1. MU: The Right Way, The
Wrong Way… and Breaking
Through the Confusion
Reid W Coleman MD FACP
MIO, Lifespan

2. Disclaimer!!!
 Presentation title provided by conference
organizers
 It assumes I know the right way!!??
 My title would have been…

3. A CMIO Looks At MU: The
View From Under The Bus

4. They Might Be Right
 Lifespan
 Four hospitals, three med surg
 1000 beds
 Half teaching, half private
 We’ve registered for year one
 Submitting the end of this month
 We think we’re okay for Stage Two

5. Our Approach
 Map the criteria to improvements that are
evidence based for quality and safety
 If the criteria are not evidence based (?patient
empowerment?) link them to something that
is
 Present this as an incentive to do what we
should do anyway
 Meet the criteria in a ‘meaningful’ way

6. Some Wrong Ways
 Duck and Cover
 One and Done
 Take the Money and Run

7. Duck and Cover
 Did you ever practice  This is a good
duck and cover at time to start!
school?

8. It Really Stinks to Be You
 You were responsible for all clinical errors
 Now you’re responsible for the financial
survival of your hospital as well
 A case can be made that the investment is too
high, the return too low, and the penalties are
tolerable
 Not a case you want to make

9. One and Done
 Some criteria for year one are measured by
“do one”
 Orders
 Problems
 Home Meds
 Immunization submission
 Generate a report
 Etc.

10. One and Done Has This Problem:
 After year one we’re done
 Slammed short term solutions don’t get you to
Stage 2
 What happens year two if you can’t substantiate
what you attested to?

11. Take the Money and Run
 It is possible that 2012 elections will produce
big changes
 Health care reform gets undone
 HITECH gets unfunded
 If this happens, getting what you can year one
is the goal…
 But if it doesn’t happen, then what…

12. Take the Money and Run
 If your hospital is sharing meaningful use
money with the docs, you live in a different
universe and should not be here
 Telling the clinicians that you’re doing this
for the money for the hospital will not make
them enthusiastic participants
 If you can’t make a case for improved quality
and safety you have a steep hill to climb

13. One Approach – Seven Projects
(Plus 3)
 Project #1 – Meeting Standards
 Project #2 – Electronically Collect Clinical
Information
 Project #3 – Transitions of Care
 Project #4 – Quality Indicators
 Project #5 – Patient/Provider Access to Information
 Project #6 – Protecting Patient Information
 Project #7 – Communication and training

14. Standards
 “LOINC’d” lab and diagnostic imaging
 Both orders and results
 It is a lot of work
 None of it is rocket science (remind me to brag here)
 Problem List in SNOMED
 NLM subset
 ICD-9 crosswalk
 RxNorm is not ready for prime time

15. Electronic Clinical Documentation
 CPOE – no longer a question, is it?
 Nursing
 “LIP’s” (I really hate this expression)
 Home meds
 Two approaches
 Collect as data
 Use NLP
 Collect as data is more work but provides a great
foundation for the future

16. Transitions of Care
 The CCD (or CCR) is the Holy Grail
 The more defined data you collect, the easier
it is to build
 A discharge instruction process wins friends
 Med Rec does not, but a pharmacy profile
from RxHub/Surescripts does

17. Quality Indicators
 Personal goal: chart abstraction will be a
memory by the time I retire
 If orders, meds, nursing observations, results,
discharge meds, and diagnosis are defined
data, quality measures flow
 If not, NLP is not a full solution but it works

18. Patient Provider Access
 No evidence supporting patient access
 Make it a subset of provider access
 Good support for this…
 Provider access
 Registry/Repository
 XDS.b

19. Protect Patient Information
 Baked into all our systems…
 Yours, too?

20. Communication and Training
 Weekly messages from the CMO’s
 Many messages from the CEO’s
 All say:
This is a quality
and safety project

21. Plus 3
 Technology
 Dragon has not been as popular as we thought
 IPads have been
 Certification
 Avoid self certification if you can – it is a
quagmire
 Actualization
 Complicated but not impossible; don’t neglect the
work to get the money….

22. Thanks
Questions?
 Reid Coleman
 rcoleman@lifespan.org
 401-444-6448
 We share most everything