1. MEANINGFUL USE
FOR NYU USING
EPIC
Presentation online at: http://bit.ly/NYUMUEPIC

2. AGENDA
• Welcome
o Review of agenda and goals for the session
• History of Meaningful Use
• Define Meaningful Use
• Demo Epic Workflow MU Allergy objective
• Demo Epic Workflow MU Smoking objective
• Review Key Points
• Answer questions
• Next Steps
o Review homework

3. DISCLAIMER
• All characters, data,
examples that appearing
in this work are fictitious.
Any resemblance to real
persons, living or dead, is
purely coincidental.

4. SITUATION: POOR
ADOPTION OF H.I.T.
• US lags behind other in industry
sectors and developed countries.

5. BACKGROUND:
REASONS
 Cost
 Software Quality and
Usability
 Standards

6. ASSESSMENT: POOR
H.I.T.:
• Medical Errors
• Increased
healthcare cost
• Decreased quality
of care
• Increase
paperwork

7. • Increase the adoption of
the Electronic Medical
Record (EMR)
• Advance Health
Information
Technology(HIT)

8. SOLUTION: HITECH
ACT
• Signed into Law Feb 17,2009 by
President Obama with a Goal by
2015 to:
o reduce the -cost of care
o Improve patient-health
centered care
o Enhance patient safety
o Improve population care

9. WHAT IS
MEANINGFUL USE?
• Meaningful Use (MU) =
Objective measures
that hospital report as a
result of HITECH act.

10. MEANINGFUL USE -
REPORT CARD
Hospital Reports on 21 Different
Objectives

11. EXAMPLE FINAL HOSPITAL
REPORT

12. STILL AWAKE?

13. MEANINGFUL USE:
THE RELIGION
• GIGO
• Adoption of
technology
• “Information
wants to be free”

14. WHY CHANGE?
• Voluntary program and you attest to being a
MU.
• I don’t need an EHR to be a good clinician?
• Where do I find time to learn a new system?
• How do I find time to see patients and enter
my own data?
• It will slow me down?
• It so uncaring and not patient friendly.
• I like paper records!

15. INCENTIVE: IMPROVE
PATIENT CARE
o MU supports evidence based objectives to
improve patient outcome.
o MU supports patient-centric care that
engages patients and families
o MU helps reduce health disparities and
improve Population and Public Health
o MU improves care coordination
o DSS supports safe patient care

16. INCENTIVE: REVENUE
• $31 Billion Dollars available
for meaningful users of
electronic health systems.
• Hospital can receive
substantial income for
“meaningful use”

17. INCENTIVE: NON USE
PENALTY
• Penalties start in
2015

18. NEXT UP:
EXAMPLES
• Any Questions
before we
move to
examples?

19. 21 COMPONENTS OF
“MEANINGFUL USE”
• 1. Interoperability objectives
• 2. Objectives that measure clinical
use of EHR

20. MU OBJECTIVES:
MEASURE
INTEROPERABILITY
• Report hospital quality measures to CMS (Stoke, ED
throughput)
• Exchange clinical information with other institutions
• Submit electronic data to immunization registries

21. MU OBJECTIVES:
MEASURE CLINICAL USE
OF EHR
• Computerized Practitioner Order Entry
(CPOE)
• Record demographics
• Maintain active medication list
Every Patient
Encounter • Maintain active problem list
• *Maintain active Allergy list
• *Record smoking status for patients 13
years or older
• Medication Reconciliation

22. MU RULE: ALLERGY LIST
• Objective :Maintain active
medication allergy list.
• Measure : More than 80 percent of all
unique patients admitted to the eligible
hospital’s have at least one entry (or an
indication that the patient has no known
medication allergies) recorded as structured
data.
Evidence:
Adverse drug events in hospitalized patients. Excess
length of stay, extra costs, and attributable mortality.
JAMA. 1997 Jan 22-29;277(4):301-6.

23. WORKFLOW TO MEET MU
OR ITEM
-Patient admitted using
Admission Navigator in
Epic.
-During your admission
suggested workflow you
will come to the allergies
section.

24. WORKFLOW TO MEET MU
OR ITEM
-Select No known allergies check box
-Select Mark as Reviewed.
-If patient leaves the hospital with no
data in the No known allergies measure
Fails.

25. RECORD ALLERGY
OBJECTIVE

26. EXAMPLE FINAL HOSPITAL
REPORT
Allergy
Objective
(80%):
Out of 1287
patients seen:
92% (passed)
8% (failed)

27. MU RULE: SMOKING
STATUS
• Objective :Record smoking
status for patients 13 years old
or older.
• Measure : More than 50 percent of all
unique patients 13 years old or older or
admitted to the eligible hospital’s inpatient
or emergency department have smoking
status recorded as structured data.
Evidence:
Smoking cessation counseling should be provided.
Smokers are 2 to 3 times more likely to get pneumonia than
nonsmokers and are at risk of more severe disease
Cleve Clin J Med. 2005 Oct;72(10):916-20.

28. WORKFLOW TO MEET MU
OR ITEM
-Select Tobacco use status of patient.
-If patient leaves the hospital Never Assessed measure
Fails. All other sections give credit. Including Unknown
If Ever Smoked.

29. RECORD SMOKING
OBJECTIVE

30. END OF YEAR RESULTS FOR
SMOKING OBJECTIVE
Record Smoking
-End of the reporting
period
-For the entire Hospital
-Inpatient and ER
admissions

31. KEY TAKEAWAYS
• Key: Start with education of users on correct
workflow – Minimize Work Around
• Key: Real Time Documentation - Minimize Batch
Documentation & Mark as reviewed
• Key: Utilize reports / Best Practice Advisories –
Reports and Advisories are your friend.

32. SOURCE READING
• Centers for Medicare & Medicaid Services
https://www.cms.gov
• The Meaningful Use Attestation Calculator
https://www.cms.gov/apps/ehr/

33. MEANINGFUL USE:
• Questions?

34. Thank you for your
Time!
This entire presentation can be found online at:
http://bit.ly/NYUMUEPIC