O'donnell feb 11 (2)

HR BILLHR BILL 35903590
A UNIQUE Implication for Health CareA UNIQUE Implication for Health Care
06/20/13 Casey Dills O'Donnell 1

BACK TO THE FUTURE
 Protects use of individual
health records (Healthcare Insurance Portability and Accountability:Aug 1996)
 Ensures storage and use of
electronic records (Electronic Freedom of Information Act: Oct 1996)
 Makes it easier to retrieve
secure information online (Electronic Freedom of Information Act)
 Electronically attributes; associates;
or links individual records (ARRA: Feb 2009)
 Enables users to select, sort,
and retrieve minimum data (Meaningful Use:July 2010)
 Enables users to electronically record,
modify and retrieve patient data over
multiple encounters. (EHR Technology Final Rule: July 2010)

Health Care Quality Improvement:
Quality Measure Prioritization
 Health Outcomes
 Multiple Chronic Conditions
 Coordination/Continuum of Care
 Efficiency
 Meaningful Use
 Clinical Decision Support & related technologies
 Patient Centered Care
 effectiveness; safety; appropriateness;
 Value Based Healthcare
 Patient Experience and satisfaction

New Goal of Health Reform
 Leverage Data Collection
 Analyze data in a way that informs policy
 Deliver patient centered care
 Support progress that utilizes evidence-based
strategies and promotes best practices
 Refocus health care system on improving
health, intervention, and coordination
 Select measures and processes that have the
greatest impact on population health
 AHRQ 2010

Ensuring the Quality of Care: Section 2717
 National Strategy for Quality Improvement
 Improve Measure of Health Outcomes
 Develop Quality Measures
 Develop Reporting Requirement
 Identify areas for Improvement Potential
 Emphasize efficiency
 Improve research (service research)
 Comparative Clinical Effectiveness

Improve Health Outcomes: Section 2717
New Emphasis in Care Management
 Implementation Activities
 Quality Reporting
 Effective Case Management & Care Coordination
 Chronic Disease Management
 Comprehensive Discharge Planning (Avoidable
Readmissions)
 Patient Safety
 Best Practice and Evidence Based Medicine (Reduce
Medical Error)
 Health and Wellness activities (preventative care)

Reporting Requirements
 Wellness and Health promotion activities
 `(1) Smoking cessation.
 `(2) Weight management.
 `(3) Stress management.
 `(4) Physical fitness.
 `(5) Nutrition.
 `(6) Heart disease prevention.
 `(7) Healthy lifestyle support.
 `(8) Diabetes prevention

Aligning Quality with Measurement
Logical Relationship
Behavior of Health Service Delivery
&
Application of Technology

Process Measures linked to outcomes
 Target Outcomes (example for readmissions)
 Reduction in adverse drug events
 Reduction in patient medical errors
 Reduction in unnecessary encounter
 Reeducation in redundant tests and procedures
 Achievement of patient goals
 Improved patient understanding
 Targeted Processes
 Timely transfer of information across settings and providers
 Effective care coordination across settings and providers
 Timely delivery of care
 Improved patient understanding
 Improved patient awareness and emergency back up
 Improved patient engagement

Goal Mapping
 Systematic approach
 Define the process your trying to improve
 What is the problem or question I am going to solve or answer
 Why is this Issue or Topic Important
 Define how you will know when it is accomplished
 Intended Outcome
 Desired Results
 Determine how this change will impact other service areas and
resources
 Use goal mapping to understand and communicate the
improvement goals throughout the process.
 What ‘benchmark’ are there to evaluate progress or success and,
 How am I going to use it to tell about my findings and solutions

Guide to Effective Case Management
 Strengthen your case management Program
 Strive for quality in your case management
 Pursue quality from the design of your care
coordination activities

Care Planning and Monitoring
Care Planning
 Individualized
 Identifies frequency/need
 Required for Authorization of Services
Monitoring
 Monitor the care and progress of the client
 Review effectiveness of services
New Service(s)
Change in service(s)
Termination of Service(s)

Quality Case Management
 Objective and Nonjudgmental
 Use only standard medical abbreviations
 Nature of Contact
 Detailed description of Contact
 Brief (if possible)
 Event focused
 Relevant Information
 Actions Taken/Follow Up

Quality Coordination
 Process are Standard
Care is Individualized
 Case Manager Roles
 Coordinate needed services.
 Communicate with service providers
regarding service delivery, and
concerns.
 Review and revise services, as
necessary

Case Management Reporting
 Medical Record (EHR) Requirements
 Central Location to document and track case
management activity
 Accessible to multiple users
 Entry for care planning and monitoring activites
 Available for Review
 Supervisors
 Colleagues
 State/Federal Auditors
 Clients
 Legal Reviews

Care Management Systems
 Effectiveness
 Systems that support clinical decision activity
 Clinical guidelines; protocols; procedures
 Standards orders; Triage (critical); clinical pathways
 Disease Case management
 Ancillary service management
 Utilization Review
 Outcomes and accountability (data)
 Benchmark Identification (data)
 Efficiencies
 System supports Information sharing
 Facilitates cross site information transfer
 Report extraction

THE CHALLENGE
Health Reform 3590 strives to enhance quality
improvement, and stresses the importance on
care management coordination.
The single most challenging opportunity in the
quest for improvement in health care, is the
harness of integrated coordinated care.

THE DILLEMA
Today most providers lack the information systems necessary to
coordinate patient care. Care Management systems that can
improve the integration of care in real time leverage the market
toward intelligent evidence based support
 Systems are fragmented
 Improvement efforts are silo/singular
 Technologies are disjointed
 Communications staggered or non existent
 Resources strained

THE REMEDIATION
 Identity common goal utilizing the resources
and technologies already available.
 Use an Evidenced-Based design to
successfully implement improvement
 Apply evidenced-based strategies to
achieve successful implementation
activities.

Coordinated Care with a Meaningful Use
“The final meaningful use regulations may be the first
domino to bring about monumental change and
transformation to the U.S. healthcare system”.
(Demers, Eric)
Meaningful use is the top priority 84%, among healthcare
executives when considering how the reform bill will
impact their organizations
(Health Populi)

Integrating care management activities
 Strategies
 Multidisciplinary TEAM case management
 CARE COORDINATION
 Aim to improve the continuum of care through
discharge planning and transitional care
modeling.
 Employ a coordinated interdisciplinary approach
 Coordinate with medical homes and/or
accountable care organizations
 Apply integrated computer technologies
 Clinical decision support

Implementation Activity
 Workflow is KEY to effective care management.
 Care Management tools that supports
interdisciplinary communication.
 Community resources
 Patient Education
 Clinical Decision Support tools
that assist at the point of care.
 Data Driven Quality
 Assessment (SIS/Functional)
 Quality Assurance and Improvement

Workflow Development
Sample Questions:
How do you sort tasks, can you sort by priority?
Can you hyperlink between tasks?
Can you print health education documents?
Can assessment trigger clinical alerts
Do triggers take the user to the necessary task?
Can completion of an assessment trigger care coordinated
document?
Can your documents be electronically transmitted to other care
providers?

Enact Implementation Activities using an
Evidence-Based design
 Implementation activities are effective when
applied to structured quality improvements.
 Implementation is successful when outcomes are
used to benchmark or compared.
 Regular feedback is critical to implementation
success.
 Assistive support (CDS), alerts and other real time
technologies aid successful implementation.
 Organizational setting must be support the
strategy.

 Research shows
 Quality improvement activities facilitate social influencing.
 Feedback and other comparative measures promote group
and individual competition and facilities social influence
through perceived intention.
 Assistive supports used in real time aid in knowledge
translation, and presents influencing at the level of
interpersonal cognitive processing.
 Organizational cultures are a construct to social influence;
Whereby the organization’s social structure has the most
ability to positively or negatively influence the desired
implementation.

 Research Shows implementation activities
are not successful when:
 Implementation is passive.
 Measures (activity outcome) or guidelines are not
accepted.
 Implementation activity lacks accountability and
ownership.
 Implementation processes are unorganized or
require competing organizational values.

ContinuousQualityImprovement
 Plan
 Do
 Check
 Act

Changing Environment
 Increased emphasis on clinical quality
 Patient safety
 Cost effectiveness
 Transparency
 Payment structures
(Value Based Purchasing)

Meeting the Challenge
 We Have
 Technologies (E.H.R) containing data that represents
health service performance (diagnostic & demographic reporting)
 Dedicated professionals
 We need
 Operationalize a structure that provides a means to
efficiently and effectively administer health services in
a way that values the delivery of care.

O'donnell feb 11 (2)

More Related Content

What's hot (20)

Viewers also liked (16)

Similar to O'donnell feb 11 (2) (20)

Recently uploaded (20)

O'donnell feb 11 (2)

Editor's Notes