Transcript File

Ryan Kreinbring
Joanne La Grange
Melody Dungee
Presenters
Ryan Kreinbring, Chief Medical Officer
Joanne LaGrange, Director of Operations
Melody Dungee, Director of Implementations
Who Are We?
Northwestern Community Hospital located: Joliet, IL
 Non-Profit Organization
 300 beds
 10 Clinics
 Patient population: High Medicare/Medicaid
 Competitors: Provena Covenant Medical Center and Silver Cross
Hospital
 EHR Adoption Level
Competitive Landscape
 Clinics not using the same EHR
 ONLY Community hospital in area
 Competitors are 2 Large IDN Networked hospitals (HCA and Tenet)
 All Hospitals using different EHR vendors
 High Medicare and Medicaid Population
 Physicians are private, relationship has been strained
Our Mission
To provide safe, effective, patient-centered, timely,
efficient and equitable patient care with an unparalleled
passion and commitment to ensure the very best
healthcare for the communities we serve.
Agenda
•Overview of where we are today
•Discuss the benefits of 5 key impacts of Meaningful Use
•Discuss the risks of implementing Meaningful Use
•Conclusions and recommendations
Hospitals Prepared to Meet Meaningful Use
We Are HERE
Source: iHealthBeat January 8, 2010
Meaningful Use Overview
Stage 1
Use CPOE (10%)
Implement drug-drug,
drug-allergy, drugformulary checks
(enabled)
Maintain an up-to-date
problem list of current
and active diagnoses
(80%)
Maintain active
medication list (80%)
Maintain active
medication allergy list
(80%)
Record demographics
(80%)
Record and chart
changes in vital signs
(80%)
Record smoking status
for patients 13 years
old or older (80%)
Incorporate clinical labtest results into EHR as
structured data (50%)
Generate lists of
patients by specific
condition (1 list)
Report hospital quality
measures to CMS or the
States
(attestation/electronic)
Implement 5 clinical
decision support rules
(5)
Check insurance
eligibility electronically
(80%)
Submit claims
electronically (80%)
Provide patients with
an electronic copy of
their health info (80%)
Provide patients with an
electronic copy of their
discharge instructions
(80%)
Capability to exchange
key clinical info (1 test)
Perform meds
reconciliation (80%)
Provide summary care
record (80%)
Capability to submit
electronic data to
immunization registries
(1 test)
Capability to provide
electronic submission
of reportable lab
results (1 test)
Capability to provide
electronic syndromic
surveillance data (1
test)
Protect electronic
health information
(security risk analysis)
Key Impacts To Patient Care
Use CPOE (10%)
Implement drug-drug,
drug-allergy, drugformulary checks
(enabled)
Maintain an up-to-date
problem list of current
and active diagnoses
(80%)
Maintain active
medication list (80%)
Maintain active
medication allergy list
(80%)
Record demographics
(80%)
Record and chart
changes in vital signs
(80%)
Record smoking status
for patients 13 years
old or older (80%)
Incorporate clinical labtest results into EHR as
structured data (50%)
Generate lists of
patients by specific
condition (1 list)
Report hospital quality
measures to CMS or the
States
(attestation/electronic)
Implement 5 clinical
decision support rules
(5)
Check insurance
eligibility electronically
(80%)
Submit claims
electronically (80%)
Provide patients with an
electronic copy of their
health info (80%)
Provide patients with
an electronic copy of
their discharge
instructions (80%)
Capability to exchange
key clinical info (1 test)
Perform meds
reconciliation (80%)
Provide summary care
record (80%)
Capability to submit
electronic data to
immunization registries
(1 test)
Capability to provide
electronic submission
of reportable lab
results (1 test)
Capability to provide
electronic syndromic
surveillance data (1
test)
Protect electronic
health information
(security risk analysis)
CPOE > 10%...why?
 NCH Plans a 2 “phase” rollout starting with ED only then
moving housewide
 Benefits Expected:
 Reduced ADE
Safe
 Standardization of Care
Patient Centered
Equitable
 Improved Efficiency of Care Delivery
 Eliminate Transcription Errors
Safe
Efficient
Timely
Impacts to Stakeholders
 Physicians – Bring the physician back to the front lines of the patient
care decision process. Should increase the timeliness of order entry
and improve TAT. Also will eliminate tedious back office steps for
order signoff.
 Hospital Staff – Real time order entry should make everyone's job
easier and decrease TAT. Eliminate deciphering of any Physician
communication, everything should be spelled out and clear.
Remove time entering orders to focus on patient needs.
 Patient – Increased interaction with Physicians. Assurance that
orders placed are accurate and backed with decision support.
Standards of care can be deployed so patients don’t fall through the
cracks.
Maintain Problem & Diagnosis List
 Joint effort between Nursing and Providers to update and
maintain
 Benefits Expected:
 Clear picture of patients health Patient Centered Effective
 Best Practice Care Planning
Efficient
Safe
 Improved Disease Management Reporting
Effective
Impacts to Stakeholders
 Physicians – Allow the Physicians to actively manage patients life
long problems and diagnosis with a clear picture of the patients
overall health status.
 Hospital Staff – Bridge the clinical gap between Physician
documentation and nursing/ancillary documentation. Provide 1
place that’s managed collaboratively.
 Patient – True patient centered listing across visits that will improve
disease management. When every care provider is managing
patients problems treatment and outcomes are tailored to patient
needs.
Maintain Active Medication & Allergy List
 Nursing will gather medications and allergies list on admission,
Physicians will perform medication reconciliation on
discharge/admission/transfer of care.
 Benefits Expected:
 Eliminate Drug – Allergy Interactions Safe
 100% compliance with Allergy documentation Equitable
 Improve compliance with tracking patients home medications
and feeds medication reconciliation process Patient Centered
Impacts to Stakeholders
 Hospital Staff & Physicians– Provide discrete data in single location
that crosses clinical disciplines. Allergies and medications entered
will allow EMR to check for harmful interactions that will be caught
before the order is even placed. Allows checks along the process
where Physicians, Pharmacy, and Nursing will have visibility to
potential interactions.
 Patient – True patient centered listing that should substantially
eliminate adverse drug events. This will substantially increase
patient safety with regards to medication administration.
Provide Patient Electronic Copy of Health
Information
 Upon discharge create Continuity of Care Document
 Benefits Expected:
Efficient
 Provide patient clear picture of health
 Build foundation for interoperability Effective
 Better care across patient venues Patient Centered
Impacts to Stakeholders
 Hospital Staff & Physicians– Will provide the hospital with
the foundation to explore expanded HIE opportunities.
 Patient – Provide patients with clear picture of overall health
picture. This should lead to better follow up care as well as
empower patients to truly own their health.
Perform Medication Reconciliation
 Physician owned process carried out at
Discharge/Admission/Transfer of care
 Benefits Expected:
 Provide all patients with Medication Reconciliation report
Patient Centered
Effective
Equitable
Safe
 Improve compliance with Joint Commission medication
reconciliation requirements
Impacts to Stakeholders
 Hospital Staff & Physicians– Physicians will perform
on admission, transfer, and discharge. Will provide
clear concise view at all times of patients active
medication orders (as well as non active).
 Patient – Provide the patient with clear guidance on
to medications they should Start, Stop, Discontinue.
Every visit will result in updated discharge medication
reconciliation reports to every patient.
What does this really mean?
Ed Archer presents to ED with
Shortness of Breath
Triage Assessment
• Past Visit Allergies Reviewed - allergy to
Warfarin added
•Notice Problem/Diagnosis documented of
Pneumonia and High Blood Pressure
•Online Nurse Protocols Initiated for Community
Acquired Pneumonia – Triggered off patient
history online
What does this really mean?
Physician Exam
Order Entry (CPOE)
at Bedside
• Online documentation recommends orders
based on Problems/Diagnosis list
•Best Practice orders recommended that align
with organization and national quality goals
(smoking cessation, blood culture before first
antibiotic, etc).
•Decision support – Warafrin alert triggered off
patient allergy
Best Practice Orders
What does this really mean?
Orders sent
immediately
Orders, Medications,
Problems, Allergies
updated real-time
• All patients provided medication reconciliation
report (start/stop/continue)
•New prescriptions prescribed digitally
•Mr Archer’s Meds changed - prescribed beta
blocker and angiotension prescription cancelled
•Mr Archer is provided electronic copy of care
record that is also secure sent to PCP for follow
up
Condition Improves,
Discharge, follow up
Risk 1: Visibility & Perception of NCH Quality
Balanced Scorecard:



Market Performance/Customer Satisfaction
Internal Operations (Competitive service, quality, efficiency)
Associate Satisfaction & Ability to Adapt and Improve
1. Community aware of medical errors
2. $25M ONC Campaign – educate providers/public (March 2010)
• To obtain approval of HIT adoption and MU
3. Consumer Partnership for eHealth (CPeH) consumer/employer survey results (March 2010)
• MU is voluntary – capabilities exist in technology now
• Harm from rapid MU deployment? “Already being harmed every day”
4. 50 Consumer & Employer Groups - HHS/CMS letter (April 2010)
• Message: Retain MU - Do not defer
• Wal-Mart, SEIU
5. Empowered Patient Coalition and Consumers Union's Safe Patient Project- Web site for
patient surveys about their experiences with an adverse medical event
Risk 1: Visibility & Perception of NCH Quality
What is important to our customers?
Substantial improvement in safety, access, communication and care coordination
To Mitigate:
1.
2.
Approve proposed marketing budget increase
Improve & sustain transparency to demonstrate ACTION
•
Ongoing media campaign to promote NCH MU efforts
•
Campaigns directed to external providers
•
NCH Website - MU page for community
•
Maintain consistent themes:
o
Safe, effective, timely, patient-centered, efficient, equitable
Risk 2: Automate Inefficiencies and NOT Improve
Safety, Quality, Effectiveness or Coordinated Care
Balanced Scorecard:



1.
2.
3.
4.
5.
Internal Operations/Clinical & Administrative Quality
Ability to Adapt and Improve
Employee Satisfaction
MU not an implementation strategy! HIT is an enabler
Transformation requires workflow process redesign or we “automate inefficiencies”
Information must be meaningful and useful to have value
Processes to support patient-centered care is a change
Premier on MU, “Hastily implemented workflow changes could have the unintended
consequence of adversely affecting quality of care rather than enhancing it.”
Risk 2: Automate Inefficiencies and NOT Improve
Safety, Quality, Effectiveness or Coordinated Care
What is important to our customers?
Six IOM aims: safe, effective, timely, patient-centered, efficient, equitable care
To Mitigate:
1. Approve budget to engage a clinical workflow redesign consultant
• Avoid costly customizations of EHR
2. Leverage Premier Healthcare Alliance HIT Collaborative
• New Meaningful Use Best-Practices Library (April 2010)
• Focus is expediting EHR implementation to qualify for MU incentives
• Strategies for cultural change and communication
Risk 3: CPOE May Not Be Safe
Balanced Scorecard:



Internal Operations/Quality, Efficiency, Safety & Quality, Timeliness of Service, Patient Safety Index
Associate Satisfaction/Ability to Adapt, Improve, Implement Changes in Timely Manner
Market Performance/Market Share
1. Research:
•
Review of FDA reports links CPOE errors to Adverse Events
• CPOE users overly confident about data accuracy & processing
• Center for Patient Safety Research – analyzing CPOE factors contributing to medical errors
& will classify errors
2. Message Overload - miss critical messages
• Alerts, reminders & CDS to prevent errors
3. Physicians provide care at different hospitals
• Learn multiple systems - different user interfaces
4. No consistent method to communicate with physicians at NCH!
Risk 3: CPOE May Not Be Safe
What is important to our customers?
Six IOM aims: safe, effective, timely, patient-centered, efficient, equitable care
To Mitigate:
1. Engage CPOE consultant
2. Invest in CMIO position (part-time)
3. Grant appropriate authority to CPOE Physician Advisory Committee
 Budget/purchase Evidenced-Based Practice Order Sets
 Consider mobile phone connectivity
4. Identify effective physician communication channel
5. Leverage Resources:
 Institute for Safe Medication Practices human factors guidelines for CPOE
Content, format, protocols for managing RX approval, revisions updates
 Premier MU Best Practices library
o
Risk 4: To Much Too Soon? Sacrificing Safety by Rushing
into MU in Year 1
Balanced Scorecard:


Internal Operations/Quality, Efficiency, Availability of Services, Measure of Safety & Quality, Timeliness of
Service, Patient Safety Index
Market Performance & Customer Satisfaction/Associate Satisfaction, Ability to Adapt and Improve
1. AHA, Premier, other professional organization – YES
2. Care Coordination among diverse healthcare providers requires:
• Standardization – coding, transmission, vocabulary, processes
3. Safe sequence of HIT efforts
• Standardized coding – CDS Logic
• Security – Patients with electronic copy of health information
5. Change Management – Education/Communication
Risk 5: To Much Too Soon? Sacrificing Safety by Rushing
into MU in Year 1
What is important to our customers?
Six IOM aims: safe, effective, timely, patient-centered, efficient, equitable care
To Mitigate
1. External consultant
• Assess organizational readiness
• Enterprise implementation strategy
o Evaluate and plan sequence of HIT
o Establish safe MU milestones
• Strategies for quality; measuring, monitoring and reporting
• Assess current application and use - adoption inventories
Conclusions & Recommendations
 Continued support for CPOE project and expand to other MU




criteria
Move forward in pursuing meaningful use at a SAFE pace
Ensure project is clinically driven, NOT IT driven
Support for non-staff physicians to adopt MU
Approve budget requirements
Budget Requests
 External Consulting
 CMIO Position
 To meet needs of our customers and grow market share -
Marketing campaigns to community and external providers
References
RECOVERY: Comprehensive Campaign for Communications and Education about Health Information Technology for Economic and Clinical
Health (HITECH) Act. (March 24, 2010).
https://www.fbo.gov/index?s=opportunity&mode=form&id=93ccf0f006ab28d8076dd69fc846f6ab&tab=core&_cview=1. Accessed April 14,
2010.
Consumers weigh in on top 10 meaningful use arguments (March 8, 2010). Health IT News. Accessed April 14, 2010).
http://www.healthcareitnews.com/news/consumers-weigh-top-10-meaningful-use-arguments.
New Meaningful Use Best-Practices Library Helps Hospitals Effectively Implement HER to Improve the Health of Their Communities (April 6,
2010). Accessed April 14, 2010. http://emrdailynews.com/2010/04/06/new-meaningful-use-best-practices-library-helps-hospitalseffectively-implement-ehr-to-improve-the-health-of-their-communities.
http://geekdoctor.blogspot.com/2010/01/do-it-yourself-board-presentation-of.html
AHRQ Report: Health IT Adoption Could Lead to Gains in Care Quality (April 15, 2010). Accessed April 16,2010.
http://www.ihealthbeat.org/articles/2010/4/15/ahrq-report-health-it-adoption-could-lead-to-gains-in-care-quality.aspx
What Percentage of Hospitals Are Prepared To Demonstrate 'Meaningful Use' of EHRs? (January 8, 2010). Accessed April 16, 2010.
http://www.ihealthbeat.org/data-points/2010/what-percentage-of-hospitals-are-prepared-to-demonstrate-meaningful-use-of-ehrs.aspx
Consumers/Employers: Keep MU Strong (April 20, 2010). Health Data Management. Accessed April 20, 2010.
http://www.healthdatamanagement.com/news/meaningful-use-comment-consumers-employers-401371.html?ET=healthdatamanagement:e1247:161947a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_0
42110.
Review of FDA Reports Links CPOE Errors to Adverse Events (April 21, 2010) ihealthbeat. Accessed April 25,
2010.http://www.ihealthbeat.org/articles/2010/4/21/review-of-fda-reports-links-cpoe-errors-to-adverse-events.aspx
ISMP Develops New Guidelines to Promote CPOE Standardization (March 15, 2010). Accesses April 25, 2010).
http://www.ihealthbeat.org/articles/2010/3/15/ismp-develops-new-guidelines-to-promote-cpoe-standardization.aspx
Researchers To Look at Medical Errors Related to Use of CPOE Tools (April 26, 2010).
http://www.ihealthbeat.org/articles/2010/4/26/researchers-to-look-at-medical-errors-related-to-use-of-cpoe-tools.aspx
New Web Site Invites Patients To Report on Adverse Medical Events (April 26, 2010). http://www.ihealthbeat.org/articles/2010/4/26/newweb-site-invites-patients-to-report-on-adverse-medical-events.aspx
References
RECOVERY: Comprehensive Campaign for Communications and Education about Health Information Technology for Economic and Clinical
Health (HITECH) Act. (March 24, 2010).
https://www.fbo.gov/index?s=opportunity&mode=form&id=93ccf0f006ab28d8076dd69fc846f6ab&tab=core&_cview=1. Accessed April 14,
2010.
Consumers weigh in on top 10 meaningful use arguments (March 8, 2010). Health IT News. Accessed April 14, 2010).
http://www.healthcareitnews.com/news/consumers-weigh-top-10-meaningful-use-arguments.
New Meaningful Use Best-Practices Library Helps Hospitals Effectively Implement HER to Improve the Health of Their Communities (April 6,
2010). Accessed April 14, 2010. http://emrdailynews.com/2010/04/06/new-meaningful-use-best-practices-library-helps-hospitalseffectively-implement-ehr-to-improve-the-health-of-their-communities.
http://geekdoctor.blogspot.com/2010/01/do-it-yourself-board-presentation-of.html
AHRQ Report: Health IT Adoption Could Lead to Gains in Care Quality (April 15, 2010). Accessed April 16,2010.
http://www.ihealthbeat.org/articles/2010/4/15/ahrq-report-health-it-adoption-could-lead-to-gains-in-care-quality.aspx
What Percentage of Hospitals Are Prepared To Demonstrate 'Meaningful Use' of EHRs? (January 8, 2010). Accessed April 16, 2010.
http://www.ihealthbeat.org/data-points/2010/what-percentage-of-hospitals-are-prepared-to-demonstrate-meaningful-use-of-ehrs.aspx
Consumers/Employers: Keep MU Strong (April 20, 2010). Health Data Management. Accessed April 20, 2010.
http://www.healthdatamanagement.com/news/meaningful-use-comment-consumers-employers-401371.html?ET=healthdatamanagement:e1247:161947a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_0
42110.
Review of FDA Reports Links CPOE Errors to Adverse Events (April 21, 2010) ihealthbeat. Accessed April 25,
2010.http://www.ihealthbeat.org/articles/2010/4/21/review-of-fda-reports-links-cpoe-errors-to-adverse-events.aspx
ISMP Develops New Guidelines to Promote CPOE Standardization (March 15, 2010). Accesses April 25, 2010).
http://www.ihealthbeat.org/articles/2010/3/15/ismp-develops-new-guidelines-to-promote-cpoe-standardization.aspx
Researchers To Look at Medical Errors Related to Use of CPOE Tools (April 26, 2010).
http://www.ihealthbeat.org/articles/2010/4/26/researchers-to-look-at-medical-errors-related-to-use-of-cpoe-tools.aspx
New Web Site Invites Patients To Report on Adverse Medical Events (April 26, 2010). http://www.ihealthbeat.org/articles/2010/4/26/newweb-site-invites-patients-to-report-on-adverse-medical-events.aspx
Appendix B: HIMSS Hierarchy of EMR Adoption