Meaningful Use RequirementsThe Main Components of Meaningful Use Are:•“Meaningful Use” rule from CMS•Establishesasetofstandards,implementationspecificationsandcertificationcriteriaforEHR

•EstablishescertifyingbodiesforEHR’s•Mustbecompletedby2015(orbeginfacingpenalties)

Current Strategy•CPOE(ComputerizedProviderOrderEntry)andnursingelectronicdocumentationinplace (eChart–SiemensSoariancustomsystem)

•ConvertPharmacysystemtoSiemens/makephysicalchangestoPharmacytoaccommodateequipment

•ImplementeMar/barcodingofmeds•Improvecapabilityofinterfacebetweensystems

Focus for Nursing•Engagedinplanning/designofeMar•IntegratingZynx(electroniccareplanningprocess)intocurrentsystem•EvaluatingeChartforprocessimprovementsassystemhasbeeninplacefor4+years

•UtilizeaClinicalDesignandImplementationCommittee(CDIC)todriveresults•IncreasecollaborationwithInformationSystemsDepartment(ISD)-meetweekly

CDIC Functions•Beganin2005toguidedesignandimplementationofeChart

•ComprisedofbothstaffandmanagersfromNursingandISD,approximately40members.AlsoincludesrepresentationfromHospitalPerformanceImprovement(PI),NursingEducationandancillarystaffasneeded.

•Meetmonthlyforanalldaymeeting

Applying the Concepts and Process of Meaningful Use to the Electronic Health Record (EHR)BeckyDodge,RN,MBA

UniversityofNorthCarolinaHospitals~NursingPerformanceImprovement

8:30 a.m. Welcome• eChartEnhancements-October21,2010• SpanishInterpreterForm–forInterpreteruseonly

8:50 a.m. Clinical Summary and Clinical Considerations• RolloutPlan

9:30 a.m. CQM• CriticalLabValues-MDnotificationanddocumentation• MDRO• VTE/Anticoagulationeducationdocumentation• ImportantInformationfromMedicare

10:00 a.m. Break

10:15 a.m. e-Chart Updates • TubesandDrains-addJTube• CriticalCare-HFOV

10:30 a.m. Accreditation• X-rayafterNGTubeinsertion• CulturalCompetencyChangestoeChart

11:15 a.m. Performance Improvement

12:00 p.m. Lunch – on your own

1:30 p.m. Pharmacy Project Updates• TalystBarcodedUnitDosePackages• MedicationDoseFrequencies• NewMARFormat• eMARFeedback-fromeChartwebpage

2:15 p.m. NPI Updates• Falls • SkinAudits-UlcerPagenFlags

3:15 p.m. Break

3:30 p.m. Housewide Project Updates• Meaningful Use

• Weights-Birth,Admission,LastRecorded,Dosing,CriticalCareFluids

• Height-requiredonNutritionScreeninAdmissionAsmt

• BMI-calculationandassociatedpop-upmessage• AdvanceDirectiveandMOSTForm• Smokingstatuschanges• PregnancyandLactation-willinterfacetonew

Pharmacysystem• Vaccines

• MDHServiceChanges• SedationFlags

What Type of Decisions Are Made?•Additions/DeletionstoeChart•Documentationpolicychangestoreflectpractice•Whentohold“downtimes”forupgrades•Staffgivefeedbackre:howchangesarebeingimplemented,howtoimproveflowofdocumentation

•Staffgiveinputonhowtodesignnewfeatures(e.g.,eKardex)

CDIC Documentation Subcommittee•IsworkingwithNursingPItofacilitateelectronicextractionofaudits(onestaffrepresentativefromeachservice,NursingQualityAnalysts,AssociateCNO,ISDstaff)

•Staffaregivinginputintohowelectronicauditingisbeingdesigned(skinandrestraintprevalencesurveys,documentationaudits,etc.)

•Staffarealsoinvolvedineffortstostreamlinedocumentation(useformsineChartforincidencereporting-insteadofaseparatesystem,especiallyforfallsandskin)

•Meetonce/monthforonehour

Challenges•Balancingcompetingpriorities•FocusingeffortonmeetingARRArequirementswhilecontinuingtoimprove/revisecurrentsystems

•Communicatingchangesinacontinuallychangingenvironment•Movingtoanorganizationwidestandardforauditing(i.e,removingtheabilityforstafftomakeadecisionbasedontheirowninterpretation)

Successes!•Staffinputatmanylevelsoftheprocesshasbeeninvaluable•Staffareengagedandaccountable,aretrulydrivingthedocumentationofcarebeinggiven

•Changesbythecommitteearecommunicatedviaminutes,staffrepresentatives,andalsothroughourquarterly“RoadShows”whichincludestafffromISD

•StrongcollaborationbetweenNursingandISD,andbetweenstaffandleadership•Fulltimecomputersupport/ITpositionforNursing

Meeting Agenda