w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Meaningful Use and Quality Measures and Healthstory

Nick van Terheyden, MDChief Medical Information Officer, NuanceExecutive Committee, Healthstory Project

Board of Directors, MTIAOctober 16, 2010

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Plant Administration Pharmacy$1,433

Foodservices

Lab$3,233

About that BillRadiology$1,290

Cardiology$3,943

Billing

Intensive Care$17,664

Operating Room$36,127

Meet Gerard Donovan….

... and his 150 medical staff...

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Session Objectives

At the end of this session you will: Understand the underlying principles of Meaningful Use (MU)

and the broad intentions of the program

Identify key Quality Measures and their source in the clinical encounter

Be familiar with the goals and document standards of the Health Story Project

Recognize how these initiatives are working together to accelerate EMR adoption and can help guide successful healthcare reform

Get to know your Simultaneous Translators

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

What is Meaningful Use?

“Meaningful use, in the long-term, is when EHRs are used by health

care providers to improve patient care, safety and quality.”

“HIT is the means, but not the end. Getting an EHR up and running in

health care is not the main objective behind the incentives

provided by the federal government under ARRA.

Improving Health is. Promoting health care reform is.

David Blumenthal, MDNational Coordinator for HIT

Slide Courtesy of HealthStory

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Meaningful Use EHR Goals

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

Largely aimed at driving healthcare organizations to collect and report on quality and safety metrics

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Meaningful use and the EHR Facilitates the Transformation

Hospitals

Specialists

Home Care

Primary Care

eHealth

Patient

Patient

eHealth

Primary Care

Home care

Specialists

Hospital

Hospital Centric To patient centric

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Meaningful Use ≈ Data Reuse

patient care

billing/claims

adjudication

research

quality reporting

clinical decisio

n suppor

t

outcomes analysis

Slide Courtesy of HealthStory

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

EMR Adoption Model (US)

0.8%

2.6%

3.2%

9.7%

50.2%

15.5%

6.8%

11.2%

n=5217

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

3 European Hospitals Awarded Stage 6 Oct 1, 2010

Odense University Hospital, Denmark (DK)

The University Hospitals of Geneva (HUG)

ISMETT Hospital The Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT) Sicily, Italy

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Meaningful Use: Core Set

Vital signs – structured data (>50%)

Problem List (1 entry for >80%)

Active Medication List (1 entry for >80%)

Smoking status (>50%)

Drug/Drug and Drug/Allergy Checking

e-Prescribing (>40%)

CPOE for medication (1 medication >30%)

Medication Allergy (1 entry >80%)

Patient Demographics (>50%)

Electronic Exchange (1 test exchange)

One clinical decision support rule

Implement privacy and security

Report Clinical quality Measures through attestation in 2011

Generate Electronic Summary (>50% within 3 days)

Provide e-copy to patients (>50% within 3 days)

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Meaningful Use – Menu Set

Medication Reconciliation (>50% of transitions of care)

Drug Formulary Checks (one internal or external formulary check)

Incorporate Labs as Structured Data (>40%)

Patients specific education (>10%)

Generate Lists of Patients by Condition

Summary of Care record (>50%)

Electronic Immunization Reporting (1 test submission)

Electronic syndrome surveillance (1 test submission)

Record Advance Directives (Hosp >50%)

Electronic submission of lab data (Hosp 1 test submission)

Patient Reminders for Preventative/f/u care (EP >20%)

Provide Patients with electronic access to Health Record (EP >105 within 4 days)

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Quality Reporting Measures

Reporting Hospital Quality Data for Annual Payment Update Acute myocardial infarction (AMI), Children’s asthma care (CAC), Heart failure

(HF), Surgical care improvement project (SCIP), Pneumonia (PN), Hospital outpatient measures (HOP), Pregnancy and related conditions (PR), Venous thromboembolism (VTE), Hospital-based inpatient psychiatric services (HBIPS), Stroke (STK)

The Joint Commissions Core Measures Acute myocardial infarction (AMI), Children’s asthma care (CAC), Heart failure

(HF), Surgical care improvement project (SCIP), Pneumonia (PN), Hospital outpatient measures (HOP), Perinatal Care (PC) – replaced Pregnancy Related, Venous thromboembolism (VTE), Hospital-based inpatient psychiatric services (HBIPS), Stroke (STK)

Physician Quality Reporting Initiative (PQRI) 216 individual quality measures in the 2010 PQRI Program (this increases every

year)

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Core Measures

Acute Myocardial Infarction AMI-1 Aspirin at Arrival 1

AMI-2 Aspirin Prescribed at Discharge 1

AMI-3 ACEI or ARB for LVSD 1

AMI-4 Adult Smoking Cessation Advice/Counseling 2

AMI-5 Beta-Blocker Prescribed at Discharge 1

AMI-6 Beta-Blocker at Arrival 1

AMI-7 Median Time to Fibrinolysis

AMI-7a Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival 2

AMI-8 Median Time to Primary PCI

AMI-8a Timing of Receipt of Primary Percutaneous Coronary Intervention (PCI) 2

AMI-9 Inpatient Mortality

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

PQRI – Measure Groups

Diabetes Mellitus

Chronic Kidney Disease

Preventive Care

Rheumatoid Arthritis

Peri-operative Care

Back Pain

Hepatitis C

Heart Failure

Coronary Artery Disease

Ischemic Vascular Disease

HIV/AIDS

Community Acquired Pneumonia

CADOral Antiplatelet Therapy Prescribed for Patients with CADInquiry Regarding Tobacco Use (Preventive Care and Screening)Advising Smokers and Tobacco Users to Quit (Preventive Care and Screening)Symptom and Activity AssessmentDrug Therapy for Lowering LDL-Cholesterol

IVDInquiry Regarding Tobacco Use (Preventive Care and Screening)Advising Smokers and Tobacco Users to Quit (Preventive Care and Screening)Blood Pressure Management ControlComplete Lipid ProfileLow Density Lipoprotein (LDL-C) ControlUse of Aspirin or Another Antithrombotic

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Unstructured Data

Structured Data

Dictation and Transcription

System generated or interfaced data

Direct data entry, not physician

Direct data entry, physician

Handwritten

Current Methods for Data Capture

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Perceived Barriers to Adoption

Major Perceived Barriers to Adoption of Electronic Health Records (EHRs) among Hospitals with Electronic-Records Systems as Compared with Hospitals without Systems.

Hospitals with electronic-records systems include hospitals with a comprehensive electronic-records system and those with a basic electronic-records system that includes functionalities for physicians' notes and nursing assessments. P<0.01 for all comparisons except physicians' resistance (P=0.20). IT denotes information technology, and ROI return on investment.

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Survey Conducted with 1,000 Physicians

• 67% cited time associated with reliance on keyboard and mouse to document within an EHR as a major hurdle for adoption

• 97% selected narrative over structured data entry as the more valuable documentation method to treating patients

• 96% expressed concern that they may lose the patient’s unique story with transition to point-and-click EHRs

MDs resist point and click

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

EMR Use in Physician Practices

Source: Texas Medical AssociationN=370, 4% response rate

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

EMR Use in Physician Practices

Source: Texas Medical AssociationN=370, 4% response rate

3 to 5 minutes / patient= 1 to 2 hours / day= 1 to 3 fewer patients / day

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Health Story Project

Vision: Comprehensive electronic clinical records that tell a patient’s complete health story.

Who We Are: A non profit alliance of healthcare vendors, providers and associations

Mission: Pool resources to develop data standards through HL7 for flow of information between common types of healthcare documents and EHR systems

Goals: Bridge the gap between the narrative documents and structured data

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

EHR Repository

HIM Applications

Clinical Applications

SNOMED CTDisease, DF-00000

Metabolic Disease, D6-00000

Disorder of glucose metabolism, D6-50100

Diabetes Mellitus, DB-61000

Type 1, DB-61010

Insulin dependant type IA, DB-61020

Neonatal, DB75110

Carpenter Syndrome, DB-02324

Disorder of carbohydrate metabolism, D6-50000

Meaningful Clinical Documents

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Meaningful Clinical Documents vs. Text

Structured and encoded clinical content enables… pre-signature alerts, decision support, best documentation practices, multiple output formats, multi-media reporting, data mining

Implements HL7 CDA4CDT standard compliant document types

Increases quality of documentation

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Current and Future Standards

HL7 Implementation GuidesCompleted History & Physical Consultation Operative Report DICOM Imaging Reports Discharge Summary (in publication)

Upcoming Procedure Note (focus on Endoscopy Report) CDA with unstructured body Billing and Reimbursement Requirements Progress Notes

w w w. h e a l t h s t o r y. c o m

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Benefits of Health Story Project

Benefit Value

Retains patient story Maintains primary role of documentation to clearly describe and communicate what is going on with patient.

Preserves physician time for clinical care

Makes efficient use of physician time by enabling choice of documentation methods

Supports meaningful use Implements HL7 CDA document standards for electronic exchange of clinical information (Patient Summary Record)

Enables dual use of information

Structured narrative enables better outcomes reporting, data mining, and decision support

Collaborative approach Developed by a broad array of providers, vendors and IT organizationsBalloted process supports harmonization

Better documentation Supports better coding, DRG optimization= better reimbursement

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

What Health Story Offers You

Allows providers to choose preferred workflow and documentation methods

Increases the value and usability of narrative documents

Accelerates the implementation of interoperable electronic health records

Allows intelligent and meaningful reuse of information

Provides on-ramp to EMR system adoption pre-populate EMR with structured documents integrate legacy documents

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Nick van Terheyden, MD Chief Medical Information Officer, Nuance CommunicationsTwitter http://twitter.com/drnic1Technorati http://technorati.com/people/technorati/nvt1Voice of the Doctor http://drvoice.blogspot.com/MyBlogLog http://www.mybloglog.com/buzz/members/nvtLinkedIn http://www.linkedin.com/in/nickvtPlaxo http://nvt.myplaxo.comFaceBook http://profile.to/drnickDigg http://digg.com/users/nvt1Delicious http://delicious.com/nvt1E-Mail nvt@nuance.com, drnick@nuance.com, drnic1@gmail.comGrandCentral (301) 355-0877

Where You Can Find Me

w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD

Meaningful Use and Quality Measures and Healthstory

Nick van Terheyden, MDChief Medical Information Officer, NuanceExecutive Committee, Healthstory Project

Board of Directors, MTIAOctober 16, 2010