Creating a Culture of Meaningful Use. Thursday, August 12, 2010

Transcription

1 Creating a Culture of Meaningful Use Thursday, August 12,

2 Christopher Jackson, DO, PhD, MBA, FACEP Certified Physician Informaticist Residency Trained Board Certified Emergency Physician Office for Medical Informatics Sisters of Mercy Health System Saint Louis, Missouri, USA, Earth, Milky Way Galaxy

3 ARRA The American Recovery and Reinvestment Act of 2009 distributes the $787 billion 3

4 HITECH ACT Health Information Technology for Economic and Clinical Health Act The Center for Medicare and Medicaid Services (CMS) released their 864-page final rule on July 13, 2010 which defines meaningful use of an EHR 4

5 Meaningful Use What is it? Physicians must meet EHR criteria Hospitals must meet EHR criteria 5

6 HITECH Act of ARRA for physicians who meet meaningful use According to the Act, physicians are eligible to receive up to $44,000 in total incentives per physician from Medicare for meaningful use of a certified Electronic Health Record (EHR) starting in

7 HITECH Act of ARRA for hospitals Hospitals will be eligible for several million dollars in the Medicaid and Medicare programs Federally qualified health centers, rural health clinics, children s hospitals and others will be eligible for funding through the Medicaid program 7

8 HITECH Act and Meaningful Use Why? Improve population health Ensure privacy and security for personal health information Improve quality, safety and efficiency, reduce disparities Goals of Meaningful Use of EHR Engage patients and families Improve care coordination The Health Information Technology for Economic and Clinical Health Act (HITECH) was enacted as part of the American Recovery and Reinvestment Act (ARRA) in Under the HITECH Act, eligible professionals (physicians) and hospitals can receive financial incentives based on timely adoption of EHRs and meeting the criteria for meaningful use of certified EHR technology PricewaterhouseCoopers 8

9 Meaningful Use Objectives are grouped in three Stages, progressing in complexity over 5 years Stage 1: 2011 Capture/share data E-copies of health information to patients Medication Orders entered by CPOE Drug-drug, drug-allergy, drug-formulary checks; medication lists/reconciliations Lab results delivery E-prescribing Low Stage 2: 2013 Advanced care processes with decision support Health summaries for continuity of care Registry reporting; reporting to public health Evidence-based order sets Clinical decision support at point of care All clinical documentation in EHR Claims and eligibility checking Level of collaboration required with external parties Stage 3: 2015 Improved outcomes Performance on quality, safety and efficiency measures Access comprehensive data from all available sources Medical device interoperability Dynamic/ad hoc quality reports Real-time surveillance Multimedia support (e.g. X- rays) Patients have access to self-management tools Use of epidemiologic data Clinical dashboards High

10 and the bar is also raised in terms of reporting timeframes Stage 3: 2015 Improved outcomes Stage 1: 2011 Capture/share data Must be able to show 90 consecutive days meeting all the measures All or nothing incentive Stage 2: 2013 Advanced care processes with decision support After the first reporting year, we must show evidence of compliance over the entire year. Low Level of collaboration required with external parties High

11 Stage 1 objectives for hospitals Core Set CPOE for medication orders Drug-Drug, Drug-Allergy checks Accurate problem list Active medication list Medication allergy list Patient demographics recorded Vital signs and BMI recorded Smoking status recorded Electronic discharge instructions Quality measures reported to CMS Clinical decision support Electronic copy of health information Exchange clinical information electronically Protect electronic health information PricewaterhouseCoopers 11

12 In addition, You must pick 5 of these Drug-Formulary checks Incorporate clinical lab results Advanced directives Medication reconciliation Patient-specific education Generate patient lists Report labs to state agencies Summary of care Submit data to immunization registries Provide surveillance data to public health agencies PricewaterhouseCoopers 12

13 Meaningful use Is not the end It is the beginning 13

14 Culture of Meaningful Use All of U.S. healthcare is transforming It is the right time to embrace HIT 14

15 Acquiring Commitment» Time» Resources» Scope» Support Electronic Health Record» Implementation» Transformation» Sustained support» Optimization 15

16 Transforming to Electronic Health Record Requires a Culture of Commitment -- Commitment from All 16

17 Creating this Culture Evaluate other businesses» UPS, McDonalds, Amazon are good examples» Healthcare is way behind 17

18 U.S. health system must embrace technology to overcome the obstacles of ever increasing costs and decreasing resources 18

19 We must work smarter to deliver safer more cost effective patient-centered care 19

20 We must use technology to get back to the bedside 20

21 Creating a Culture for Success Patient-first mentality Patient safety is everyone's responsibility» Admissions and HIM» Clinicians: Nurses, Allied Health and Physicians» Executive leadership» Patient s family and friends» Patient s clergy and church» The Patient Electronic Health Records offer great potential 21

22 Sisters of Mercy Health System Catholic healthcare ministry providing health and social services Headquartered in St. Louis with hospitals in four states (Arkansas, Kansas, Missouri and Oklahoma) Outreach ministries in Texas, Mississippi and Louisiana 8th largest Catholic healthcare system in the United States (based on net patient revenue) 22

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24 Our System 7 integrated health systems o 26 acute care hospitals o 3 heart hospitals o 4,000 licensed beds Our People 36,900 co-workers 4,650 medical staff o 1,250 integrated physicians Community-based outreach o Mercy Ministries of Laredo o 3,400 other medical staff members 24

25 EHR Corporate Leadership Facts How much is this going to cost? How long will it take to implement? Will it meet meaningful use? Will it be flexible to meet future needs? When will I have ROI? Will it increase Safety with better outcomes? Will it drive down costs? 25

26 Facts of Life with Electronic Health Record People procrastinate. People are busy. People want to know only the facts. People are concerned with: How does this affect me? People are resistant to change. The EHR has a learning curve which will slow down everything for a period of time The EHR will touch all processes, break down silos and expose all your hidden secrets & broken workflows

27 Pre-EHR Involvement Why EHR?» Always available» Legible» CPOE» Access labs, imaging and information» All active orders in one location» Shared Problem list, Allergies, PMH, PSH, FHx, etc Why now?

28 Timeline and Project Plan Pre-EHR involvement and communications Financials Leadership commitment Clear project plan Clear scope Design, build and test hardware and software Training Implementation Transformation Fix, support and maintenance Optimization meeting ARRA, HiTech and Meaningful USE ROI

29 EHR isn t the panacea to fix problems It will not solve all issues In fact it will highlight present ones EHR touches everything. No more hiding issues Everyone using an EHR now practices transparently which some are uncomfortable with 29

30 Alleviating fears and frustrations Anxiety and rumors are our enemies Deal with facts Key personality types

31 Adopter Types 31

32 Training Look over curriculum closely» Make sure it is simple» Make sure it is clinically correct» Make sure it reflects the present EHR state» Make sure it follows adult learning guidelines» Make sure you have an electronic interactive option» Make sure it meets Meaningful Use

33 Implementation

34 Clear, concise communications May need unique lines of communication Intranet, newsletters, Web sites, etc. s: correct ones and are read Office managers Bulletin boards Countdown clocks Posters: Sister, 700 lb. Gorilla, etc. Medical Directors of Medical Informatics

35 Sister watching over you

36 700 lb. Gorilla a

37 5 Keys 1) Key = open and willing attitude 2) Basic computer skills 3) Best way to inform & communicate 4) Rumor control 5) Use local support structure & resources

38 Red Shirt Support

39 Change Control Process Universal call-in number Triage, create, prioritize & manage Systematic approach to working these issues Use for end user support Use to identify issues and fixes Use to identify optimization potential

40 Problems with EHR GI =GO Garbage into EHR yields Garbage out Many users are not comfortable with ease of visualization Legacy systems interfaces or data entry EHR Etiquette Clinicians are often not collaborative Decades of delivering care in the same manner will be changed by EHR

41 Formal Post-live Optimization Processes Must be well-established Clearly communicated Prioritized to truly maximize resources Supported

42 Meaningful Use of EHR Creating a Culture of Meaningful Use The time is right for Health care:» To embrace technology» To improve patient safety and quality» To put patient at Center of Care» To empower Missouri Patients» To improve Missouri patient outcomes» To drive out unnecessary costs» To decrease pain, suffering and premature death by keeping our Missouri population healthy 42

43 Questions?