Getting to the Data for Direct
Quality Reporting
Tessie Bushey, MA, ANP, RN
Andrea Jaeckels
Julie Koski
HRSA Grant No: D1BRH20559
“Meaningful Use”
ARRA, 2009
Components:
• The use of the EHR in a meaningful manner,
such as e-prescribing
• The use of certified EHR technology for
electronic exchange of health information to
improve quality of health care
• The use of certified EHR technology to submit
clinical quality and other measures
The College of St. Scholastica
• Center for Healthcare
Innovation
• School of Nursing
• School of Health
Sciences
– Department of
Healthcare Informatics
and Information
Management
Partner Sites
Project Goals
• HRSA Grant No: D1BRH20559
Focused on EHR Data Standardization and Direct Quality
Reporting
GOALS
1. Use data captured in the EHR to meet quality
improvement efforts and external quality reporting
requirements as the basis for increasing patient safety,
improving quality of care, and reducing healthcare costs
2. Expand, validate and extend previous work done by the
College of St. Scholastica on an HIT Best Practice
Framework
Project Objectives
Goal 1: Objectives
• Standardize the collection of clinical data within each facility’s respective EHR
• Accelerate the ease with which rural healthcare organizations capture, report,
and analyze clinical quality data using the capabilities of the EHR systems
• Electronically report from each facility 3-5 commonly identified clinical quality
measures as defined by CMS in section II(A)(3) of the Electronic Health Record
Incentive Program Final Rule
• Provide aggregated data back to clinicians in each facility to inform healthcare
delivery and quality improvement efforts
Goal 2: Objectives
• Understand how multiple, independent rural healthcare organizations can
work collaboratively to standardize the capture and reporting of required data
elements
• Understand how rural healthcare organizations use aggregated data for quality
improvement purposes within their particular settings
• Facilitate the dissemination of project findings to other healthcare facilities
facing similar challenges
Project Activities
• Project Initiation
• Conduct Needs Assessment
• Standardize Process for Electronic Capture of
Clinical Data
– Document Current Environment
– Establish Process for Standardization
– Implement Revised Clinical Workflows
• Select/Implement Electronic Quality Reporting
Tool
• Trend Quality/Cost Improvements
• Extend HIT Best Practice Framework
SISU Medical Systems
• Who we are
• SISU Team
– Clinical Analysts
– Meaningful Use Expert
– Programmers
Reporting Tool Requirements
•
•
•
•
•
Potential Vendors
Vendor Review
Narrowed Selection
Final Vendor Selection
Remaining Steps
Potential Vendors
•
•
•
•
Hospital Input
SISU Input
Meditech Preferred Vendor
Four Chosen
Vendor Review
• Demonstrations
• Identified Criteria
– ONC/ATCB Certified
– Implementation Timeline
– 17 Additional Criteria
• Hospitals Surveys
• Vendor Matrix
Narrowed Selection
• Reviewed Matrix
• Additional Criteria
– Pricing
• Comparing “apples to apples”
– New Pricing Solutions
• Hospitals Selected Two Vendors to Review
Final Vendor Selection
• Host Vendors
– Review Matrix
– Participate in Demonstrations
– Additional Q & A
• Review Pricing
• Hospital Selection Deadline
Remaining Steps
• Select Vendor
• Sign Contract
• Implement Solution
Cuyuna Regional Medical Center
• Located in Crosby, Minnesota
• Main campus - primary care and surgery clinic,
retail pharmacy, hospital, long term care
center, home care/hospice, and assisted living
• 17 range cities and townships joined together
to build district hospital
• 750 Employees
• Member of SISU Medical Systems
Current Environment Documentation
• Purpose – Understand how each site is currently
collecting the data related to each measure.
• Template Utilized to Document Current
Environment
– Captures both workflow processes and data
element information
– The workflows and data elements are predefined in the template based on the measure
Current Environment Documentation
• Trigger point is identified for each workflow
– Trigger point – a decision or event that initiates
the workflow.
• The process for each workflow is defined using
swimlane format.
– Swimlane – outlines the “actions” for each role
involved in the workflow
Current Environment Documentation
Trigger Point and Swimlane Example
• VTE Prophylaxis order/Reason for no VTE
Prophylaxis order
Current Environment Documentation
• Data Element Collection
– Identify the role(s) that can enter, revise and
undo the data element within a workflow
– Define the attributes of the data element
• Software module or routine
• Standard or facility-defined field
• If facility-defined, what type of field
– Yes/no, Group response (“pick-list”), Free text
– Identify form if still manual/paper
Current Environment Data Element
Documentation Example
Documentation of Reason for no VTE
Prophylaxis
One Example
What have we learned so far?
• Which data elements currently captured
electronically?
• How to capture data elements that are not
currently electronic?
– Is workflow re-design needed?
– What role(s) can be or should be responsible?
– Does deployment vary between roles?
– How does the software functionality work with
real-life workflow?
• What added value does standardizing
between facilities bring?
Questions?
Tessie Bushey, MA, ANP, RN
Assistant Professor, Nursing
College of St. Scholastica
[email protected]
Mark Sandvick
Meaningful Use Director
SISU
[email protected]
Lisa Hennen, RN
Clinical IT Specialist
Cuyuna Regional Medical Center
[email protected]