4. They Might Be Right
Lifespan
Four hospitals, three med surg
1000 beds
Half teaching, half private
We’ve registered for year one
Submitting the end of this month
We think we’re okay for Stage Two
5. Our Approach
Map the criteria to improvements that are
evidence based for quality and safety
If the criteria are not evidence based (?patient
empowerment?) link them to something that
is
Present this as an incentive to do what we
should do anyway
Meet the criteria in a ‘meaningful’ way
6. Some Wrong Ways
Duck and Cover
One and Done
Take the Money and Run
7. Duck and Cover
Did you ever practice This is a good
duck and cover at time to start!
school?
8. It Really Stinks to Be You
You were responsible for all clinical errors
Now you’re responsible for the financial
survival of your hospital as well
A case can be made that the investment is too
high, the return too low, and the penalties are
tolerable
Not a case you want to make
9. One and Done
Some criteria for year one are measured by
“do one”
Orders
Problems
Home Meds
Immunization submission
Generate a report
Etc.
10. One and Done Has This Problem:
After year one we’re done
Slammed short term solutions don’t get you to
Stage 2
What happens year two if you can’t substantiate
what you attested to?
11. Take the Money and Run
It is possible that 2012 elections will produce
big changes
Health care reform gets undone
HITECH gets unfunded
If this happens, getting what you can year one
is the goal…
But if it doesn’t happen, then what…
12. Take the Money and Run
If your hospital is sharing meaningful use
money with the docs, you live in a different
universe and should not be here
Telling the clinicians that you’re doing this
for the money for the hospital will not make
them enthusiastic participants
If you can’t make a case for improved quality
and safety you have a steep hill to climb
13. One Approach – Seven Projects
(Plus 3)
Project #1 – Meeting Standards
Project #2 – Electronically Collect Clinical
Information
Project #3 – Transitions of Care
Project #4 – Quality Indicators
Project #5 – Patient/Provider Access to Information
Project #6 – Protecting Patient Information
Project #7 – Communication and training
14. Standards
“LOINC’d” lab and diagnostic imaging
Both orders and results
It is a lot of work
None of it is rocket science (remind me to brag here)
Problem List in SNOMED
NLM subset
ICD-9 crosswalk
RxNorm is not ready for prime time
15. Electronic Clinical Documentation
CPOE – no longer a question, is it?
Nursing
“LIP’s” (I really hate this expression)
Home meds
Two approaches
Collect as data
Use NLP
Collect as data is more work but provides a great
foundation for the future
16. Transitions of Care
The CCD (or CCR) is the Holy Grail
The more defined data you collect, the easier
it is to build
A discharge instruction process wins friends
Med Rec does not, but a pharmacy profile
from RxHub/Surescripts does
17. Quality Indicators
Personal goal: chart abstraction will be a
memory by the time I retire
If orders, meds, nursing observations, results,
discharge meds, and diagnosis are defined
data, quality measures flow
If not, NLP is not a full solution but it works
18. Patient Provider Access
No evidence supporting patient access
Make it a subset of provider access
Good support for this…
Provider access
Registry/Repository
XDS.b
20. Communication and Training
Weekly messages from the CMO’s
Many messages from the CEO’s
All say:
This is a quality
and safety project
21. Plus 3
Technology
Dragon has not been as popular as we thought
IPads have been
Certification
Avoid self certification if you can – it is a
quagmire
Actualization
Complicated but not impossible; don’t neglect the
work to get the money….
22. Thanks
Questions?
Reid Coleman
rcoleman@lifespan.org
401-444-6448
We share most everything