Presentation to TurkMIA on Meaningful Use

1. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Meaningful Use and Quality
Measures and Healthstory
Nick van Terheyden, MD
Chief Medical Information Officer, Nuance
Executive Committee, Healthstory Project
Board of Directors, MTIA
October 16, 2010

2. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
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3. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Session Objectives
At the end of this session you will:
 Understand the underlying principles of Meaningful Use (MU)
and the broad intentions of the program
 Identify key Quality Measures and their source in the clinical
encounter
 Be familiar with the goals and document standards of the
Health Story Project
 Recognize how these initiatives are working together to
accelerate EMR adoption and can help guide successful
healthcare reform
 Get to know your Simultaneous Translators

4. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
What is Meaningful Use?
“Meaningful use, in the long-term, is
when EHRs are used by health
care providers to improve patient
care, safety and quality.”
“HIT is the means, but not the end.
Getting an EHR up and running in
health care is not the main
objective behind the incentives
provided by the federal
government under ARRA.
Improving Health is. Promoting
health care reform is.
David Blumenthal, MD
National Coordinator for HIT
Slide Courtesy of HealthStory

5. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Meaningful Use EHR Goals
 Improve quality, safety, efficiency, and reduce
health disparities
 Engage patients and families
 Improve care coordination
 Improve population and public health
 Ensure adequate privacy and security
protections for personal health information
 Largely aimed at driving healthcare organizations
to collect and report on quality and safety metrics

6. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Meaningful use and the EHR
Facilitates the Transformation
Hospital Centric To patient centric

7. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Meaningful Use ≈ Data Reuse
patient care
billing/claims
adjudication
research
quality reporting
clinical
decision
support
outcomes
analysis
Slide Courtesy of HealthStory

8. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
EMR Adoption Model (US)
0.8%
2.6%
3.2%
9.7%
50.2%
15.5%
6.8%
11.2%
n=5217

9. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
3 European Hospitals Awarded
Stage 6 Oct 1, 2010
 Odense University Hospital, Denmark (DK)
 The University Hospitals of Geneva (HUG)
 ISMETT Hospital The Istituto Mediterraneo
per i Trapianti e Terapie ad Alta
Specializzazione (ISMETT) Sicily, Italy

10. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Meaningful Use: Core Set
 Vital signs – structured data
(>50%)
 Problem List (1 entry for >80%)
 Active Medication List (1 entry for
>80%)
 Smoking status (>50%)
 Drug/Drug and Drug/Allergy
Checking
 e-Prescribing (>40%)
 CPOE for medication (1 medication
>30%)
 Medication Allergy (1 entry >80%)
 Patient Demographics (>50%)
 Electronic Exchange (1 test
exchange)
 One clinical decision support rule
 Implement privacy and security
 Report Clinical quality Measures
through attestation in 2011
 Generate Electronic Summary
(>50% within 3 days)
 Provide e-copy to patients (>50%
within 3 days)

11. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Meaningful Use – Menu Set
 Medication Reconciliation (>50% of transitions of care)
 Drug Formulary Checks (one internal or external formulary check)
 Incorporate Labs as Structured Data (>40%)
 Patients specific education (>10%)
 Generate Lists of Patients by Condition
 Summary of Care record (>50%)
 Electronic Immunization Reporting (1 test submission)
 Electronic syndrome surveillance (1 test submission)
 Record Advance Directives (Hosp >50%)
 Electronic submission of lab data (Hosp 1 test submission)
 Patient Reminders for Preventative/f/u care (EP >20%)
 Provide Patients with electronic access to Health Record (EP >105 within 4 days)

12. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Quality Reporting Measures
 Reporting Hospital Quality Data for Annual Payment Update
 Acute myocardial infarction (AMI), Children’s asthma care (CAC), Heart failure
(HF), Surgical care improvement project (SCIP), Pneumonia (PN), Hospital
outpatient measures (HOP), Pregnancy and related conditions (PR), Venous
thromboembolism (VTE), Hospital-based inpatient psychiatric services (HBIPS),
Stroke (STK)
 The Joint Commissions Core Measures
 Acute myocardial infarction (AMI), Children’s asthma care (CAC), Heart failure
(HF), Surgical care improvement project (SCIP), Pneumonia (PN), Hospital
outpatient measures (HOP), Perinatal Care (PC) – replaced Pregnancy Related,
Venous thromboembolism (VTE), Hospital-based inpatient psychiatric services
(HBIPS), Stroke (STK)
 Physician Quality Reporting Initiative (PQRI)
 216 individual quality measures in the 2010 PQRI Program (this increases every
year)

13. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Core Measures
Acute Myocardial Infarction
 AMI-1 Aspirin at Arrival 1
 AMI-2 Aspirin Prescribed at Discharge 1
 AMI-3 ACEI or ARB for LVSD 1
 AMI-4 Adult Smoking Cessation Advice/Counseling 2
 AMI-5 Beta-Blocker Prescribed at Discharge 1
 AMI-6 Beta-Blocker at Arrival 1
 AMI-7 Median Time to Fibrinolysis
 AMI-7a Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival 2
 AMI-8 Median Time to Primary PCI
 AMI-8a Timing of Receipt of Primary Percutaneous Coronary Intervention (PCI) 2
 AMI-9 Inpatient Mortality

14. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
PQRI – Measure Groups
 Diabetes Mellitus
 Chronic Kidney Disease
 Preventive Care
 Rheumatoid Arthritis
 Peri-operative Care
 Back Pain
 Hepatitis C
 Heart Failure
 Coronary Artery Disease
 Ischemic Vascular Disease
 HIV/AIDS
 Community Acquired Pneumonia
CAD
Oral Antiplatelet Therapy Prescribed for Patients with CAD
Inquiry Regarding Tobacco Use (Preventive Care and Screening)
Advising Smokers and Tobacco Users to Quit (Preventive Care and
Screening)
Symptom and Activity Assessment
Drug Therapy for Lowering LDL-Cholesterol
IVD
Inquiry Regarding Tobacco Use (Preventive Care and Screening)
Advising Smokers and Tobacco Users to Quit (Preventive Care and
Screening)
Blood Pressure Management Control
Complete Lipid Profile
Low Density Lipoprotein (LDL-C) Control
Use of Aspirin or Another Antithrombotic

15. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Unstructured
Data
Structured
Data
Dictation
and
Transcription
System
generated or
interfaced
data
Direct data entry,
not physician
Direct data entry,
physician
Handwritten
Current Methods for Data Capture

16. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Perceived Barriers to Adoption
Major Perceived Barriers to Adoption of Electronic Health Records (EHRs) among Hospitals with Electronic-
Records Systems as Compared with Hospitals without Systems.
Hospitals with electronic-records systems include hospitals with a comprehensive electronic-records system and
those with a basic electronic-records system that includes functionalities for physicians' notes and nursing
assessments. P<0.01 for all comparisons except physicians' resistance (P=0.20). IT denotes information
technology, and ROI return on investment.

17. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Survey Conducted with 1,000 Physicians
 • 67% cited time associated with reliance on
keyboard and mouse to document within an EHR
as a major hurdle for adoption
 • 97% selected narrative over structured data
entry as the more valuable documentation
method to treating patients
 • 96% expressed concern that they may lose the
patient’s unique story with transition to point-and-
click EHRs
 MDs resist point and click

18. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
EMR Use in Physician Practices
Source: Texas Medical Association
N=370, 4% response rate

19. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
EMR Use in Physician Practices
Source: Texas Medical Association
N=370, 4% response rate
3 to 5 minutes / patient
= 1 to 2 hours / day
= 1 to 3 fewer patients /
day

20. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Health Story Project
 Vision: Comprehensive electronic clinical
records that tell a patient’s complete health story.
 Who We Are: A non profit alliance of healthcare
vendors, providers and associations
 Mission: Pool resources to develop data
standards through HL7 for flow of information
between common types of healthcare documents
and EHR systems
 Goals: Bridge the gap between the narrative
documents and structured data

21. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Narrative
Text
Structured
Documents
Extracted, Coded
Discrete Data
Elements
EHR
Repository
HIM
Applications
Clinical
Applications
SNOMED CT
Disease, DF-
00000
Metabolic Disease, D6-
00000
Disorder of glucose metabolism,
D6-50100
Diabetes Mellitus, DB-
61000
Type 1, DB-
61010
Insulin dependant type IA,
DB-61020
Neonatal,
DB75110
Carpenter Syndrome,
DB-02324
Disorder of carbohydrate
metabolism, D6-50000
Meaningful Clinical Documents

22. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Meaningful Clinical Documents vs. Text
 Structured and encoded clinical content
enables…
 pre-signature alerts,
 decision support,
 best documentation practices,
 multiple output formats,
 multi-media reporting,
 data mining
 Implements HL7 CDA4CDT standard
compliant document types
 Increases quality of documentation

23. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Current and Future Standards
HL7 Implementation Guides
Completed
 History & Physical
 Consultation
 Operative Report
 DICOM Imaging Reports
 Discharge Summary (in publication)
Upcoming
 Procedure Note (focus on Endoscopy Report)
 CDA with unstructured body
 Billing and Reimbursement Requirements
 Progress Notes
w w w . h e a l t h s t o r y. c o m

24. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Benefits of Health Story Project
Benefit Value
Retains patient story Maintains primary role of documentation to clearly
describe and communicate what is going on with patient.
Preserves physician time
for clinical care
Makes efficient use of physician time by enabling choice
of documentation methods
Supports meaningful use Implements HL7 CDA document standards for electronic
exchange of clinical information (Patient Summary Record)
Enables dual use of
information
Structured narrative enables better outcomes reporting,
data mining, and decision support
Collaborative approach Developed by a broad array of providers, vendors and IT
organizations
Balloted process supports harmonization
Better documentation Supports better coding, DRG optimization
= better reimbursement

25. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
What Health Story Offers You
 Allows providers to choose preferred workflow
and documentation methods
 Increases the value and usability of narrative
documents
 Accelerates the implementation of interoperable
electronic health records
 Allows intelligent and meaningful reuse of
information
 Provides on-ramp to EMR system adoption
 pre-populate EMR with structured documents
 integrate legacy documents

26. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Nick van Terheyden, MD Chief Medical Information Officer, Nuance Communications
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Where You Can Find Me

27. w w w . h e a l t h s t o r y . c o mNick van Terheyden, MD
Meaningful Use and Quality
Measures and Healthstory
Nick van Terheyden, MD
Chief Medical Information Officer, Nuance
Executive Committee, Healthstory Project
Board of Directors, MTIA
October 16, 2010