nwh transition of care document for mu stage 2

NWH TRANSITION OF CARE DOCUMENT FOR MU STAGE 2

JUNE 6, 2014

WHAT IS THE DEFINITION OF MEANINGFUL USE (MU)?

• MU is using certified electronic health record (EHR) technology to:– Improve quality, safety, efficiency, and reduce

health disparities– Engage patients and family– Improve care coordination, and population and

public health– Maintain privacy and security of patient health

information

DeJuan Skelton IMS Project Manager; Mary Pat O'Donnell CIT Specialist

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WHAT ARE THE OBJECTIVES OF MEANINGFUL USE

• Ultimately CMS hopes that MU will result in – Better clinical Outcomes– Increased transparency and efficiency– Empowered individuals– More robust research data on health systems


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STAGES OF MEANINGFUL USE

• 2014• Stage 2• Advance clinical

processes

• 2016• Stage 3• Improve

outcomes

• 2011-2012• Stage 1• Data capture

and sharing

• NWH is preparing to begin MU Stage 2 reporting on July 1st 2014


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OVERVIEW – MU 2 OBJECTIVESObjective Stage 2 Measure Stage 1 Measure

CPOE >60% Med orders>30% Lab >30% Radiology orders

>30 % Med orders

Demographics >80% of eligible patients >50% of eligible patients

Vital Signs >80% of eligible patients >50% of eligible patients

Smoking Status >80% of eligible patients >50% of eligible patients

Clinical Decision Support 5 Clinical Decision Support RulesAligned with Clinical Quality Measures

1 Clinical Decision Support Rule

Patient Electronic Access >50% of eligible patients have their info avail. online within 36 hours of discharge>5% view download or transmit health info.

New for stage 2

Protect E PHI • Continued review and security risk analysis

• Encryption of data at rest

Initial review / security risk analysis


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OVERVIEW – MU 2 OBJECTIVES CONT.Objective Stage 2 Measure Stage 1 Measure

Clinical Lab – Test Results >55% >40%

Patient Lists At least one list (required) At least one list (optional)

Patient Specific Education Resources

>10% (required) >10% (optional)

Medication Reconciliation >50% (required) >50% (optional)

Summary of Care >50% of transitions of care and referrals>10% of transitions leverage electronic transmission, Healthcare exchange

Not pursued by NWH(optional)

Immunization Registries Data Submission

Ongoing submission of Immunization data to an Immunization registry

Test of capability

Submission of Lab results to Health Agency

Ongoing submission of Lab results to Health Agency

(Optional)


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OVERVIEW – MU 2 OBJECTIVES CONT.Objective Stage 2 Measure Stage 1 Measure

Syndromic Surveillance Data Submission

Ongoing submission of Syndromic Surveillance data to Health Agency

(Optional)

Electronic Medication Administration Record (eMAR)

>10% of med orders are tracked using eMAR

New for stage 2

Advanced Directives >50% of eligible patients have an indication of an advanced directive status recorded

(Optional)

Imaging Results in Certified EHR

>10% of all scan and test images are accessible through cert. EHR

New for Stage 2

ePrescribing >10% of hospital discharge med orders are transmitted electronically

New for Stage 2

Reporting on Clinical Quality Measures

Reporting on 16 of 29 available CQMs

Successfully report to CMS hospital clinical quality meas. using certified technology.


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MU INITIATIVES

• CPOE• Med Reconciliation• Drug-Drug/ Drug-Allergy

Alerts• Plans of Care – Problem

Management• Patient and Clinical Portals• Data Standards• LOINC Codes/ ELR Interfaces• Ethnicity • Race

• Smoking Status • Immunizations• Discharge Process

– Discharge Assessment– Discharge Clinical Letter– Patient Specific Education

• Transition of Care Document

• Krames Patient Education• ePrescribing


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USES FOR TRANSITION OF CARE DOCUMENT

• One Document leveraged to address the needs of 2 MU measures.

• 50 % of patients able to View online Download and Transmit info related to their hospital visit w/in 36 hours

• 50% of patients transfers or referrals include a Summary of Care doc; 10% of these sent electronically


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TRANSITION OF CARE SECTIONS Extracted from Data Sources Document Header Allergies (RxNorm) Problems and Encounter Diagnosis

(SNOMED-CT) Configured Results (LOINC for

Laboratory) Discharge Medications (RxNorm) Immunizations (CVX) Procedures (SNOMED-CT) Chief Complaint Customer Configurable

Detailed instructions Social History Functional Status Vital Signs (HT, WT, BP, BMI) and

other configured Observations Reason for Visit Treatment Plan Hospital Course


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TRANSITION OF CARE DOCUMENT HEADER

Auto-populated with data when the CCDA has been generated. STAR is the data source The Header includes:

Date range that the document summarizes Location of Care, Entity, Service, Caregivers Race and Ethnicity Patient’s sex and date of birth Patient’s preferred language Account number, medical record number, visit identifier

Patient’s masked Social Security number – Last 4 digits


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CHALLENGES

• Not being able to limit results• Vendor limitations• Capturing Medical Problems • Capturing Procedures


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CHALLENGES (CON’T)

• Auto Generation of ToC• Communication to staff/patients• Patient Provisioning


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DISCHARGE PROCESS• Discharge Assessment

– Timing of Discharge Orders– Appropriate Roles/ Scope of Practice in completion of

assessment– Moving from paper to electronic (Soarian)

• Discharge Instructions Report– Creating a patient friendly, readable report– Supplemented by patient education materials from Krames

• Patient Specific Education ( Krames)• UW Medicine Standard for patient education

– Using “infobutton” in Soarian


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Our MU2 reporting period starts on July 1st, we’ll collect data to prove that we’re meeting our objectives and making it all work

Q: The recognition and incentive reward will be nice, but what’s our real, big-picture goal?A: We have amazing technology & want to use it in the best possible way to benefit our patients!

Secure online website that gives patients convenient 24-hour access to personal health information and other

health tools from anywhere with an Internet connection

THE PATIENT PORTAL

QUESTIONS?


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nwh transition of care document for mu stage 2

Documents

mu stage

eligible patients50

stage 2eprescribing10

data capture

eligible patientsvital

advance clinical processes

med orders30

objectives cont