Archive for January, 2010

H1N1 in Children

January 8th, 2010 by Melanie Matthews

According to the World Health Organization, as of the end of 2009, rates of hospitalization in North America for H1N1 among cases aged 5-17 years and 18-49 years far exceeded rates observed during recent influenza seasons, while rates of hospitalizations among cases aged >65 years were far lower. In this issue of the DM Update, learn how age, symptoms and other factors affect the transmission of the flu, how H1N1 affects children with sickle cell disease, and whether school closures are an effective way to control influenza epidemics.

Three Tools to Assess Medication Adherence

January 5th, 2010 by Melanie Matthews

Connie Commander, president of Commander’s Premier Consulting Corporation and immediate past president of the Case Management Society of America, discusses three assessment tools that physicians should use to improve medication adherence in patients.

Three validated assessment tools for medication adherence are the Rapid Estimate of Adult Literacy in Medicine – Revised (REALM-R), the Medication Knowledge Survey and the Modified Morisky Scale.

The REALM-R tool is a simple, brief, eight-item screening tool in which you ask the patient to read the words to you listed on the tool’s record. From those results you can determine if they’re able to read them correctly. You’re looking for their ability to pronounce the words appropriately — not for them to define them or use them in a sentence correctly. The first three — fat, flu and pill — are to get the patient started. After that, an example is “allergic.” Do they say “allergies” rather than “allergic?” If so, they would not get a point for that. Also, if they said “anemic” rather than “anemia,” there’s no point. That’s how you utilize this tool. The patient scores give the case manager or caregiver an idea of whether they’ll struggle. I often tell case managers to never think that intelligence quotient (IQ) is related to health literacy. It’s not. You can have a Fortune 500 CEO who is very highly educated but cannot understand anything regarding a diagnosis for themselves or their family member. Therefore, this tool will give you an idea of an individual’s health literacy level.

The Medication Knowledge Survey tool looks at the medication the patient is taking and what they know about the medication. We can learn many things from the medication knowledge assessment form. Where do they keep the medication? Do they know if it needs to get refilled? Do they know the pros and cons of taking the medicine? Do they know the name of it? We find that they may know some of this — but not all of it. They may put the medication away somewhere or take it once a day rather than once a week. From the case management perspective, this is another important tool to tell us what we need to do with the patient.

Once you’ve got someone following a treatment plan, you use a Modified Morisky Scale for existing therapy. It’s a check and balance of where they are with knowledge and motivation and allows them to be categorized as either high or low. Some questions are:

Do you ever forget to take your medicine?
When you feel better, do you sometimes stop taking your medicine?
Do you sometimes forget to refill your prescription?

I tell caregivers to be careful about refills. Often patients get medical supplies from the physician, so they don’t need to refill it for a while. Again, the patient’s answers give you an idea of where you go next with your case management intervention.

23 EHR Meaningful Use Objectives for Eligible Hospitals

January 4th, 2010 by Melanie Matthews

CMS has proposed 23 objectives for eligible hospitals (EHs) to demonstrate meaningful use of EHRs to further the care goal of improving quality, safety, efficiency and reducing health disparities. Read the measures necessary for each objective in the full CMS proposed rule. More than $17 billion in federal funds have been set aside as incentives for meaningful use of certified EHRs.

Click here for CMS’s Stage 1 25 EHR meaningful use objectives for eligible providers.

  1. Use computerized physician order entry (CPOE) for orders (any type) directly entered by authorizing provider (for example, MD, DO, RN, PA, NP)
  2. Implement drug-drug, drug-allergy, drug-formulary checks.
  3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®.

  4. Generate and transmit permissible prescriptions electronically (eRx).
  5. Maintain active medication list.
  6. Maintain active medication allergy list.
  7. Record the following demographics: preferred language, insurance type, gender, race and ethnicity and date of birth.
  8. Record and chart changes in the following vital signs: height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children 2 – 20 years, including BMI.
  9. Record smoking status for patients 13 years old or older.
  10. Incorporate clinical lab-test results into EHR as structured data — data that have specified data type and response categories within an electronic record or file.
  11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research and outreach.
  12. Report hospital quality measures to CMS (or, for EPs seeking the Medicaid incentive payment, to individual states).
  13. Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules.
  14. Check insurance eligibility electronically from public and private payors.
  15. Submit claims electronically to public and private payors.
  16. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, allergies, discharge summary, and procedures), upon request.
  17. Capability to exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, allergies, diagnostic test results), among providers of care and patient authorized entities electronically.

  18. Perform medication reconciliation at relevant encounters and each transition of care.
  19. Provide summary care record for each transition of care and referral.
  20. Capability to submit electronic data to immunization registries and actual submission where required and accepted.
  21. Capability to provide electronic submission of reportable lab results to public health agencies and actual submission where it can be received.
  22. Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

  23. Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.

25 EHR Meaningful Use Objectives for Eligible Providers

January 4th, 2010 by Melanie Matthews

CMS has proposed 25 objectives for eligible providers (EPs) to demonstrate meaningful use of EHRs to further the care goal of improving quality, safety, efficiency and reducing health disparities. Read the measures necessary for each objective in the full CMS proposed rule. More than $17 billion in federal funds have been set aside as incentives for meaningful use of certified EHRs.

Click here for CMS’s 23 EHR meaningful use objectives for eligible hospitals.

  1. Use computerized physician order entry (CPOE) to directly enter medical orders (for example, medications, consultations with other providers, laboratory services, imaging studies, and other auxiliary services) from a computer or mobile device.
  2. Implement drug-drug, drug-allergy, drug-formulary checks.
  3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®.

  4. Generate and transmit permissible prescriptions electronically (eRx).
  5. Maintain active medication list.
  6. Maintain active medication allergy list.
  7. Record the following demographics: preferred language, insurance type, gender, race and ethnicity and date of birth.
  8. Record and chart changes in the following vital signs: height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children 2 – 20 years, including BMI.
  9. Record smoking status for patients 13 years old or older.
  10. Incorporate clinical lab-test results into EHR as structured data — data that have specified data type and response categories within an electronic record or file.
  11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research and outreach.
  12. Report ambulatory quality measures to CMS (or, for EPs seeking the Medicaid incentive payment, to individual states).
  13. Send reminders to patients per patient preference for preventive/follow-up care. Patient preference refers to the patient’s choice of delivery method between Internet-based delivery or delivery not requiring Internet access.
  14. Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules.
  15. Check insurance eligibility electronically from public and private payors.
  16. Submit claims electronically to public and private payors.
  17. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists and allergies) upon request
  18. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)

  19. Provide clinical summaries to patients for each office visit.
  20. Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results) among providers of care and patient authorized entities electronically.
  21. Perform medication reconciliation at relevant encounters and each transition of care.
  22. Provide summary care record for each transition of care and referral.
  23. Capability to submit electronic data to immunization registries and actual submission where required and accepted.
  24. Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

  25. Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.