PhD, RN, MBA, FAAN icarequality, Inc.

Transcription

1 EHRs, Quality Measurement, and the Foundation for a Learning Health System Rosemary Kennedy, PhD, RN, MBA, FAAN icarequality, Inc.

2 Learning Objectives At the completion of this session, the learner will: Describe standards necessary to extract data for quality measurement and performance improvement Describe an electronic measure (emeasure) Articulate the definition of nursing informatics Describe the relationship between Meaningful Use, quality measurement and a learning health system Learning Objectives

3 3 Informatics Defined IMIA Special Interest Group on Nursing Informatics Nursing Informatics science and practice integrates nursing, its information and knowledge and their management with information and communication technologies to promote the health of people, families and communities world wide. mia-ni-definition-of-nursing-informaticsupdated/

4 Foundational Framework for the Benefits of Clinical Information Systems (CIS) DIWK framework. Reprinted with permission from Nelson.

5 5 The skill of writing is to create a context in which other people can think Edwin Schlossberg

6 7 What do These Diverse Projects have in Common with Healthcare? Fewer A pattern-matching troops are harmed tool is from developed explosive to find 3. devices Any citizen because can go lethal online schools that provide fake mines and, student are in a discovered few clicks, visas to before see how potential they his terrorists. detonate. tax dollars are spent by award size, jobs created, status, location, and other variables.

7 8 What do These Diverse Projects have in Common with Healthcare? Management of Data, Information, and Knowledge 1. Fewer troops in Afghanistan are harmed from explosive devices because lethal mines are discovered before they detonate. 2. A pattern-matching tool is developed to find schools that provide The fake student Use of visas Data to potential to Gain terrorists. Insight and Knowledge Different Ways Stakeholders are Accomplishing 3. Any citizen can go online and, in a few clicks, see how his tax dollars are spent by award size, jobs created, status, location, and Business other variables. Objectives Using Data

8 Important Ideas Exponential Growth of Technology and Informatics - so You Must Jump the Curve in Order to Stay Competitive Explosion of devices Too much data, not enough insight Seeing this across all areas of informatics, within research, education, and practice Meaningful Use Re-defining the EHR 9

9 National Quality Strategy: Infrastructure Health and Well Being Health Information Technology Affordable Care Prevention and Treatment Workforce Development Better Care Affordable Care Health People/Communities Measurement of Process and Outcomes Patient Safety Person Centered Care Rapid Cycle Learning & Innovation Care Coordination Infrastructure Supports Payment Patient Safety Organizations Quality Improvement Organizations Certification Regulation Consumer Incentives Public Reporting 2011 Report to Congress: National Strategy for Quality Improvement in Health Care 10

10 Redefinition of the Electronic Health Record The EHR must support care delivery AND quality measurement all in real time

11 STAGE 2 MEANINGFUL USE CLINICAL QUALITY MEASURES

12 Quality Measurement Shift From Using Claims Data And Chart Audits for Quality Measurement To Using Electronic Point of Care Documentation For Quality Measurement Burden Shifts from Abstractor to Point of Care

13 EHR to Guide Care Peer Audits to Assess Quality Quality Measurement as a Byproduct of Care Delivery Data for Performance Improvement Learning Health System Foundation

14 Electronic Measure (emeasure) Life Cycle Quality Measure Measure Content (Logic, Numerator, Denominator Represent Using QDM (Quality Data Model) Map to Standardized Terminologies (Value Sets) EHR Electronic Reporting and Sharing Capture Data Provide Care

15 What s an emeasure? An emeasure is the electronic format for quality measures using the Quality Data Model (QDM) and the Healthcare Quality Measure Format (HQMF), an HL7standard

16 Human Readable - Header

17 Computer Readable

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19 Electronic Quality Management Life Cycle epressulcer Representation

20 ANA s Pressure Ulcer Cumulative Incidence emeasure (epressulcer CI ) Pressure Ulcer emeasure purpose: Determine the incidence of pressure ulcers using data from the Electronic Healthcare Record (EHR). Determine the rate and timing of skin and pressure ulcer risk assessment performance and prevention using EHR data. Explore the relationships among nursing assessments performed, intervention plans in use, and pressure ulcer development.

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23 Think Differently

24 Using Meaningful Use as the Foundation for a Learning Health System

25 Trends in Informatics 1. Near Continuous Patient (Consumer) Monitoring 2. Rise in Nontraditional Sources of Data 3. Big data Clinical Analytics 4. Empowered end users 5. Learning Health System

26 Important Ideas 1. HIT Data Driven Sensors / Devices Clinician Entered Collective Action of Consumers 2. Harvesting of Data to Find Solutions and Create Knowledge Collective Intelligence Learning Health System

27 Exponential Growth of Patient Data Available for Improving Outcomes Patient Data

28 Turning Structured Empowering Data Into End Users Information Alerts to potentially prevent bed sores Designed to detect falls Is this patient getting out of bed? Remote observation for tracheotomy patients (Are they sitting up?) Level of activity Viewing trends of the vital signs

29 32 Turning Data into Information and Knowledge

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31 Informatics Top 10 Tech Trends Increases the importance of formal data governance, management and architecture Path that describes where data was created And by whom How it is transformed How it flows How it is combined with other data Focus on specific problems you re trying to solve targeted approach If you neglect these fundamental principles, you ll paint yourself into a corner

32 36 Turning Data into Information, Knowledge, and Quality Improvement Create Learning Health Systems

33 A Learning Health System for the Nation Roberts, D.W. (2013). Improving care and practice through learning health systems. Nursing Management, 44(4),

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35 39 The Future

36 Crossing the Quality Chasm This sort of change in healthcare will not be evolutionary but revolutionary, like going from water to steam This vision is a chasm that cannot be crossed in two steps 40

37 Know what to do with the data you have 41

38 Redefinition of the Electronic Health Record What was secondary use of data is now primary use of data Creation of a Strategic Plan for Data If You Can t be There Yourself, Don t Send Anyone Deming

39 1. Roberts, D.W. (2013). Improving care and practice through learning health systems. Nursing Management, 44(4), Guidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures.html 4. Agency for Healthcare Research and Quality. Closing the quality gap: a critical analysis of quality improvement strategies Institute of Medicine. Crossing the Quality Chasm. Washington, DC: National Academies Press; Institute of Medicine. Best care at lower cost: the path to continuously learning health care in America. Reports/2012/Best-Care-at-Lower- Cost-The- Path-to-Continuously-Learning-Health-Care- in-america.aspx. 7. Friedman CP, Wong AK, Blumenthal D. Achieving a nationwide learning health sys- tem. Sci Transl Med. 2010;2(57):57cm Kanter JH. Your Life, Your Health: Share Your Health Data Electronically It May Save Your Life. Los Angeles, CA: Joseph H. Kanter Fam- ily Foundation; Greene SM, Reid RJ, Larson EB. Implementing the learning health system: from concept to action. Ann Intern Med. 2012;157(3):

40 Rosemary Kennedy, PhD, RN, MBA, FAAN We are happy to help you!