Integrating Quality Reporting into the Electronic Medical Record

Integrating Quality Reporting into the

Electronic Medical Record

February 28, 2014

Karen Collum, MSN, RN, OCN

Clinical Program Nurse Leader – Transplant Service www. MSKCC.org

Objectives

Introduction

Electronic Documentation development to support

Quality Reporting

Electronic Medical Record features to support Quality

Reporting

Conclusion

OVERVIEW

OBJECTIVES

o

Identify steps within building electronic documentation

to support Quality Reporting

o

Identify areas within the Electronic Medical Record to

INTRODUCTION

o

Hospitals are implementing Electronic Medical Records

(EMR) at a growing rate.

o

EMRs, designed well, can help monitor, improve, and

INTRODUCTION

o

American Recovery and Reinvestment Act of 2009

–

Health Information Technology for Economic and

Clinical Health (HITECH) Act

Incentive program for Medicaid and Medicare programs for demonstrating ‘meaningful use’

INTRODUCTION

Meaningful Use

o

Use of certified EMR technology to

– Improve quality, safety, efficiency, and reduce health disparities

– Engage patients and families in their health care

– Improve care coordination

– Improve population and public health

INTRODUCTION

o

Medicare & Medicaid EHR Incentive Program

Meaningful Use Stage 1 Requirements Overview

o

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/

MU_Stage1_ReqOverview.pdf

ELECTRONIC MEDICAL RECORDS

• Efficient communication

• Enhanced care coordination

• Positive financial return

• Standardization

BENEFITS

• Free text fields

• Scanned laboratory reports

• Inconsistent

Documentation

ELECTRONIC MEDICAL RECORDS

o

Important to determine what information will

need to be retrieved from EMR, while

determining what information needs to be

captured/documented in EMR.

QUALITY IN ELECTRONIC DOCUMENTATION

o

Development of Electronic Documentation

–

Identify significant data routinely captured/ extracted from

EMR related to Transplantation

Customization for individual department/services would need to be addressed

QUALITY IN ELECTRONIC DOCUMENTATION

EXAMPLE: Inpatient Progress/Outpatient Follow Up

o

‘Significant Transplant Data’ (HSCT Summary)

– HSCT Date

– Number of days pre/post Transplant

– Diagnosis – Co-morbidities – Conditioning Regimen – Donor Type – Graft Source – Match – CMV/EBV/Toxo Status

QUALITY IN ELECTRONIC DOCUMENTATION

Inpatient Progress /Outpatient Follow Up Note

o

Specific Fields

– Query-able

o

Standardization/Consistency

– Populated into each note

o

Logic/Calculation (Transplant Date)

QUALITY IN ELECTRONIC DOCUMENTATION

EXAMPLE: Cell Infusion Document

o

Significant Data:

– Cell Infusion Type

– Cell Source – Method – Donor – Manipulation – Bag Number – Cell Doses

QUALITY IN ELECTRONIC DOCUMENTATION

Cell Infusion Document

o

Required Fields

– Increase compliance

o

Data points specific to infusion type

– Manipulation Options different for each Infusion type

– CD 34+ and CD 3+ for Allogeneic Infusions

– CD34+ Only for Autologous

QUALITY IN ELECTRONIC DOCUMENTATION

Cell Infusion Document

o

Electronic Documentation use to increase data capture

compliance

o

Reports used to confirm volumes/statistics and accuracy of data

captured in database.

– Report 1: Complete vs Incomplete Type of Transplant

EXAMPLES

EXAMPLES

QUALITY IN ELECTRONIC DOCUMENTATION

Cell Infusion Document

o

Ways to Use Document Reports

–

Compliance Audit

Are all notes completed/signed out

–

Statistic Report

How many Autologous vs Allogeneic

How many Related vs Unrelated

–

Quality Audit

ELECTRONIC MEDICAL RECORDS

In addition to the Electronic Documentation, the

Electronic Medical Record can be used to

QUALITY IN ELECTRONIC MEDICAL RECORD

o

Sources to Extract Data

–

Laboratory Orders

–

Laboratory Results

–

Medication Orders

–

Patient Care Orders

–

Flowsheets

EXAMPLES

EXAMPLES

QUALITY IN ELECTRONIC MEDICAL RECORD

o

Information can be extracted based on the Order Name or

content of the order

–

Example: Allogeneic Collection/Processing Order

Were the orders placed 48 hours prior to Collection?

–

Example: Allogeneic Donor Eligibility Order

EXAMPLES

QUALITY IN ELECTRONIC MEDICAL RECORD

o

Audit Example

– Orders Received same day

or After product collected: 16% (15% in 3rd Quarter)

– Orders Received 24 hours

or more before product received: 85%

– Collection/Orders

cancelled: 16 orders (This also includes ‘duplicate’ orders)

TOTALS

Data Breakdown Number Percentage

Late

(after product collected)

1

1%

Day of Collection

18

15%

24 hours prior

17

14%

>24 hours prior

87

71%

Cancelled

16

EXAMPLES

EXAMPLES

EXAMPLES

Reasons for Ineligible as documented on the order

CONCLUSION

o

Electronic documentation should not be reproductions of paper

forms.

o

Utilize features of electronic system to enhance documentation

and create smarter documents

– Dropdown/multi-select checkboxes create data that can be extracted

– Calculation logic for dates

CONCLUSION

o

Identifying areas in the EMR where data in

entered/captured will allow for development of reports

for quality review.

CONCLUSION

o

Report Types

–

Delivered – Excel/PDF

Time based (weekly, quarterly)

–

On Demand/Self generated

–

Parameter based

Content pre built

REFERENCES

o _{CMS.gov., (2013). EHR Incentive Programs: Meaningful Use. Retrieved from:}

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html

o _{Price, M., Singer, A, & Kim, J. (2013). Adopting Electronic Medical Records: Are they just}

electronic paper records? Cancer Family Physician, 59 e322-9

o _{Silow-Carroll, S., Edwards, J., & Rodin D. (2012). Using Electronic Health Records to}

Improve Quality and Efficiency: The Experience of Leading Hospitals. The

ACKNOWLEDGEMENTS

• ASBMT Administrative Directors SIG Quality Working Committee

– Kathie Viers, RN, MS CPHQ

– Leslie Parran, MS, RN, AOCN, NE-BC

• Memorial Sloan Kettering Cancer Center

– Transplant Service

– Information Systems Team