applying the concepts and process of meaningful use to the ... · (e.g., ekardex) cdic...
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Meaningful Use RequirementsThe Main Components of Meaningful Use Are:•“Meaningful Use” rule from CMS•Establishesasetofstandards,implementationspecificationsandcertificationcriteriaforEHR
•EstablishescertifyingbodiesforEHR’s•Mustbecompletedby2015(orbeginfacingpenalties)
Current Strategy•CPOE(ComputerizedProviderOrderEntry)andnursingelectronicdocumentationinplace (eChart–SiemensSoariancustomsystem)
•ConvertPharmacysystemtoSiemens/makephysicalchangestoPharmacytoaccommodateequipment
•ImplementeMar/barcodingofmeds•Improvecapabilityofinterfacebetweensystems
Focus for Nursing•Engagedinplanning/designofeMar•IntegratingZynx(electroniccareplanningprocess)intocurrentsystem•EvaluatingeChartforprocessimprovementsassystemhasbeeninplacefor4+years
•UtilizeaClinicalDesignandImplementationCommittee(CDIC)todriveresults•IncreasecollaborationwithInformationSystemsDepartment(ISD)-meetweekly
CDIC Functions•Beganin2005toguidedesignandimplementationofeChart
•ComprisedofbothstaffandmanagersfromNursingandISD,approximately40members.AlsoincludesrepresentationfromHospitalPerformanceImprovement(PI),NursingEducationandancillarystaffasneeded.
•Meetmonthlyforanalldaymeeting
Applying the Concepts and Process of Meaningful Use to the Electronic Health Record (EHR)BeckyDodge,RN,MBA
UniversityofNorthCarolinaHospitals~NursingPerformanceImprovement
8:30 a.m. Welcome• eChartEnhancements-October21,2010• SpanishInterpreterForm–forInterpreteruseonly
8:50 a.m. Clinical Summary and Clinical Considerations• RolloutPlan
9:30 a.m. CQM• CriticalLabValues-MDnotificationanddocumentation• MDRO• VTE/Anticoagulationeducationdocumentation• ImportantInformationfromMedicare
10:00 a.m. Break
10:15 a.m. e-Chart Updates • TubesandDrains-addJTube• CriticalCare-HFOV
10:30 a.m. Accreditation• X-rayafterNGTubeinsertion• CulturalCompetencyChangestoeChart
11:15 a.m. Performance Improvement
12:00 p.m. Lunch – on your own
1:30 p.m. Pharmacy Project Updates• TalystBarcodedUnitDosePackages• MedicationDoseFrequencies• NewMARFormat• eMARFeedback-fromeChartwebpage
2:15 p.m. NPI Updates• Falls • SkinAudits-UlcerPagenFlags
3:15 p.m. Break
3:30 p.m. Housewide Project Updates• Meaningful Use
• Weights-Birth,Admission,LastRecorded,Dosing,CriticalCareFluids
• Height-requiredonNutritionScreeninAdmissionAsmt
• BMI-calculationandassociatedpop-upmessage• AdvanceDirectiveandMOSTForm• Smokingstatuschanges• PregnancyandLactation-willinterfacetonew
Pharmacysystem• Vaccines
• MDHServiceChanges• SedationFlags
What Type of Decisions Are Made?•Additions/DeletionstoeChart•Documentationpolicychangestoreflectpractice•Whentohold“downtimes”forupgrades•Staffgivefeedbackre:howchangesarebeingimplemented,howtoimproveflowofdocumentation
•Staffgiveinputonhowtodesignnewfeatures(e.g.,eKardex)
CDIC Documentation Subcommittee•IsworkingwithNursingPItofacilitateelectronicextractionofaudits(onestaffrepresentativefromeachservice,NursingQualityAnalysts,AssociateCNO,ISDstaff)
•Staffaregivinginputintohowelectronicauditingisbeingdesigned(skinandrestraintprevalencesurveys,documentationaudits,etc.)
•Staffarealsoinvolvedineffortstostreamlinedocumentation(useformsineChartforincidencereporting-insteadofaseparatesystem,especiallyforfallsandskin)
•Meetonce/monthforonehour
Challenges•Balancingcompetingpriorities•FocusingeffortonmeetingARRArequirementswhilecontinuingtoimprove/revisecurrentsystems
•Communicatingchangesinacontinuallychangingenvironment•Movingtoanorganizationwidestandardforauditing(i.e,removingtheabilityforstafftomakeadecisionbasedontheirowninterpretation)
Successes!•Staffinputatmanylevelsoftheprocesshasbeeninvaluable•Staffareengagedandaccountable,aretrulydrivingthedocumentationofcarebeinggiven
•Changesbythecommitteearecommunicatedviaminutes,staffrepresentatives,andalsothroughourquarterly“RoadShows”whichincludestafffromISD
•StrongcollaborationbetweenNursingandISD,andbetweenstaffandleadership•Fulltimecomputersupport/ITpositionforNursing
Meeting Agenda