HFAP and Osteopathic Musculoskeletal Examination

Francis A. Cortez, DO

Introduction to Osteopathic Medicine for Non-DO Faculty:

What Makes an Osteopathic Education Different?

Educational Council of Osteopathic Principles

Photo courtesy of NSU-COM

A.T. Still, MDRural farmer, hunter, inventor,

local politician

Civil War abolitionist

Personal tragedy 1864

Denounces medical treatment

Becomes a medical reformer

Musculoskeletal System (OPP)

American School of Osteopathy in 1892

Osteopathic Medicine30 Accredited Colleges

41 Teaching Locations in 28 states

23,000 future physicians

20% of US medical students

63,000 licensed DO’s

Feb 26, 2014 AOA and ACGME agree to a single GME system

2015-2020 GME Transition

DO and MD will have access to all GME programs

Healthcare Facilities Accreditation Program (HFAP)Accreditation organization with deeming

authority from CMS (Centers for Medicare and Medicaid)

“Our mission is to advance high quality patient care and safety through objective application of recognized standards.”

Several Standards/Elements

Osteopathic Physicians and OME

HFAP Standard 10.01.23

For Osteopathic Physicians (DO)OME is required for every H&P on admitted

patients unless contraindicatedOsteopathic Musculoskeletal Examination

(OME)

The REASON for omitting OME must be documented when contraindicated

HFAP Standard 10.01.23Verify Medical Staff Rules for Osteopathic

Physician

Will pull last 10 inpatient charts discharged by Osteopathic Physician to determine if OME or exemption of OME is documented.

Osteopathic Methods and Concepts CommitteePulled 10 charts50% (Had some mention of OME)

HFAP Osteopathic Musculoskeletal Exam

Appendix B in HFAP

Document OME by either1. Standardized form (Recommended)

2. Narrative report with includes1. Description of exam performed in 2 positions

2. Based on inspection, palpation, motion testing, of spine and pelvis or Major findings of extremities

3. Mention AP and lateral spinal curves, areas of tenderness, spasm, or limited motion

4. If spine not examined, this should be noted along with reason

HFAP Standardized Form

Grandview OME Form

Epic OME Template

EPIC OME TemplateOpen your note

Position Cursor where you want OME

.khnome

Press ENTER

The text with will appear in your note

Putting OME in your H&PEPIC - Smart phrase manager, double click your

H&P template

Position cursor where you want OME to appear@KHNOME@Click acceptWhenever you use your template OME will be

there

You can add OME to any template, note etc.

Osteopathic Musculoskeletal Exam (compliant)

“Patient examined in supine and sitting position, cervical lordosis, thoracic kyphosis were normal, there was decreased lumbar lordosis however there were no gross abnormalities to spine. Muscle Spasm noted to left lumbar region with palpation. Level 1 somatic dysfunction to left lateral lumbar region”

“On seated inspection patient has normal cervical lordosis, thoracic kyphosis and lumbar lordosis. Palpation to these regions reveal no major somatic dysfunction.”

“Exam not performed due to extreme distress”

Unclear“no somatic dysfunction or background levels”

“no kyphosis, no lordosis, no somatic dysfunction”

“Exam deferred”

Using these HFAP standards

GMH3 of 5 OME2 of 3 missing some element of HFAP OMESo only 1 of 5 were compliant

SOIN2 of 5 OME3 “deferred”

Osteopathic Methods & Concepts Committee

Goal is 100% compliance

Pull all charts in next 30 days to evaluate OME

Will provide feedback to physicians

We have room for improvement

Any questions please email me at

Francis.Cortez@khnetwork.org