1. NWH TRANSITION OF CARE DOCUMENT FOR MU STAGE 2 JUNE 6, 2014

2. WHAT IS THE DEFINITION OF MEANINGFUL USE (MU)? MU is using certified electronic health record (EHR) technology to: –Improve quality, safety, efficiency, and reduce health disparities –Engage patients and family –Improve care coordination, and population and public health –Maintain privacy and security of patient health information DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 2

3. WHAT ARE THE OBJECTIVES OF MEANINGFUL USE Ultimately CMS hopes that MU will result in –Better clinical Outcomes –Increased transparency and efficiency –Empowered individuals –More robust research data on health systems DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 3

4. STAGES OF MEANINGFUL USE 2014 Stage 2 Advance clinical processes 2016 Stage 3 Improve outcomes 2011-2012 Stage 1 Data capture and sharing NWH is preparing to begin MU Stage 2 reporting on July 1 st 2014 DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 4

5. OVERVIEW – MU 2 OBJECTIVES ObjectiveStage 2 MeasureStage 1 Measure CPOE>60% Med orders >30% Lab >30% Radiology orders >30 % Med orders Demographics>80% of eligible patients>50% of eligible patients Vital Signs>80% of eligible patients>50% of eligible patients Smoking Status>80% of eligible patients>50% of eligible patients Clinical Decision Support5 Clinical Decision Support Rules Aligned with Clinical Quality Measures 1 Clinical Decision Support Rule Patient Electronic Access>50% of eligible patients have their info avail. online within 36 hours of discharge >5% view download or transmit health info. New for stage 2 Protect E PHI Continued review and security risk analysis Encryption of data at rest Initial review / security risk analysis DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 5

6. OVERVIEW – MU 2 OBJECTIVES CONT. ObjectiveStage 2 MeasureStage 1 Measure Clinical Lab – Test Results>55%>40% Patient ListsAt least one list (required)At least one list (optional) Patient Specific Education Resources >10% (required)>10% (optional) Medication Reconciliation>50% (required)>50% (optional) Summary of Care>50% of transitions of care and referrals >10% of transitions leverage electronic transmission, Healthcare exchange Not pursued by NWH(optional) Immunization Registries Data Submission Ongoing submission of Immunization data to an Immunization registry Test of capability Submission of Lab results to Health Agency Ongoing submission of Lab results to Health Agency (Optional) DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 6

7. OVERVIEW – MU 2 OBJECTIVES CONT. ObjectiveStage 2 MeasureStage 1 Measure Syndromic Surveillance Data Submission Ongoing submission of Syndromic Surveillance data to Health Agency (Optional) Electronic Medication Administration Record (eMAR) >10% of med orders are tracked using eMAR New for stage 2 Advanced Directives>50% of eligible patients have an indication of an advanced directive status recorded (Optional) Imaging Results in Certified EHR >10% of all scan and test images are accessible through cert. EHR New for Stage 2 ePrescribing>10% of hospital discharge med orders are transmitted electronically New for Stage 2 Reporting on Clinical Quality Measures Reporting on 16 of 29 available CQMs Successfully report to CMS hospital clinical quality meas. using certified technology. DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 7

8. MU INITIATIVES CPOE Med Reconciliation Drug-Drug/ Drug-Allergy Alerts Plans of Care – Problem Management Patient and Clinical Portals Data Standards LOINC Codes/ ELR Interfaces Ethnicity Race Smoking Status Immunizations Discharge Process –Discharge Assessment –Discharge Clinical Letter –Patient Specific Education Transition of Care Document Krames Patient Education ePrescribing DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 8

9. USES FOR TRANSITION OF CARE DOCUMENT One Document leveraged to address the needs of 2 MU measures. 50 % of patients able to View online Download and Transmit info related to their hospital visit w/in 36 hours 50% of patients transfers or referrals include a Summary of Care doc; 10% of these sent electronically DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 9

10. TRANSITION OF CARE SECTIONS Extracted from Data Sources  Document Header  Allergies (RxNorm)  Problems and Encounter Diagnosis (SNOMED-CT)  Configured Results (LOINC for Laboratory)  Discharge Medications (RxNorm)  Immunizations (CVX)  Procedures (SNOMED-CT)  Chief Complaint Customer Configurable  Detailed instructions  Social History  Functional Status  Vital Signs (HT, WT, BP, BMI) and other configured Observations  Reason for Visit  Treatment Plan  Hospital Course DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 10

11. TRANSITION OF CARE DOCUMENT HEADER  Auto-populated with data when the CCDA has been generated.  STAR is the data source  The Header includes:  Date range that the document summarizes  Location of Care, Entity, Service, Caregivers  Race and Ethnicity  Patient’s sex and date of birth  Patient’s preferred language  Account number, medical record number, visit identifier  Patient’s masked Social Security number – Last 4 digits DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 11

12. CHALLENGES Not being able to limit results Vendor limitations Capturing Medical Problems Capturing Procedures DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 12

13. CHALLENGES ( CON’T) Auto Generation of ToC Communication to staff/patients Patient Provisioning DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 13

14. DISCHARGE PROCESS Discharge Assessment –Timing of Discharge Orders –Appropriate Roles/ Scope of Practice in completion of assessment –Moving from paper to electronic (Soarian) Discharge Instructions Report –Creating a patient friendly, readable report –Supplemented by patient education materials from Krames Patient Specific Education ( Krames) UW Medicine Standard for patient education – Using “infobutton” in Soarian DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 14

15. Our reporting period starts on July 1 st, we’ll collect data to prove that we’re meeting our objectives and making it all work Our MU2 reporting period starts on July 1 st, we’ll collect data to prove that we’re meeting our objectives and making it all work Q: The recognition and incentive reward will be nice, but what’s our real, big-picture goal? A: We have amazing technology & want to use it in the best possible way to benefit our patients!

16. Secure online website that gives patients convenient 24-hour access to personal health information and other health tools from anywhere with an Internet connection THE PATIENT PORTAL

17. QUESTIONS? DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist 17