HR BILLHR BILL 35903590 A UNIQUE Implication for Health CareA UNIQUE Implication for Health Care

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BACK TO THE FUTURE Protects use of individual health records (Healthcare Insurance Portability and Accountability:Aug 1996)

Ensures storage and use of electronic records (Electronic Freedom of Information Act: Oct 1996)

Makes it easier to retrieve secure information online (Electronic Freedom of Information Act)

Electronically attributes; associates; or links individual records (ARRA: Feb 2009)

Enables users to select, sort, and retrieve minimum data (Meaningful Use:July 2010)

Enables users to electronically record, modify and retrieve patient data over multiple encounters. (EHR Technology Final Rule: July 2010)

Health Care Quality Improvement: Quality Measure Prioritization

Health Outcomes Multiple Chronic Conditions

Coordination/Continuum of Care Efficiency

Meaningful Use Clinical Decision Support & related technologies

Patient Centered Care effectiveness; safety; appropriateness;

Value Based Healthcare Patient Experience and satisfaction

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New Goal of Health Reform

Leverage Data Collection Analyze data in a way that informs policy

Deliver patient centered care Support progress that utilizes evidence-based

strategies and promotes best practices Refocus health care system on improving

health, intervention, and coordination Select measures and processes that have the

greatest impact on population health

AHRQ 2010

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Ensuring the Quality of Care: Section 2717 National Strategy for Quality Improvement

Improve Measure of Health Outcomes Develop Quality Measures Develop Reporting Requirement

Identify areas for Improvement Potential Emphasize efficiency

Improve research (service research) Comparative Clinical Effectiveness

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Improve Health Outcomes: Section 2717New Emphasis in Care Management Implementation Activities

Quality Reporting Effective Case Management & Care Coordination Chronic Disease Management Comprehensive Discharge Planning (Avoidable

Readmissions) Patient Safety Best Practice and Evidence Based Medicine (Reduce

Medical Error) Health and Wellness activities (preventative care)

Reporting Requirements Wellness and Health promotion activities

`(1) Smoking cessation. `(2) Weight management. `(3) Stress management. `(4) Physical fitness. `(5) Nutrition. `(6) Heart disease prevention. `(7) Healthy lifestyle support. `(8) Diabetes prevention

Aligning Quality with MeasurementLogical Relationship

Behavior of Health Service Delivery

&

Application of Technology

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Process Measures linked to outcomes Target Outcomes (example for readmissions)

Reduction in adverse drug events Reduction in patient medical errors Reduction in unnecessary encounter Reeducation in redundant tests and procedures Achievement of patient goals Improved patient understanding

Targeted Processes Timely transfer of information across settings and providers Effective care coordination across settings and providers Timely delivery of care Improved patient understanding Improved patient awareness and emergency back up Improved patient engagement

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Goal Mapping Systematic approach

Define the process your trying to improve What is the problem or question I am going to solve or answer

Why is this Issue or Topic Important

Define how you will know when it is accomplished Intended Outcome

Desired Results Determine how this change will impact other service areas and

resources

Use goal mapping to understand and communicate the improvement goals throughout the process.

What ‘benchmark’ are there to evaluate progress or success and,

How am I going to use it to tell about my findings and solutions

Guide to Effective Case Management Strengthen your case management Program Strive for quality in your case management Pursue quality from the design of your care

coordination activities

Care Planning and Monitoring Care Planning

Individualized Identifies frequency/need Required for Authorization of Services

Monitoring Monitor the care and progress of the clientReview effectiveness of services

New Service(s)Change in service(s)Termination of Service(s)

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Quality Case Management Objective and Nonjudgmental Use only standard medical abbreviations Nature of Contact Detailed description of Contact

Brief (if possible) Event focused Relevant Information

Actions Taken/Follow Up

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Quality Coordination Process are Standard

Care is Individualized Case Manager Roles

Coordinate needed services. Communicate with service providers

regarding service delivery, and concerns.

Review and revise services, as necessary

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Case Management Reporting Medical Record (EHR) Requirements

Central Location to document and track case management activity

Accessible to multiple users Entry for care planning and monitoring activites

Available for Review Supervisors Colleagues State/Federal Auditors Clients Legal Reviews

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Care Management Systems Effectiveness

Systems that support clinical decision activity Clinical guidelines; protocols; procedures Standards orders; Triage (critical); clinical pathways Disease Case management Ancillary service management Utilization Review Outcomes and accountability (data) Benchmark Identification (data)

Efficiencies System supports Information sharing

Facilitates cross site information transfer Report extraction

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THE CHALLENGE

Health Reform 3590 strives to enhance quality improvement, and stresses the importance on

care management coordination.

The single most challenging opportunity in the quest for improvement in health

care, is the harness of integrated coordinated care.

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THE DILLEMA Today most providers lack the information systems necessary to

coordinate patient care. Care Management systems that can improve the integration of care in real time leverage the market

toward intelligent evidence based support

Systems are fragmented Improvement efforts are silo/singular Technologies are disjointed Communications staggered or non existent Resources strained

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THE REMEDIATION

Identity common goal utilizing the resources and technologies already available.

Use an Evidenced-Based design to successfully implement improvement

Apply evidenced-based strategies to achieve successful implementation activities.

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Coordinated Care with a Meaningful Use

“The final meaningful use regulations may be the first domino to bring about monumental change and

transformation to the U.S. healthcare system”. (Demers, Eric)

Meaningful use is the top priority 84%, among healthcare executives when considering how the reform bill will

impact their organizations(Health Populi)

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Integrating care management activities Strategies

Multidisciplinary TEAM case management CARE COORDINATION

Aim to improve the continuum of care through discharge planning and transitional care modeling.

Employ a coordinated interdisciplinary approach Coordinate with medical homes and/or

accountable care organizations Apply integrated computer technologies

Clinical decision support

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Implementation Activity

Workflow is KEY to effective care management. Care Management tools that supports

interdisciplinary communication. Community resources Patient Education Clinical Decision Support tools

that assist at the point of care. Data Driven Quality

Assessment (SIS/Functional) Quality Assurance and Improvement

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Workflow Development

Sample Questions:

How do you sort tasks, can you sort by priority? Can you hyperlink between tasks?Can you print health education documents? Can assessment trigger clinical alerts Do triggers take the user to the necessary task? Can completion of an assessment trigger care coordinated document?Can your documents be electronically transmitted to other care providers?

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Enact Implementation Activities using an Evidence-Based design

Implementation activities are effective when applied to structured quality improvements.

Implementation is successful when outcomes are used to benchmark or compared.

Regular feedback is critical to implementation success.

Assistive support (CDS), alerts and other real time technologies aid successful implementation.

Organizational setting must be support the strategy.

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Enact Implementation Activities using an Evidence-Based design

Research shows Quality improvement activities facilitate social influencing. Feedback and other comparative measures promote group

and individual competition and facilities social influence through perceived intention.

Assistive supports used in real time aid in knowledge translation, and presents influencing at the level of interpersonal cognitive processing.

Organizational cultures are a construct to social influence; Whereby the organization’s social structure has the most ability to positively or negatively influence the desired implementation.

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Enact Implementation Activities using an Evidence-Based design Research Shows implementation activities

are not successful when: Implementation is passive. Measures (activity outcome) or guidelines are not

accepted. Implementation activity lacks accountability and

ownership. Implementation processes are unorganized or

require competing organizational values.

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ContinuousQualityImprovement Plan

Do Check Act        

Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier

Changing Environment

Increased emphasis on clinical quality Patient safety Cost effectiveness Transparency Payment structures

(Value Based Purchasing)

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Meeting the Challenge We Have

Technologies (E.H.R) containing data that represents health service performance (diagnostic & demographic reporting)

Dedicated professionals

We need Operationalize a structure that provides a means to

efficiently and effectively administer health services in a way that values the delivery of care.