The University of Illinois at Chicago presents the next Webinar in our series:
Meaningful Use Stage 1: What does it mean to us?
Melissa Zimmerman, RN, BSN will discuss the topic of meaningful use and answer questions including:
- What is meaningful use?
- What is the incentive?
- What are the requirements?
- How will it affect healthcare?
Transcription: Meaningful Use Stage 1: What Does It Mean To Us?
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0:00 Keira Sullivan: … University of Illinois at Chicago Webinar series. Today our Webinar is, “Meaningful Use Stage 1: What Does It Mean To Us. We have with us today Melissa Zimmerman. She is a BSN with about three years of critical care nursing experience. She’s currently on her Health Informatics committee at the hospital that she works at, and she is involved as a clinician’s perspective with upgrades to their Cerner system. Melissa is also a current UIC Health Informatics graduate student, and at this time, I’m pleased to announce Melissa Zimmerman, she will be taking over from here on out and discussing Meaningful Use Stage 1. Melissa?
0:48 Melissa Zimmerman: Hi, yes. Thank you so much Keira. Hi, my name is Melissa Zimmerman, again. I’m a critical care nurse from Summerset Medical Center in New Jersey. My hospital has just successfully attested to Meaningful Use Stage 1, so that’s what I wanted to talk to you about today.
1:05 MZ: What do you think of when you hear the term “meaningful use?” We all come from different backgrounds so it may mean different things to each of us. As a clinician, I’m always asking, “How is this going to affect our workflow?” “How is this going to affect the patient and end-users of these programs?” “What are the requirements?” When I talk about meaningful use, I’m speaking from a clinician’s perspective, so I hope to give you an overview of what meaningful use is, what the requirements are, and how it will affect us in the future.
1:34: MZ: So what is “meaningful use?” Meaningful use is basically using electronic health records to improve the quality of health care. As stated on the Centers for Medicare and Medicaid site, the American Recovery and Reinvestment Act of 2009 identified three components of meaningful use. First, it must use an electronic health records in a meaningful way, such as e-prescribing. This is where a doctor can enter a prescription right into the EHR and it will be immediately transferred to the patient’s local pharmacy, so when the patient leaves, he or she can go pick it up right away. They don’t have to worry about losing any papers, being able to read the prescription. The EHR is also used to improve the quality care and improve the exchange of information. Through the EHR, we also have to be able to transmit statistic and data for quality improvement.
2:21 MZ: The government is giving us monetary incentives to purchase an HER. There are two programs your facility may be eligible for, either Medicare or Medicaid. Medicare will provide $44,000 dollars over a span of five years, and Medicaid will provide $63,750 over a span of six years. There are three stages to meaningful use. We’re currently in Stage 1, and we have to show the government that we meet the stage requirements.
2:46 MZ: For Stage 1, CMS has outlined 24 objectives for hospitals and 25 objectives for professionals. These are a laundry list of requirements that the EHR we are implementing needs to meet. I’m going to focus mainly on the hospital objectives, as both requirements are very similar. Hospitals need to meet 19 out of those 24 objectives. There are 14 core measures and then they pick five out of a 10-item menu set. Similarly, professionals need to meet 15 core measures, and pick 5 from the 10-item menu set.
3:19 MZ: When looking at the list of objectives, I found that they can be categorized into six groups. I would need a lot more time to go through each objective, so I’m going to highlight each category with examples of how you might achieve some of the objectives in a hospital setting.
3:33 MZ: The first category highlights two important objectives CMS has listed. First, is to place orders electronically through the EHR. This can be particularly helpful in an emergency situation or even with pain medication. Let’s say the doctor is ordering for pain medications. He simply needs to place the order in the computer. It will be routed directly to the pharmacy and if there’s a med station on your unit, you can get the medication immediately. This reduces wait time and you can get the pain medication to your patient right away. This can also help to improve patient satisfaction. Not only do you need electronic orders, you also need to make sure the patient’s privacy is protected. Companies developing EHR technologies have security measures in place to try to adhere to HIPAA laws. For example, you’d have a user name and password in order to log into the system. If you leave the system idle for too long, it will log you out automatically. Also, if you access a patient’s chart, you need to establish what your role is, whether you’re a physician, nurse or lab technician. This allows you to only have certain capabilities, and protects the patient from any unnecessary personnel from accessing his or her chart.
4:39 MZ: So, besides privacy and electronic orders, one of the main categories of this objective is to record data in your EHR. Let’s say a patient – we’ll call him Jack – comes in with a GI bleed. Upon admission, you want to be able to record demographics, allergies, diagnosis and vital signs. So for Jack, let’s say he’s allergic to penicillin and the doctor has entered a diagnosis of GI bleed. When Jack comes in, the nurses will take his vitals and also draw lab work. This data should be displayed in the EHR in a structured and easy-to-read format. Usually in a tabular trend, so that you can easily compare the current results to the latest results so that you can see any change.
5:18 MZ: Along with recording data, you want to make sure that the patient’s information is up-to-date. When Jack comes in, the nurse takes down his current medication list and enters that into the computer. The doctor can then do medication reconciliation and go through the list of meds and make any appropriate ones active, so the patient doesn’t miss a dose while he’s in the hospital. He can also easily update the diagnosis. So let’s say that while Jack is an inpatient, he vomits and aspirates or some of it goes into his lungs and he gets pneumonia. The doctor had already established GI bleed as a diagnosis, and he can easily update the EHR to include pneumonia as an additional diagnosis or problem. This way, any doctor involved in Jack’s care can see the change.
6:01 MZ: So now Jack has pneumonia. Another category of objectives is to have electronic safety checks. For example, if the doctor goes to order those Zosyn for Jack’s pneumonia, an alert will come up on the system. Zosyn is part of the penicillin family, and it will remind the doctor that Jack is allergic to penicillin. This is a [unclear] check to make sure that the doctor is ordering the appropriate medication for Jack. Drug formulary checks will also be in place in the EHR, so the doctor orders the right dose with the right route with the right timing. So, Jack’s been at the hospital and he’s feeling much better. He’s no longer bleeding and his pneumonia is almost gone, so he’s getting ready to go home.
6:38 MZ: The next category is how the EHR facilitates the exchange of information. One objective is to have the capability to get an electronic copy to Jack of his health information and discharge instructions, if he requests one. Also upon discharge, the EHR will compile a summary of Jack’s stay and send it electronically to his primary care physician’s office. That way, when he goes to follow up, all the information is already there. This decreases the loss of information and helps to facilitate continuity of care. This can be particularly helpful if you have a chronically ill patient who’s being transferred to a nursing home or a long-term care facility.
7:13: MZ: The last group of objectives is about research data and quality assurance. The government requires our systems to be able to compile statistical data on certain diseases. They also want us to report on clinical quality measures, or CQMs. These are percentages of populations with a certain disease and what their outcomes are. There are 44 determined CQMs. Hospitals must report on 15 of them and providers must report on 6. Some examples of CQMs are smoking and tobacco cessation, controlling high blood pressure, and adult weight screening and followup. For example, if Jack was a smoker, we need to indicate this in the EHR, and also record that we gave him smoking cessation education. That way, he’ll be part of the CQM outcomes later on. Now, I’ve talked a lot about the requirements but how is this going to affect us in the future?
8:00 MZ: There are some initial disadvantages to take into account when purchasing a new system. At first, the initial costs are going to go up. The cost for buying the system, new equipment, making sure everything works together. Even though the government is giving us monetary incentives, it’s still a huge financial commitment. Also you need to train the staff on meaningful use and the EHR. You might run into resistance, especially from clinicians who have been doing things a certain way for many years. Also as the systems develop, you’re going to run into privacy and legal issues. So they’re working to adhere to HIPAA laws, but there are still going to be problems that we can’t foresee.
8:38 MZ: But by far, the advantages outweigh the disadvantages. Through a computerized system, information exchange will be much easier, more streamlined and more efficient. Even though there will be an increase in cost at first, over time it will reduce costs, so it will be more productivity, less double charting and most importantly, more time to spend with your patients at the bedside.
8:59 MZ: So, in conclusion “meaningful use” means to implement electronic health records in a meaningful way. It will streamline healthcare and improve the overall quality. After we meet Stage 1 requirements, we’ll be looking to Stage 2 and 3 of meaningful use in the next few years. This will further improve healthcare, such as using the EHR to work with medical devices. This will improve patient safety and also the delivery of care. So I hope I gave you a better understanding of Stage 1 for meaningful use.
9:27 MZ: These are some of the references I used during my presentation and thank you so much for your time.
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