Adoption and Meaningful Use of EHR Technology in a Hospital

Transcription

1 Monday, March, 00 :5 :5 pm Adoption and Meaningful Use of EHR Technology in a Hospital Sanjay Shah, MBA, CMPE, FHIMSS President, HCIT+ (Former) VP & CIO, Cabell Huntington Hospital Anthony Adkins, RN Director of Clinical Solutions Cabell Huntington Hospital Sanjay Shah, MBA, CMPE, FHIMSS President, HCIT+ (Former) VP & CIO, Cabell Huntington Hospital Anthony Adkins, RN Director, Clinical Solutions Cabell Huntington Hospital Have no real or apparent conflict of interest Identify the different aspects of meaningful use of electronic health record technology Identify strategies that lead toward achieving meaningful use Describe the value of creating awareness and promoting education, communication, and clinical workflow transformation for successful adoption Assess one s own organization s readiness for adoption and meaningful use Create an action plan for lasting adoption and meaningful use of EHR technology

2 Source: PWC, March 005 A fully digital hospital would not produce or use paper records. It would have digital imaging, order transmission, clinical notes and other aspects of the electronic health record. It would have integrated supply chain management and integrated revenue cycle management. Don t focus on a technical or engineered vision; this process is not comparable to constructing a dam or a building. It can t be context free how do you define success? You must build a vision with the technology. The digital hospital must have a care vision and a process vision. A digital hospital means all digital, with EMR, CPOE, PACS and labs that dump into EMR. A digital hospital should be as paperless and wireless as you can make it. A digital hospital needs to be defined in chunks because healthcare is a grouping of so many different businesses. Typically you try to automate systems from a patient-experience point of view. The digital hospital could be paperless, but many will still have some paper and some film. Either way, it is an iterative process. The digital hospital is an effort, a spectrum, and a concept. It is a process of managing more by computer and less by manual processes. A digital hospital is the use of electronic information beyond administrative and billing purposes really integrating electronic information into the clinical aspects of the delivery of care. A digital hospital makes use of electronic information to provide the highest quality status and most efficient care possible. A digital hospital uses digital technology for communications, tracking and information flow. David Brailer, MD, PhD National Health Information Technology Coordinator; U.S. Department of Health and Human Services John Glaser, MD, PhD, VP and CIO; Partners HealthCare System Brad Bjornstad, MD, CMO; University Community Hospital Laureen O Brien, Regional CIO; Providence Health System Dick Gibson, MD, PhD, CMIO; Providence Health System Suzanne Delbanco, PhD, CEO; The Leapfrog Group Cindy Slaydon, RN, MSN, CHE, CNO; Centennial Medical Center Defined by Centers for Medicare and Medicaid Services (CMS) as: The use of Health IT to further Improve quality, safety, efficiency, and reduce health disparities Engage patients and Families Improve care coordination Ensure adequate privacy and security protections for personal health information Improve population and public health Further the goal of information exchange among health professionals Stage (Begins 0) Focused on Electronically capturing health information Implementing clinical decision support tools to facilitate disease and medication management Reporting clinical quality measures and public health information Stage (Begins 03) Focused on Using captured information to improve care Electronic transmission of diagnostic test results Computerized provider order entry (CPOE) Stage 3 (Begins 05) Focused on Decision support and improvements in quality and safety

3 Final Notice of Proposed Rulemaking (NPRM) January 3, 00 Public Comments till March 0, 00 Ruling details: Roll out in will begin in 0 Roll out will occur in three stages Stage criteria can be used until 05 3 Meaningful Use Criteria Medicaid payments will be provided through state Hospital payment year is based on the Federal Fiscal Year (Oct -Sept 30) CPOE is used for at least 0 percent of all orders Implement drug-drug, drug-allergy, drug- formulary checks Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT Record and chart changes in vital sign for patients age and over. Chart blood pressure, BMI and plot a growth chart for age -0. Record demographics Maintain active medication list Maintain active medication allergy list

4 Record smoking status for patients 3 years old or older Incorporate clinical lab-test results into EHR as structured data for at least 50 percent of all tests with either a positive/negative or numeric format. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach. (At least one) Report hospital quality measures to CMS or the States. 0 Through attestation (Section II.A.3) 0 Through electronic transfer (Section II.A.3) Implement five clinical decision support rules relevant to the clinical quality metrics of the hospital Check insurance eligibility electronically from public and private payers Submit claims electronically to public and private payers. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, allergies, discharge summary, and procedures), upon request within 48 hours. Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request. Capability to exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, allergies, diagnostic test results), among providers of care and patient authorized entities electronically. (One Test) Perform medication reconciliation at relevant encounters and each transition of care. Provide summary care record for each transition of care and referral. Capability to submit electronic data to immunization registries and actual submission where required and accepted. (One Test)

5 Capability to provide electronic submission of reportable lab results to public health agencies and actual submission where it can be received. (One Test) May be ruled out of public agencies have not means to accept Capability to provide electronic syndrome surveillance data to public health agencies and actual transmission according to applicable law and practice. May be ruled out of public agencies have not means to accept Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities. Meaningful use designation now not tied to dates Hospitals and providers can qualify for stage one up till 04 3 months of meaningful use data needs to be proven in first year only To get maximum Medicare payments, eligible providers need to qualify by 0 with hospitals in 03 Both eligible providers and hospitals need to meet stage 3 criteria by 05 to avoid penalties

6 To be the hospital of choice for all ages in the community we serve by strategically using our advanced clinical system to streamline service, quality, and efficiency. Hand-written or dictated when Convenient Practitioner Specific Break / Fix Focus Memory Based Practice Event Driven (Episode Centric) Minimal Technology Task-Focused Medical Record Data Capture Standardization Workflow Optimization Knowledge Driven Patient Focus Technology Culture Electronic Codified, Real-time Evidence Driven Quality Driven; Results/Measurement Decision Support; Results Focused Person Driven (Cross Venue) Cutting Edge Technology Aligned for Transformation Enhance patient satisfaction by reducing documentation redundancy Standardize the way we communicate and receive patient information Expedite the delivery of care by increasing real time access to data Improve patient safety by providing clinical alerts and unifying patient documentation

7 004 Nursing requested cleanup of paper chart to help with documentation and compliance Nursing complained too much distractions with charting and not enough integration 005 Administration approved committee to research a hospital based electronic medical record 006 Three primary vendors were narrowed down by demos and clinician reviews EMR Choice made by clinicians 007 Big Bang Go Live complete with implementation of 4 solutions including CPOE in ED, nursing documentation and orders hospital wide, paperless emergency room, pharmacy, radiology, health information, and a physician inbox for electronic results and orders signature. 008 onwards Continue adoption efforts, and ensure hospital meets meaningful use criteria July Aug Nov Dec Jan Mar July Aug Oct Dec Jan April July Oct Dec Jan April July Oct Dec Cerner Partnership Timeline Early Rollout Facility Coding (paper) Big Ban g GO LIVE Clinical Data Repository, Orders Management, Clinical Documentation, emar and Point of Care Basic, Critical Care, APACHE Pharmacy, ED Nursing Documentation, ED Physician Orders & Doc, ED Facility Coding, HIM Deficiency Tracking, Physician Inbox / esignature, EMPI - Master Person Index, Radiology w Dept Scheduling And more Power Insight Upgrade CPDI Document Imaging Hand-written or dictated when Convenient Practitioner Specific Break / Fix Focus Memory Based Practice Event Driven (Episode Centric) Minimal Technology Medical Record Data Capture Standardization Workflow Optimization Knowledge Driven Patient Focus Technology Electronic Codified, Real-time Evidence Driven Quality Driven; Results/Measurement Decision Support; Results Focused Person Driven (Cross Venue) Cutting Edge Technology Task-Focused Culture Aligned for Transformation

8 Patient issue of electronic chart too slow E-Prescribing needed hospital wide CPOE only in emergency department Potential upgrade needed for EHR Certification 00 0 Jan Feb Mar April May June July Sept Oct Nov Dec Jan Feb Mar April May June July Sept Oct Nov Dec Cerner Partnership Timeline RAC Audit Printing Multi-Media Integration Physician Portal View Integrated Regulatory Compliance Solution Certification Upgrade with E- Prescribing Surgery Automation Anesthesia Automation Physician Automation The Journey continues.. Medical Record Electronic Hand-written or dictated when Convenient Data Capture Codified, Real-time Practitioner Specific Standardization Evidence Driven Break / Fix Focus Workflow Optimization Quality Driven; Results/Measurement Memory Based Practice Knowledge Driven Decision Support; Results Focused Event Driven (Episode Centric) Patient Focus Person Driven (Cross Venue) Minimal Technology Technology Cutting Edge Technology Task-Focused Culture Aligned for Transformation

9 Create awareness committees with key stake holders Use Interim Final Rule (IFR) and Notice of Proposed Rulemaking (NPRM) as guide, and print Certification Criteria (IFR pg 5-6) Adopted Content Exchange, Vocabulary, and Privacy/Security Standards - (IFR pg 79-8, and 85) Stage Criteria for Meaningful Use (NPR pg 03-08) Work with other facilities to make recommendations on any rules that need clarity or adjustments Develop final policies and strategies from rules Assure your EHR vendor is certified Review 3 meaningful use criteria for gaps Educate staff on the requirements during solution implementation Incorporate meaningful use audits into tracers Achieve Vision Establish Short & Long Term Goals Define Meaningful Use For Your Institution Review Your Digital Continuum

10 Sanjay Shah President, HCIT+ (304) Anthony Adkins Director of Clinical Solutions (304)