2011 Summer Institute in Nursing Informatics The Tenet Story
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1 2011 Summer Institute in Nursing Informatics The Tenet Story Liz Johnson, MS, FHIMSS, CPHIMS, RN-BC VP of Applied Clinical Informatics HHS Health Information Technology Standards Committee Member Modern Healthcare 2010 Top 25 Clinical Informaticist HIMSS 2010 Nursing Informatics Leadership Award HIMSS50 in 50: Memorable Contributors in HIMSS 50 Year History
2 Tenet Healthcare Corporation One of the Largest Investor-Owned Health Care Delivery Systems in the Nation 49 acute care hospitals in 11 states 64 outpatient centers 57,000 employees $9.01 billion net operating revenues (CY'09) 519,390 admissions (CY'09) 3.88 million outpatient visits (CY'09) 2
3 Every Strategic Initiative Has a Clear Vision and Mission IMPACT Vision To provide the right information when and where it s needed to improve the care and life of every person in the communities that we serve IMPACT Mission Have an Electronic Health Record(EHR) and Patient Health Record(PHR) by 2015 Get people to use technology Share health information in our hospitals and across our communities 3
4 Program Governance BOARD OF DIRECTORS SUB-COMMITTEE Corporate Accountability Global Business Functions PMO/FMO Delivery Solutions Liz Johnson, IMPACT Program Leader EXECUTIVE STEERING COMMITTEE Operations/Regional Accountability HOSPITAL STEERING COMMITTEES MEANINGFUL USE COMMITTEE 4 Hospital Accountability Hospital Project Leads OPERATIONS COMMITTEE Clinical Leadership Council Physician Advisory Council Clinical Advisory Councils
5 5 IMPACT Schedule
6 Round 2 Round 1 Multi-vendor Sites Today Evolution of Tenet Clinical Systems Orders Closed Loop Med Reconciliation Rx Lab Clin Doc Electronic Meds Admin CPOE Bar-coded Meds Orders X Rx X Lab X Rad PACS OB ED Others Round 2 Closed Loop Med Reconciliation CPOE Round 1 Legacy Vendor Sites Today X Orders X Rx Clin Doc Electronic Meds Admin Bar-coded Meds Orders Rx Lab Rad PACS OB ED Others Round 2 Closed Loop Med Reconciliation CPOE 6 Round 1 Current Vendor Sites Today Clin Doc Electronic Meds Admin Bar-coded Meds Orders Rx Lab Rad PACS OB ED Others
7 Tenet s Position Quality Measures Develop reporting capabilities to deliver all 15 electronic specified measures Incorporate specific data elements in the EHR build design for 20 measures proposed for Stage 2 and 3 24 Utilization Measures Develop reporting capabilities to deliver all 24 Utilization Measures Develop reporting and compliance for 14 Core Set measures Develop reporting and compliance for all 10 Menu Set measures providing flexibility in choosing 5 for submission 7 Attesting for both Medicare and Medicaid
8 Tenet Measure by Measure Conducted functional and application level analysis Researched documentation for each measure Populated validation tool of identified data elements Coordinated with a multi-disciplinary team Met with representatives from key functional areas Ongoing managing and working issues and risks 8
9 Meaningful Use (Stage 1) Requirements Key Meaningful Use Workflows Foundation System Workflows Smoking Status Advanced Directives Recording Allergies Medication Reconciliation- Nurses Use of the Medication List Use of the Problem List- Nurses CPOE Workflows Documenting clinical trials Problem List-Physician Medication Reconciliation-Physician Capturing preliminary cause of death -Physician Comfort Measures-Physician Medication Contraindications- Physician Depart Process-discharge medications-physician Patient request for electronic discharge instructions-nurse Quality Measures: stroke and VTE Transition of care 9
10 Life Cycle of a Meaningful Use Measure with supporting Tools and Resources 10
11 Meaningful Use (Stage 1) Requirements Life Cycle of a Meaningful Use Measure Attest to CMS Drives design decisions & build (workflow, data elements, order sets, content) Data Tool Provider Uses a Certified EHR PBAR* Cerner* EDW* Document Compliance & Evidence MU Attestation Documentation Module Monitor & Track Compliance MU Dashboard Data populates Enterprise Data Warehouse EDW 11 * Certified
12 12 Clinical Business Intelligence Demonstration
13 Document Compliance & Evidence Tenet MU Attestation and Documentation Module (MUADM) Compliance tool Built on Pega (same platform as Compliance Central) Provides detailed instructions and procedures for hospital to complete required steps for attestation submission by Corporate Supports dashboard for yes/no measures interfaced with DW Reminder/scheduling tool Start and end times associated with Meaningful Use attestation Electronic communication between Hospital and Corporate submitter Central repository Attestation responses for each hospital Evidence to support CMS audit Audit tool Time stamps work-flows, responses, authors, and evidence 13
14 Document Compliance & Evidence MUADM: The Tool Review Screen: Tracking and Evidence 14
15 Applied Clinical Informatics at Tenet Liz Johnson VP 15
16 16 Value Realization
17 Informatics Development at Tenet Mentorship of hospital informaticists by IMPACT program informaticists experienced in EHR implementations Annual Tenet Clinical Informatics Academy Academy lapel pin and certificate for 18 nursing Continuing Ed credits CI Collaborative calls and website to share best practices CI competency assessments Visits and assistance to other Tenet hospitals 17
18 Lesson Learned with Meaningful Use Stage 1 Make decisions now with the future in mind Prepare for Stage 2 and 3 Shared accountability programs Pay for performance (quality based) The data matters, a lot Summary analysis of the CMS regulations is not enough - need to get to the data level (measure by measure) Data must be discrete, at the lowest level Can t build for the future without the data in mind Must be able to aggregate, calculate and report Overlap between CMS Core Measures and CMS EHR Clinical Quality Measure programs exists These will not be 100% harmonized Will require expansion of hospital quality programs 18
19 Lesson Learned with Meaningful Use Stage 1 Have a team dedicated to tracking, interpreting and attesting It s a balancing act that requires effective governance to manage other priorities (e.g. 5010, ICD-10) Engage your clinicians, early, often and get their input Communicate, communicate, communicate Help users understand what is coming Set expectations, things will change 19
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