ARRA Stage 1 Meaningful Use
Journey to Attestation
Pamela Feeler, RNC
Director of Nursing Informatics, PCRMC
Phelps County Regional Medical Center
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235 Licensed Beds
MEDITECH MAGIC 5.64
Located in Rolla, Missouri
Approx 100 miles between St. Louis and
Springfield
History
2001
• IT Steering Committee
• Physician Advisory Committee – paid
advisory committee
• Super User Community
• PCRMC Board Support
2011
• Meaningful Use 2011 – Not an IT project
• Requires entire organization
Timeline
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
Gap Analysis
Worked
with Education,
RxNorm
Go LIVE
PDI Loaded
90-Day
MedisolvCodes
Team on
Documentation
Attestation
Meditech
Work Flows
Begins June 1
Assembled
Upgrade to
ConsultReport
with Building
Team
5.64
Consult PACS
with regarding
with Medisolv
Identify
PACS regarding
CQM decisions
and Validation
Menu
CQM decisions
Objectives
Built CDSs, PDoc
Built CDSs,
Templates,
PDoc Order
Templates,
Sets
Order
Sets
SEPT
OCT
NOV
DEC
Received
90-Day Entered
Attestation
Attestation
Ends datapayments for
Medicaid and
Aug 29 on ARRA
Medicare
Meaningful Use
Attestation
Website Sept
19th
Meaningful Use Team
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Project Manager
Director of IT Applications
Director of Nursing Informatics
IT Pharmacist
Clinical Quality Measurement
Physician IT Liaisons
Physician Advisory Committee (Ad hoc)
Attestation Committee (CFO, CIO, COO,
CCO)
Core and Menu Objectives
Required
Threshold
Objective
Type
Patient Demographics
Core
50%
Vital Signs/Growth Charts
Core
50%
Up-to-date problem list
Core
80%
Active Medication List
Core
80%
Active Medication Allergy List
Core
80%
Smoking Status
Core
50%
Electronic Discharge Instructions
Core
50%
Electronic copy of PHI
Core
50%
CPOE Medication Orders
Core
30%
Drug-Drug/Drug-allergy Interaction checks
Core
Implemented
Electronic Exchange Key Clinical Information
Core
Implemented
Clinical Decision Support Rule
Core
Implemented
Privacy/Security Systems to protect data
Core
Implemented
Report Clinical Quality Measures to CMS/State
Core
Implemented
Drug Formulary
Menu
Implemented
Advance Directives
Menu
50%
Lab Tests in EHR
Menu
40%
Syndromic Surveillance Interface
Menu
Implemented
Patient specific education resources
Menu
10%
Immunization Interface
EHR
Implemented
Lab Interface
EHR
Implemented
CCD Interface - MEDITECH
EHR
Implemented
Prepare Foundation
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MEDITECH Upgrade to 5.64
OS Upgrade
Rx Norm Code Download
Patient Discharge Instruction
Implementation
• Medisolv Encor+ Beta site
• Iatrics CCD
Clinical Quality Measures
• VTE
• Stroke
• ED Throughput
(19 Measures)
Useful Documents
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MEDITECH Best Practices
HITSP Document
CMS clarifications
Testing Certification Document
MEDITECH Best Practices
Data Capture for VTE Measures
Meaningful Use Requirement: Centers for Medicare & Medicaid Services (CMS) identified
15 clinical quality measures that eligible hospitals need to report on to meet Meaningful Use
incentives for Stage 1. Hospitals must report clinical quality measures results to Centers for
Medicare & Medicaid Services to meet the program requirements. There are currently six
venous thromboembolism (VTE) measurements included.
Overview
In order for organizations to meet Centers for Medicare & Medicaid Services clinical quality
measures for Meaningful Use incentives, a workflow for VTE measure data capture needs to
be developed. The workflow should be efficient in meeting the measures, as well as, safe for
hospital practice. This Best Practice outlines this process – which captures the required data
in a structured and codified format for Meaningful Use. Capturing data in a structured and
codified format is key in identifying patients for inclusion and exclusion in the reporting
algorithms. Centers for Medicare & Medicaid Services requires the use of TN906 - Quality
Measures Technical Note Version: 1.1 specifications for the VTE measures and is referenced
throughout this document. Please see the HITSP Web site
http://www.hitsp.org/ConstructSet_Details.aspx?&PrefixAlpha=5&PrefixNumeric=906 for
more information.
VTE Measure
Details
VTE - 1 NQF 0371
Title
VTE prophylaxis within 24 hours of arrival (including
surgeries)
Description
This measure assesses the number of patients who
received VTE prophylaxis or have documentation why no
VTE prophylaxis was given the day of or the day after
hospital admission or surgery end date for surgeries that
start the day of or the day after hospital admission.
MEDITECH Best Practice Document
www.meditech.com
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Description of Each Measure
Numerator Statement
Denominator Statement
MEDITECH Fields for Denominator Reporting
Recommended Workflows (with screen shots)
Related Joint Commission Value Set Tables with
RXNorm, LOINC, and SNOMED Codes
Process Investigation
• Determine best workflows and methods
for documentation. Very important for
future compliance.
• Physician Advisory Committee
recommendations regarding physician
workflow and best methods
• Worked with Medisolv on workflows and
reporting
Example: Stroke 4
Acute Ischemic stroke patients
arriving to hospital within two hours of
the last known time well will receive
IV t-PA within three hours of last
known time well
Stroke 4 Workflow
Physician
Documentation
Nursing
Documentation
Physician Order
Dx Acute Ischemic
Stroke
IV-tPA
Contraindicatio
n
Time last
well
Unknown
last well
Abstracting
EMAR
SNOME
D
Calculatio
n
SNOME
D
ICD
Procedur
e Code
RXNOR
M
Physician
Documentation
Carotid Intervention
Abstracting
ICD
Procedur
e Code
Nursing Documentation of
Symptom Onset Time
Physician Order for t-PA
(ED CVA/Mental Status Order Set)
Physician order for documentation
of contraindication for t-PA
Consolidation of Documentation
• When possible to maximize efficiency, we
consolidated documentation
• Example: Contraindication of
medications for Stroke 2,3, and 6 were
placed on Discharge Instructions for
Stroke
Physician Discharge Function
Physician Discharge documentation of
contraindications to Stroke measure
medications
CQM Reporting
• Medisolv Encor+ beta site
• Tool used for reporting and validation of
data
• Very useful for education and drilling
down to points of failure in process
Encor+ Reporting Results
Issues and Concerns
Encountered
• RX Norm Issue
– JC Value sets missing many Semantic Branded Codes
• For us this included all of our Lovenox and Warfarin
– CMS Response: “Most HITSP RxNorm value sets
only include Semantic Clinical Drug codes. This is, in
our opinion, desirable, because given any Semantic
Branded Drug, you can always compute the
corresponding Semantic Clinical Drug, and it keeps
the value sets more manageable. There are cases
where HITSP RxNorm value sets also or instead
include Semantic Branded Drug value sets - there’s no
harm in this, it’s just inconsistent and harder to
maintain. You may map all possible medications used
in patient care to the related RxNorm codes
referenced in the HITSP specifications.” June 30,
2011.
RX Norm Codes
Issues and Concerns
• Missing Data in DR
– Requires higher Level of use of DR than ever
before
– Through validation process with Encor+ –
noted that data missing in tables in DR
– MEDITECH reloaded tables to correct;
reloads may be time consuming (weeks)
– Needed to develop methods to ensure
accuracy of DR - Implementing a DR auditor
tool
Clinical Quality Measures Attestation
Measure
Denominator
Numerator
Exclusions
Stroke 2
13
1
6
Stroke 3
4
0
3
Stroke 4
13
0
0
Stroke 5
13
11
1
Stroke 6
13
1
6
Stroke 8
2
1
0
Stroke10
13
2
6
VTE 1
2042
583
1051
VTE 2
101
32
46
VTE 3
0
VTE 4
1
0
1
VTE 5
7
0
5
VTE 6
12
3
9
Eligible Instances
Median (min)
ED 1.1
624
256
ED 1.2
241
273
ED 1.3
710
252.5
ED 2.1
624
83
ED 2.2
241
68
ED 2.3
710
77
PCRMC Results at end of 90 days
Required
Threshold
90-Day
Compliance
Objective
Type
Patient Demographics
Core
50%
98%
Vital Signs/Growth Charts
Core
50%
83%
Up-to-date problem list
Core
80%
100%
Active Medication List
Core
80%
99%
Active Medication Allergy List
Core
80%
99%
Smoking Status
Core
50%
98%
Electronic Discharge Instructions
Core
50%
N/A
Electronic copy of PHI
Core
50%
100%
CPOE Medication Orders
Core
30%
80%
Drug-Drug/Drug-allergy Interaction checks
Core
Implemented
Implemented
Electronic Exchange Key Clinical Information
Core
Implemented
Implemented
Clinical Decision Support Rule
Core
Implemented
Implemented
Privacy/Security Systems to protect data
Core
Implemented
Implemented
Report Clinical Quality Measures to CMS/State
Core
Implemented
Implemented
Drug Formulary
Menu
Implemented
Implemented
Advance Directives
Menu
50%
100%
Lab Tests in EHR
Menu
40%
100%
Syndromic Surveillance Interface
Menu
Implemented
Implemented
Patient specific education resources
Menu
10%
79%
Immunization Interface
EHR
Implemented
Implemented
Lab Interface
EHR
Implemented
Implemented
CCD Interface - MEDITECH
EHR
Implemented
Implemented
Sweet Success!!