It s All About Outcomes HITECH ACOs Readmissions
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1 Improving Patient Outcomes or Achieving Paperless Organizations The Meaningful Use Balancing Act Timothy Kelly, MS, MBA C&SOHIMSS Spring Conference Premier Health Partners Miami Valley Hospital May 4, 2012 Dayton, OH Slide 1 May 4, 2012 Improving Patient Outcomes It s All About Outcomes HITECH ACOs Readmissions Slide 2 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 1
2 Improving Patient Outcomes HITECH Act Benefits of EHRs Improve caregiver decisions Better outcomes Blumenthal D and Tavenner M, N Engl J Med 2010;363(6): Slide 3 May 4, 2012 Improving Patient Outcomes ACOs Presently two models Advance Payment Model Five organizations non-hospital/critical access/rural Pioneer Model 32 organizations Three Goals for ACOs Better care for individuals Better health for populations Slower growth in costs through improvements in care Berwick DM, N Engl J Med 2011;364(16):e32. Slide 4 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 2
3 Improving Patient Outcomes Readmissions In 2005 readmissions accounted for $15 billion in Medicare spending $12 billion was preventable The (PPACA) will penalize hospitals and IDNs with higher than expected readmission rates Slide 5 May 4, 2012 Good Outcomes and the Efficient Provision of Health Care Are Predicated on Sound Medical Decisions Slide 6 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 3
4 Medical Decisions Medical Decisions 82.2% of adults age 40 or older have made at least one medical decision in the past two years Based on a 3,010- subject sample Zikmund-Fisher BJ, Couper MP, Singer E, et al. Med Decis Making 2010;30:20S-34S. Slide 7 May 4, 2012 Medical Decisions National Survey of Physicians 402 physicians surveyed 87% report that most or some of their patients are currently under or misinformed 78% report that recent changes in reimbursements have decreased the time they can spend with each patient Executive Summary of Findings from a National Survey of Physicians. Conducted by Lake Research Partners. February Slide 8 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 4
5 Medical Decisions Medical Decisions the Latest Research 71% of cases alleging inadequate informed consent included a claim that failed to mention or explain risks and complications Gogos AJ, et al. MJA 2011;195(6): Issa MM, et al. J Urol 2006;176: Slide 9 May 4, 2012 Medical Decisions Medical Decisions the Latest Research Patients overwhelmingly want to know if residents will participate in surgical procedures Porta CR, et al. Arch Surg 2011; Published online Sept. 19, doi: /archsurg Slide 10 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 5
6 What is Holding Us Back? Slide 11 May 4, 2012 Issues with Communication Impediments to Communication Physician issues Lack of reimbursement for educating patients - emphasis is volume Medical liability concerns Lack of tools Patient issues Impediments to understanding Concerns about denial of care/coverage Slide 12 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 6
7 Council/Resources/Posters/2012/~/media/Advisorycom/Research/ITSC/Resources/Posters/2012/MU-Whiteboard-Story-Zoomed-in.pdf Improving Patient Outcomes or Achieving Paperless The Solution... Meaningful Use? Slide 13 May 4, 2012 Meaningful Use Stage 1 Stage 2 Slide 14 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 7
8 Meaningful Use Meaningful Use Requirements (Stage 1) Maintain an up-to-date problem list (Core Objective) Maintain active medication list (Core Objective) Maintain active medication allergy list (Core Objective) Record advanced directives for patients age 65 or older (Menu Objective) Provide patient-specific educational resources (Menu Objective) Provide patients with an electronic copy of their health information (Core Objective) Provide patients with an electronic copy of their discharge instructions (Core Objective) Slide 15 May 4, 2012 Meaningful Use Meaningful Use Requirements Provide patients with an electronic copy of their health information (Core Objective) Patients whose information available on-line within 36 hours Stage 2 Provide patients with an electronic copy of their discharge instructions (Core Objective) Stage 2 Total number of patients discharged from hospital s inpatient or ER departments Patients who view, download or transmit information to a third party Total number of patients discharged from hospital s inpatient or ER departments > 50% > 10% Slide 16 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 8
9 Meaningful Use Meaningful Use Requirements (Stage 1) Provide patients with an electronic copy of their discharge instructions (Stage 2: patients view, download or transmit) Slide 17 May 4, 2012 Who Are Our Patients? Slide 18 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 9
10 John (83) and Terry (81) Medical History Stroke Prostate Cataracts Knee Joints Thyroid High Cholesterol High Blood Pressure IT Capability/Proficiency AOL Dial-up Medications Extensive Slide 19 May 4, 2012 How s the Technology Working for Us? Slide 20 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 10
11 How is Technology Working? We Are Doing the Wrong Procedures Ring DC, Herndon JH, Meyer GS. N Engl J Med 2010;363: Slide 21 May 4, 2012 How is Technology Working? We Are Doing Procedures on the Wrong Body Parts Slide 22 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 11
12 How is Technology Working? We Are Doing Procedures Patients Don t Want McShane L. The New York Daily News /08/18/ _man_sues_doctor_for_amputating_ his_penis_in_what_was_supposed_to_ be_a_routine_ci.html August 18, Accessed September 1, Slide 23 May 4, 2012 How is Technology Working? Outcomes vs. Processes You really don't want to measure outcomes - you want to measure the processes that improve outcomes. Example: Measuring the infection rate of a particular hospital-acquired infection (HAI) does not capture the processes that reduce all HAIs. Challenges include the variability of processes and the emeasure challenges associated with measuring processes. Frank Opelka, MD, Chair of the Surgical Quality Alliance, Louisiana State University (MAP Hospital and Ad Hoc Safety Workgroup Chair). National Quality Forum Annual Meeting. April 4, Slide 24 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 12
13 Best Practice Examples Slide 25 May 4, 2012 A Traditional Informed Consent Document - Paper Slide 26 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 13
14 A Traditional Informed Consent Document - Paperless Slide 27 May 4, 2012 Procedure- Specific Informed Consent Document Slide 28 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 14
15 Procedure-Specific Informed Consent Document This is only useful if a copy is printed and provided to the patient Wortz G. J Med Pract Mgmt 2011;27(1): Slide 29 May 4, 2012 NQF Safe Practice 5 Ask each patient or legal surrogate to teach back, in his or her own words, key information about the proposed treatments or procedures for which he or she is being asked to provide informed consent. Slide 30 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 15
16 NQF Safe Practice 5 The latest evidence a prospective, randomized, controlled trial of teach back ( repeat back ) 575 patients 7 sites Fink AS, Prochazka AV, Henderson WG, et al. Ann Surg 2010;252: Slide 31 May 4, 2012 Repeat-Back Study Two arms: An automated informed consent software application that produces detailed, procedurespecific consent forms The same system with a series of six repeat-back (teach-back) prompts based on NQF-recommended language and a mechanism for documenting the patient s response Slide 32 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 16
17 Repeat-Back Study Easy to implement with an EHR Slide 33 May 4, 2012 Repeat-Back Study Results: Significantly higher patient comprehension in the group exposed to repeat-back Majority of providers also reported a belief that use of Safe Practice 5 improved patient understanding The repeat-back process took only 2.6 additional minutes on average Fink AS, Prochazka AV, Henderson WG, et al. Ann Surg 2010;252: Slide 34 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 17
18 Pre-Procedure Instructions Reduce the risk of potentially life-threatening perioperative complications. Tea C. Perioperative concepts and nursing management. In: Smeltzer SC, Bare BG, Hinkle JL, Cheever KH, eds. Brunner and Suddarth s Textbook of Medical- Surgical Nursing. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010: Courtesy of the Baltimore VA Medical Center Slide 35 May 4, 2012 Pre-Procedure Instructions Lower the incidence of preventable surgery cancellations. Henderson BA et al. Incidence and causes of ocular surgery cancellations in an ambulatory surgical center. J Catarct Refract Surg. 2006;32(1): Pletta C et al. Efficiency improvement plan through patient education on thyroid imaging procedures. J Nucl Med. 2008;49(Supp 1):426P Courtesy of the Baltimore VAMC Slide 36 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 18
19 Discharge Instructions Providing patients with incomplete information at discharge can result in patient harm. Pennsylvania Patient Safety Advisory Jun;5[2]: Courtesy of the Portland VA Medical Center Slide 37 May 4, 2012 Discharge Instructions Reduced the 14-day readmission rate threefold by employing procedure-specific discharge instructions (4.1 per 1,000 outpatient procedures to 1.5 per 1,000). Boast P, Potts C. PS&QH. 2010;7(1): Courtesy of the Portland VA Medical Center Slide 38 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 19
20 Key Points Slide 39 May 4, 2012 Key Points Key Points Don t be exclusively paperless when it comes to supplying information to patients Do keep an image of all documentation provided to patients Don t provide paper without noting what was provided Do document the provision of paper documents in the EHR Slide 40 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 20
21 Key Points Key Points Don t assume generic documents are helpful Do provide detailed, easy-to-understand procedure and treatment-specific materials Don t provide illegible materials Do print materials a required (in a font size that is readable for patients) Slide 41 May 4, 2012 Key Points Key Points Don t limit your meaningful use goals to attaining Stage 1 measures Do incorporate the Stage 2 objectives and measures into your near-term strategy Don t focus exclusively on quantitative measures Do examine the broader processes that contribute to the measures of interest Slide 42 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 21
22 Questions? Tim Kelly, Slide 43 May 4, 2012 C&SO HIMSS Spring Meeting Dayton, OH Page 22
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