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Health Care Quality Improvement for Meaningful Use,[object Object],Adrienne Mims, MD MPH,[object Object],Medical Director for Medicare Quality Improvement,[object Object],GMCF,[object Object]
Health Care Quality Improvement for Meaningful Use,[object Object],AGENDA,[object Object],What is meaningful use? Why is it relevant for TeleHealth?,[object Object],The quality improvement process,[object Object],Resources,[object Object]
Meaningful Use,[object Object],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).  ,[object Object]
Meaningful Use is using certified EHR technology to…,[object Object],•  Improve quality, safety, efficiency, and reduce health disparities,[object Object],•  Engage patients and families in their health care,[object Object],•  Improve care coordination,[object Object],•  Improve population and public health,[object Object],•  All the while maintaining privacy and security,[object Object],Relevant for TeleHealthcare?,[object Object]
Meaningful Use,[object Object],Three components – Use of certified EHR,[object Object],in a meaningful manner,[object Object],for electronic exchange of health information to improve quality of health care,[object Object],to submit clinical quality measures,[object Object],Established 3 stages of meaningful use: ,[object Object],2011, 2013 and 2015,[object Object]
Meaningful Use,[object Object],Stage 1 Objectives and Measures Reporting,[object Object],Must complete: ,[object Object],[object Object]
 5 objectives out of 10 from menu set
 6 total Clinical Quality Measures (out of 38),[object Object]
Meaningful Use 15 Core Objectives,[object Object],Maintain an up-to-date problem list of  current and active diagnoses,[object Object],Maintain active medication list,[object Object],Maintain active medication allergy list,[object Object],Record and chart changes in vital signs,[object Object],Record smoking status for patients 13 years or older,[object Object],Capability to exchange key clinical information among providers of care and patient-authorized entities electronically,[object Object],Protect electronic health information ,[object Object]
Meaningful Use 5 out of 10 Menu Objectives,[object Object],Incorporate clinical lab test results as structured data,[object Object],Generate lists of patients by specific conditions,[object Object],Send reminders to patients per patient preference for preventive/follow up care,[object Object],Provide patients with timely electronic access to their health information,[object Object],Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate,[object Object]
Meaningful Use 5 out of 10 Menu Objectives,[object Object],Medication reconciliation,[object Object],Summary of care record for each transition of care/referrals,[object Object],Capability to submit electronic data to immunization registries/systems,[object Object],Capability to provide electronic syndromic surveillance data to public health agencies,[object Object],Drug-formulary checks,[object Object]
How can you evolve into a system of meaningful use?,[object Object],A structured methodology is needed,[object Object]
Quality Improvement is a formal approach to the analysis of performance and systematic efforts to improve it. ,[object Object]
Quality Improvement - Methods,[object Object],FADE=focus, analyze, develop, execute, evaluate,[object Object],PDSA=plan, do, study, act,[object Object],Six Sigma=(define, measure, analyze, improve, ,[object Object],                      control),[object Object],CQI=Continuous Quality Improvement ,[object Object],TQM=Total Quality Management ,[object Object],Utilize an approach that matches employees and company’s culture.,[object Object]
Support for Quality Improvement,[object Object],Leadership Team*,[object Object],[object Object]
Project sponsor
Improvement leaderDesign team,[object Object],Additional stakeholders,[object Object],* Upper management must be on board Realistic expectations of ROI,[object Object]
Did you develop a project charter or set definitive goals?,[object Object],Examples:,[object Object],Foster better communication between providers,[object Object],Implement e-prescribing,[object Object],Achieve meaningful use,[object Object],Reduce 30-day readmission rate,[object Object]
Fundamental Questions for Improvement,[object Object],What are we trying to accomplish?,[object Object],How will we know that a change is an improvement?,[object Object],What changes can we make that will result in an improvement?,[object Object]
To improve, you must ,[object Object],make changes.But…,[object Object],Not all changes lead to improvement,[object Object]
Model for Improvement,[object Object],What are we trying to accomplish?,[object Object],Aim,[object Object],How will we know a change is an improvement?,[object Object],Measures,[object Object],What change can we make that will result in Improvement?,[object Object],Ideas,[object Object],      PLAN          DO,[object Object],       ACT         STUDY,[object Object]
Why an Aim Statement?,[object Object],Answers and clarifies “What we are trying to accomplish?”,[object Object],Creates a shared language to communicate the project to others.,[object Object]
Aim Statement,[object Object],S =pecific,[object Object],M = easureable,[object Object],A= ttainable,[object Object],R=elevant/realistic,[object Object],T  =imely,[object Object]
Defining the Measures,[object Object],A good aim statement helps define the measures.,[object Object],Measurement should not slow things down,[object Object],Seek usefulness, not perfection,[object Object],Use sampling,[object Object],Use accessible measures (don’t wait for IT),[object Object]
AIM Statement,[object Object],   To increase the number of patients with diabetes who have urine kidney tests performed from 25% to 50% by June 2011,[object Object]
Did you collect baseline measurement?,[object Object],Measurement defines expectations and values,[object Object],Evaluate compliance ,[object Object],[object Object]
Track improvements
Identify opportunitiesUsed by stakeholders,[object Object],[object Object]
Provider selection
Align incentivesData drives decision making,[object Object]
Types of Data ,[object Object],Patient self-reported data,[object Object],[object Object]
Productivity
Satisfaction surveysDemographic ,[object Object],Plan design,[object Object],Medical claims,[object Object],Pharmacy claims,[object Object],Laboratory data,[object Object],Biometric screening,[object Object],Disability data,[object Object]
Measure Caveats ,[object Object],Measure types ,[object Object],[object Object]
Process:how the system works/demonstrates compliance with the current process
Outcome:demonstrates the overall impact of the new process/the final product or resultsData collection is resource-intensive,[object Object],Robust IT systems enable more efficient, timely reporting,[object Object],Use of case studies to clarify through examples,[object Object]
“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”,[object Object],~ Jan Berger, MD,[object Object],[object Object]
Create partnerships
Identify data sources
Convene a data summit
Collect and analyze data,[object Object]
Healthcare quality improvement for meaningful use

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Healthcare quality improvement for meaningful use

Notes de l'éditeur

  1. As healthcare is increasingly delivered by telehealth technologies, looking into the future to plan that these visits meet the qualification for meaningful use is helpful.
  2. All goals that are relevant to TeleHealthcare
  3. The root cause template makes it easy to: Quickly record people's ideas as fast as they can generate them - with "handwriting" that everyone can read!Keep asking "why?" until you begin to arrive at the root causes for your problem - so that you can "dig out the roots" instead of "hacking at the leaves". (This method is also known as "5 whys", because if you ask "why?" 5 times, you are likely to arrive at root causes)Easily re-arrange ideas into logical groups - spawning even better ideas
  4. Who or what committee is charged with overseeing it?