nursing informatics portfolio - home · web viewas part of the 2009 american recovery and...
TRANSCRIPT
Running head: MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 1
Scholarly Project Proposal: Meaningful Use Executive Report and Presentation
Jennifer Dilly
Ferris State University
April 22, 2012
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 2
Abstract
Healthcare delivery is complex and continually changing. Part of this change includes how new
technology is being used to promote safer patient care and better patient outcomes. The following
proposal intends to outline a Scholarly Project related to the quality metrics, stroke and venous
thromboembolism (VTE), required for attestation of Meaningful Use (MU). The background related to
healthcare reform and technology is first provided. The setting for the project is explained in detail as are
the qualifications of the selected preceptor. Goals and objectives are provided along with an explanation
of activities that will support accomplishment. The major goal to be achieved includes ensuring the
facility will meet the MU requirements through use of an electronic health record (EHR). The timeline
for completion of each activity is included. An evaluation tool is provided with the intent of showing
whether the student has met or exceeded each objective.
Keywords: healthcare reform, Meaningful Use, quality metrics, technology
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 3
Scholarly Project Proposal: Meaningful Use Executive Report and Presentation
Huckvale et al. (2010) suggest that correct usage of well-established technology tools can
lead to safer and higher quality patient care. Capture of patient information and the exchange of
the information between caregivers can be complicated but ultimately quite beneficial. A
workgroup, established by the World Health Organization (WHO), has conducted a systematic
review of literature surrounding the influence of information technology (IT) on patient safety
(Huckvale et al., 2010). There is a potential for technology to increase safe patient care, however
there are still many barriers including incorrect implementation methods, improper interfaces
between multiple systems, and incorrect usage. According to Shaw (2012), a community
hospital in New Hampshire has shown significant decreases in patient readmissions, improved
door-to-balloon times, and increases in other key performance indicators by correct usage of
technology. The technology has enabled caregivers to have patient data at their fingertips, data
that can be used to track patient progress in real-time and respond immediately or even thwart an
adverse event. There is also the potential for alerting the caregivers that further actions need to
be performed for the patient yet. For this hospital, these functions are the epitome of how
technology and the data gained from technology becomes meaningful.
The government has also stepped in to ensure the use of technology and the data it
produces is meaningful. As part of the 2009 American Recovery and Reinvestment Act
(ARRA), the Health Information Technology for Economic and Clinical Health (HITECH) Act
was developed to incentivize facilities and providers to use Electronic Health Records (EHR) to
increase the delivery of safe, quality care (Goldschmidt, 2012). In order for facilities to receive
incentive payments, they not only need to adopt EHRs, but also prove that the EHR is being used
in a meaningful way to improve care (Blumenthal and Tavenner, 2010). Meaningful Use (MU)
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 4
objectives were developed by The Centers for Medicare and Medicaid Services (CMS) along
with the Department of Health and Human Services (DHHS) with the intent that incentives can
be obtained if these specified objectives were met (or penalties if not met). There are many
requirements for hospitals to meet Stage 1 of MU. Hospitals must attest that their EHR has the
capability of electronically sending patient information surrounding stroke and venous
thromboembolism (VTE) care, and throughput in the Emergency Department (ED) (Abett, Bates,
and Kachalia, 2011). CMS has provided the definitions for the quality measure sets, Stroke,
VTE, and ED Throughput, including what patient information facilities will be required to
monitor and report (Quality Net, 2012). Hospitals are already required to report data
surrounding ED Throughput to CMS, but the other two measure sets have remained optional.
Spectrum Health Zeeland Community Hospital (SHZCH) is required to adopt an EHR
and, by January 2013, attest that the EHR has the capability to meet MU requirements. The
hospital has already addressed how data will be captured for the required ED Throughput
measure set, however, the Stroke and VTE measures sets have yet to be addressed. Without
clearly guiding caregivers in providing and recording evidence-based care, there is a potential to
lose significant incentive payment and, most importantly, the potential to see a decrease in
quality of care. According to Simpson (2011), Nursing Informatics Specialists (NIS) are essential
in helping hospitals meet MU requirements due to their combined knowledge of nursing,
computer and information science. The facility does not have an NIS to aide in the
understanding of required nursing and physician documentation for the quality measure sets, to
assess if the EHR to be adopted covers all aspects of the required documentation, and to provide
the executive team with a clear explanation of how or if the requirements will be met.
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 5
The purpose of this paper is to present a project proposal that addresses how MU
requirements related to stroke and VTE care will be met for SHZCH, what gaps in the
requirements are present, and what can be improved to close those gaps. An overview of the
setting where the project will be implemented will be reviewed as will the qualifications and
background of the selected preceptor. The goals and objectives including the theory and
research behind the project will be presented along with clear timelines of activities to
accomplish the objectives. Letters indicating full agency approval for the project will be
included, and an evaluation tool, developed to gain feedback about the project, will be explained.
Setting
The Scholarly Project will be completed for Spectrum Health Zeeland Community
Hospital (SHZCH). The hospital has been serving Zeeland and the surrounding communities for
over 80 years, and within the past six years has moved in to a brand new facility. The 57 bed
acute care hospital was built with all private rooms on the inpatient units as well as in the
Emergency Department. Units within the hospital include Emergency, Urgent Care,
Medical-Surgical Adult and Pediatrics, Bariatrics, Family Birth Center, Surgery, and ICU. The
Strategic Plan includes continued growth with the new Bariatrics program, Diabetes Center, and
will eventually focus on Women’s Health. The hospital employs over 500 staff members and
relies upon over 150 volunteers. The employees and volunteers have created a culture within the
hospital that truly encompasses the whole patient experience, not only the provision of safe,
quality care, but also the personalized experience that keeps patients choosing the hospital each
time care is needed.
Starting January 2011, SHZCH began integration into the Spectrum Health system with
full integration expected to be complete in two to three years. As part of the integration, the
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 6
Cerner Electronic Health Record (EHR) will be adopted by SHZCH by October 2012. The
Cerner EHR has been used by the Spectrum Health system for many years. Currently SHZCH
uses a mix of paper and electronic documentation processes using a very limited electronic
documentation system. The training of the basic knowledge for documentation in Cerner is
being planned for nurses by the Spectrum Health system’s Nursing Informatics department and
facilitated by SHZCH’s nursing directors, IT department, and nursing educator, however, there
has been little activity assessing how documentation surrounding Stroke and VTE quality
measures as part of the requirements to meet MU will be captured within the newly adopted
EHR. While the larger entities are addressing whether their current EHR build has the capability
to capture and send the required documentation to regulatory agencies, it is unknown whether the
build for SHZCH will adequately capture the information because of some differences in
processes at this smaller facility. There has been limited information provided to the executive
team of SHZCH, and therefore, they do not have a full understanding of the requirements for
meeting MU, nor whether the facility will be able to meet the requirements for the quality
measurement part of MU.
There is no specific department the project will be set in as activities for the project will
require contact with multidisciplinary groups from SHZCH and the Spectrum Health system
including Quality, IT, Education, Pharmacy, Medicine, Nursing, and Nursing Informatics. The
two measure sets require documentation from caregivers in multiple departments such as
emergency, medical-surgical, intensive care, and surgery. The EHR being adopted is split into
different modules for different areas of care. For example, the Emergency Department (ED) will
be using the Cerner product called FirstNet for ED related care, while the surgery department
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 7
will use SurgiNet for surgery related care. The setting for the project will span across multiple
departments.
Goal and Objectives
The goal of the Scholarly Project is to develop an executive level report and presentation
outlining how Meaningful Use (MU) requirements, related to the Stroke and VTE quality
measure sets, have been met for this facility. The report and presentation are the deliverables for
the project. The accomplishments of multiple objectives will enable the understanding of the
topic as well as aide in the creation of a succinct report and presentation to the executive team.
The Planning Guide in Appendix A contains a complete listing of goals, objectives, activities and
timelines for completion.
The first objective is to obtain the literature and information surrounding MU
requirements. The focus will stay on what the facility will need to attest to in relation to the
specific quality measures. Information surrounding documentation requirements for the Stroke
and VTE measure set compliance will also be gathered.
The second objective will include identifying the specific necessary documentation that is
required to for each measure within the measure sets. The Center for Medicare and Medicaid
Services (CMS) has a specification manual which outlines what data elements need to be
captured proving that care surrounding each measure has been provided (Quality Net, 2012).
The data elements required for each measure are highly specific and are listed in an alphabetical
data dictionary. CMS considers the information within the data dictionary to be their rules for
abstraction. Learning the necessary documentation is critical to the success of the project.
The third objective will be to learn all pertinent aspects of the Electronic Health Record
(EHR). The basics of documentation within the system will need to be understood before the
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 8
investigation of the how the EHR has been built to capture specifics surrounding the Stroke and
VTE measures can begin. Reigeluth’s Elaboration Theory (ET) includes a method of learning
based on how the basics of a topic are first mastered before more specifics about the topic can be
learned or new topics introduced (Cooper, 2009). Without basic knowledge of a topic, the
learner cannot understand in depth information surrounding the topic. Once meaning is gained
from the content, the learner becomes more confident and learning of the finer details can
continue. For this objective, the learning of how documentation surrounding the specific
measures is completed is considered the finer detail.
Performing a gap analysis for documentation needs that ensure measure set compliance
and the ability to attest to the MU requirements is the fourth objective. A gap analysis provides
the identification of differences, or gaps, between current state and what one wants the future
state to be (Rueckert, Krenzischek & Poe, 2011). Analyzing what has already been built into the
EHR, the current state, with the listing of documentation that is required; the future state should
reveal any gaps. The gap analysis is closely related to the next objective in which any identified
gaps related to missing data points within the EHR, either in general or in relation to the unique
needs of this smaller hospital, can be submitted to the Information Technology department for
improvement. Submitting improvements will be important because if the EHR is not built
according to what is needed, keeping in mind caregiver’s workflows, the technology will not be
useful for caregivers. Rogers (1995) created a theory called Diffusion of Innovations (DOI)
which examines the patterns of innovation adoption. Identifying the patterns of adoption in
various settings creates an opportunity to realize solutions to barriers and encourage a more
timely diffusion of the innovation. As DOI suggests, identifying and anticipating barriers
caregivers may encounter in an EHR not built to support what is required of them, will help
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 9
provide solutions and assist in the diffusion of the technology. EHRs have potential to cause
barriers to obtaining correct information for MU. The DOI theory is useful for this project as
identifying patterns of how the technology is currently built for and used by the main healthcare
system may reveal barriers and facilitate improvement applicable to this specific facility.
An objective related to communication with the hospital’s executive team is next. A
written report and presentation for the executive team will be prepared. The report and
presentation will contain information about how the facility will meet MU requirements related
to stroke and vte care through use of the EHR that is scheduled to be adopted. The executive
team will need to know the evidence behind use of an EHR to improve patient outcomes. They
also need to understand how the EHR will help caregivers prove care for patients included in
these measure sets has been given and that technology needs to be built to reliably automate
processes surrounding clinical practices (Hazlehurst, McBurnie, Mularski, Puro and Chauvie,
2009). The objective also includes the preparation of an evaluation tool so feedback can be
obtained.
The next objective is to give the presentation and written report to the executive team so
they can give feedback. The feedback will be reviewed with the preceptor. Any necessary
additional information the executive team requires can be obtained and given to them at a later
date.
Preceptor
The preceptor for the Scholarly Project is Julianne Carey, Director of Medical-Surgical,
Pediatrics, Bariatrics, Family Birth Center, Case and Utilization Management, and Medical
Social Work for Spectrum Health Zeeland Community Hospital (SHZCH) in Zeeland, Michigan.
Julianne started her nursing career as a Licensed Practical Nurse in a small, rural community
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 10
hospital east of Grand Rapids, Michigan. She is now a Bachelor prepared nurse with a Master’s
of Business Administration for Health Care Management, and has been employed by SHZCH
since 1997. Julianne reports directly to the Vice President of Clinical Services and has over 90
staff members that directly report to her including nurses, patient care technicians, unit
secretaries, case managers, medical social workers, and an administrative assistant. There are no
managers assigned to each department in this hospital, however, there are patient care managers
sharing shifts of daily hospital-wide coverage that also report to Julianne and the other nursing
director for the facility.
Along with Julianne’s directorship, she also is heavily involved in projects related to
technology adoption throughout the entire hospital. Prior to the integration into the Spectrum
Health system in 2011, the hospital was preparing to choose an Electronic Health Record (EHR).
Working with the Information Technology (IT) department, Julianne was an integral part in
research, site visit set-up, and analysis of each potential vendor. Simultaneously she helped her
own staff create an organized view of their everyday work enabling the staff to understand which
potential vendor’s product would be the most viable for their work and the organization in
general. Julianne’s expertise was also being used to guide choices of a vendor that would
support Computerized Physician Order Entry (CPOE).
Eventually, the hospital did not need to choose a vendor because of the decision to
integrate into a larger system that had an established EHR vendor. The integration work is
on-going and includes full adoption of the system’s EHR. Along with the healthcare system’s
project managers, IT and Nursing Informatics departments, Julianne is facilitating SHZCH’s
specific EHR build, mapping of her department’s current and future state workflow, nursing
staff’s EHR education, analysis of necessary nursing specific EHR hardware, and analysis of
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 11
needs related to Meaningful Use. Essentially she has been and for now will continue to fill these
roles that would be part of an Informatics Nurse Specialist’s (INS) practice, and therefore is an
ideal preceptor in assisting in the achievement of the goals and objectives for the proposed
Scholarly Project.
Activity Timelines
The Planning Guide in Appendix A includes a complete overview of all Timelines related
to accomplishing the activities for the project. Objective 1.1 includes multiple activities starting
with the search of various databases for research and information surrounding Meaningful Use
(MU) requirements, scheduled to be accomplished by June 5th. The same timeframe is identified
for searching The Center for Medicare and Medicaid Services’ (CMS) website, Quality Net, for
the documentation requirements surrounding the two measure sets, the compilation of the
literature and information source reference list, and information gathering from the healthcare
system’s lead of MU related to the Quality Measures. The amount of information to be reviewed
is extensive and therefore will take approximately three weeks to accomplish with a deadline of
June 5th.
Objective 1.2 includes just one activity. On preliminary review, the Stroke and Venous
Thromboembolism (VTE) measure sets include many measures and have specific, extensive
documentation requirements (Quality Net, 2012). Listing each measure and outlining the
required documentation for each measure is necessary for the future gap assessment and will
require some time to accomplish. The timeline for this activity includes a completion date of
June 15th.
Next, accomplishing Objective 1.3 will include learning the details of documentation
within the Cerner EHR. Learning these details will provide an overview of how Cerner has been
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 12
built to capture the measure sets’ required documentation. Attending Cerner classes that cover
nursing documentation, Computerized Physician Order Entry (CPOE), and the Lighthouse
product related to the quality metrics will need to be completed by June 29. Meeting with the
healthcare system’s Quality Department members who abstract the Stroke and VTE measure set
information from Cerner will allow further learning of the data points included in Cerner for
each measure. The meeting is scheduled to be completed by July 6. Cerner includes Power
Plans to guide care of patients with different diagnoses. A review of the current healthcare
system’s Power Plans related to Stroke and VTE will also enable learning of how the EHR has
been built to guide care of these types of patients and will be completed by July 6 as well. One
more activity for the objective will bring all information learned about Cerner together in one
outline. The data points surrounding Stroke and VTE care will be outlined as will the
information about where the data points are contained within the EHR. The outline will be
useful in the next objective and will be created by July 11.
Objective 1.4, performing the gap analysis, will be accomplished first by comparing the
list of measures and the required documentation for each with the outline of the data points
contained in Cerner created in the previous activity. The differences between what is required
and what Cerner currently contains will be identified, analyzed, and recorded, so the next activity
can facilitate filling those gaps (Rueckert, Krenzischek, & Poe, 2011). The gap analysis will be
completed no later than July 16.
According to VanAuken, Chrysler, Gricenko-Wells, and Simkin (2011), the gap analysis
results should be used to impact the organization’s needs. Submitting suggestions to fix any gaps
identified through the gap analysis will help meet Objective 1.5. The suggestions will be
submitted to the system’s IT department with the help of the SHZCH site-specific IT department.
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 13
The preceptor, as well as project managers for service lines that the suggestions may affect, will
be aware of the needed improvements and will facilitate the submission of the suggestions. The
improvements will be submitted no later than July 27.
A Power Point presentation and written report will be created to meet Objective 1.6 by
July 27. Both types of reports will be created so the executives not only have the information
verbally, but also in written format for later reference. The verbal presentation will also
encourage an open dialogue for questions and discussion. An evaluation tool will be created
during the same timeframe to ensure the information being presented is understood and has been
helpful. The presentation and written report will be given to the executive team at their weekly
meeting on July 30. At the end of the presentation, they will be asked to give feedback via the
evaluation tool.
The last activities will include reviewing the feedback with the preceptor and providing
any necessary additional information the executive team and preceptor feel were missing or still
requires clarification. Any updates can be provided in an addendum to the report and sent to the
executive team if needed. These activities will be completed by August 3.
Evaluation
An evaluation tool to determine whether all objectives for the Scholarly Project have
been adequately met is contained in Appendix C. I will provide feedback as will the preceptor
regarding whether the activities have enabled all objectives to be exceeded or met. The tool was
created to obtain qualitative feedback on the specific, measureable, attainable, relevant, and
timely (SMART) goals identified (Bovend’Eerdt, Botell, & Wade, 2009).
The first objective includes obtaining information related to Meaningful Use (MU)
requirements for attestation for the specific quality measures and documentation requirements
for both quality measure sets. A meeting with Spectrum Health’s lead for MU will also provide
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 14
an opportunity to learn. The accomplishment of the objective will be evident through the
provision of a literature and reference list.
The second objective includes identifying specific necessary documentation requirement
for each quality measure within each measure set. For instance, the Stroke measure set includes
eight different indicators each with varying points of documentation needed and the VTE
measure set includes six (Quality Net, 2012). Outlining the required documentation for each
indicator will allow for easier comparison in subsequent objectives. The outline provided will
show the accomplishment of the second objective.
Learning the electronic health record (EHR) system the facility will be adopting
including how the EHR has been built to capture documentation surrounding the measure sets is
the third objective. The first step in the objective includes learning the basics about
documentation and order entry within the system. The next step, learning specifics about how
the EHR has been built to capture specific documentation, cannot occur until the basics have
been learned. Charles Reigeluth’s Elaboration Theory (ET) supports this method of learning by
suggesting that a learner needs to master the basics of the tasks before the addition of further
learning material (Cooper, 2009). The final steps include meeting with Spectrum Health’s data
abstractors and reviewing the Power Plans related to the two measure sets to supplement the
information learned. The preceptor will be able to see whether the objective has been met
through review of the outline created to show all data points the EHR contains for documentation
related to measure set requirements.
The next two objectives include the performance of a gap analysis between current and
future needs related to the EHR and MU requirements. The preceptor understands that the
facility has unique needs within the EHR and the build will need to encompass these unique
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 15
needs as well as meet the requirements for MU. The objectives will be considered accomplished
after the comparison between the required documentation for each quality measure and the
outline of the EHR’s data points has been completed and the suggestions for improvement have
been submitted to the IT department. Both student and preceptor again will provide comments
or examples of accomplishment.
Next, the objectives related to preparation of report and presentation to the facility’s
executive team will be evaluated. Simpson (2009) suggests that nurse informaticians are highly
valuable to organizations in proving meaningful use of technology related to better patient
outcomes. The author feels that these nurses have knowledge of the MU requirements, data
points necessary for documentation, and knowledge of how the technology is used for
documentation. Therefore, an informative PowerPoint presentation and written report regarding
how the facility will meet MU requirement for the two quality measure sets will be created and
presented to the executive team. There will be opportunity for the executive team to provide
feedback through an evaluation tool. Once the presentation occurs, the feedback will be
reviewed with the preceptor. The objectives will be met if the preceptor feels the presentation
was succinct and informative as evidenced by feedback from the executive team.
Finally, the evaluation tool will ask for further identification of SMART goals the student
should address. The preceptor may have knowledge of other requirements for MU originally
thought to be unrelated to the quality measure sets, and therefore may recommend that the
student continue learning about other requirements that in the future could affect the work
already accomplished. There is one more area on the evaluation tool provided for any other
comments or recommendations related to the project.
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 16
Conclusion
While there is potential for technology to create safer care and better patient outcomes, barriers
such as incorrect usage, still exist. Through the use of the 2009 American Recovery and Reinvestment
Act (ARRA) and the Health Information Technology for Economic and Clinical Health Act (HITECH),
the government intends to incentivize facilities that show that their technology is used in a way that is
meaningful in improving patient care. This project proposal outlines how the Meaningful Use
requirements related to stroke and VTE care will be met for Spectrum Health Zeeland Community
Hospital. As there may be gaps in the requirements related to the electronic health record the facility is
adopting, the proposal includes the performance of a gap analysis giving the ability to identify and submit
improvement suggestions to the Information Technology department. Learning the requirement of MU as
well as the measure sets is essential during the project. The preceptor is very well qualified to evaluate
the work throughout the project as she has been integral in the adoption of new technology as well as the
implementation of technology related to nursing care. She will be able to evaluate the accomplishment of
the objectives including the presentation of findings from the project to the executive team.
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 17
References
Abbett, S. K., Bates, D. W., and Kachalia, A. (2011). The meaningful use regulations in
information technology: What do they mean for quality improvement in hospitals? The
Joint Commission Journal on Quality and Patient Safety, 37(7), 333-336.
Blumenthal, D. and Tavenner, M. (2010). The “Meaningful Use” regulation for electronic health
records. The New England Journal of Medicine, 363(6), 501-504.
doi:10.1056/NEJMp1006114
Bovend’Eerdt, T. J., Botell, R. E., and Wade, D. T. (2009). Writing SMART rehabilitation goals
and achieving goal attainment scaling: A practical guide. Clinical Rehabilitation, 23(4),
352-361. doi:10.1177/0269215508101741
Cooper, S. (2009). Charles M. Reigeluth: Elaboration theory. Theories of Learning in
Educational Psychology. Retrieved from http://www.lifecircles-
inc.com/Learningtheories/reigeluth.html
Goldschmidt, K. (2012). Finding meaning in meaningful use: Understanding the health
information technology for economic and clinical health act and its impact on nursing
practice. Journal of Pediatric Nursing, 27(1), 88-89. doi:10.1016/j.pedn.2011.10.002
Hazlenurst, B., McBurnie, M. A., Mularski, R., Puro, J., and Chauvie, S. (2009). Automating
quality measurement: A system for scalable, comprehensive, and routine care quality
assessment. AMIA 2009 Symposium Proceedings. Symposium conducted at the meeting
of AMIA, San Francisco, CA.
Huckvale, C., Car, J., Akiyama, M, Jaafar, S., Khoia, T., Khalid, A. B., Sheikh, A., and Majeed,
A. (2010). Information technology for patient safety. Quality and Safety in Healthcare,
19(Suppl 2), i25-i33. doi:10.1136/qshc.2009.038497
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 18
Quality Net (2012). Specification manual for the National Hospital Quality Measures. Retrieved
from http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic
%2FPage %2FQnetTier2&cid=1141662756099.
Rogers, E. M. (1995). Diffusion of innovations (4th ed.). New York, NY: The Free Press.
Rueckert, N. L., Krenzischek, D. A., & Poe, S. (2011). Conversion from paper to electronic
documentation: A data gap analysis process. Journal of PeriAnesthesia Nursing, 26(3),
195. doi:10.1016/j.jopan.2011.04.051
Shaw, G. (2012). Putting data in nurses’ hands. HealthLeaders. Retrieved from www.
healthleadersmedia.com
Simpson, R. L. (2011). Nurse informaticians critical to proving meaningful use. Nursing
Administration Quarterly, 35(1), 82-84. Doi:10.1097/NAQ.0b013e318203462a
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 19
APPENDIX A
NURS 710 Project Planning GuideProject: Meaningful Use requirements Executive level report and presentation.
Goals Objectives Activities TimelineGoal 1:
Develop an Executive level report and presentation outlining how Meaningful Use requirements, related to the Stroke and VTE quality measure sets, have been met for this facility by August 2012.
1.1
Obtain and review literature and information surrounding: Meaningful Use requirements for attestation related to the specific quality measures, and documentation requirements for Stroke and VTE measure set compliance.
1.2
Identify specific necessary
1.1 a
Search Cinahl, PubMed and other databases for research and information about Meaningful Use requirements.
1.1 b
Search Quality Net for the Center for Medicare and Medicaid Services’ Specification Manual related to measure set compliance requirements
1.1 c
Compile literature and other information sources’ reference list
1.1 d
Obtain information related to the quality metrics from Spectrum Health’s lead for Meaningful Use
1.2 a
List each measure within each measure
1.1 a
Complete by June 5, 2012
1.1 b
Complete by June 5, 2012
1.1 c
Complete by June 5, 2012
1.1 d
Complete by June 5, 2012
1.2 a
Complete by June 15, 2012
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 20
documentation requirements for each measure within each measure set
1.3
Learn the EHR system the facility will be adopting including how the EHR has been built to capture documentation surrounding the Stroke and VTE measure sets.
set and outline required documentation for each
1.3 a
Attend Cerner classes specific to nursing documentation
1.3 b
Attend Cerner CPOE classes
1.3 c
Review Cerner Lighthouse product related to quality metrics
1.3 d
Meet with Spectrum Health’s Quality department’s Stroke and VTE measure abstractors to learn specific areas of Cerner where data points related to each measure is documented
1.3 e
Review current Spectrum Health Power plans related to Stroke and VTE care
1.3 a
Complete by June 29, 2012
1.3 b
Complete by June 29, 2012
1.3 c
Complete by June 29, 2012
1.3 d
Complete by June 29, 2012
1.3 e
Complete by July 6, 2012
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 21
1.4
Perform a gap analysis for documentation needs that ensure measure set compliance and the ability to attest to the MU requirements.
1.5
As identified through the gap analysis, develop specific EHR data points that are still needed or need to be unique to this facility to meet requirements of MU and submit to facility’s Information Technology department.
1.3 f
Create outline of data points Cerner contains to capture documentation related to the measure sets and where in Cerner the data points are located
1.4 a
Compare previously created list of measures and required documentation with the outline of data points Cerner currently contains
1.4 b
Identify and outline the gaps between the two lists
1.5a
Submit suggestions of data points to capture necessary documentation
1.3 f
Complete by July 11, 2012
1.4 a
Complete by July 16, 2012
1.4 b
Complete by July 16, 2012
1.5 a
Submit by July 27, 2012
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 22
1.6
Prepare a report and presentation for the facility’s Executive team regarding how facility will meet MU requirements related to the two quality measure sets. Prepare an evaluation tool
1.7
Present report to Executive team and ask for feedback
1.8
Review feedback
1.6 a
Create a PowerPoint presentation as well as a written report for the executive team
1.6 b
Develop an evaluation tool
1.7 a
Present PowerPoint to executive team and administer evaluation tool
1.8 a
Review feedback with preceptor
1.8 b
Provide any necessary additional information to executive team and preceptor
1.6a
Complete by July 27, 2012
1.6 b
Complete by July 27, 2012
1.7a
July 30, 2012
1.8 a
August 3, 2012
1.8 b
August 3, 2012
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 23
APPENDIX B
Preceptor and Agency Agreements
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 24
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 25
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 26
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 27
APPENDIX C
Student-Preceptor Evaluation Tool
Student ____Jennifer Dilly______Preceptor ___Julianne Carey ___
For each objective, please provide comments or examples as to how objectives were exceeded, met, or not met.
Preceptor and Student Evaluation ToolObjective 1.1 Obtain and review literature and information surrounding Meaningful Use requirements for attestation related to the specific quality measures, and documentation requirements for Stroke and VTE measure set compliance.The student has researched Meaningful Use and the quality measure set compliance requirements from various databases, information sources, and through discussion with Spectrum Health’s lead for Meaningful Use. The research is evident through the provision of a literature and reference list.Preceptor Comments/Examples
Objective Exceeded Objective Met Objective Not Met
Student Comments/ExamplesObjective Exceeded Objective Met Objective Not Met
Objective 1.2 Identify specific necessary documentation requirements for each measure
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 28
within each measure setThe student has succinctly listed each measure within each measure sent and outlined the required documentation for each.Preceptor Comments/Examples
Objective Exceeded Objective Met Objective Not Met
Student Comments/ExamplesObjective Exceeded Objective Met Objective Not Met
Objective 1.3 Learn the EHR system the facility will be adopting including how the EHR has been built to capture documentation surrounding the Stroke and VTE measure sets.Through attendance at various classes, the student has learned the basic documentation, computerized physician order entry, and quality metrics systems related to documentation of quality metrics for Meaningful Use. Additional meetings with Spectrum Health’s Quality department measure abstractors and review of applicable power plans has allowed the student to provide a succinct outline of data points related to documentation of the quality metrics for Meaningful Use.Preceptor Comments/Examples
Objective Exceeded Objective Met Objective Not Met
Student Comments/Examples
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 29
Objective Exceeded Objective Met Objective Not Met
Objective 1.4 Perform a gap analysis for documentation needs that ensure measure set compliance and the ability to attest to the MU requirements.The student has compared the required documentation for each quality measure with the outline of the EHR’s data points related to documentation of the quality metrics for Meaningful Use and has effectively identified and outlined the gaps between the two. Preceptor Comments/Examples
Objective Exceeded Objective Met Objective Not Met
Student Comments/ExamplesObjective Exceeded Objective Met Objective Not Met
Objective 1.5 As identified through the gap analysis, develop specific EHR data points that are still needed or need to be unique to this facility to meet requirements of MU and submit to facility’s Information Technology department.As identified through the gap analysis, suggestions of data points necessary for capture of accurate documentation have been submitted.
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 30
Preceptor Comments/ExamplesObjective Exceeded Objective Met Objective Not Met
Student Comments/ExamplesObjective Exceeded Objective Met Objective Not Met
Objectives 1.6 and 1.7 Prepare a report and presentation for the facility’s Executive team regarding how facility will meet MU requirements related to the two quality measure sets. Prepare an evaluation tool. Present report to Executive team and ask for feedback. The student has created an informative PowerPoint presentation as well as a written report regarding how the facility will meet MU requirements for the two quality measure sets. The student has developed an evaluation tool to identify further information needed by the executive team. The student has effectively presented the Power Point to the executive team and obtained feedback.
Preceptor Comments/ExamplesObjective Exceeded Objective Met Objective Not Met
Student Comments/ExamplesObjective Exceeded Objective Met Objective Not Met
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 31
Objective 1.8 Review feedbackThe student has reviewed the executive team’s feedback with the preceptor and has provided them with any additional necessary information.Preceptor Comments/Examples
Objective Exceeded Objective Met Objective Not Met
Student Comments/ExamplesObjective Exceeded Objective Met Objective Not Met
Please provide any further SMART (specific, measureable, attainable, relevant, timed) goals recommended:
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 32
Any additional comments/suggestions.
Student Signature __________________________________ Date __________________
Preceptor Signature ________________________________ Date __________________
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 33
APPENDIX D
Bibliography/Literature Resource List
Abbett, S. K., Bates, D. W., and Kachalia, A. (2011). The meaningful use regulations in
information technology: What do they mean for quality improvement in hospitals? The
Joint Commission Journal on Quality and Patient Safety, 37(7), 333-336.
Alexander, D., Carroll, K., Fields, W., Halley, E., Martin, K.S., Murphy, J., …Anderson, K.
(2011). HIMSS position statement on transforming nursing practice through technology
and informatics. Critical Care Nursing Quarterly, 34(4), 367-376. Retrieved from
http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=1236309
American Nurses Association (ANA). (2008). Nursing informatics: Scope & standards of
practice. Washington , D.C.: Nursesbooks.org.
Benson, S. (2011). Meaningful use and clinical documentation. Journal of AHIMA, 82 (2),
36-37. Retrieved from http://journal.ahima.org/2011/02/01/february-2011/
Blumenthal, D. and Tavenner, M. (2010). The “Meaningful Use” regulation for electronic health
records. The New England Journal of Medicine, 363(6), 501-504.
doi:10.1056/NEJMp1006114
Bovend’Eerdt, T. J., Botell, R. E., and Wade, D. T. (2009). Writing SMART rehabilitation goals
and achieving goal attainment scaling: A practical guide. Clinical Rehabilitation, 23(4),
352-361. doi:10.1177/0269215508101741
Cooper, S. (2009). Charles M. Reigeluth: Elaboration theory. Theories of Learning in
Educational Psychology. Retrieved from http://www.lifecircles-
inc.com/Learningtheories/reigeluth.html
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 34
Crosson, J. C. (2011). EHR implementation without meaningful use can lead to worse outcomes.
Graham Center Policy One-Pager. Retrieved from www.aafp.org/afp
Goldschmidt, K. (2012). Finding meaning in meaningful use: Understanding the health
information technology for economic and clinical health act and its impact on nursing
practice. Journal of Pediatric Nursing, 27(1), 88-89. doi:10.1016/j.pedn.2011.10.002
Hazlenurst, B., McBurnie, M. A., Mularski, R., Puro, J., and Chauvie, S. (2009). Automating
quality measurement: A system for scalable, comprehensive, and routine care quality
assessment. AMIA 2009 Symposium Proceedings. Symposium conducted at the meeting
of AMIA, San Francisco, CA.
Huckvale, C., Car, J., Akiyama, M, Jaafar, S., Khoia, T., Khalid, A. B., Sheikh, A., and Majeed,
A. (2010). Information technology for patient safety. Quality and Safety in Healthcare,
19(Suppl 2), i25-i33. doi:10.1136/qshc.2009.038497
Kallem, C. (2011). Analyzing clinical quality measures for meaningful use. Journal of AHIMA,
82(11), 52-53. Retrieved from http://journal.ahima.org/2011/11/01/november-
december- 2011/
Kallem, C. (2011). Transforming clinical quality measures for EHR use. Journal of AHIMA,
82(11), 52-53. Retrieved from http://journal.ahima.org/2011/11/01/november-
december- 2011/
Ozbolt, J. G. and Saba, V. K. (2008). A brief history of nursing informatics in the United States
of America. Nursing Outlook, 56(5), 199-205. doi:10.1013/joutlook.2008.06.008
Quality Net (2012). Specification manual for the National Hospital Quality Measures. Retrieved
from http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic
%2FPage %2FQnetTier2&cid=1141662756099.
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 35
Page, C. K. (2011). Leveraging technology for excellence. Nurse Leader, 9(5), 32-34.
doi:10.1016/j.mnl.2011.07.005
Rueckert, N. L., Krenzischek, D. A., & Poe, S. (2011). Conversion from paper to electronic
documentation: A data gap analysis process. Journal of PeriAnesthesia Nursing, 26(3),
195. doi:10.1016/j.jopan.2011.04.051
Sensmeier, J. (2011). Transforming nursing practice through technology and informatics.
Nursing Management, 42(11), 20-23. Retrieved from
http://journals.lww.com/nursingmanagement/pages/results.aspx?k=november%202011&
Scope=AllIssues&txtKeywords=november%202011
Shaw, G. (2012). Putting data in nurses’ hands. HealthLeaders. Retrieved from www.
healthleadersmedia.com
Simpson, R. L. (2011). Nurse informaticians critical to proving meaningful use. Nursing
Administration Quarterly, 35(1), 82-84. Doi:10.1097/NAQ.0b013e318203462a
Tjia, J., Field, T. S., Fischer, S. H., Gagne, S. J., Peterson, D. J., Garber, L. D., and Gurwitz, J. H.
(2011). Quality measurement of medication monitoring in the “Meaningful Use” era. The
American Journal of Managed Care, 17(9), 633-637. Retrieved from
http://www.ajmc.com/publications/issue/2011/2011-9-vol17-
n9/AJMC_11sep_Tjia_633to637/
VanAuken, S., Chrysler, E., Gricenko Wells, L, & Simkin, M. (2011). Relating gap analysis
results to information systems program attitudes: The identification of gap priorities and
implications. Journal of Education for Business, 86(6), 346-351. Doi:
10.1080/08832323.2010.538448
MEANINGFUL USE EXECUTIVE REPORT AND PRESENTATION 36