Agenda. Topic Industry Today - Quality Measure Reporting Stage 1 Meaningful Use - Overview - Tenet Experience

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Achieving Meaningful Use Symposium

Eligible Hospital Perspective – Stage 1 Learnings, Stage

2 Preparation

Liz Johnson, MS, FHIMSS, CPHIMS, RN-BC, VP, Applied Clinical Informatics, Tenet Health

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Agenda

Topic

Industry Today - Quality Measure Reporting

Stage 1 Meaningful Use

- Overview

- Tenet Experience

Stage 2 Meaningful Use

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The Industry Today

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1999 IOM Report:

• 44K – 98K patients die each year from medical errors • 18 types of medical errors account for 2.4 million

hospital days and $9.3B in excess charges per year

Quality Reporting Today Merges Quality and

Finance

1999 2001 2003 2006 2008 2009 2010

Quality Reporting

Compliance 11%-79% of the time

McGlynn EA et al. NEJM 2003; 348:2635-2645

PQRI

HACs MS-DRGs

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The New York Times, June 2, 2010

Does Higher Reimbursement Equal Better

Quality?

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The Cost Conundrum

• McAllen, TX

– Lowest household income in

country ($12,000/yr)

– One of most expensive healthcare markets in country

($15,000/enrollee/yr)

• El Paso, TX

– 8 miles from McAllen

– Same demographics

– Lower Medicare expenditures

($7,504/enrollee/yr)

• How to reconcile the difference?

– Pay for quality, not quantity…

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The Rate of HIT Change Used to Be Leisurely

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Regulations Accelerated Change Exponentially

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EHR Incentive Program Meaningful Use

Detailed Components

A hospital must be a “meaningful user” to receive payment incentives By law, a “meaningful user” must:

Staged approach over several years

• Stage 1 – Data Capture & Sharing

• Final rule published in 2010 • Begin data collection in 2011 • Stage 2 – Advanced Clinical

Processes

• Final rule due July 2012 • Begin data collection

October 2013

• Stage 3 – Improve Outcomes • Final rule due ~ end of 2013 • Use a certified EHR

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Meaningful Use Stage 1 Measure Breakdown

Demonstrate MU The Measures Utilization Measures (24) Core (14)* Yes/No Menu (10) Clinical Quality Measures (15) Aggregate/ calculate from electronic specs Percent based -automate numerator, denominator

* One utilization measure is Report Clinical Quality Measures

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EHR Incentive Program

Registrations and Payments through 12/11

Monthly stats available at http://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Reg_Rpt.zip

Medicare/ Medicaid

Provider/ Hospital

Registered Attested Paid

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Tenet

Healthcare Corporation

One of the Largest Investor-Owned Health Care Delivery Systems in the Nation

• 50 acute care hospitals in 11 states • 90outpatient centers

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CPOE Live (9) In Flight (33)

Key

2012 IMPACT Rollout Schedule

•CPOE Go Live at 19 hospitals

•Foundation Systems* at 11 hospitals •Cerner OB rollout for 3 hospitals •ED pilot and ePrescribing kickoff

•Optimization Program initiated, initial focus 1st_{7 CPOE hospitals}

2012 Initiatives

•38 hospitals live on Foundation Systems •26 hospitals live on CPOE •26 hospitals will attest for

Meaningful Use Stage 1

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Meaningful Use Life Cycle – Tenet Program

Meaningful Use Stage 1 Requirements Provide Users a Certified EHR Enterprise Wide Data Warehouse Meaningful Use Dashboard Monitor & Track

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Tenet’s Approach to “Electronify” Measures

Data Warehouse PBAR* Cerner* EDW* Identify Content Sources Develop Processes Workflows Impacted Reporting Compliance Capture Data MU Dashboard Make Design Decisions 19

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The Tenet MU Attestation Process

Attestation Scheduled Attestation Evidence Collected or Generated Attestation Acknowledgement and Response Hospital Sponsor Review and Sign-off

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Meaningful Use Attestation Documentation

– Compliance tool that supports the hospital workflows to complete the attestation for submission to Headquarters

– Reminder tool for start and end times associated with Meaningful Use attestation timelines

– Central repository for

• Links to instructions for steps to attestation • Attestation responses for each hospital

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Meaningful Use Attestation

Evidence Checklist Example

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Lessons Learned Engage Entire Team to

Keep Process Moving Forward

• Make decisions focused towards the horizon

Bigger than you think

• Have end users test function and provide feedback prior to release • Improve process continuously

• Don’t be reactive – keep larger picture in mind

Avoid pitfalls

• Have program ownership at all operating levels

• Have shared vision with leadership on clinical and financial goals • Ensure open feedback loop

Focus on end goal

• Creative physician training

• Balance CDS strategy to avoid “alert fatigue”

• Include clinicians in review process, and incorporate their suggestions

Keep clinicians engaged

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Preparing for

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Stage 2 -Most Significant for Eligible Hospitals

• Continued adoption 30 to 60% and expansion - rad and lab CPOE

• Integration into EHR, 30% medication orders automatically tracked

eMar

• Generate and transmit 10% of all hospital discharge orders ePrescribing for discharge meds

• Patient access required Patient View and download

• Requirement note to be “searchable” Physician Notes

• Format still being defined – CCD Summary of Care/Care

Plan/CareTeam

• Selection of measure(s) and criteria for demonstration of improvement

Clinical Decision Support

• eMeasure still being defined by HITPC Quality Measures Working Group

Clinical Quality Measures

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Prepare for Future

CPOE Developed our plan

for 80%

eMar _{Part of our Standard}

Implementation

CDS Part of our Standard

Implementation

Menu

Develop reporting and

compliance for all 10 Menu Set measures providing flexibility in choosing 5 for submission

ePres Software license in

place

Quality Measures

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Prepare for the Future

• Develop reporting capabilities to deliver all 15 electronic specified quality measures • Incorporate specific data elements in the EHR build design for 20 measures

proposed for Stage 2 and 3

• Ability to drill down to the patient and

nursing unit 68.0% 80.0% 80.6% 84.2% 89.5% 90.3% 100.0% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Stroke-5 Antithrombotic Therapy by Day 2 (Ischemic

Stroke)

Quality Measures Measured Electronically 90 Days

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Alerts will expand in

logic, with more

interpretation and proactive

interventions, such as….

Clinical Decision Support Rules – Blood transfusions – IV to PO conversion reminders – Restraint monitoring – Advanced Directives – Vaccine administration – VTE therapy – Etc

Better Analytics – Decision Support, Alerts

“Mrs. Jones’ creatinine has

doubled over last 6

months, from 0.5 to

1.0, consider switching her

ACE Inhibitor to an ARB for

her hypertension therapy.”

Prepare for the Future

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eMar - Tools to improve safety: barcode scanners

• New workflow for nurses and pharmacy • Allows us to capture “near miss” information Barcode Scanners Today Future

Prepare for the Future

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Lessons Learned

Maintain corporate support for Meaningful Use Project and New Reimbursement Models

Budgets don’t end at the end of Stage 1 attestation

Plan out projects to continue for at least 6 months beyond Stage 2 attestation

Remember there is a Stage 3….proposed rule due for release about 12 to 18 months after Stage 2 is released

Collect data for ALL measures during stage 1

Strive to stage 2 thresholds during stage 1

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Don’t let the future be the enemy of now…

Imagine a world where integrated data…

EHR Data Pharmacy Data Lab Data Medical Device Data Radiology Data Improved Disease Mgmt Better informed Clinicians Safer Care Improved Satisfaction

…becomes information that drives patient care

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Meaningful Use as a Stepping Stone for

Meaningful Care

“Liz Johnson”

EHR Implementation Roll out

Enterprise Data Warehouse

• Financial gains (MU, VBP) • Time to adjust workflows

Fully Integrated Data

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