1 / 32

Implementation OF MU: Hospital based practice

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

Download Presentation

Implementation OF MU: Hospital based practice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Implementation OF MU: Hospital based practice Mark Huang, M.D. Chief Medical Information Officer Rehabilitation Institute of Chicago

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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)

  10. 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

  11. Problem list

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. E-prescribe • Clinicians route prescription directly to pharmacy

  18. Decision support • Create decision support that may assist in other areas (clinical quality measures)

  19. 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)

  20. 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

  21. 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

  22. 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

  23. 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

  24. Reports

  25. Reports

  26. 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

  27. Stage 2 Challenges

  28. 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

  29. 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

  30. 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

  31. 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

  32. Conclusion • Workflow analysis • EHR usability critical to success and satisfaction • Reports key to measuring progress • Feedback from providers critical

More Related