Learning about the Newest Clinical System and Nursing Quality Measures

Nancy Beale, BSN, RNC-OB, RN-BCClinical Lead – ImplementationEpic

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 objectives24 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.

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 documentationOpportunities 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

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

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