Meaningful Use and Quality Measures and Healthstory

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Meaningful Use and Quality Measures and
Healthstory

• Nick van Terheyden, MD
• Chief Medical Information Officer, Nuance
• Executive Committee, Healthstory Project
• Board of Directors, MTIA
• October 16, 2010

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Meet Gerard Donovan.
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Session Objectives

• At the end of this session you will
• Understand the underlying principles of
  Meaningful Use (MU) and the broad intentions of
  the program
• Identify key Quality Measures and their source in
  the clinical encounter
• Be familiar with the goals and document standards
  of the Health Story Project
• Recognize how these initiatives are working
  together to accelerate EMR adoption and can help
  guide successful healthcare reform
• Get to know your Simultaneous Translators

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What is Meaningful Use?

• Meaningful use, in the long-term, is when EHRs
  are used by health care providers to improve
  patient care, safety and quality.
• HIT is the means, but not the end. Getting an
  EHR up and running in health care is not the main
  objective behind the incentives provided by the
  federal government under ARRA. Improving Health
  is. Promoting health care reform is.
• David Blumenthal, MD
• National Coordinator for HIT

Slide Courtesy of HealthStory
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Meaningful Use EHR Goals

• Improve quality, safety, efficiency, and reduce
  health disparities
• Engage patients and families
• Improve care coordination
• Improve population and public health
• Ensure adequate privacy and security protections
  for personal health information
• Largely aimed at driving healthcare organizations
  to collect and report on quality and safety
  metrics

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Meaningful use and the EHR Facilitates the
Transformation
Hospital Centric
To patient centric
Patient
Hospital
eHealth
Specialists
Home Care
Primary Care
Primary Care
Home care
Specialists
eHealth
Hospitals
Patient
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Meaningful Use Data Reuse
patient care
quality reporting
clinical decision support
outcomes analysis
research
billing/claims adjudication
Slide Courtesy of HealthStory
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EMR Adoption Model (US)
n5217
0.8
2.6
3.2
9.7
50.2
15.5
6.8
11.2
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3 European Hospitals Awarded Stage 6 Oct 1, 2010

• Odense University Hospital, Denmark (DK)
• The University Hospitals of Geneva (HUG)
• ISMETT Hospital The Istituto Mediterraneo per i
  Trapianti e Terapie ad Alta Specializzazione
  (ISMETT) Sicily, Italy

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Meaningful Use Core Set

• Vital signs structured data (gt50)
• Problem List (1 entry for gt80)
• Active Medication List (1 entry for gt80)
• Smoking status (gt50)
• Drug/Drug and Drug/Allergy Checking
• e-Prescribing (gt40)
• CPOE for medication (1 medication gt30)
• Medication Allergy (1 entry gt80)

• Patient Demographics (gt50)
• Electronic Exchange (1 test exchange)
• One clinical decision support rule
• Implement privacy and security
• Report Clinical quality Measures through
  attestation in 2011
• Generate Electronic Summary (gt50 within 3 days)
• Provide e-copy to patients (gt50 within 3 days)

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Meaningful Use Menu Set

• Medication Reconciliation (gt50 of transitions of
  care)
• Drug Formulary Checks (one internal or external
  formulary check)
• Incorporate Labs as Structured Data (gt40)
• Patients specific education (gt10)
• Generate Lists of Patients by Condition
• Summary of Care record (gt50)
• Electronic Immunization Reporting (1 test
  submission)
• Electronic syndrome surveillance (1 test
  submission)
• Record Advance Directives (Hosp gt50)
• Electronic submission of lab data (Hosp 1 test
  submission)
• Patient Reminders for Preventative/f/u care (EP
  gt20)
• Provide Patients with electronic access to Health
  Record (EP gt105 within 4 days)

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Quality Reporting Measures

• Reporting Hospital Quality Data for Annual
  Payment Update
• Acute myocardial infarction (AMI), Childrens
  asthma care (CAC), Heart failure (HF), Surgical
  care improvement project (SCIP), Pneumonia (PN),
  Hospital outpatient measures (HOP), Pregnancy and
  related conditions (PR), Venous thromboembolism
  (VTE), Hospital-based inpatient psychiatric
  services (HBIPS), Stroke (STK)
• The Joint Commissions Core Measures
• Acute myocardial infarction (AMI), Childrens
  asthma care (CAC), Heart failure (HF), Surgical
  care improvement project (SCIP), Pneumonia (PN),
  Hospital outpatient measures (HOP), Perinatal
  Care (PC) replaced Pregnancy Related, Venous
  thromboembolism (VTE), Hospital-based inpatient
  psychiatric services (HBIPS), Stroke (STK)
• Physician Quality Reporting Initiative (PQRI)
• 216 individual quality measures in the 2010 PQRI
  Program (this increases every year)

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Core Measures

• Acute Myocardial Infarction
• AMI-1 Aspirin at Arrival 1
• AMI-2 Aspirin Prescribed at Discharge 1
• AMI-3 ACEI or ARB for LVSD 1
• AMI-4 Adult Smoking Cessation Advice/Counseling 2
  
• AMI-5 Beta-Blocker Prescribed at Discharge 1
• AMI-6 Beta-Blocker at Arrival 1
• AMI-7 Median Time to Fibrinolysis
• AMI-7a Fibrinolytic Therapy Received Within 30
  Minutes of Hospital Arrival 2
• AMI-8 Median Time to Primary PCI
• AMI-8a Timing of Receipt of Primary Percutaneous
  Coronary Intervention (PCI) 2
• AMI-9 Inpatient Mortality

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PQRI Measure Groups

• Diabetes Mellitus
• Chronic Kidney Disease
• Preventive Care
• Rheumatoid Arthritis
• Peri-operative Care
• Back Pain
• Hepatitis C
• Heart Failure
• Coronary Artery Disease
• Ischemic Vascular Disease
• HIV/AIDS
• Community Acquired Pneumonia

CAD Oral Antiplatelet Therapy Prescribed for
Patients with CAD Inquiry Regarding Tobacco Use
(Preventive Care and Screening) Advising Smokers
and Tobacco Users to Quit (Preventive Care and
Screening) Symptom and Activity Assessment Drug
Therapy for Lowering LDL-Cholesterol
IVD Inquiry Regarding Tobacco Use (Preventive
Care and Screening) Advising Smokers and Tobacco
Users to Quit (Preventive Care and
Screening) Blood Pressure Management
Control Complete Lipid Profile Low Density
Lipoprotein (LDL-C) Control Use of Aspirin or
Another Antithrombotic
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Current Methods for Data Capture
Direct data entry, physician
Direct data entry, not physician
Unstructured Data
System generated or interfaced data
Structured Data
Dictation and Transcription
Handwritten
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Perceived Barriers to Adoption
Major Perceived Barriers to Adoption of
Electronic Health Records (EHRs) among Hospitals
with Electronic-Records Systems as Compared with
Hospitals without Systems. Hospitals with
electronic-records systems include hospitals with
a comprehensive electronic-records system and
those with a basic electronic-records system that
includes functionalities for physicians' notes
and nursing assessments. Plt0.01 for all
comparisons except physicians' resistance
(P0.20). IT denotes information technology, and
ROI return on investment.
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Survey Conducted with 1,000 Physicians

• 67 cited time associated with reliance on
  keyboard and mouse to document within an EHR as a
  major hurdle for adoption
• 97 selected narrative over structured data
  entry as the more valuable documentation method
  to treating patients
• 96 expressed concern that they may lose the
  patients unique story with transition to
  point-and-click EHRs
• MDs resist point and click

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EMR Use in Physician Practices
Source Texas Medical Association N370, 4
response rate
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EMR Use in Physician Practices
3 to 5 minutes / patient 1 to 2 hours /
day 1 to 3 fewer patients / day
Source Texas Medical Association N370, 4
response rate
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Health Story Project

• Vision Comprehensive electronic clinical records
  that tell a patients complete health story.
• Who We Are A non profit alliance of healthcare
  vendors, providers and associations
• Mission Pool resources to develop data standards
  through HL7 for flow of information between
  common types of healthcare documents and EHR
  systems
• Goals Bridge the gap between the narrative
  documents and structured data

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Meaningful Clinical Documents
SNOMED CT

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Meaningful Clinical Documents vs. Text

• Structured and encoded clinical content enables
• pre-signature alerts,
• decision support,
• best documentation practices,
• multiple output formats,
• multi-media reporting,
• data mining
• Implements HL7 CDA4CDT standard compliant
  document types
• Increases quality of documentation

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Current and Future Standards

• HL7 Implementation Guides
• Completed
• History Physical
• Consultation
• Operative Report
• DICOM Imaging Reports
• Discharge Summary
• Procedure Note
• Unstructured Documents
• Upcoming
• Progress Notes (in HL7 ballot)
• Billing and Reimbursement Requirements

www.healthstory.com
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Benefits of Health Story Project
Benefit Value
Retains patient story Maintains primary role of documentation to clearly describe and communicate what is going on with patient.
Preserves physician time for clinical care Makes efficient use of physician time by enabling choice of documentation methods
Supports meaningful use Implements HL7 CDA document standards for electronic exchange of clinical information (Patient Summary Record)
Enables dual use of information Structured narrative enables better outcomes reporting, data mining, and decision support
Collaborative approach Developed by a broad array of providers, vendors and IT organizations Balloted process supports harmonization
Better documentation Supports better coding, DRG optimization better reimbursement
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Where You Can Find Me
Nick van Terheyden, MD Chief Medical Information
Officer, Nuance Communications Twitter http//tw
itter.com/drnic1 Technorati http//technorati.com
/people/technorati/nvt1 Voice of the
Doctor http//drvoice.blogspot.com/ MyBlogLog ht
tp//www.mybloglog.com/buzz/members/nvt LinkedIn
http//www.linkedin.com/in/nickvt Plaxo http//
nvt.myplaxo.com FaceBook http//profile.to/drnic
k Digg http//digg.com/users/nvt1 Delicious ht
tp//delicious.com/nvt1 E-Mail nvt_at_nuance.com,
drnick_at_nuance.com, drnic1_at_gmail.com GrandCentral
[phone]
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Meaningful Use and Quality Measures and
Healthstory

• Nick van Terheyden, MD
• Chief Medical Information Officer, Nuance
• Executive Committee, Healthstory Project
• Board of Directors, MTIA
• October 16, 2010