Truly Meaningful Use

Transcription

1 Truly Meaningful Use Deborah Cohen, MSW Community Mental Health Center, Inc. - Director of Evaluation University of Kentucky Social Work PhD Candidate

2 Federal Definition of Meaningful Use The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use: The use of a certified EHR in a meaningful manner, such as e- prescribing. The use of certified EHR technology for electronic exchange of health information to improve quality of health care. The use of certified EHR technology to submit clinical quality and other measures. Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.

3 But is that truly meaningful The purpose of this session is to provide you with examples of how an electronic health record can be used in a truly meaningful way by using it to make data driven decisions. Questions to ask yourself I trust the data that is collected by my agency. I use data to make clinical decisions about client care. The use of data to make decisions is highly valued at my place of work. The data collected by my agency is informative. I have access to client or agency level data in order to inform my decisions at work. If you answered yes to any of the above then your agency is on the way to becoming a data driven agency.

4 Using the data to inform an agency Data Driven Decision Making (DDDM) Relevant, reliable information is used to inform decisions related to planning and implementation strategies at the agency, program and client level. What is necessary for an agency to implement DDDM? Agency staff need to be data literate. This can happen only when the agency leadership actively encourages and assists staff in understanding the importance of relating valid client assessment information. A culture must be created in which client information is considered essential to improving client results.

5 Using the data to inform an agency Providing professional development and ongoing support for all staff As with any new initiative, the agency must provide the professional development necessary to build the capacity and desire of each staff member to utilize DDDM. Professional development must extend beyond simply using data to inform others about client improvement. It must ensure that data is used to design and revise practice so that it more closely conforms to the state standards and results in improved outcomes. Many social worker are math phobic. You must be aware of your population

6 Using the data to inform an agency Make relevant agency data available to staff for planning The agency must be committed to using DDDM as a pre-requisite to the effective and sustained use of data to inform planning at the agency, program, and client levels. Providing for technology applications that will equip staff to obtain data on demand and in a user-friendly format: It is very important to utilize an EHR where real time reports are available to all staff within their own portal.

7 Indiana CMHC EHR Survey All of the Indiana CMHC CEOs received an invitation from the Indiana Council to complete a survey May Agencies of the 26 completed the survey (69%) Of that 15 have an EHR and all have some kind of MIS system Changes due to implementing an EHR 41% Saw an increase in productivity 58.8% Saw a decrease in paperwork redundancy 52.9% Increase in document timelessness 52.9% decrease in Medicaid/Medicare payback 47.1% Increase in supervision 70.6% Increase in communication All had real time information

8 Advantages of an EHR Paper Charts Timely to complete chart abstractions. Incomplete data. Contradictory data. Hard to find items. Electronic Charts System can prevent/check for incomplete or contradictory data. Thousands of elements can be searched instantly. Everything is date and time stamped. Reminder just as there are errors in paper charts there will still be data entry errors in an EHR.

9 Exploring an EHR Discover what data elements are available within a specific EHR. Observe the workflow of specific providers in an agency. Obtain a database schema from the company that developed the EHR

10 Mental Health EHR database ***Important to understand your database Service event billing General ledger Human resources information Client demographics Progress note documentation (non-psychiatric) If an evaluator seeks the information that if provided within this text, they will still have to be extracted using the cumbersome paper-pencil method. Treatment plan Clinical assessment (non-psychiatric) Psychiatric visit documentation Psychiatric assessment Psychiatric medications Medical medications Vital signs (i.e weight, blood pressure, ect.) Allergies

11 Extracting data Learning SQL For Dummies Books Learning SQL Beaulieu Local Classes Online Classes Other options Work with IT staff who know SQL. Hire a staff member who can write code. Work with EHR company to write reports.

12 Using the data to inform an agency The strength in EHR implementation is the possibility of all staff members accessing data to improve their daily processes. Most systems offer a way to publish reports for all staff to review within the system. Many organizations have not had access to data in the past. Important for evaluators to teach agencies how to use their data.

13 Empowerment Evaluation The idea of agency wide accountability is in line with the idea of the empowerment evaluation model (Fetterman & Wandersman, 2004). In empowerment evaluation there are 10 principles. In order for an agency to be transformed to use data informed decision making, 6 of the 10 principles will be very important: Principle 1: Improvement Principle 2: Community Ownership Principle 3: Inclusion Principle 8: Capacity Building Principle 9: Organizational Learning Principle 10: Accountability

14 Community Ownership and Inclusion Sharing ownership of a program or process will increase the interest in the group to work towards a shared goal. It is very important to include all levels of staff, community members, and consumers when assessing how a program/agency is performing.

15 Capacity Building and Organizational Learning The role of the evaluator is to work as the facilitator. The transformation to become a data driven agency will take time. The most important step is transforming the agency's culture to value informing oneself about a program/agency and what is truly going on

16 NIATx Model CMHC is currently using the NIATx model for process improvement. This model is an quick change application of Total Quality Management using the PDSA Cycle Plan - Do - Study - Act It is a good fit with empowerment evaluation approaches and the use of EHR data.

17 Marrying NIATx Model with Empowerment Evaluation NIATx change teams: Includes staff members, consumers, and community members. (Inclusion) Focus on a key area of concern for the CEO. (Improvement) Uses techniques to ensure all voices are heard. (Inclusion) Team reviews data as a group. (Capacity Building and Organizational Learning) The group gets to decide what small interventions are tried and then measured again. (Community Ownership) The process builds accountability because the group sees first hand, actual improvement that they helped to enact.

18 Change Team Example A change team is working to decrease the amount of time between the first contact with the mental health agency to request a substance use assessment and the date of the actual assessment. The group uses service data dates and time stamp dates to calculate when someone calls to request an intake appointment and when their appointment occurs. The group has tried multiple interventions to reduce the time between first contact and the assessment, most recently the implementation of a walk in clinic.

19 Reduction in Wait Time # Days between 1st Contact and Assesment # People served in walk in clinic Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr

20 Reduction in No Shows Comparison of No Show Rates Substance Use Assessment No Show Rates July- September 2010 January- March 2011 No Show 48 (29.8%) 17 (13.11%) Kept 98 (60.9%) 106 (81.5%) Cancel 15(9.3%) 7 (5.39%) Without directly attending to this, the team hypothesized if the wait time was reduced so would the no show rate.

21 Sustaining the Change 70 Utilization of Walk-in Clinic: Dearborn Plaza location Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

22 Sustaining the Change Increase in Program Admissions

23 Sustaining the Change Increase in Revenue $175, $150, $125, $100, $75, $50, $25, $

24 Other Simple Projects Import client address data into GIS software to look at distribution of client locations. Agency/Program admission and discharge trends Caseload/Program composition (LON, location, diagnosis, insurance, ect.) Changes in level of need assessment scores. Staff turnover. Payments (by program, staff, reimbursements, ect.)

25 Questions? The goal is to transform data into information, and information into insight Carly Fiorina -Former Chairwoman of Hewlett-Packard Company

26 Contact Information Deborah Cohen, MSW Director of Evaluation Community Mental Health Center, Inc. 285 Bielby Road, Lawrenceburg, IN Office: