Meaningful Use and Your Periop EHR: What you should know ...

What is all the commotion about?

2014 CQM Facts:

All hospitals must report on the NEW 2014 Clinical Quality Measures regardless of reporting Stage

All hospitals must report on 16 of the 29 quality measures from at least 3 of the 6 National Quality Strategy Domains

All hospitals must report a 3 month period fixed to a fiscal year quarter. NOTE: the first federal fiscal quarter started October 1, 2013

If your organization is like most, you’ve been hearing a lot about Meaningful Use but your department has been mostly on the periphery … until now. The overall goal of Meaningful Use is to promote the spread of electronic health records to improve healthcare in the United States. The government program is being rolled out in stages and most organizations are currently in Stage 1 or headed into Stage 2...

http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html 

Why it is important.

The program has carried significant financial incentives for hospitals (and providers). However, as the program moves to future stages the financial incentives will be replaced with financial penalties for organizations that have chosen not to participate and/or that do not meet the requirements. 

What it means to Perioperative Departments.

Until now – most of the thousands of data elements (with the exception of perhaps two elements: anesthesia type and timestamps) have all come from non-OR specific systems. However, with the roll out of the 2014 Quality Measures (which all organizations, regardless of Stage, must report on) there are now six quality measures that require perioperative data collection (from both nursing and anesthesia documentation). 

Deciphering the data logic for these measures and getting meaningful data out of your perioperative EHR can be (and likely will be) a challenge. Resources are available. Two key resources that we highly recommend reviewing are: 

  1. CMS-2014 eCQM specifications for Eligible Hospitals
  2. United States Health Information Knowledgebase’s (USHIK)’s Clinical Quality Measures’
    Meaningful Use tab

 Additionally, please refer to the "where to start" section of this article for additional tips and information.

A look at (some of) the specifics:

  • Six (6) 2014 Clinical Quality Measures require perioperative data– SCIP 1, SCIP 2, SCIP 9, VTE 1, VTE 2, VTE 6
  • Data collected must be structured, codified (SNOMEDCT, ICD-9/10, RxNorm) and transmitted electronically (no free text entry…)
  • Four (4) of the six (6) Patient Safety Measures require perioperative data
  • Table 1 identifies the perioperative data required from the following categories (“data elements”):
    • Device Applied
    • Medications Administered
    • Procedures Performed.  (Anesthesia data falls into the Procedures Performed category)
Data ElementSCIP-
INF-1
SCIP-
INF-2
SCIP-
INF-9
VTE-
1&2
VTE-6
Anes Type, Start & Stop D/T   X X X X
Device Type, D/T Applied X X X X  
Medication, Admin D/T, Route X X   X  
Patient Expired Intra-operatively   X X    
Physical Finding, Urinary Diversion     X    
Procedure Type, Start & Stop D/T X X X X  
Urinary Catheter Type, D/T
(insertion/removal)
    X    

Here are some examples of data elements and codification required from each of these categories.

 Category Codification Data ElementMeasures
Device Applied SNOMEDCT Indwelling urinary catheter  SCIP 9
Compression stockings, intermittent pneumatic compression VTE 1 & 2
Pacemaker SCIP 1 & 2
(exclusions)
Suprapubic Catheter SCIP 9
(exclusions)
Medications
Administered
RxNorm Antibiotics SCIP 1 & 2
VTE Prophylactics-Heparin, Low Molecular Weight Heparin, Warfarin VTE 1 & 2
Procedures
Performed
SNOMEDCT
or ICD-9/10
General or Neuraxial Anesthesia SCIP2, 9,
VTE 1 & 2
CABG
Other Cardiac Surgeries
Hip or Knee Arthroplasty
Colon Surgery
Abdominal or Vaginal Hysterectomy
Vascular Surgery
SCIP 1, 2, 9
Pacemaker Insertion
Cesarean Section
SCIP 1 & 2
(exclusions)

Capturing the data that excludes a patient from eligibility (“exclusions” above) for the quality measure is just as important as data which includes the patient. Not capturing exclusions can result in lower performance rates and subsequently, potential financial penalties.

Example: SCIP-INF1 Antibiotic within 1 hour of Incision

DateTimeEvent
10/01/2013 6:45 AM Patient Admitted to Hospital
10/01/2013 8:15 AM Anesthesia administers IV Cefazolin 250mg/ml RxNorm 562062
10/01/2013 8:45 AM INCISION - Intraop Procedure Performed:
Arthroplasty of knee using cement Snomed 307817008

Quality Measure Denominator = Procedure, Performed: CABG, or Other Cardiac, or Hip arthroplasty, or Knee arthroplasty, or Colon surgery, or Abdominal hysterectomy, or Vaginal hysterectomy, or Vascular surgery

Quality Measure Numerator = Medication, Administered: IV Antimicrobial Medication starts < = 60 minutes before Incision, or SCIP IV quinolone starts < = 120 minutes before Incision, or IV Vancomycin starts < = 120 minutes before incision

Example:

Procedure, Performed: Knee arthroplasty coded with Snomed code 307817008 has an Incision Date/Time of 10/1/13 at 8:45am

Medication Administered: Cefazolin coded with RxNorm code 562062 is administered at 8:15am which is < = 60 minutes before Incision Date/Time 

Patient meets Clinical Quality Measures SCIP-INF1 

Where to start/How to prepare.

Getting started can be daunting and like most projects, taking a team approach works best. Key players to involve on the team include perioperative leadership, anesthesia and surgical IT system administrators, hospital quality and/or meaningful use project manager, and pharmacy technician.

Recommended steps for the team include:

  1. Assess current state (what clinical quality measures is your organization attesting to?)
  2. Identify gaps (are you capturing data in freetext? Is data coded?)
  3. Develop an Implementation Plan (how/where will you add SNOMEDCT and/or ICD9/10?)

Need help getting started?

Contact us using the form below and/or feel free to give us a call 423.753.0054.

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