ARRA Stage 1 Meaningful Use

1. ARRA Stage 1 Meaningful Use Journey to Attestation Pamela Feeler, RNC Director of Nursing Informatics, PCRMC

2. Phelps County Regional Medical Center • 235 Licensed Beds • MEDITECH MAGIC 5.64 • Located in Rolla, Missouri • Approx 100 miles between St. Louis and Springfield

3. 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

4. Timeline JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC Gap Analysis Meditech Upgrade to 5.64 Identify Menu Objectives Go LIVE PDI Assembled Team Worked with Medisolv Team on Work Flows Consult with PACS regarding CQM decisions Built CDSs, PDoc Templates, Order Sets Loaded RxNorm Codes Consult with PACS regarding CQM decisions Built CDSs, PDoc Templates, Order Sets Education, Documentation Report Building with Medisolv and Validation 90-Day Attestation Ends Aug 29 Entered Attestation data on ARRA Meaningful Use Website Sept 19th Received payments for Medicaid and Medicare Attestation 90-Day Attestation Begins June 1

5. Meaningful Use Team • 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)

6. Core and Menu Objectives

7. Prepare Foundation • MEDITECH Upgrade to 5.64 • OS Upgrade • Rx Norm Code Download • Patient Discharge Instruction Implementation • Medisolv Encor+ Beta site • Iatrics CCD

8. Clinical Quality Measures • VTE • Stroke • ED Throughput (19 Measures)

9. Useful Documents • MEDITECH Best Practices • HITSP Document • CMS clarifications • Testing Certification Document

10. 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 sitehttp://www.hitsp.org/ConstructSet_Details.aspx?&PrefixAlpha=5&PrefixNumeric=906for more information.

11. MEDITECH Best Practice Document www.meditech.com • 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

12. 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

13. 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

14. Stroke 4 Workflow Physician Documentation Nursing Documentation Physician Order Dx Acute Ischemic Stroke IV-tPA Contraindication Time last well Unknown last well EMAR Abstracting Calculation SNOMED SNOMED RXNORM ICD Procedure Code Physician Documentation Carotid Intervention Abstracting ICD Procedure Code

15. Nursing Documentation of Symptom Onset Time

16. Physician Order for t-PA(ED CVA/Mental Status Order Set)

17. Physician order for documentation of contraindication for t-PA

18. 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

19. Physician Discharge Function

21. Physician Discharge documentation of contraindications to Stroke measure medications

22. 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

23. Encor+ Reporting Results

24. 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.

25. RX Norm Codes

27. 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

28. Clinical Quality Measures Attestation

29. PCRMC Results at end of 90 days

30. Sweet Success!!