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Institute of Medicine (IOM)6 Quality Areas for Health care

1. Safe

2. Effective

3. Efficient

4. Timely

5. Patient centered

6. Equitable

1Health IT Workforce Curriculum

Version 3.0/Spring 2012

Fundamentals of Health Workflow Process Analysis and Redesign

Concepts of Health Care Processes & Process Analysis

Lecture a

(Institution on Medicine, 2001)

EHR Meaningful Use

• Term coined by the framers of the 2009 American Recovery & Reinvestment Act (ARRA)

• Addresses five national health policy priorities1. Improve quality, safety and efficiency and reduce health disparities

2. Engage patients and families

3. Improve health care coordination

4. Improve population and public health

5. Ensure adequate privacy and security protections for personal health information (PHI)

Lecture a

Meaningful Use

• Qualified EHR - an electronic record of health-related information that:

• Includes patient demographic and clinical health information

• Has the capacity to: −Provide clinical decision support

−Support physician order entry

−Capture and query information relevant to health care quality

−Exchange electronic health information with, and integrate such information from, other sources

(Department of Health and Human Services, 2010)

Lecture a

Meaningful Use

Stage 1

• Lays the groundwork for a planned secure nationwide health information network

• Establishes minimal functionality for Certified EHR Technology

Lecture a

EP CO 1 Workflow Impact

“The order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This necessitates that the CPOE occurs when the order first becomes part of the patient’s medical record and before any action can be taken on the order.”

Workflow Impact:

• Role entering the order is determined by state, local and professional guideline.

• Task sequence is specified by the Meaningful Use Objective

Fundamentals of Health Workflow Process Analysis & Redesign

Process Redesign

Lecture d

EP CO 2

Drug-drug and drug-allergy interaction checks:

“Implement drug-drug and drug-allergy interaction checks.”

Workflow Impact:

• Task sequence and timing is implied by the Meaningful Use Objective

Process Redesign

Lecture d

EP CO 3

Problem list:

“Maintain an up-to-date problem list of current and active diagnoses.”

Workflow Impact:

• Addition of a new reconciliation and documentation task

Process Redesign

Lecture d

EP CO 4

ePrescribing (eRx)

“Generate and transmit permissible prescriptions electronically”

Workflow Impact:

• New workflow for an existing task

Process Redesign

Lecture d

EP CO 5

Medication list

“Maintain an active medication list”

Workflow Impact:

• New workflow for an existing task

Process Redesign

Lecture d

EP CO 6

Medication allergy list

“Maintain an active medication allergy list”

Workflow Impact:

• Possible new workflow for an existing task

Process Redesign

Lecture d

EP CO 7Demographics

“Record all of the following demographics:

(A)Preferred language

(B)Gender.

(C) Race.

(D) Ethnicity.

(E) Date of birth.”

Workflow Impact:

• Minimal

Process Redesign

Lecture d

EP CO 8Changes in vital signs

“Record and chart changes in all of the following vital signs:

(A) Height.

(B) Weight.

(C) Blood pressure.

(D) Calculate and display body mass index (BMI).

(E) Plot and display growth charts for children 2-20 years, including BMI”

Workflow Impact:

• Changes existing tasks

Process Redesign

Lecture d

EP CO 9

Smoking status

“Record smoking status for patients 13 years or older”

Workflow Impact:

• Possible changes to an existing task

Process Redesign

Lecture d

EP CO 10

Clinical quality measures

“Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States.”

Workflow Impact:

• Changes to an existing administrative task

Process Redesign

Lecture e

Requirements and electronic specifications for ambulatory clinical quality measures can be found at: http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPage

What are CQMs? Any of a number of measures which measure various aspects of clinical care. Some of them are process measures – things like “what percentage of my diabetic patients had an LDL-cholesterol level drawn?” Some of them are more endpoint measures – “what percentage of my diabetics have LDL-cholesterol levels less that 100?”

3 CORE CQMs or Alternate CORE CQMs

Plus 3 Additional CQMs

EP CO 11

Clinical decision support

“Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.”

Workflow Impact:

• Possible new task

• Changes to an existing leadership and technical task

Process Redesign

Lecture e

EP CO 12

Providing patients an electronic copy of their health information

“Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request.”

Workflow Impact:

• Changes to an existing administrative task

Process Redesign

Lecture e

EP CO 13

Clinical summaries

“Provide clinical summaries for patients for each office visit.”

Workflow Impact:

• Probable new task

Process Redesign

Lecture e

EP CO 14

Exchange key clinical information

“Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.”

Workflow Impact:

• Probable new task

Process Redesign

Lecture e

EP CO 15

Protect electronic health information

“Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.”

Workflow Impact:

• Probable new tasks, and

• New workflow for existing tasks

Process Redesign

Lecture e

Meaningful Use

“The Medicare and Medicaid EHR Incentive Programs provide a financial incentive for the "meaningful use" of certified EHR technology to achieve health and efficiency goals. By putting into action and meaningfully using an EHR system, providers will reap benefits beyond financial incentives–such as reduction in errors, availability of records and data, reminders and alerts, clinical decision support, and e-prescribing/refill automation.” (CMS EHR Meaningful Use Overview, n.d., para. 1)

Process Redesign

Lecture e

Meaningful Use Stages

Process Redesign

Lecture e

Stage 1 – 2011

Stage 2 – 2013

Stage 3 – 2015

Menu Objectives

meaningful use review slide share

redesign of health care

health care system

health care providers

health care facilities

clinical health information

health information technology

national health care

greater health care

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