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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)
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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)
2Health 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
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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)
3Health 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
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Meaningful Use
Stage 1
• Lays the groundwork for a planned secure nationwide health information network
• Establishes minimal functionality for Certified EHR Technology
4Health 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
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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
6Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture d
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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
7Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture d
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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
9Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture d
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EP CO 4
ePrescribing (eRx)
“Generate and transmit permissible prescriptions electronically”
Workflow Impact:
• New workflow for an existing task
11Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture d
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EP CO 5
Medication list
“Maintain an active medication list”
Workflow Impact:
• New workflow for an existing task
13Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture d
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EP CO 6
Medication allergy list
“Maintain an active medication allergy list”
Workflow Impact:
• Possible new workflow for an existing task
15Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture d
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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
17Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture d
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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
19Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture d
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EP CO 9
Smoking status
“Record smoking status for patients 13 years or older”
Workflow Impact:
• Possible changes to an existing task
21Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture d
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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
23Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
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
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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?”
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3 CORE CQMs or Alternate CORE CQMs
Plus 3 Additional CQMs
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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
28Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture e
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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
30Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture e
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EP CO 13
Clinical summaries
“Provide clinical summaries for patients for each office visit.”
Workflow Impact:
• Probable new task
32Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture e
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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
34Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture e
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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
36Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture e
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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)
38Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture e
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Meaningful Use Stages
39Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Health Workflow Process Analysis & Redesign
Process Redesign
Lecture e
Stage 1 – 2011
Stage 2 – 2013
Stage 3 – 2015
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Menu Objectives
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