1. QSEN, HITECH, EHRs, Meaningful Use and the Learning Health System of the Future Judith J. Warren, PhD, RN, FAAN, FACMI 10/19/2013 Warren Associates, LLC 1

2. Ease on Down the Road to QSEN, HITECH, EHRs, Meaningful Use and the Learning Health System of the Future  What do I pay attention to?  Who is involved?  How do I keep up?  What do I teach?  So much is happening!  Then, there is health care reform!!!!!!!! 10/19/2013 Warren Associates, LLC 2

3. www.qsen.org 10/19/2013 Warren Associates, LLC 3

4. QSEN Competencies  Patient-centered Care Patient-centered Care  Teamwork and Collaboration Teamwork and Collaboration  Evidence-based Practice (EBP) Evidence-based Practice (EBP)  Quality Improvement (QI) Quality Improvement (QI)  Safety Safety  Informatics Informatics 10/19/2013 Warren Associates, LLC 4

5. Patient-Centered Care  Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs 10/19/2013 Warren Associates, LLC 5

6. Teamwork and Collaboration  Function effectively within nursing and inter-professional teams, fostering open communications, mutual respect and shared decision- making to achieve quality patient care 10/19/2013 Warren Associates, LLC 6

7. Evidence-Based Practice  Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care 10/19/2013 Warren Associates, LLC 7

8. Quality Improvement 10/19/2013 Warren Associates, LLC 8  Use data to monitor the outcome s of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems

9. Safety  Minimizes risk of harm to patients and providers through both system effectiveness and individual performance 10/19/2013 Warren Associates, LLC 9

10. Informatics  Use information and technology to communicate, manage knowledge, mitigate error, and support decision making 10/19/2013 Warren Associates, LLC 10

11. HIPAA  Transaction and Code Set Standards  X12  NCPDP  National Provider Identifier  https://nppes.cms.hhs.gov/NPPES/Welcome.do 10/19/2013 Warren Associates, LLC 11

12. HITECH and Meaningful Use ACA and Health Reform 10/19/2013 Warren Associates, LLC 12 www.healthit.gov

13. Nurses in Decision-making Circles: A Professional Responsibility  Office of the National Coordinator  National Committee on Vital and Health Statistics  CMS Panels  NQF committees and panels  IOM  S&I Framework  HL7  IHTSDO and LOINC  Other committees  and Task Forces!!!!!! 10/19/2013 Warren Associates, LLC 13

14. Federally Required Terminology  SNOMED CT  LOINC  ICD-10-CM  RxNORM  CPT 10/19/2013 Warren Associates, LLC 14

15. Warren Associates, LLC http://www.nlm.nih.gov/research/umls/Snomed/nursing_ problemlist_subset.html 10/19/2013 15

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17. Transitions of Care Initiative Overview  Empowering patients, engaging the clinician, and enabling health information exchange in support of national health initiatives to increase patient safety and improve health care outcomes  Improve the electronic exchange of core clinical information.  Key Functions of the Initiative  Focus on clinical content to be exchanged in patient care transitions  Build on existing standards to accelerate adoption  Work with the HIT community to remove barriers to implementation  Key Outputs of the Initiative  Unambiguous definition of the clinical elements that should be included in care transitions  Guidance on the exchange of information during patient care transitions  Agreement on a single standard (Consolidated CDA) in support of Meaningful Use requirements 10/19/2013 Warren Associates, LLC 17

18. Continuity of Care Document 10/19/2013 Warren Associates, LLC 18  Patient Information  Allergies, adverse reactions & alerts  Immunizations  Medications  Care Plan  Discharge medications  Reason for referral  Problem list  Procedures  Functional and cognitive status  Results—labs, etc  Social history  Vital signs  Discharge instructions

19. S&I Framework  Working on Care Plan specifications  Scope and attention to the work will be driving EHR design, build and implementation  http://wiki.siframework.org http://wiki.siframework.org  Need more nurses involved 10/19/2013 Warren Associates, LLC 19

20. Plan of Care 10/19/2013 Warren Associates, LLC 20

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22. Mobile Apps for Health 10/19/2013 Warren Associates, LLC 22 Mobilizing Data for Pressure Ulcer Prevention Challenge, http://www.health2con.com/devchallenge/challenges/onc-i2- challenges http://www.health2con.com/devchallenge/challenges/onc-i2- challenges

23. Evidence-based practice is standardized content that is semantically interoperable. 10/19/2013 Warren Associates, LLC 23

24. ONC Releases MU Stage 3 Recommendations 10/19/2013 Warren Associates, LLC 24  Build on the foundation to improve patient outcomes.  Using electronic Clinical Quality Measures (eCQMs) to measure identified care outcomes  Stage 3 objectives recommended  Providing the ability to electronically submit patient- generated data  Ensuring EHRs can assist with follow-up orders and identify potentially appropriate clinical trials  Sending electronic notifications to a patient's primary care provider or other member of the care team following a significant healthcare event  These recommendations are not finalized  http://www.healthit.gov/policy-researchers- implementers/policy-meaningful-use-workgroup-7http://www.healthit.gov/policy-researchers- implementers/policy-meaningful-use-workgroup-7

25.  Quality Data Model  Foundation for eMeasures as required in Meaningful Use  Appointed groups  Health Information Technology Advisory Committee  National Priorities Partnership  Measure Applications Partnership  Consensus Standards Approval Committee  NLM’s Value Set Authority Center 10/19/2013 Warren Associates, LLC 25

26. http://www.nursingquality.org 10/19/2013 Warren Associates, LLC 26

27. Transforming NDNQI into eMeasures and Lessons Learned Feasibility studies with partners to extract information from EHRs 10/19/2013 Warren Associates, LLC 27

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30. Three A’s of Blue Button  Increase consumer ACCESS to their health information  Enable consumers to take ACTION with their information  Shift ATTITUDE to support patient- provider partnership 10/19/2013 Warren Associates, LLC 30

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32. 10/19/2013 Warren Associates, LLC 32 http://www.healthit.gov/patients- families/video/health-it-you-giving-you- access-your-medical-records

33. Institute of Medicine (IOM)  Landmark reports  Computer-base Patient Record  Now known as Electronic Health Record  To Err Is Human and the series of Patient Safety and Quality reports  The Learning Health System  Health IT and Patient Safety: Building Safer Systems for Better Care  Race, Ethnicity, and Language Data  The Future of Nursing: Leading Change, Advancing Health  http://iom.edu 10/19/2013 Warren Associates, LLC 33

34. Establishing Transdisciplinary Professionalism for Health: A Workshop  How can the “shared understanding” be integrated into education and practice to promote a transdisciplinary model of professionalism?  What are the ethical implications of a transdisciplinary professionalism?  How can health and wellness be integrated into transdisciplinary education and practice?  How is “leadership” taught and practiced within a model of transdisciplinary professionalism?  What are the barriers to transdisciplinary professionalism?  What measures are relevant to transdisciplinary professionalism?  What is the impact of an evolving professional context on patients, students and others working within the health care system? 10/19/2013 Warren Associates, LLC 34

35. Assessing Health Professional Education: A Workshop  What is currently being assessed and how might the outcomes be used (i.e., greater social accountability, promotion by media, learner skills, faculty development)?  How can different disciplines be assessed such that the data informs a new transdisciplinary professionalism?  Which kind of assessment will lead to a “new professionalism”?  What is the role of peer assessment?  What is the role of patients in assessment?  What is the role of work-based assessments?  How might learners and practitioners be prepared for a lifetime of assessment? 10/19/2013 Warren Associates, LLC 35

36. Learning Healthcare System 10/19/2013 Warren Associates, LLC 36

37. Learning Health System Reports 10/19/2013 Warren Associates, LLC 37

38. Questions? 10/19/2013 Warren Associates, LLC 38 jjwarren@live.com