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Implementation OF MU: Hospital based practice. Mark Huang, M.D. Chief Medical Information Officer Rehabilitation Institute of Chicago. REHABILITATION Institute of Chicago. Hospital based practice with academic affiliation to Northwestern University - PowerPoint PPT Presentation
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IMPLEMENTATION OF MU: HOSPITAL BASED PRACTICEMark Huang, M.D.Chief Medical Information OfficerRehabilitation Institute of Chicago
REHABILITATION INSTITUTE OF CHICAGO
Hospital based practice with academic affiliation to Northwestern University– 65 medical staff including mid level providers– 40 residents, 6 fellows
Main hospital outpatient clinic Cerner EHR (Powerchart) Offsite clinics on the main EHR Partnerships not fully on EHR
DECISION TO PURSUE MU
Cost analysis: – software costs– incentive payments– impending penalty consideration
Roughly break even for the organization Overlap with PQRS compliance Some aspects were “meaningful”
– Eprescribe– Problem list– Visit summary for instructions– Patient portal
IMPLEMENTATION STRATEGIES
Establish implementation task force– Weekly status updates
Analyze current clinic workflows Review proposed changes with EHR
– Extra tasks needed for MU– Review exactly who does what for each measure to
ensure this will be completed
Involve clinical staff in decisions
ADDITIONAL OFFICE STAFF TASKS
Invite patients to participate in patient portal (automate registration, encourage use for refills, electronic communication)
Record demographic information (race) Record vital signs (BP, height and weight) Record smoking status
– Document smoking cessation plan
Record family history Update allergies and medications Generate transition of care document
WHAT PHYSICIANS NEED TO DO?
Medication reconciliation Maintain/update problem list E-prescribe Generate clinic visit summary Patient education Secure messaging with patients via the EHR
WORKFLOW IMPACTS
Less clinic efficiency– Clinicians taking longer to complete visits per
patient– Office staff duties diverted to meaningful use
compliance tasks– Increased after hours catch up work
Information given to patients not relevant to scope of practice
VITAL SIGNS
Height, weight, BP, BMI– Growth curves in children 0-20
Target: 50% of unique patients Exclusion: < 3yrs Establish process with office staff that ensures
height and weight routinely obtained– Obtain scales for clinic– Height recording
Those in wheelchairs, ask for estimated height Many EHR uses metric system Issue quick conversion charts for english to metric
SMOKING
Target: < 50% unique patients older than 13 Smoking
– Ensure staff assess for smoking– Can also use documentation to record any
interventions (one of the clinical quality measures includes smoking cessation)
PROBLEM LIST
Target: 80% of patients must have a problem documented
Maintain active problem list Encourage use of problems, often these can
be used to create diagnosis for charges Clinician needs to review PRIOR to printing
visit summary Strategy:
– could have clinical staff enter initially and physician review/edit as approp
PROBLEM LIST
VISIT SUMMARY
Target: 50% of all office visits Provide summary within 3 business days
– Excludes procedures
Include at minimum following information– Problem List – Diagnostic Test Results – Medication List – Medication Allergy List
VISIT SUMMARY
Providing clinical summary one of most challenging objectives to meet
How will patient get document?– End of visit– If not done at end of visit who will track visit
summary completion and how patient will get document
Mailed to home Patient portal
Need to ensure process for completion– Can use extender to print document
VISIT SUMMARY WORKFLOWS
Physician or designee updates medication list before patient leaves clinic.
Visit Summary replaces patient’s copy of the Med Reconciliation List
Physician or designee will sign visit summary document
Front desk staff will print visit summary and distribute to patient at check out– this was later changed to clinician prints to front
desk
VIEW TRANSMIT DOWNLOAD
Target 50% of unique patients Patients are provided online access within 4
business days to their health information– Problems, allergies, medications, vitals instructions
Patients only need to be invited to have access, they do not actually need to view or access the actual online content
Emphasize enrollment with patients– Allows easier access to visit summary if done after
the visit
ELECTRONIC PRESCRIPTIONS
Target: 40% of eligible prescriptions must be sent electronically
Electronic prescription of non controlled substances– Must be sent directly to the pharmacy
Controlled substances Controlled eprescribe requires 2 levels of
authentication
E-PRESCRIBE
Clinicians route prescription directly to pharmacy
DECISION SUPPORT
Create decision support that may assist in other areas (clinical quality measures)
MEDICATION RECONCILIATION
Target: 50% of visits must have medication reconciliation performed
At each office visit, review medications patient is taking
Most EHRs offer some method of medication reconciliation (must be able to simultaneously compare 2 different lists of medication)
QUALITY MEASURES
Few measures are applicable to PM & R Even those that seem applicable may not Not all measures are built within EHR reporting Consider group reporting for quality measures
and PQRS
QUALITY MEASURES:
Measure #238 (NQF 0022): Drugs to be Avoided in the Elderly
Measure #312 (NQF 0052): Low Back Pain: Use of Imaging Studies
Measure #39 (NQF 0046): Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older
QUALITY MEASURES
Measure #48 (NQF 0098): Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older
Measure #154 (NQF 101): Assessment of Fall Risk in the Elderly
MU REPORTS
Status reports– Ensure accuracy of reports– Use reports to target providers at risk– Deploy resource to assist with education and
support
Early intervention critical to compliance– Identify personnel to review reports– Examine feedback from users in regards to
workflow– Observe for best practices that can be applied
across users
REPORTS
REPORTS
ATTESTATION
Ensure that you have supporting information Begin registering early Complete attestation by end of Feb of
subsequent year BE SURE TO KEEP CAREFUL RECORDS OF
COMPLIANCE in case of an audit
STAGE 2 CHALLENGES
TRANSITION OF CARE
Provide a summary of care document for more than 50% of transitions or referrals to another provider of care– Includes therapy and home health referrals
A further 10% of these summary of care documents need to be sent electronically– Challenge is finding enough referral sources who
can receive these
Conduct test with a another separate EHR or conduct successful electronic exchange of information
TRANSITION OF CARE
Sometime difficult to determine exactly which provider to send document– Patient has not decided on provider– May not know by end of office visit– Requires process to follow through
Identifying referral sources that can receive the information– Many therapy sites and home health agencies not
equipped to receive transition of care electronically
SECURE MESSAGING
5% of patients need to message provider via secure messaging means (patient portal)
Email does not count Challenging for certain disabled populations
– Often requires use of email to enroll– Many clients do not use email or have a computer
Elderly, indigent population, those with language barrier
SECURE MESSAGING
Strategies– Automate enrollment in patient portal– Ask patient to review portal information– Message patients who have signed up to get them
to respond– Discourage email communication
CONCLUSION
Workflow analysis EHR usability critical to success and
satisfaction Reports key to measuring progress Feedback from providers critical