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Health Care Quality Improvement for Meaningful Use Adrienne Mims, MD MPH Medical Director for Medicare Quality Improvement GMCF

Healthcare quality improvement for meaningful use

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Page 1: Healthcare quality improvement for meaningful use

Health Care Quality Improvement

for Meaningful Use

Adrienne Mims, MD MPHMedical Director for Medicare Quality Improvement

GMCF

Page 2: Healthcare quality improvement for meaningful use

Health Care Quality Improvement for Meaningful Use

AGENDA

• What is meaningful use? Why is it relevant for TeleHealth?

• The quality improvement process

• Resources

Page 3: Healthcare quality improvement for meaningful use

Meaningful Use

The American Recovery and Reinvestment Act of 2009 authorizes the Centers for Medicare & Medicaid Services (CMS) to provide a reimbursement incentive for physician and hospital providers who are successful in becoming “meaningful users” of an electronic health record (EHR).

Page 4: Healthcare quality improvement for meaningful use

Meaningful Use is using certified EHR 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

• All the while maintaining privacy and security

Relevant for TeleHealthcare?

Page 5: Healthcare quality improvement for meaningful use

Three components – Use of certified EHR• in a meaningful manner• for electronic exchange of health information to

improve quality of health care• to submit clinical quality measures

Meaningful Use

Established 3 stages of meaningful use: 2011, 2013 and 2015

Page 6: Healthcare quality improvement for meaningful use

Meaningful Use

Stage 1 Objectives and Measures Reporting

Must complete: 15 core objectives

5 objectives out of 10 from menu set

6 total Clinical Quality Measures (out of 38)

Page 7: Healthcare quality improvement for meaningful use

Meaningful Use 15 Core Objectives

1. Computerized physician order entry2. E-Prescribing3. Report ambulatory clinical quality measures to

CMS/States4. Implement one clinical decision support rule5. Provide patients with an electronic copy of their health

information, upon request6. Provide clinical summaries for patients for each office

visit7. Drug-drug and drug-allergy interaction checks8. Record demographics

Page 8: Healthcare quality improvement for meaningful use

9. Maintain an up-to-date problem list of current and active diagnoses

10. Maintain active medication list

11. Maintain active medication allergy list

12. Record and chart changes in vital signs

13. Record smoking status for patients 13 years or older

14. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically

15. Protect electronic health information

Meaningful Use 15 Core Objectives

Page 9: Healthcare quality improvement for meaningful use

Meaningful Use 5 out of 10 Menu Objectives

• Incorporate clinical lab test results as structured data

• Generate lists of patients by specific conditions• Send reminders to patients per patient preference

for preventive/follow up care• Provide patients with timely electronic access to

their health information• Use certified EHR technology to identify patient-

specific education resources and provide to patient, if appropriate

Page 10: Healthcare quality improvement for meaningful use

• Medication reconciliation

• Summary of care record for each transition of care/referrals

• Capability to submit electronic data to immunization registries/systems

• Capability to provide electronic syndromic surveillance data to public health agencies

• Drug-formulary checks

Meaningful Use 5 out of 10 Menu Objectives

Page 11: Healthcare quality improvement for meaningful use

How can you evolve into a system of meaningful use?

A structured methodology is needed

Page 12: Healthcare quality improvement for meaningful use

Quality Improvement is a formal approach to the

analysis of performance and systematic efforts to

improve it.

Page 13: Healthcare quality improvement for meaningful use

Quality Improvement - Methods

FADE = focus, analyze, develop, execute, evaluate

PDSA = plan, do, study, act

Six Sigma = (define, measure, analyze, improve,

control)

CQI = Continuous Quality Improvement

TQM = Total Quality Management

Utilize an approach that matches employees and company’s culture.

Page 14: Healthcare quality improvement for meaningful use

Support for Quality Improvement

• Leadership Team *− Executive sponsor− Project sponsor− Improvement leader

• Design team• Additional stakeholders

* Upper management must be on board Realistic expectations of ROI

Page 15: Healthcare quality improvement for meaningful use

Did you develop a project charter or set definitive goals?

Examples:– Foster better communication

between providers

– Implement e-prescribing

– Achieve meaningful use

– Reduce 30-day readmission rate

Page 16: Healthcare quality improvement for meaningful use

Fundamental Questions for Improvement

• What are we trying to accomplish?

• How will we know that a change is an improvement?

• What changes can we make that will result in an improvement?

Page 17: Healthcare quality improvement for meaningful use

To improve, you must make changes.

But…

Not all changes lead to improvement

Page 18: Healthcare quality improvement for meaningful use

Model for Improvement

What are we trying to accomplish?

How will we know a change is an improvement?

What change can we make that will result in Improvement?

Aim

Measures

Ideas

PLAN DO

ACT STUDY

Page 19: Healthcare quality improvement for meaningful use

Why an Aim Statement?

• Answers and clarifies “What we are trying to accomplish?”

• Creates a shared language to communicate the project to others.

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Aim Statement

S = pecificM = easureable

A = ttainable

R = elevant/realistic

T = imely

Page 21: Healthcare quality improvement for meaningful use

Defining the Measures

A good aim statement helps define the measures.• Measurement should not slow things down

• Seek usefulness, not perfection

• Use sampling

• Use accessible measures (don’t wait for IT)

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AIM Statement

To increase the number of patients with diabetes who have urine kidney tests performed from 25% to 50% by June 2011

Page 23: Healthcare quality improvement for meaningful use

Did you collect baseline measurement?

Measurement defines expectations and values• Evaluate compliance

− Compare to benchmarks− Track improvements− Identify opportunities

• Used by stakeholders− Improve care− Provider selection− Align incentives

Data drives decision making

Page 24: Healthcare quality improvement for meaningful use

Types of Data

• Patient self-reported data− HRA− Productivity− Satisfaction surveys

• Demographic • Plan design• Medical claims• Pharmacy claims• Laboratory data• Biometric screening• Disability data

Page 25: Healthcare quality improvement for meaningful use

Measure Caveats

• Measure types Structure: physical equipment and facilities

Process: how the system works/demonstrates compliance

with the current process

Outcome: demonstrates the overall impact of the new

process/the final product or results

• Data collection is resource-intensive

• Robust IT systems enable more efficient, timely reporting

• Use of case studies to clarify through examples

Page 26: Healthcare quality improvement for meaningful use

“Data collection and analysis is a journey,

one that must be taken carefully and with

significant deliberation, but one that has the

potential to bring great value”

~ Jan Berger, MD

• Get buy-in and agreement across the organization• Create partnerships• Identify data sources• Convene a data summit• Collect and analyze data

Page 27: Healthcare quality improvement for meaningful use

What does our process look like?

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Page 29: Healthcare quality improvement for meaningful use

Process Mapping

• What are the steps that you would go through as a patient for an office visit in primary care?

• Procedure– Identify who is involved in the process– Identify the starting and end points– Draw swim lines and post the steps in the

process over time– Map the process using sticky notes– Use 2 words for the process (noun + verb)

Page 30: Healthcare quality improvement for meaningful use

Swim Lanes Receptionist

               

               

Nurse               

               

Physician               

               

Lab               

               

Health Education               

               

Pharmacy               

               

Check out               

               

Page 31: Healthcare quality improvement for meaningful use

What is the root of the problem?

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Was a root cause analysis performed?

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Pick one area to focus on for improvement at a time

Page 34: Healthcare quality improvement for meaningful use

PDSA Cycle for Process Improvement

• What changes are to be made?

• Next cycle?

• Objective• Questions and predictions• Plan to carry out the cycle

(who, what, where, when)• Plan for data collection

PLAN

• Carry out the plan• Document the problems

and unexpected observations

• Begin analysis of the data

DO• Complete the analysis

of the data• Compare data to

predictions• Summarize what is

learned

STUDY

ACT

Page 35: Healthcare quality improvement for meaningful use

PDSA Pitfalls

• Plan, Plan, Plan, Panic

• The Nike Model “Just do it”

• The research model – Plan-do-study-publish

• Neglecting to follow up on previous changes introduced (leaving out the “s”)

• Piloting on a large scale – more than just a test

• “Do” and “Act” are NOT a PDSA cycle

Page 36: Healthcare quality improvement for meaningful use

Was an action plan created? 

Action PlanItem Person (Who) Action (What)

Target Date (When) Follow Up

After visit/discharge

Summary Lead MD Consider adding

diagnosis and medication 11/21/10 Pending

Registry of patients on Warfarin Analyst

Determine the volume and distribution of patients on Warfarin 1/15/11

Wallet card evaluation

Lab assistant Hand each patient with survey 10/1/10 Complete

Page 37: Healthcare quality improvement for meaningful use

How are projects steps tracked?

Internal Quality Control Measures

Indicator Name Patient Satisfaction Days without staff call outs

Measure Frequency Quarterly Monthly

Data Source Survey Daily Schedule

Numerator 50 10

Denominator 100 20

Final Goal 80% 10%

Most Recent Measurement Period Fall 2010 December

Most Recent Measure 50% 50%

Interim Goal 75% 20%

Variance 5% 30%

RCA Needed? Yes Yes

Page 38: Healthcare quality improvement for meaningful use

Were interim measures defined?  If so, are they tracked on a dashboard?

Page 39: Healthcare quality improvement for meaningful use

What is the reporting mechanism for informing others of the project?

www.gmcf.org

Page 40: Healthcare quality improvement for meaningful use

Summary

Obtaining Meaningful Use

certification is a goal that can

be accomplished through a

well-planned quality

improvement process.

Page 41: Healthcare quality improvement for meaningful use

Resources

Get information, tip sheets and more at CMS’ official website for the

EHR incentive programs: www.cms.gov/EHRIncentivePrograms

Learn about certification and certified EHRs, as well as other ONC

programs: http://healthit.hhs.gov

Learn about Georgia’s Regional Extension Center Institute for

Healthcare Improvement: http://www.ihi.org/IHI/

GMCF – The Medicare Quality Improvement Organization for Georgia:

www.gmcf.org [email protected]

Page 42: Healthcare quality improvement for meaningful use

This material was prepared by GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 9SOW-GA-PRV-11-03