Post on 03-Feb-2018
transcript
Informatics Strategies & Tools to Link Nursing Care with Patient Outcomes in
the Learning Health Care System
Patricia C. Dykes PhD, RN, FAAN, FACMI
Judy Murphy RN, FHIMSS, FAAN, FACMI
Dana Womack MS, RN
March 31, 2014
Nursing Informatics Working Group
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Overview
• Best Care at Lower Cost: The Learning Health Care System (LHCS)
– Meaningful Use
– Informatics strategies to support the LHCS
• Credentialing in nursing education and practice
• Data harmonization
– Advantages
• Demonstration: NDNQI Dashboards
• Discussion/Conclusions
2
Best Care at Lower CostThe Path to Continuously Learning
Health Care in America
September 2012
iom.edu/bestcare
3
• Patient harm – One-fifth to one-third of hospital patients are
harmed during their stay, largely preventable.
• Recommended care – Only about half of the recommended
preventive, acute, and chronic care is actually received.
• Outcome shortfalls – If all states matched care quality in the
highest-performing states, 75,000 fewer deaths would have
occurred in 2005.
Why now?
Quality – persistent shortfalls
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From Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, IOM, 2012
The Result?The U.S. health care system today
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From Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, IOM, 2012
The VisionContinuous Learning, Best
Care, Lower Cost
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Transition to the
Learning Health System
From Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, IOM, 2012
Meaningful Use
HITECH ACT
The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act:
• Provides $30 billion in Medicare and Medicaid incentive payments
• For the meaningful use of health information technology by clinicians and hospitals
• Estimated to yield savings of $93 billion between 2011 and 2019
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A Remarkable Journey
Stage 2 MUACO’s
“Stage 3 MU”PCMH
3-Part Aim
Registries to manage patient populations
Team based care, case management
Enhanced access and continuity
Privacy & security protections
Care coordination
Privacy & security protections
Patient centered care coordination
Improved population health
Registries for disease
management
Evidenced based medicine
Patient self management
Privacy & security protections
Care coordination
Structured data utilized
Data utilized to improve delivery
and outcomes
Data utilized to improve delivery
and outcomes
Patient informed
Patient engaged, community resources
Stage 1 MU
Privacy & security protections
Basic EHR functionality,
structured data
Utilize technology
Access to information
Transform health care
Meaningful Use as a Building Block
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EHR Adoption Has Reached a Tipping Point
Meaningful Use – Professionals and Hospitals Registered and Paid by Medicare or Medicaid
Source: CMS EHR Incentive Program Data as of 12/31/2013
0
100,000
200,000
300,000
400,000
500,000
Total Professionals Paid: 335,646
(64%)
Total Professionals Registered: 436,295
(83%)
527,000Total Eligible Professionals
0
1,000
2,000
3,000
4,000
5,000
Total Hospitals Paid: 4,400(88%)
Total Hospitals Registered: 4,693
(94%)
5,011 Total Eligible Hospitals
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Total EHR Incentive Payments to All Eligible Providers and Hospitals by Month
$22 $16 $26 $31
$108 $81
$116
$276 $237
$387
$605
$831
$564
$629 $660
$623 $587
$445 $409
$536 $576
$715
$907
$1,400
$1,109
$823
$1,021
$906
$354
$723
$360 $344 $342
$419
$797
$1,451
Cumulative Total$19,438
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
Jan
-11
Feb
-11
Mar
-11
Ap
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1
May
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Jun
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Jul-
11
Au
g-1
1
Sep
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Oct
-11
No
v-1
1
De
c-1
1
Jan
-12
Feb
-12
Mar
-12
Ap
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2
May
-12
Jun
-12
Jul-
12
Au
g-1
2
Sep
-12
Oct
-12
No
v-1
2
De
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2
Jan
-13
Feb
-13
Mar
-13
Ap
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3
May
-13
Jun
-13
Jul-
13
Au
g-1
3
Sep
-13
Oct
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No
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Cu
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lati
ve A
mo
un
t P
aid
(M
illio
ns)
Am
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nt
Pai
d p
er
Mo
nth
(M
illio
ns)
Source: CMS EHR Incentive Program Data as of 12/31/2013 10
Stage Cumulative Capabilities 2011Q1
2013Q4
Stage 7Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP
1.0% 2.9%
Stage 6Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS
3.5% 12.5%
Stage 5 Closed loop medication administration 5.9% 22.0%
Stage 4 CPOE, Clinical Decision Support (clinical protocols) 10.7% 15.5%
Stage 3Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology
48.4% 30.3%
Stage 2CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable
14.1% 7.6%
Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 6.7% 3.3%
Stage 0 All Three Ancillaries Not Installed 9.6% 5.8%
Data from HIMSS Analytics® Database ©2012, 2014 N = 5,275 N = 5,458
U.S. EMR Adoption ModelTM - Progress in 3 YearsFrom HIMSS Analytics
53%
17%31%
21%
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Health Information Technology Informatics Competency
Critical for nursing:
• Largest number of health care providers in the US.
• 19.6% of all healthcare workers or over 3 million nurses.
Courtesy of Clancy, T. (2013). Nursing Organization Alliance Fall Summit 12
Quality and Safety Education for Nurses (QSEN) Project*
Based on IOM competenciesProposes knowledge, skill, and
attitude targets to be developed in nursing programs
Defines quality, safety, informatics competencies for
nursing
Available as guides to curricular development , certification, and
continuing education
Goal: To prepare student nurses with knowledge, skills and attitudes needed
to continuously improve the quality and safety of healthcare systems
*http://qsen.org/competencies 13
Quality• Describe strategies for
improving outcomes of care in the setting in which one is engaged in clinical practice.
• Explain common causes of variation in outcomes of care in the practice specialty.
• Describe common quality measures in the practice specialty.
Safety• Describe best practices
that promote patient and provider safety in the practice specialty.
• Describe processes used to analyze causes of error and allocation of responsibility and accountability.
Informatics• Formulate essential
information that must be available in a common database to support patient care in the practice specialty.
• Describe and critique taxonomic and terminology systems used in national efforts to enhance interoperability of information systems and knowledge management systems.
Quality and Safety Education for Nurses (QSEN) Competencies
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Using Electronic Documentation to Measure Clinical Competence
• Are nurses documenting accurately?
• Is documentation in a structured, coded format?
• Does the data have integrity?
• Can nurses pull out data needed to engage in clinical decision-making?
• What are the right things that nurses need to do? Did they do them?
• Does a nurses’ documentation and their patients’ corresponding outcomes suggest that he/she is practicing at height of their license?
• Does the documentation of each individual nurse support building linkages between nursing care and patient outcomes?
Quality
Safety
Informatics
Clinical Competencies
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‘Continuing Competence’ and the Learning Health Care System
• Current state of clinical documentation is a barrier to nurses demonstrating meaningful use.
• Strategies are needed to link nursing documentation to patient safety and quality measures, to nurse competency, and to organizational competency.
Institute of Medicine Report Brief (2009). Redesigning Continuing Education in the Health Professions. http://www.acrm.org/pdf/IOM_Report_Brief.pdfCommittee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine (2011). The Future of Nursing: Leading Change, Advancing Health. http://www.iom.edu/Reports/2010/The-future-of-nursing-leading-change-advancing-health.aspx
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‘Continuing Competence’ and the Learning Health Care System
• Integration of QSEN competencies into practice settings:
– Ensures that “all health professionals engage effectively in a process of lifelong learning aimed squarely at improving patient care and population health” (IOM, 2009).
– Supports data integrity so that data entered for clinical documentation is available for secondary use and for building evidence from practice.
Institute of Medicine Report Brief (2009). Redesigning Continuing Education in the Health Professions. http://www.acrm.org/pdf/IOM_Report_Brief.pdfCommittee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine (2011). The Future of Nursing: Leading Change, Advancing Health. http://www.iom.edu/Reports/2010/The-future-of-nursing-leading-change-advancing-health.aspx
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Advantages: Data Integrity• Improved data quality for building evidence from practice and
secondary use:– Clinical decision support– Populate quality/safety dashboards– Populate quality measures– Research
• Nurses are responsible for defining their practice through what is documented for their patients and by analyzing the impact of their practice on patient outcomes.
• Provides a means to visualize the linkage between nursing care provided, how that care is documented and patient outcomes.
• Structured coded data will be available across organizations benchmarking.
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Demo
NDNQI Quality Dashboards
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Summary• Adoption and meaningful use of health IT are foundational to
the learning healthcare system.• Competencies to ensure data integrity and harmonization are
also needed. • The QSEN quality, safety, and informatics competencies can
address the skills needed by practicing nurses to build a digital infrastructure, but they are not used yet in practice settings.
• Use of quality, safety, and informatics competencies across healthcare settings will ensure that data entered once can be reused for decision support, performance improvement, benchmarking, and research.
Meaningful use of health IT and integration of quality, safety, and informatics competencies into educational AND practice settings would support evidence based
practice and build the foundation for a learning health care system.20
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AMIA NIWG
AMIA Nursing Informatics Working Group (NIWG)
Patricia Dykes,
PhD, RN, FAAN,
FACMI
Chair
Laura Heerman
Langford, RN, PhD
Chair-Elect
www.amia.org/NIWG
AMIA’s 450 nurse informaticians work as developers of communication and information technologies, educators, researchers, chief nursing officers, chief information officers, software engineers, implementation consultants, policy developers, and business owners, to advance healthcare.