Transcript Meaningful Use, eMeasures, Blue Buttons: Oh My! What Should I

10/19/2013
QSEN, HITECH,
EHRs, Meaningful
Use and the
Learning Health
System of the
Future
Judith J. Warren, PhD, RN, FAAN, FACMI
1
Warren Associates, LLC
2
10/19/2013
Ease on Down the Road to QSEN,
HITECH, EHRs, Meaningful Use and the
Learning Health System of the Future






What do I pay attention
to?
Who is involved?
How do I keep up?
What do I teach?
So much is happening!
Then, there is health care
reform!!!!!!!!
Warren Associates, LLC
3
www.qsen.org
10/19/2013
Warren Associates, LLC
4
10/19/2013
QSEN Competencies
 Patient-centered
Care
 Teamwork and Collaboration
 Evidence-based Practice (EBP)
 Quality Improvement (QI)
 Safety
 Informatics
Warren Associates, LLC
5
10/19/2013
Patient-Centered Care
 Recognize
the patient or
designee as the source
of control and full
partner in providing
compassionate and
coordinated care based
on respect for patient’s
preferences, values, and
needs
Warren Associates, LLC
6
10/19/2013
Teamwork and Collaboration
 Function
effectively
within nursing and
inter-professional
teams, fostering
open
communications,
mutual respect and
shared decisionmaking to achieve
quality patient care
Warren Associates, LLC
7
10/19/2013
Evidence-Based Practice
 Integrate
best current evidence with
clinical expertise and patient/family
preferences and values for delivery of
optimal health care
Warren Associates, LLC
8
10/19/2013
Quality Improvement
 Use
data to monitor the outcome s of care
processes and use improvement methods to
design and test changes to continuously
improve the quality and safety of health care
systems
Warren Associates, LLC
9
10/19/2013
Safety
 Minimizes
risk of harm to patients and providers
through both system effectiveness and
individual performance
Warren Associates, LLC
10
10/19/2013
Informatics
 Use
information and technology to
communicate, manage knowledge,
mitigate error, and support decision
making
Warren Associates, LLC
11
10/19/2013
HIPAA
 Transaction
and Code Set Standards
 X12
 NCPDP
 National

Provider Identifier
https://nppes.cms.hhs.gov/NPPES/Welcome.do
Warren Associates, LLC
12
10/19/2013
HITECH and
Meaningful Use
ACA and
Health Reform
www.healthit.gov
Warren Associates, LLC
13
10/19/2013
Nurses in Decision-making Circles: A
Professional Responsibility









Office of the National Coordinator
National Committee on Vital and Health Statistics
CMS Panels
NQF committees and panels
IOM
S&I Framework
HL7
IHTSDO and LOINC
Other committees
 and Task Forces!!!!!!
Warren Associates, LLC
14
10/19/2013
Federally Required Terminology
 SNOMED
CT
 LOINC
 ICD-10-CM
 RxNORM
 CPT
Warren Associates, LLC
15
10/19/2013
Warren Associates, LLC
http://www.nlm.nih.gov/research/umls/Snomed/nursing_
problemlist_subset.html
16
10/19/2013
Warren Associates, LLC
17
10/19/2013
Transitions of Care Initiative Overview




Empowering patients, engaging the clinician, and enabling
health information exchange in support of national health
initiatives to increase patient safety and improve health care
outcomes
Improve the electronic exchange of core clinical information.
Key Functions of the Initiative
 Focus on clinical content to be exchanged in patient care
transitions
 Build on existing standards to accelerate adoption
 Work with the HIT community to remove barriers to
implementation
Key Outputs of the Initiative
 Unambiguous definition of the clinical elements that should be
included in care transitions
 Guidance on the exchange of information during patient care
transitions
 Agreement on a single standard (Consolidated CDA) in
support of Meaningful Use requirements
Warren Associates, LLC
18
10/19/2013
Continuity of
Care Document
 Patient
Information
 Allergies, adverse
reactions & alerts
 Immunizations
 Medications
 Care Plan
 Discharge
medications
 Reason for referral
 Problem
list
 Procedures
 Functional and
cognitive status
 Results—labs, etc
 Social history
 Vital signs
 Discharge
instructions
Warren Associates, LLC
19
10/19/2013
S&I Framework
 Working
on Care Plan
specifications
 Scope and attention to the work will
be driving EHR design, build and
implementation
 http://wiki.siframework.org
 Need
more nurses involved
Warren Associates, LLC
20
10/19/2013
Plan of Care
Warren Associates, LLC
21
10/19/2013
Warren Associates, LLC
22
10/19/2013
Mobile Apps for Health
Mobilizing Data for Pressure Ulcer Prevention Challenge,
Warren Associates, LLC
http://www.health2con.com/devchallenge/challenges/onc-i2challenges
23
10/19/2013
Evidence-based practice is
standardized content that is
semantically interoperable.
Warren Associates, LLC
24
10/19/2013
ONC Releases MU Stage 3
Recommendations

Build on the foundation to improve patient outcomes.


Stage 3 objectives recommended




Using electronic Clinical Quality Measures (eCQMs) to
measure identified care outcomes
Providing the ability to electronically submit patientgenerated data
Ensuring EHRs can assist with follow-up orders and identify
potentially appropriate clinical trials
Sending electronic notifications to a patient's primary
care provider or other member of the care team
following a significant healthcare event
These recommendations are not finalized

http://www.healthit.gov/policy-researchersimplementers/policy-meaningful-use-workgroup-7
Warren Associates, LLC
25
 Quality

Data Model
Foundation for eMeasures as required
in Meaningful Use
 Appointed




10/19/2013
groups
Health Information Technology
Advisory Committee
National Priorities Partnership
Measure Applications Partnership
Consensus Standards Approval
Committee
 NLM’s
Value Set Authority Center
Warren Associates, LLC
26
10/19/2013
http://www.nursingquality.org
Warren Associates, LLC
27
10/19/2013
Transforming NDNQI into
eMeasures and Lessons Learned
Feasibility studies with
partners to extract
information from EHRs
Warren Associates, LLC
28
10/19/2013
Warren Associates, LLC
29
10/19/2013
Warren Associates, LLC
30
10/19/2013
Three A’s of Blue Button
 Increase
consumer
ACCESS to their
health information
 Enable consumers to
take ACTION with
their information
 Shift ATTITUDE to
support patientprovider partnership
Warren Associates, LLC
31
10/19/2013
Warren Associates, LLC
32
10/19/2013
http://www.healthit.gov/patientsfamilies/video/health-it-you-giving-youWarren Associates, LLC
access-your-medical-records
33
10/19/2013
Institute of Medicine (IOM)

Landmark reports
 Computer-base Patient Record
 Now known as Electronic Health Record
 To Err Is Human and the series of Patient Safety
and Quality reports
 The Learning Health System
 Health IT and Patient Safety: Building Safer
Systems for Better Care
 Race, Ethnicity, and Language Data
 The Future of Nursing: Leading Change,
Advancing Health
 http://iom.edu
Warren Associates, LLC
34
10/19/2013
Establishing Transdisciplinary
Professionalism for Health: A Workshop







How can the “shared understanding” be integrated into
education and practice to promote a transdisciplinary model of
professionalism?
What are the ethical implications of a transdisciplinary
professionalism?
How can health and wellness be integrated into transdisciplinary
education and practice?
How is “leadership” taught and practiced within a model of
transdisciplinary professionalism?
What are the barriers to transdisciplinary professionalism?
What measures are relevant to transdisciplinary professionalism?
What is the impact of an evolving professional context on patients,
students and others working within the health care system?
Warren Associates, LLC
35
10/19/2013
Assessing Health Professional
Education: A Workshop







What is currently being assessed and how might the
outcomes be used (i.e., greater social accountability,
promotion by media, learner skills, faculty development)?
How can different disciplines be assessed such that the
data informs a new transdisciplinary professionalism?
Which kind of assessment will lead to a “new
professionalism”?
What is the role of peer assessment?
What is the role of patients in assessment?
What is the role of work-based assessments?
How might learners and practitioners be prepared for a
lifetime of assessment?
Warren Associates, LLC
36
10/19/2013
Learning Healthcare System
Warren Associates, LLC
37
10/19/2013
Learning Health System Reports
Warren Associates, LLC
38
10/19/2013
Questions?
[email protected]
Warren Associates, LLC