Promoting Interoperability (PI) Formerly Meaningful Use 1
What is Promoting Interoperability Formerly known as Meaningful Use In 2011 CMS established the Medicare and Medicaid EHR Incentive program to encourage facilities and providers to demonstrate the meaningful use of the EHR. KYOne Health s goal is to achieve Stage 3 PI in 2019. (Centers for Medicare and Medicaid Services, 2018) 2
How Does Promoting Interoperability Improve Patient Outcomes? https://www.google.com/search?q=meaningful+use&rlz=1c1chbf_enus723us723&source=lnms&tbm=isch&sa=x&ved=0ahukewiisjexg7paahuf4imkhuj8dl0q_auicygc& biw=1920&bih=949#imgrc=aihhj1mrk8ss8m 3
What is Clinical Reconciliation? 4
Criteria: Clinical Reconciliation Clinical Reconciliation will involve review of home medications, problems, and allergies with other outside facility records available from the state health information exchange (HIE). Health Information Exchange allows the secure sharing of patient information between healthcare facilities and providers. The transparency of this information allows for safer, more effective care for the patient s needs producing better outcomes. https://www.google.com/search?q=health+information+exchange&rlz=1c1chbf_enus723us723&source=lnms&tb OneCare/ Catholic m=isch&sa=x&ved=0ahukewix6aqnsolaahvi74mkhbgebqyq_auicygc&biw=1920&bih=989#imgrc=cwkyxysnh Health Initiatives / MU Measure Owner Training HEFkM: 5
Nursing Workflow mpages OneCare/ Catholic Health Initiatives / MU Measure Owner Training 6
Admission Workflow mpages Admission Workflow mpages/summary Allows ability for the reconciliation process (Home Medications/Allergies/Problems). For Nursing: The Admission Workflow mpage will be used in conjunction with the Admission History PowerForm when admitting new patients. For other clinicians: (Pharmacy, CM, Rehab, Stroke Navigators, Joint Navigators, etc) The mpage will serve as a tool to review and enter home meds, problems and allergies as applicable. To enter long term goals and interventions that are applicable across the continuity of care after the patient s discharge. Case Managers/Joint & Stroke Navigators will be able to enter health concerns if applicable. Also contains links to the most frequently used PowerForms, IVIEW bands and clinical documents surrounding the patient s admission. OneCare/ Catholic Health Initiatives / MU Measure Owner Training 7
Admission Workflow mpage The Admission Workflow mpage will be located in the menu displaying after the Patient Handoff or the Inpatient Summary depending on the user s position. The Admission Workflow mpage contains the following components (Components in red indicate PI functionality). Home Medications Allegis Histories (Problems and Procedures) Admission History Documents Continuity of Care Goals/Interventions Health Concerns Patient Provided Health Information Link 8
Admission Workflow mpage 9
Admission Workflow mpage Home Medications Home medications from outside records will display with a purple diamond. The clinician will add or decline each home med and then select Complete History to mark the reconciliation of outside record home medications as complete. Next, the clinician will finalize the home medication list via the Document Home Medication tool. 10
Admission Workflow mpage Home Medications Component The Document Medication by History tool will open, the nurse will enter home medications per current practice. Review final list for all medications and make any remaining updates. Select Document History. 11
Workflow mpages Allergies Component Allergies that have automatically pulled in from outside records will display with a purple diamond. The clinician will add or decline each outside record allergy and then click on COMPLETE RECONCILLIATION If No Results Found displays- select COMPLETE RECONCILLIATION. 12
Admission Workflow mpages Allergies Next, click on the Allergies hyperlink to add new allergies or modify existing allergies that were not displaying as part of the outside record reconciliation step. 13
Admission Workflow mpages Allergies Component NOTICE-Mark As Reviewed-If Allergies already display from a previous admission and no new updates are needed, the clinician is to click on the Allergies link and then select the Mark All as Reviewed button. 14
Admission Workflow mpages Histories Component (Problems/Procedures) Problems that have automatically pulled in from outside records will display with a purple diamond. The clinician will add or decline each outside record problem and then select COMPLETE RECONCILLIATION. If No Results Found displays- select COMPLETE RECONCILLIATION 15
Admission Workflow mpages Histories Component (Problems/Procedures) Next, click on the Histories hyperlink to add or modify existing problems. Add appropriate problem information and select OK in the Problem Control once complete. 16
Admission Workflow mpages Histories Component (Problems/Procedures) Procedures will not pull in from outside records. This will be a manual add just as it currently is today in the Procedure Tool within Cerner. Click on the Procedures Tab and then enter the name of the procedure in the Add Procedure search box. A list of procedures to choose from will display. Select the appropriate procedure and then enter applicable procedure information then select Save. If the clinician chooses to free text the procedure, select the last option in the drop down list to add as a free text. 17
Admission Workflow mpages Admission History Component Pertinent fields documented in the Admission History PowerForm will display within the Admission History Component of the Admission Workflow mpage. 18
Admission Workflow mpages Admission History Component For inpatient departments (SJH HISSU, SJE Women's Hospital, etc) who ad hoc their Admission History or Pre Procedure PowerForm in PowerChart, these forms can be accessed by clicking on the drop down arrow and selecting the appropriate form. This is the recommended workflow instead of the Nurse leaving the mpage and clicking on ad hoc to access to the form. 19
Admission Workflow mpages Documents Component The documents component will display specific documents completed related to Admission Histories. Admission History PowerForms ED Triage PowerForms Physician H&P Surgery Notes Etc 20
Admission Workflow mpages Continuity of Care Goals/Interventions Component It is NOT required that nurses and other clinicians enter this documentation. PI requires that the electronic health record has the ability to enter long term goals and interventions. These are long term patient health goals and interventions will flow into the patient portal information. Goals and Interventions will cross encounters and will remain active until removed from the component. 21
Admission Workflow mpages Health Concerns Component Health Concerns are only able to be documented by Case Managers, Social Workers, Joint and Stroke Navigators. All other positions will have the ability to VIEW any health concern entered into the component. It is NOT required that clinicians enter this documentation. PI only requires that the electronic health record has the ability to document health concerns and flow to the patient portal. Health Concerns are non-medical concerns that affect a patient s ability to achieve a successful recovery. For example, a patient may have transportation issues and may not be able to make their numerous follow up appointments. Health Concerns will cross encounters and remain active until removed from the component. 22
Admission Workflow mpages Patient Provided Health Information Link Component It is a PI requirement for an electronic health record to have the ability to document and access patient provided health information links, however there is NOT a threshold % of patients to meet. Therefore, this PI requirement is NOT required for nursing to document. If the patient has a personal health information link or app, enter the information into the Patient Provided Health Information Link Component. 23
Admission Workflow mpage Tips Refresh is available in each component to ensure most up to date information is available. Back button returns to the last location visited in the record. 24
What s Next? 25
What s next? SuperUser Training In Class Training Tip Sheets PI Go Live Nursing SuperUsers will attend a session with additional information and check off. Multiple 2 hour in class training will be available for clinicians late Septemberearly November. In depth tip sheets will be provided to all clinicians who attend class. November 2018 26
References References Centers for Medicare and Medicaid Services. (2018, March 27). Electronic health records (EHR) incentive programs. Retrieved from https://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRincentiveprograms 27