1/16/2015 HOW CLINICAL EDUCATORS CAN DISCLOSURE LEARNING OBJECTIVES MAKE MEANINGFUL USE MEANINGFUL. We have no financial disclosures

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1 HOW CLINICAL EDUCATORS CAN MAKE MEANINGFUL USE MEANINGFUL Daryl Wieland, MD Tammy Gruenberg, MD Michelle Giannone, MD Albert Einstein College of Medicine, Bronx, NY DISCLOSURE We have no financial disclosures LEARNING OBJECTIVES Following this presentation, the participant will: Understand the background of meaningful use State the core objectives of meaningful use Review Clinical Quality Measures Align the ACGME milestones with meaningful use Explore how to incorporate these objectives into the training curriculum. 1

2 THE STATE OF PAPER MEDICAL RECORDS One copy of a medical record Notes and orders can be illegible Communication between providers is limited Medicine became more complex POLITICAL FORCES By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care. President George W. Bush State of the Union Address January 20, 2004 He set a timeline of 10 years Added $100 million to budget Created a subcabinet position in HHS 2

3 TRADITIONALIST This is the way I have always done it! UNSOPHISTICATED ADOPTER Spent a lot of money and time on a system that did not function well for the practice INNOVATORS Created home grown systems that adapted to the needs of the institution Collected data Decision support Met multiple needs Invested time and money 3

4 WHAT IS NEEDED TO MAKE THIS WORK Users need to adopt/adapt Computer systems need to meet the needs for individual and public health All of this costs money AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 (ARRA) HITECH Act Center for Medicare and Medicaid Services (CMS) to incentivizes hospitals and professionals to adopt electronic health records technology Certifies EHR Technology Requires the meaningful use of the technology by Eligible Professionals and Eligible Hospitals Provided a budget HITECH GOALS Use the EHR in a meaningful way Maintain Patient Privacy Exchange information Use the technology to improve quality and measure outcomes Improve individual and population health Reduce medical errors 4

5 MEANINGFUL USE Properly Designed Computers + Trained Users + $$$$ = Better data, better healthcare, lower costs CERTIFIED EHR TECHNOLOGY CEHRT USERS ELIGIBLE HOSPITALS & PROVIDERS 5

6 CMS INCENTIVES: $$$$ >25 billion dollars Penalties yet to come MEANINGFUL USE CORE OBJECTIVES 1. Computerized Physician Order Entry 2. Drug Drug Interactions and Drug-Allergy interactions 3. Problem List 4. e-prescribe 5. Active Medication List 6. Medication Allergy List 7. Demographics Language, Gender, DOB, Ethnicity, Race 8. Vitals Height, Weight, BMI, BP 9. Record Smoking Status 10. Clinical Decision Support 11. Provide Patients with an electronic copy of their health info 12. Provide patients clinical summaries of the office visit 13. Protect privacy MENU SET CHOOSE 5 OF THE 9 Drug Formulary check Record Advanced Directives Lab results as structured data Generate a list of patients by specific condition for QI, outreach or research, reduction of disparities Send reminders to patients for preventive or follow up care Provide patient specific educational resources Medication Reconciliation Transition of care summaries Immunizations Registries data submission Syndromic Surveillance data submission 6

7 CLINICAL QUALITY MEASURES Must report on 9 or the 64 CQMs listed from NQF Must represent 3 of the 6 NQS domains: Patient engagement Patient Safety Care coordination Population and Public Health Efficient use of health care Clinical Processes and Effectiveness MILESTONES & COMPETENCIES Patient care: Medical knowledge and application of evidence Medical Knowledge: Healthcare maintenance & use of guidelines Systems Based Practice: Patient safety and systems approach to medical errors Practice Based Learning: Quality Improvement Respect for patient privacy: HIPAA Communication: transitions of care, health information exchange Milestones Respect for privacy Medical Knowledge Patient Safety & Systems approach to Medical Errors Patient Education & engagement Health Care Maintenance Meaningful use HIPAA, Security Decision Support, CPOE Drug:Drug Interaction Drug: Allergy checks Med Reconciliation Visit Summaries Patient Reminders Smoking status 7

8 SMALL GROUPS 8