MOC, Quality of Care and Your EMRDonna M. D’Alessandro, M.D., FAAP

Professor of PediatricsUniversity of Iowa

Available at Slide Share

Please sit at table that is the closest to QI project you are doing or thinking about doing

Disclosures and Disclaimers“I have no relevant financial relationships with the

manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.”

I know a little bit about each– so before you do something, please recheck with the appropriate group to make sure doing the activity will get you what you want/need

Overview Mini Lecture

MOC EMR QI

Start Planning your Project Write an AIMS statement Write a measure Process flow for ideas

Handouts Quality Improvement Project Planner Resources

URL for Handout

Objectives Learn about MOC and EMRs and how they can be used to develop

quality improvement programs I hope to show you that

MOC – can be integrated into maintaining your professional competency

EMRs – are continually advancing tools for us to use in our practice QI – is a continuous process to improve the care you provide

Together they form a stalwart trio to help us provide the best care possible so “Every Child, Gets the Right Care Every time” - AAP

Alphabet Soup ABP – American Board of Pediatrics, “The Board” AAP – American Academy of Pediatrics, “The Academy” CME – Continuing Medical Education CMS – Center for Medicare and Medicaid Services MOC – Maintenance of Certification QI – Quality Improvement EMR/EHR – Electronic Medical Records or Electronic Health Records MU – Meaningful Use

Maintenance of Certification (MOC)What is MOC?

Program of activities to “maintain” professional competency

There is no expiration date as long as the physician is enrolled in the program

ABP is requiring MOC to maintain board certification Potentially state boards, hospitals and insurance

companies could require board certification, therefore indirectly requiring MOC

Basic Plan of MOC

4 parts like Puzzle Pieces, not chronologically orderedPart 1 Professional Standing and Licensure: unrestricted

license to practicePart 2 Life-long Learning Self Assessment: participating in

knowledge self assessment toolsPart 3 Cognitive Expertise: passing a secure examinationPart 4 Performance in Practice: participating in quality

improvement projects

Basic Plan of MOC

5-year cycle with 100 points for activities40 points each Part 2 and Part 4 20 points either Part 2 or Part 4

Part 3 – one test every 10 years (every 2 cycles)

Actually Doing MOCCheck the ABP website to see your personal requirements –

www.abp.org If you don’t understand contact the ABPWebsite has lists of activities that qualify for each partAll activities

Have a expiration date Have a different MOC point value May be free or have an additional cost in addition to the ABP’s MOC

fee May or may not award CME

Part 4 Pathways- Join Other Groups Project sponsor

Originates and manages a single activity Ex: Insurance company, organization

Portfolio sponsors Originate and manage multiple activities or projects

Ex. AAP, Institutions Important – the sponsor applies to the ABP for the MOC and

attests to your fulfillment of the MOC requirements AAP offers projects through their portfolio QuINN Network (Quality Improvement and Innovations Network) Chapter Quality Network

Part 4 Pathways - Use Your Own Practice

National Center on Quality Assurance Patient Centered Medical Home projects It is considered an individual activity even if you participated as a group (40

MOC points, $0) Proposed Small Group QI Projects (1-10 physicians, 0 MOC points, $0 for

group) ABP will review the process, provide tips and resources. This helps to ensure

that your finished project will qualify for credit, but it is NOT the actual application for MOC credit.

Completed Small Group QI Projects – finished projects apply for credit (1-10 physicians, 25 MOC points, $75 for entire group) Important – you must apply to the ABP directly and attest that you have

fulfilled the MOC requirements

Part 4 Pathways - Use Your Own Practice

Part 4 Pathways - OtherQI Program Development – you are a

leader of QI projects at an institution or organization (40 MOC points, $150)

QI Posters or Platform presentations at national scientific meetings (20 MOC points, $75)

QI Articles – for authors (25 MOC points, $75)

Electronic Medical Records (EMRs)Computers that store health information that then

health care personnel (and patient/family) can access and utilize to provide care, and hopefully improve health

EMRs are Not New Depending on how you want to define an EMR, first ones go back to late 60s

or earlier EMRs have improved documentation and availability = improved

communication Holy grail is integration – getting computers to talk to each other – still have

problems but better tools and policies continue to improve integration Policies and standards are set by CMS for :

“Certified” EHRs For “meaningful use” of the EHRs Reporting quality measures Create an incentive system for providers to acquire, use and report using EHRs

Meaningful Use (MU)Goal: to promote the spread of EMRs to improve

health care in the US, Improve quality, safety, efficiency, and reduce health disparitiesEngage patients and families Improve care coordination, and population and

public health Maintain privacy and security of patient health

information

MUHas criteria that defines

Eligible professionals Eligible hospitals

MU was developed as a progressive, staged program: Stage 1: Data Capturing and Sharing (began 2011) Stage 2: Advance Clinical Processes (began 2014) Stage 3: Improved Health Outcomes (begins 2018)

MU Stage 2Must use a certified EMR- certified

using specific standardsStandardizes reporting time

periods – basically continuous 90 day period during the calendar year

Reporting times – 1 year

Report on 1 set of objectives Protect Patient Health Information Clinical Decision Support Computerized Provider Order Entry Electronic Prescribing

Health Information Exchange Patient Specific Education Medication Reconciliation Patient Electronic Access Secure Electronic Messaging Public Health Reporting (EPs only)

CMS regulations - https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/

2015_NeedtoKnowEP.pdf

MU Example - CPOE

MU Example – Secure MessagingSecure Electronic Messaging

Quality Improvement (QI)

What is Quality?Meeting the needs and exceeding the

expectations of the patients and families that healthcare providers serve

Delivering all and only the care that the patient and family needs

“Every child gets the right care, every time” - Institute for Healthcare Improvement

- AAP

Improving QualityRequires change – every system is

designed perfectly to achieve exactly the results its gets

Needs to be kept simpleIf you don’t, you destroy productivity and

unintended consequences results in too big a disruption

Delivering Care and Making Changes

StructureProcesses and People*

Outcomes of CareInputs Steps Outputs

•Patients•Equipment•Supplies•Environment•Training

•Physician orders•Nursing care•Ancillary staff•Coordination•Business practice

•Physiologic parameters•Functional status•Satisfaction•Cost

*Has the greatest chance to improve care, also the closest to the care - Modified from Institute for

Healthcare Improvement

What are we trying to accomplish? (AIM)

How will we know that a change is an improvement? (Measurement)

What changes will we make that will results in an improvement? (Ideas)

Plan: How should we modify our latest changes?

- Institute for Healthcare Improvement

Planning Steps for the Change

What Are We Trying to Accomplish?

Need an AIM statement that is SMART Specific Measureable Achievable Relevant and reliable Time limited

Example: “Increase the screening rates for dental caries in 5-year olds within 6 months”

May have more than 1 goal, so discuss options with the team and chose one goal to work on

Nee

How will we know that a change is an improvement?

You need measurement. Otherwise, how will you know how far you have come to realizing your goal?

Need more than 1 measure, Measures don’t have to be perfect

Use measures that are already developed if possible

How will we know that a change is an improvement?

How will we know that a change is an improvement?

Select changes that are the most likely to improve outcomes

Recognize that not all changes improve outcomes – “Just because you can, doesn’t mean you should” and conversely, “Just because you think you can’t, doesn’t mean you shouldn’t try.”

Example: “Changing the EMR to include discrete structured data to improve reporting”

How will we know that a change is an improvement?

You will need to Pilot test – determine your baseline Collect data Evaluate the data and compare it– overtime,

to benchmarks, to end aim Evaluate regularly not just at the end

Measurement– Run Charts

- Minnesota Department of Health

PDSA Cycles - How should we modify our latest changes?

Run PDSA cycles to implement your changes and see your results

The analysis phase is imbedded in the planning

Helpful Planners – Clinical Site Diagram

From ABP Quality Improvement Guide

Helpful Planners – Key Drivers

From ABP Quality Improvement Guide

Helpful Planners – Process Flow Diagram

-From AB

- ABP Quality Improvement Guide

End of Part 1 – Mini Lecture Any Questions?

Part 2. Planning Your ProjectQuality Improvement Project Planner- Introduction

Write an AIM StatementWrite a MeasureProcess Flow

URL for Project Planner

Quality Improvement Project Planner

URL for Project Planner“It’s long”

Yes it is long – but hopefully all or most of the important questions will be there to think about, discuss and make thoughtful decisions about so the project runs well

“Do I really have to do fill out it out or have to fill out everything?” Of course not, but you might want to so you have record of the

decisions you made and why

Activity 1 – Write an AIM Statement

QI Project Planner Page 1 1 minute on first two statements:

The general problem we want to improve is __________

This is important because _________

5 minutes on writing an AIM statement

10 minutes – sharing with partners

AIM Statement Iteration Improve HPV immunization rates in our practice. (7 words)

Improve HPV immunization rates in 11-13 year olds in our practice (11 words)

Improve HPV immunization rates in 11-13 year olds in our practice by 5% (13 words)

Improve HPV immunization rates in 11-13 year olds in our practice by 5 % over the next 6 months (19 words)

Improve HPV immunization rates in 11-13 year olds in our practice for the receiving the first vaccine by 5 % over the next 6 months (25 words)

Improve HPV immunization rates in 11-13 year olds in our practice for receive the first vaccine by 5 % and completing the series by 10% over the next 6 months. (30 words)

As cancer prevention is important to long term health we will improve HPV immunization rates in 11-13 year olds in our practice for receive the first vaccine by 5 % and completing the series by 10% over the next 6 months by implementing an EMR reminder system and screening for HPV vaccinations at all nursing visits. (50 words)

Activity 2 – Write a Measure

QI Project Planner Page 2 5-8 minutes

Write the measure in wordsDetermine the numerator/denominator and exclusion

criteria5-8 minutes – sharing at the table

Activity 2 – Write a Measure

Activity 2 – Write a Measure Discussion

ExamplesWhat was difficult?

Activity 3 – Idea Process FlowNeed to plan what actual changes you want to make and

how you are going to do them 8 minutes, sticky notes and back of your handout.

Think about one part of the system that will need to changeWrite down each step on a sticky noteOrder the sticky notes so it shows the process that will need

to be performed each time, every time

8 minutes – share with partner

Activity 3 Process Flow for Ideas –

Other planningTeam members – page 4

One person (rarely) can make the changes necessary. It is a system of processes and personnel that is delivering care

Team – can be small or large, with everyone involved in some way

It is the actual people doing the work, not a representative for others

Resources – page 5Timeline – page 7

Thank you for coming

This presentation is available at:Slide shareHandouts are available at: AAP NCE Conference website