Integrating Quality Reporting into the Electronic Medical Record

Transcription

1 Integrating Quality Reporting into the Electronic Medical Record February 28, 2014 Karen Collum, MSN, RN, OCN Clinical Program Nurse Leader Transplant Service www. MSKCC.org

2 OVERVIEW Objectives Introduction Electronic Documentation development to support Quality Reporting Electronic Medical Record features to support Quality Reporting Conclusion

3 OBJECTIVES o Identify steps within building electronic documentation to support Quality Reporting o Identify areas within the Electronic Medical Record to query data from for Quality Reporting

4 INTRODUCTION o Hospitals are implementing Electronic Medical Records (EMR) at a growing rate. o EMRs, designed well, can help monitor, improve, and report data on Quality and Safety.

5 INTRODUCTION o American Recovery and Reinvestment Act of 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act Incentive program for Medicaid and Medicare programs for demonstrating meaningful use

6 INTRODUCTION Meaningful Use o Use of certified EMR technology to Improve quality, safety, efficiency, and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health All the while maintaining privacy and security

7 INTRODUCTION o Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Requirements Overview o Guidance/Legislation/EHRIncentivePrograms/Downloads/ MU_Stage1_ReqOverview.pdf

8 ELECTRONIC MEDICAL RECORDS Efficient communication Enhanced care coordination Positive financial return Standardization Free text fields Scanned laboratory reports Inconsistent Documentation BENEFITS DRAWBACKS

9 ELECTRONIC MEDICAL RECORDS o Important to determine what information will need to be retrieved from EMR, while determining what information needs to be captured/documented in EMR.

10 QUALITY IN ELECTRONIC DOCUMENTATION o Development of Electronic Documentation Identify significant data routinely captured/ extracted from EMR related to Transplantation Customization for individual department/services would need to be addressed

11 QUALITY IN ELECTRONIC DOCUMENTATION EXAMPLE: Inpatient Progress/Outpatient Follow Up o Significant Transplant Data (HSCT Summary) HSCT Date Number of days pre/post Transplant Diagnosis Co-morbidities Conditioning Regimen Donor Type Graft Source Match CMV/EBV/Toxo Status

12 QUALITY IN ELECTRONIC DOCUMENTATION Inpatient Progress /Outpatient Follow Up Note o Specific Fields Query-able o Standardization/Consistency Populated into each note o Logic/Calculation (Transplant Date) Increases accuracy

13 EXAMPLES

14 EXAMPLES

15 QUALITY IN ELECTRONIC DOCUMENTATION EXAMPLE: Cell Infusion Document o Significant Data: Cell Infusion Type Cell Source Method Donor Manipulation Bag Number Cell Doses

16 EXAMPLES

17 QUALITY IN ELECTRONIC DOCUMENTATION Cell Infusion Document o Required Fields Increase compliance o Data points specific to infusion type Manipulation Options different for each Infusion type CD 34+ and CD 3+ for Allogeneic Infusions CD34+ Only for Autologous o Infusion Reaction Logic

18 EXAMPLES

19 EXAMPLES

20 EXAMPLES

21 QUALITY IN ELECTRONIC DOCUMENTATION Cell Infusion Document o Electronic Documentation use to increase data capture compliance o Reports used to confirm volumes/statistics and accuracy of data captured in database. Report 1: Complete vs Incomplete Type of Transplant Report 2: Detailed Data Query

22 EXAMPLES Report 1

23 EXAMPLES Report 2

24 QUALITY IN ELECTRONIC DOCUMENTATION Cell Infusion Document o Ways to Use Document Reports Compliance Audit Are all notes completed/signed out Statistic Report How many Autologous vs Allogeneic How many Related vs Unrelated Quality Audit How many infusion include cell dose less than 2 x10 e6 CD34+?

25 ELECTRONIC MEDICAL RECORDS In addition to the Electronic Documentation, the Electronic Medical Record can be used to extract data and support quality improvement.

26 QUALITY IN ELECTRONIC MEDICAL RECORD o Sources to Extract Data Laboratory Orders Laboratory Results Medication Orders Patient Care Orders Flowsheets

27 EXAMPLES Allogeneic Collection/Processing Order

28 EXAMPLES Allogeneic Donor Eligibility Order

29 QUALITY IN ELECTRONIC MEDICAL RECORD o Information can be extracted based on the Order Name or content of the order Example: Allogeneic Collection/Processing Order How many orders were placed? Were the orders placed 48 hours prior to Collection? Example: Allogeneic Donor Eligibility Order How many orders were placed? How many donors were Ineligible?

30 EXAMPLES Report 1 Order Name

31 QUALITY IN ELECTRONIC MEDICAL RECORD o Audit Example TOTALS Orders Received same day or After product collected: 16% (15% in 3rd Quarter) Orders Received 24 hours or more before product received: 85% Collection/Orders cancelled: 16 orders (This also includes duplicate orders) Data Breakdown Number Percentage Late (after product collected) 1 1% Day of Collection 18 15% 24 hours prior 17 14% >24 hours prior 87 71% Cancelled 16 Total %

32 EXAMPLES Report 2 Order Content

33 EXAMPLES Report 2 Order Content

34 EXAMPLES Reasons for Ineligible as documented on the order Report 2 Order Content

35 CONCLUSION o Electronic documentation should not be reproductions of paper forms. o Utilize features of electronic system to enhance documentation and create smarter documents Dropdown/multi-select checkboxes create data that can be extracted Calculation logic for dates Documentation reminders/notification alerts

36 CONCLUSION o Identifying areas in the EMR where data in entered/captured will allow for development of reports for quality review. o Reports have the ability to be conditional and repetitious

37 CONCLUSION o Report Types Delivered Excel/PDF Time based (weekly, quarterly) On Demand/Self generated Parameter based Content pre built Time frame variable

38 REFERENCES o CMS.gov., (2013). EHR Incentive Programs: Meaningful Use. Retrieved from: Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html o Price, M., Singer, A, & Kim, J. (2013). Adopting Electronic Medical Records: Are they just electronic paper records? Cancer Family Physician, 59 e322-9 o Silow-Carroll, S., Edwards, J., & Rodin D. (2012). Using Electronic Health Records to Improve Quality and Efficiency: The Experience of Leading Hospitals. The Commonwealth Fund. 17 p1-40

39 ACKNOWLEDGEMENTS ASBMT Administrative Directors SIG Quality Working Committee Kathie Viers, RN, MS CPHQ Leslie Parran, MS, RN, AOCN, NE-BC Memorial Sloan Kettering Cancer Center Transplant Service Information Systems Team Especially the DARWIN Team

40 QUESTIONS