ehrs in quality improvement alice loveys, md, faap, fhimss florida pediatric medical home...
TRANSCRIPT
EHRs in Quality ImprovementAlice Loveys, MD, FAAP, FHIMSS
Florida Pediatric Medical Home Demonstration Project (C4K) Learning Session 3December 7, 2012
Disclosure
I have the following financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity Consultant for: Optum Insight
I do not intend to discuss an unapproved/ investigative use of a commercial product/device in their presentation.
Objectives
Quality Improvement EHR Targets Identify the “Crosswalks” Areas that
satisfy multiple QI programs CHIPRA MU
Focus Targeted Areas for Improvement Priority Areas for Intervention
Asthma
Objectives
Show EHR Examples Vendor Independent Workflows
Dr. Ali Loveys Background
Practice Pediatrician Electronic for over 10 years – HIMSS Davies Award
Winner – Chair of Committee Co-Author Go-Live: Smart Strategies from Davies
Award-Winning EHR Implementations – Physician Engagement
AAP – Advisor to the Child Health Informatics Center
Dr. Ali Loveys Background
CMIO for a group the targets HIT Optimization in specific projects such as PCMH MU – NYS Regional Extension Center Health Information Exchange HIPAA Security
Work with >100 vendors 100% VENDOR NEUTRAL
EHRs in Use
AllscriptsAthena ClinicalsCaretrackereClinical WorkseMedys (Trimed)Epic
GE CentricityMeditabsOffice PracticumPaper (OOPS)
EHR Elements
Where data goes in depends on HOW we want it to come out.
Problem Lists – ICD-9 Codes CPT Codes Health Maintenance, Disease Management; Preventive
Care Immunization Modules Reporting Tools – Dashboards, Registry Reporting; MAQ
Dashboard
EHR Optimization Approach
Team LeadersPractice AssessmentTasks broken down into manageable
steps Practices need to continue to practice New Concept about every two weeks
Communication Tools
EHR Optimization Approach
Crosswalks NCQA EHR Incentives Meaningful Use Health Information Exchanges Payer Programs
COLLABORATION Use the same tools where possible
EHR Optimization Approach
EHR is JUST A TOOLCreate Policies for QI Area
What protocol are you using?
Map Workflow Who does what? Where do they do it? What do they do it with?
Example Vital Signs
When are they taken?Where?Crosswalk
CHIPRA MU PCMH
Workflow OPTIONS No one perfect way to do things
Workflow
Targeted Areas for Improvement Asthma
Chronic Medical Condition Coordination of Care PCMH
MU Clinical Quality Metric Reporting Clinical Decision Support Rule
CHIPRA Measure Annual Number of Asthma Patients with 1 Or
More Asthma Related ED Visits
Practice AssessmentPolicy
Asthma Control Test and Asthma Action PlanACT: May 2012: 43%, August 2012: 53%Action Plan: May 2012: 36%, August 2012: 45%
How often does the practice evaluate? How are asthmatics Identified?How are medications tracked?
Crosswalks for Asthma?Meaningful Use
Core Objectives Implement one clinical decision support rule
Follow NHLBI Guidelines for the diagnosis and treatment of asthma Report ambulatory quality measures to CMS/States
3 apply specifically to Asthma Provide clinical summaries for patients for each office visit
Comprehensive Asthma Action and Care plan Protect electronic health information
Regardless of Program Maintain an up-to-date problem list of current and active diagnoses
Structured Data entry with Asthma Diagnosis Maintain active medication list
Structured Data of all medications
Using the EHR in MU CrosswalksAsthma
Menu Objectives Generate lists of patients by specific conditions
Identify all patients with an Asthma Diagnosis
Send reminders to patients per patient preference for preventive/follow-up care
Identify recommended Asthmatic care such as • Annual Flu Shots• Annual Spirometry• Bi-annual ACT
Summary of care record for each transition of care/referrals Referrals of Asthmatics to specialists Transfer of Asthmatic to ED
Using the EHR in MU Crosswalks
Clinical Quality Metrics All EPs must report on all 3 core measures, even
if the denominator is zero. For each of those Core CQMs for which the
denominator is zero, an EP must report an equal number from the Alternate Core Measures. If the denominator is zero for all of those Alternate measures then the EP must report this as well.
All EPs must report on 3 additional measures from the remaining 38 published CQMs.
Crosswalk Clinical Quality Metrics MU
Asthma Assessment Percentage of patients aged 5 through 40 years
with a diagnosis of asthma and who have been seen for at least 2 office visits, who were evaluated during at least one office visit within 12 months for the frequency (numeric) of daytime and nocturnal asthma symptoms
Crosswalk Clinical Quality Metrics MU
Use of Appropriate Medications for Asthma The percentage of patients 5-50 years of age
during the measurement year who were identified as having persistent asthma and were appropriately prescribed medication during the measurement year. Report three age stratifications (5-11 years, 12-50 years, and total).
Crosswalk Clinical Quality Metrics MU
Asthma Pharmacologic Therapy Percentage of patients aged 5 through 40 years
with a diagnosis of mild, moderate, or severe persistent asthma who were prescribed either the preferred long-term control medication (inhaled corticosteroid) or an acceptable alternative treatment.
Asthma Workflow EHR Elements
Diagnosis Structured in problem list ICD-9
(493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.81, 493.82, 493.90, 493.91, 493.92).
Medications Structured in Medication List
Asthma Workflow EHR Elements
Health Maintenance ACT Evaluation
The CPT code c1005F
Flu Vaccine CPT codes multiple
Spirometry CPT codes multiple
Asthma Action Plan CPT code 99411 with modifier
Asthma Workflow EHR Elements
Patient HandoutsReporting
EHR Example
Other Quality Metrics
Childhood ImmunizationsPharyngitis
Crosswalk Clinical Quality Metrics MU
Childhood immunization Status The percentage of children 2 years of age who had
four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates
Crosswalk Clinical Quality Metrics MU
Appropriate Testing for Children with Pharyngitis The percentage of children 2–18 years of age
who were diagnosed with Pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode.
