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Achieve MU3: Measure 3 with these 5 MEDITECH Clinical Decision Support Interventions (CDSi)

Posted on August 11, 2017 I Written By

The following is a guest blog post by Kelly Del Gaudio, Principal Consultant at Galen Healthcare Solutions.

Over the past several years, there has been significant investment and effort to attest to the various stages of meaningful use, with the goal of achieving better clinical outcomes. One area of MU3 that directly contributes to improved clinical outcomes is implementation of Clinical Decision Support Interventions (CDSi). Medicaid hospitals must implement 5 CDSi and enable drug-drug and/or drug-allergy checking.

From looking at this measure it seems like a walk in the park, but how does your organization fair when it comes to CDS?

Thanks to First Databank, users of EMR’s have been accomplishing drug to drug and drug to allergy checking for over a decade, but what about the edge cases you think will be covered but aren’t? Take a patient that is allergic to contrast for example. Since imaging studies requiring contrast are not drugs, what happens when they are ordered? Are they checking for allergies? In most cases, additional configuration is required to get that flag to pop. This is usually where we come in.

Let’s take a look at a simple CDSi definition provided by CMS.gov

“CDS intervention interaction. Interventions provided to a user must occur when a user is interacting with technology. These interventions should be based on the following data:  Problem list; Medication list; Medication allergy list; Laboratory tests; and Vital signs. “

Without a decent rule writer on staff, there are limitations within MEDITECH for accomplishing full CDSi. The primary reason we started recording these discrete data elements in the first place is the glimmer of hope that they would someday prove themselves useful. That day is here, friends. (If you don’t believe me, check out IBM’s Watson diagnosing cancer on YouTube. . .you might want to block off your schedule.)

In collaboration with 9 hospitals as part of a MEDITECH Rules focus group – Project Claire[IT] – we researched and designed intuitive tools to address Clinical Quality Measures (eCQM’s) and incorporated them into a content package. If your organization is struggling to meet these measures or you are interested in improving the patient and provider experience, but don’t have the resources to dedicate to months of research and development, Project Claire[IT]’s accelerated deployment schedule (less than 1 month) can help you meet that mark. Below are just some examples of the eCQM’s and CDS delivered by Project Claire[IT].

CMS131v5     Diabetes Eye Exam
CMS123v5     Diabetes: Foot Exam
CMS22v5       Screening for High Blood Pressure and Follow-Up Documented

Synopsis: The chronic disease management template will only display questions relevant to the Problem List (or other documented confirmed problems since we know not everyone uses the problem list). Popup suggestions trigger orders reminding the provider to complete these chronic condition follow-up items before letting the patient out of their sights. Our goal was to save providers time by ordering all orders in 1 click.

CMS71v7     Anticoagulation Therapy for Atrial Fibrillation/Flutter
CMS102v6   Assessed for Rehabilitation

“The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation.” – CMS71v7

The above quote is taken directly from this measure indicating the use of the Framingham Heart Study we used to identify and risk stratify stroke. Claire[IT] content comes complete with three Framingham Scoring tools:

                Framingham Risk for Stroke
                Framingham Risk for Cardiovascular Disease
                Framingham Risk for Heart Attack

These calculators use all the aforementioned data elements to drive the score, interpretation and recommendations and the best part is they only require one click.

*User adds BP. BP mean auto calculates. Diabetes and Smoking Status update from the Problem List. Total Cholesterol and HDL update from last lab values.
Ten year and comparative risk by age auto calculates.

*User adds BP. BP mean auto calculates. Diabetes, Smoking Status, CVD, Afib and LVH update from the Problem List. On Hypertension meds looks to Ambulatory Orders.
Ten year risk auto calculates.

*User adds BP. BP mean auto calculates. Diabetes and Smoking Status update from the Problem List. Hypertension meds looks to Ambulatory Orders. Total Cholesterol and HDL update from lab values.
Ten year risk auto calculates.

CMS149v5      Dementia: Cognitive Assessment

Synopsis: Not only is this tool built specifically as a conversational assessment, it screens for 4 tiers of mental status within one tool (Mental Status, Education, Cognitive Function and Dementia). The utilization of popup messages allows us to overcome the barrier of character limits and makes for a really smooth display on a tablet or hybrid. Our popups are driven by the primary language field in registration and our content currently consists of English and Spanish translations.

CMS108v6     VTE Prophylaxis
CMS190v6     VTE Prophylaxis is the ICU

Synopsis: Patients that have an acute or suspected VTE problem with no orders placed for coumadin (acute/ambulatory or both) receive clinical decision support flags. Clicking the acknowledge tracks the user mnemonic and date/time stamp in an audit trail. Hard stops are also in place if NONE is chosen as a contraindication. The discharge order cannot be filed unless coumadin is ordered or a contraindication is defined. These rules evaluate the problem list and compare it to the medication list to present the provider with the right message.

Learn more about the work of our focus group and Project Claire[IT] by viewing our MEDITECH Clinical Optimization Toolkit.

VIEW THE TOOLKIT TO ACCESS:

  • Deliverable Package of Complex Rules, Assessments, CDS’s and Workflows
    • Problem List Evaluation
    • Total Parenteral Nutrition
    • Manage Transfer Guidance
  • Surveillance Dashboard Setup Guide
    • Dictionary Setup & Validation
  • 6.x Rules Setup Guide
    • Basic Rules for Assessments, Documents & Orders
  • IV Charge Capture Setup Guide

About Kelly Del Gaudio
Kelly is Principal Consultant at Galen Healthcare Solutions, and has been optimizing MEDITECH systems for over 10 years. She worked for MEDITECH on an elite 4-person team (the MEDITECH SWAT Team), whose sole concentration was clinical optimization, ROI analysis, MU certification, and achievement of HIMSS EMRAM Stage 6/7. Kelly currently leads Galen’s MEDITECH practice, and championed a focus group, which led to the delivery of Project Claire[IT], a MEDITECH content package of complex rules, assessments, CDS’s, and workflows that evaluate, suggest, and support documentation of chronic and acute problems. Learn more about Kelly in the #IAmGalen series.

About Galen Healthcare Solutions

Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the EMR Clinical Optimization Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

EMR Clinical Optimization CIO Perspectives – EMR Clinical Optimization Series

Posted on July 26, 2017 I Written By

The following is a guest blog post by Julie Champagne, Strategist at Galen Healthcare Solutions.

Most HDOs today face a decision: start over with a new EMR or optimize what you have. A poorly executed implementation, coupled with substandard vendor support, makes EMR replacement an attractive and necessary measure. Further, the increase in mergers and acquisitions is driving system consolidation and consequently increasing the number of HDOs seeking EMR replacement to address usability and productivity concerns.

Galen Healthcare Solutions spoke with two prominent health information technology leaders, who have quite a bit of experience in the optimization field to hear their views on the topic. Sue Schade, MBA, LCHIME, FCHIME, FHIMSS, is a nationally recognized health IT leader and Principal at StarBridge Advisors, providing consulting, coaching and interim management services. Jim Boyle, MPH, CGEIT is Vice President of Information Services of St. Joseph Heritage Healthcare (Anaheim, Calif.). In his current role, Jim oversees the delivery of applications and technology and is a member of the executive leadership team. Below are their perspectives

Opportunities for EMR optimization generally fall into three categories:

  • Usability & efficiency: Improve end-user satisfaction and make providers more efficient and productive
  • Cost Avoidance: Improve workflows to increase utilization and decrease variability
  • Increase Revenue: Implement analytics to transition from volume to value


Recently, three prominent Boston-area physicians contributed an opinion piece to WBUR, “Death By A Thousand Clicks”. They postured that when doctors and nurses turn their backs on patients in order to pay attention to a computer screen, it pulls their focus from the “time and undivided attention” required to provide the right care. Multiple prompts and clicks in an EMR system impact patients and contribute to physician burnout.

HDOs should then limit their intake to what can be accomplished within one quarter, referred to as a sprint. Accountability should be assigned, and visual controls or Kanban should be leveraged.


 
For HDOs that experienced failed EMR implementations, making corrections and reengineering is a necessary first measure. Typically, a deficiency in the additional support for the system implementation is to blame, and employing qualified application support staff will help to address and resolve end user dissatisfaction.
 
 
 
To realize lasting impact from the EMR, extensive post go-live enhancement and optimization is needed. Leveraging the operational data in the EMR system can support many initiatives to improve workflows, as well as clinical and financial performance. Prioritization of the levers that can be adjusted depends on the HDO’s implementation baseline and strategic goals.

 
The most important deciding success factor for an optimization project is focusing effort and ensuring the scope is not too large. Further, it is of critical importance to set measurable and attainable metrics and KPIs to gauge the success and ROI of the initiative. Quantification of staff effort and IT investment is also important.

Gain perspectives from HDO leaders who have successfully navigated EMR clinical optimization and refine your EMR strategy to transform it from a short-term clinical documentation data repository to a long-term asset by downloading our EMR Optimization Whitepaper.

About Sue Schade
Sue Schade, MBA, LCHIME, FCHIME, FHIMSS, is a nationally recognized health IT leader and Principal at StarBridge Advisors providing consulting, coaching and interim management services. Sue is currently serving as the interim Chief Information Offi cer (CIO) at Stony Brook Medicine in New York. She was a founding advisor at Next Wave Health Advisors and in 2016 served as the interim CIO at University Hospitals in Cleveland, Ohio. Sue previously served as the CIO for the University of Michigan Hospitals and Health Centers and prior to that as CIO for Brigham and Women’s Hospital in Boston. Previous experience includes leadership roles at Advocate Health Care in Chicago, Ernst and Young, and a software/outsourcing vendor. Sue can be found on Twitter at @sgschade and writes a weekly blog called “Health IT Connect” – http://sueschade.com/

About Jim Boyle
Jim Boyle, MPH, CGEIT is a Vice President of Information Services of St. Joseph Heritage Healthcare (Anaheim, Calif.). Jim Boyle is nationally recognized as part of a new generation of health care informatics professionals who understand IT’s full potential to greatly improve peoples’ lives. In his current role Jim oversees the delivery of applications and technology and is a member of the executive leadership team for St. Joseph Heritage Healthcare, which comprises over 860 medical group providers and 1300 affiliated physicians across California. Since joining St. Joseph Health 12 years ago, he has held eight different positions, including project manager, application analyst and IT director at Fullerton, Calif.-based St. Jude Medical Center. Jim can be found on Twitter at @JBHealthIT and LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the EMR Clinical Optimization Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

 

EMR Clinical Optimization Infographic – EMR Clinical Optimization Series

Posted on July 12, 2017 I Written By

The following is a guest blog post by Justin Campbell, Vice President, Strategy, at Galen Healthcare Solutions.


(See Full EMR Optimization Infographic)

In this infographic, Galen Healthcare Solutions provides critical information and statistics pertaining to EMR optimization including:

  • EMR Market Maturation
  • EMR Capital Investment Priorities
  • EMR as a Valuable Asset vs Required Repository
  • Clinical Optimization Goals & Benefits
  • Types of Clinical Optimization
  • Clinical Optimization Effort & ROI Matrix

EMR products get widely varying reviews. There is strong support and appreciation for EMRs in some HDOs, where the sentiment exists that the EMR is well-designed, saves time, and supports clinical workflows. That said, in other HDOs, providers using the same EMR complain that EMRs add work, decrease face time with patients and create usability issues and slowdowns. Multiple prompts and clicks in an EMR system impact patients and contribute to physician burnout. The resounding sentiment for these set of providers is that the EMRs are not designed for the way they think and work. Why then the varying response among providers to the same EMR products? Deficient implementations.

Under the pressure of moving ahead to meet the requirements of the Meaningful Use program, most EMRs were implemented using a Big Bang approach, and very rapidly. While this approach may have been the most effective to capture incentives, generic, rapid EMR implementation led to several unintended consequences, resulting in widespread user dissatisfaction. EMRs today serve more as a transactional system of record than a system of engagement. To be used to their full capacity, the different components and modules of the EMR should be evaluated against baseline metrics to harness additional capabilities including clinical decision support, analytics at the point of care, and efficiency of workflow. To realize lasting impact from the EMR, extensive post go-live enhancement and optimization is needed. Leveraging the operational data in the EMR system can support many initiatives to improve workflows, as well as clinical and financial performance. Prioritization of the levers that can be adjusted depends on the HDO’s implementation baseline and strategic goals.


(Click to see larger version of graphic)

A robust EMR optimization strategy can help HDOs realize the promised value from implementation of an EMR. EMR optimization is the driver of strategic value, and can become a sustainable competitive advantage through leadership, innovation and measurement. Success requires a disciplined, data-driven, outcomes-based approach to meet a defined set of objectives.

Gain perspectives from HDO leaders who have successfully navigated EMR clinical optimization and refine your EMR strategy to transform it from a short-term clinical documentation data repository to a long-term asset by downloading our EMR Optimization Whitepaper.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration, and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the EMR Clinical Optimization Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

Deriving ROI from Data-driven EMR Clinical Optimization

Posted on June 28, 2017 I Written By

The following is a guest blog post by Justin Campbell Vice President, Strategy, at Galen Healthcare Solutions.  Learn more about their work by downloading their EHR Clinical Optimization Whitepaper.

Resistance to change is natural. People are uncomfortable with it. Organizations are frightened by it. Acceptance of healthcare information technology took a long time and even in these first two decades of a new century, despite incentives such as the Meaningful Use program, and promises of increased efficiency, implementation of Electronic Medical Records has been a bumpy ride.

Between 2008 and 2016, healthcare organizations spent more than 20 billion dollars adopting electronic health record systems. Many different approaches were applied. Many HCOs decided to act quickly, using what we now call a “Big Bang” fix. Installations of generic systems were in place but users of the new systems were unhappy. In 2013, with the process well underway throughout the nation, two thirds of doctors polled said they used EMR systems unwillingly, with 87% of these aggravated physicians complaining about usability and 92% of physician practices complaining that their EMRs were “clunky” and/or too difficult. Specifically, only 35% reported that it had become easier to respond to patient issues, one third said they could not more effectively manage patient treatment plans, and despite the belief that technology would permit caregivers to spend more time with their patients, only 10% said this was occurring.

The medical side was not alone in expressing dissatisfaction. Hospital executive and IT employees who had replaced their Electronic Health Record systems reported higher than expected costs, layoffs, declining revenues, disenfranchised clinicians and serious misgivings about the benefits gained:

  • 14% of all hospitals that replaced their original EMR since 2011 were losing inpatient revenue at a pace that would not support the total cost of their replacement EMR
  • 87% of hospitals facing financial challenges now regret the decision to change systems
  • 63% of executive-level respondents admitted they feared losing their jobs as a result of the EMR replacement process
  • 66% of the system users believe that interoperability and patient data exchange functionality have declined.


Not all reviews are negative. There is strong support and appreciation for EMRs in some Healthcare Delivery Organizations (HDOs) who believe well-designed EMRs save time and support clinical workflows. But, there is no escaping the majority sentiment: EMRs are not designed for the way providers think and work.

Today, most HDOs are at a crossroads. They can start over with a new EMR or optimize the one they have. The case for a do-over is supported by sub-standard vendor support for their existing systems and the increase in mergers and acquisitions, which drive system consolidation. One fifth of large practices and clinics report they intend to replace their EMRs and studies show that the EMR replacement markets will likely grow at an annual rate of 7%-8% over the next five years. The case for the status quo is made primarily by the HCOs that do not have the financial resources to undertake EMR replacement.

All options face the same key inter-related questions: how to generate additional margin? How to maximize return on technology investments? Which path will best serve the HCO, caregivers and patients?

This is a bit of vicious circle. HCOs are cash-strapped and the transition from fee for service to value-based care exerts downward cost pressures, exacerbating the problem. But patchwork fixes have not resolved that problem. Alternatively, some attempted to do too much too quickly and became frustrated because they lacked the depth of experience and knowledge to perform remediation. And, as KPMG concluded after studying the problem, “The length of time to resolve the issues increased and frustrations mounted as clinical, senior management, IT and human resources staff found themselves spinning their wheels.”

Like a patient being pressured to swallow medicine, HDOs are beginning to accept their situation. According to a recent survey conducted by KPMG in collaboration with CHIME, 38% of 112 respondents ranked EMR/EMR optimization as their top choice for the majority of their capital investments for the next three years.

EMR adoption is already approaching maximum levels. Consequently, healthcare delivery organizations have begun to shift their EMR strategies from short-term clinical documentation data repositories to long-term assets with substantial functionality in support of clinical decisions, health maintenance planning and quality reporting. They are coming to see their IT investments as platforms rather than limited systems of record or glorified data banks. In short, they now understand that the capture of information is only the most basic attribute of an EMR, and that instead, the EMR in which they invest can be flexible and extensible, capable of adopting emerging technologies that are driving insights to the point of care.

Assess opportunity, formulate strategy, improve usability & derive additional ROI & by downloading our EHR Clinical Optimization Whitepaper.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

About Galen Healthcare Solutions

Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the Tackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

Thoughts on Leveraging EMRs Effectively

Posted on September 28, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Whenever I scan Twitter for #HIT ideas, I find something neat. For example, consider this intriguing tweet:

I say intriguing not because the formula outlined will surprise anyone, but rather, because it captures some very difficult problems in a concise and impactful manner.

Here’s some thoughts on the issues Portnoy raises:

* Optimization:  Of course, every healthcare IT organization works to optimize every technology it deploys. But doing so with EMRs is one of the most difficult problems it is likely to encounter. Not only do IT leaders need to optimize the EMR platform technically, they may also face external demands placed by ACOs, HIE partners and affiliated providers. And it’s also important to optimize for Meaningful Use functions.

* Workflows:  Building workflows that address the needs of various stakeholders is critical, as pre-designed vendor workflow options may be far from adequate. While implementing an EMR may be an opportunity for a hospital to redesign workflows, or to enshrine existing workflows in the EMR interface and logic, hospital leaders need to take charge of the workflow implementation process. Inefficiencies at this level can be costly and will erode the confidence of clinical teams.

* Revenue capture:  When properly implemented, EMRs can help providers generate more complete documentation for claims reimbursement, which leads to higher collections volume. As time has shown, difficult-to-use EMRs can lead to physician frustration, and in turn, cut-and-paste re-use of existing documentation — which is why carefully-designed workflow is so important. But if they are used appropriately, EMRs can boost revenue painlessly.

* Patient and provider engagement: True, IT needs to take the lead on getting the EMR in place, and must make some important deployment decisions on its own. Still, hospitals will have trouble meeting their goals if patients and providers aren’t invested in its success, and without patient interest in their data I’d argue that meeting long-term population health goals is unlikely. On the flip side, if clinicians and patients are engaged, the feedback they offer can help hospitals shape not only the future of their EMR, but also the rest of their clinical data infrastructure.

If there’s any common theme to all of this, I’d submit, it’s participation. Unlike most efforts corporate IT departments undertake, EMR rollouts are unlikely to work until everyone they touch gets on board. Hospitals can invest in any EMR technology they like, but if providers can’t use the system comfortably to document care, patients don’t log on to access their data, or revenue cycle managers don’t see how it can improve revenue capture, the project is unlikely to offer much ROI.