Learning about the Newest Clinical System and Nursing Quality Measures Nancy Beale, BSN, RNC-OB, RN-BC Clinical Lead – Implementation Epic

 Joint Commission Accreditation  CMS  Meaningful Use  Institute for Healthcare Improvement  National Quality Forum  TIGER Initiative  National Patient Safety Goals  NDNQI

American Recovery and Reinvestment Act of 2009 provided for incentive payments for the meaningful use of certified EHR technology through HITECH (Health Information Technology for Economic and Clinical Health Act). Payments made through CMS to “eligible providers” (EP), eligible hospitals, and critical access hospitals. EPs include all healthcare professionals in an integrated healthcare community including nurses (RNs), advance practice registered nurses (APRNs), and other clinicians as well as expanding sites to include patient centered care delivered by interdisciplinary teams.

 Federal incentive program established in ARRA/HITECH  Incentives are paid through CMS (for Medicare) and through the states (for Medicaid)  Incentive requirements ◦ Use certified EHR technology ◦ Be a “meaningful EHR user” ◦ Report clinical quality measures to CMS

It’s all about quality Need to move from systems that are designed to manage and share financial data to those that address clinical data Desire to transform health care Use certified EHR technology to improve: ◦Quality ◦Efficiency ◦Safety

Medicare Physician Incentive Medicare and Medicaid Hospital Incentive Medicaid Physician Incentive

 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

 44 quality measures for eligible professionals ◦ Everyone reports on 3 measures in core measures group ◦ Additionally report on 3 other measures of the EP’s choosing ◦ Must report even if have no patients in denominator  15 quality measures for hospitals  Must report even if have no patients in denominator

Objectives 25 EP objectives 24 hospital objectives

 Three sets of quality measures: ◦ Emergency Department ◦ Venous Thromboembolism ◦ Stroke (except measure one)  EHRs must use the HITSP specifications.  HITSP specifications are similar but not identical to Joint Commission specifications for these measure sets.

Meaningful Use Final Rule (from CMS) Objective Maintain active medication list. Measure More than 80% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. Numerator The number of patients in the denominator who have a medication (or an indication that the patient is not currently prescribed any medication) recorded as structured data. Denominator Number of unique patients seen by the EP or admitted to an eligible hospital’s or CAH’s inpatient or emergency departments (POS 21 or 23) during the EHR reporting period. Standards Final Rule ( from ONC) Functionality Enable a user to electronically record, modify, and retrieve a patient’s active medication list as well as medication history for longitudinal care.

It’s not about the technology, it’s how you use the data!

Acute Myocardial Infarction Children’s Asthma Care Emergency Department* Heart Failure Pneumonia SCIP (Inf) Stroke* Venous Thromboembolism*

 Problem list documentation  Flowsheet documentation  Drug combination, abnormal lab results, and other additional Reporting Workbench criteria

 Admitted patients: ◦ All patients ◦ Admission Diagnosis ◦ Clinical Impression ◦ Principal Problem ◦ Hospital Problems ◦ Non-hospital Problems ◦ Missing Diagnosis  Discharged Patients  Coded Diagnosis  Problem List  Encounter Diagnosis

 Navigators ◦ Prior-to-admission medications ◦ Allergies ◦ History  Orders  Medication Administration  SmartData Elements (SDE)

 Documentation built into workflows ◦ Order Sets ◦ BestPractice Advisories

Core Measures Automation Non-Discrete Discrete

 Reporting Workbench  Operational reporting tool in Hyperspace  Real-time or Near real-time Production server or shadow server  Concurrent and retrospective reporting Automated abstraction Improved documentation Opportunities to educate users

Monitor Compliance: 1. Identify patients. 2. Gather data from charts. 3. Open or review charts. 4. Create patient lists. Collect

 Templates A base set of search criteria, display criteria, and restrictions on report configuration. Example: IP AMI Core Measure  Report Includes options for end-user configuration. Example: IP (AMI-1) Aspirin at arrival: admitted patients Collect

 Manual alerting  Patient lists  Sticky notes  Educate end users

 BestPractice advisories  Required documentation  Order Set text  Abstractor enhancements  AVS checks

 Retrospective reports similar to concurrent reports  Automated abstraction  Exports to Excel  Data available in Clarity for the Epic 2010 release

Submit

 Your ORYX vendor aggregates the data and submits it to The Joint Commission.

 Focus on POC documentation  Real-time or concurrent review of data  Importance of workflow  Discrete data capture  Training  Compliance

 Comparative Effectiveness Research ◦ …is the process of determining the relative clinical effectiveness among a number of diagnostic and intervention choices, when multiple choices exist.  Improve quality outcomes through evidence based nursing practice  Measure the impact of nursing care on patient outcomes by capturing select data in EHR  Embed quality measures sensitive to nursing care in meaningful use criteria for adoption

 ANA taking the lead with Alliance for Nursing Informatics to introduce “pressure ulcer prevention”as a quality measure sensitive to nursing care for adoption in meaningful use incentives  3 Million adults per year treated for pressure ulcers  Cost in excess of $15Billion/year  Goal to ↓Cost, ↓Patient and Staff burden  Move from prevalence to prevention

The Beginning