Below are a few to bookmark:

Have to lead with the CPM Resource Center :-) who has been very engaged with ARRA and Meaningful Use – by both informing and influencing.  Elsevier/CPMRC submitted recommendations to CMS during the proposed rule period – and had two accepted, including the description of clinical decision support makes clear that “clinical information” is a key component of clinical decision support, along with the technology itself.  This suggestion is successfully reflected in the final commentary where CMS re-iterates that clinical decision support must be implemented in a manner that uses clinical information to provide person-specific information in order to meet meaningful use requirements.  The CPM Resource Center also is bringing to healthcare the importance of “Framework-Driven Transformation along with Initiative/Project initiative changes”.  Too often we only see the initiative/project side of the equation (a very common occurrence in the HIT world!) which is not scalable or sustainable.  In addition, CPMRC has an ARRA-Meaningful Use section on their website which provides updates and continuing education, including recorded ARRA/MU webinars.  The ARRA Webinar on the site is recorded and focuses on getting ready for the next stages of ARRA-Meaningful Use.

There is also the Elsevier Clinical Decision Support ARRA Resource Center that has expert blogs and videos.  The videos offer insight into the role of clinical decision support and ARRA Meaningful Use.  Check them out!  Another valuable resource is HIMSS website with a section dedicated to HIMSS ARRA and Economic Stimulus – HIMSS is currently running an ARRA webinar series.

Finally, the CMS EHR Incentive Program is a new site that is continuously updated with the CMS incentive ARRA Meaningful Use criteria.  This is one we should all have book-marked.

This is a topic that I will be blogging on frequently……along with many other fellow bloggers!  Have a great weekend!

Michelle

My thesis on Nurse-Physician Collaboration (1997) began with a quote by Meg Wheatley, “It is all about relationships”. It is so true when you try to achieve quality working relationships and quality patient outcomes.  For the Practice-Technology Collaboration era we are now entering, the new macro mantra is, “It is all about partnerships”. There are some key points worth highlighting in Bousfield’s Outsell posting today:

• Care crosses clinical lines – period! The fact that leading healthcare vendors are merging to address the care gap between inpatient and outpatient is logical.  What is needed “inside” each of these EMR inpatient-outpatient solutions is a systems-thinking evidence-based professional practice framework to enhance the care coordination and clinical decision support required to reduce fragmentation and redundancies as well as achieve quality outcomes. In other words, “integrated product offerings” will require more than “integrated technology”.

• Meaningful use is about practice & technology. The ARRA Meaningful Use criteria should not address one without the other.  Elsevier’s CPM Resource Center recognized this long ago and began partnering and integrating evidence-based interdisciplinary content within EMR vendor applications as early as the 1990’s leading the practice-technology polarity that will be our new reality in healthcare.  While we all study the 800+ page CMS/ONS Meaningful Use Final Rules posted just yesterday (7/13/10 Link) we can celebrate the focus on results, “certified EHR technology should result in health care that is patient centered, evidence-based, prevention-oriented, efficient, and equitable.” In other words, it will require more than technology.

• Usability and design are key to adoption. So glad Bousfield addressed this important aspect.  The new challenge for EMR vendors is how to best leverage CDS tools and evidence-based content to really meet the needs of clinicians as well as “meaningful use criteria”.  In the new market place, selling clinical applications without usable and well-designed evidence-based CDS solutions is no longer an option. In other words, technology alone is not the answer…..let the new competition begin!

Today, December 3, 2009, nurses are gathering in Philadelphia for the Forum on the Future of Nursing: Community Health, Public Health, Primary Care, and Long-Term Care. The forum dedicated to Education will be held on February 22. 2010 in Houston, TX

I had the privilege of testifying at the Acute Care Forum held on October 19^th at Cedars-Sinai Medical Center.  There was a cause for celebration as RWJF/IOM called for input on Quality/Safety, Technology, and Interdisciplinary Collaboration. It was great to hear nursing leaders around the country share their perspectives, as well as hear the testimonies provided by my dear colleagues Joyce Sensmeier for the Alliance for Nursing Informatics (ANI) and Dana Alexander on behalf of the Technology Informatics Guiding Education Reform (TIGER) – both of which I am proud to a part of and the contributions we are collectively making in supporting nurses throughout the country.

Among topics were innovative models used to improve quality and safety in acute-care settings. During this session, I discussed the Clinical Practice Model (CPM)™, which has been evolving since 1983 with the input of thousands of nurses and interdisciplinary clinicians via an international healthcare consortium. 

The CPM Resource Center supports a professional practice framework that addresses the fundamental elements of creating healthy healing work cultures keeping patients and nurses safe. The CPM Framework™, innovative in its inception, is fundamental today as nurses continue to face many complexities in acute care environments to provide interdisciplinary care and successfully integrate intentionally designed technology to support quality care and outcomes. 

The CPM Framework was created to address the primary barriers nurses face in maximizing quality and safety. Identified in a six-year, multi-site pilot, these barriers include a lack of shared purpose, clarity on scope of practice, evidence-based clinical tools and resources at the point of care, dialogue, healthy relationships and effective engagement processes and infrastructures. The CPM Framework partners with organizations to implement and sustain these foundational elements of care. As a result, CPM Consortium sites have demonstrated statistically significant improvement in care based on national quality/safety standards and sustained them over long periods of time. 

The CPM Framework has developed innovative technologies by leading Intentionally Designed Automation (IDA)™ at the point of care in partnership with multiple HIT companies. IDA is intentionally designed by nurses to assure that the technology supports professional practice – the workflow and thought-flow of professional nurses providing care in acute-care settings. It includes components of the CPM point-of-care documentation that assure capturing the patient’s story, developing an evidence-based plan of care utilizing Clinical Practice Guidelines, individualizing the plan for a patient’s  values/situation, providing assessments and interventions within the context of the patients diagnosis and situation, evaluating progress toward goals and education.

Having innovative technologies and a standardized common framework at the point of care for nurses and allied health clinicians to deliver their professional services is critical to practice interoperability and improvement measurements. There are more than 125 acute-care settings that have nurses and interdisciplinary teams using IDA today who use the CPM Framework. Outcome measurements include:  reduced patient falls, reduced pressure ulcers, exceeding core measure national and regional benchmarks by 85-95%, increased nursing satisfaction and more. CPM Consortium sites have been national exemplars for the TIGER Initiative, Sigma Theta Tau International and ANCC Magnet Designated Hospitals.

Barriers to the adoption and use of innovative technology, however, remain. These barriers center on a lack of understanding of the need to do the fundamental work of embedding a professional practice framework inside technology and how to unitize an implementation science for effective and sustainable adoption. 

Thus I proposed that, in the spirit of the IOM report “Knowing What Works in Healthcare: A Roadmap for the Nation (IOM -2008),” we focus on “what works” and stop recreating the wheel – looking to better understand and utilize the  best practices and technologies at hand. This includes the CPM Framework™, which is grounded in complexity science and chaos theory and has been proven in many, many acute-care to work and be replicated.

Having innovative technologies and a standardized common framework at the point of care to deliver professional services is critical to practice interoperability and improvement measurements. They also are an integral part of the solution – not only to our current healthcare crisis but also the meaningful use of healthcare tools and funds going forward and sustainability.

Stay tuned for more on the Forums….and please speak up!

The other key point Blumenthal stressed was that the two most frequently used words:  “meaningful use”….is “not about a technology project” . . . but more of a “change management project”.  Last week in Chicago, the CPMRC International Consortium Summit dedicated a whole day to Foundations in Polarity Management™ in which groups uncovered the dilemmas we must manage as healthcare leaders in regards to technology innovations & practice innovations, framework-driven change & project/initiative driven change, individual & integrated competency, etc.  To achieve Meaningful Use we must see the whole and parts with their dynamic tensions as we move to true transformation to achieve a higher purpose.  The CPMRC learning healthcare community also worked together on leading the implementation science of healthcare transformation and advancement of interdisciplinary integration.  Collaborating and learning together are key to success and sustainability.  There are many collaborative groups here at AMIA as well such as NIWG and TIGER…with a commitment to stretch our thinking and actions in the new world.  These are opportunities of new dimensions and if we “focus on the end-product” it will be a fun, hard, challenging and rewarding ride.

Stay tuned . . .

The past several months have been energizing as healthcare organizations and companies get clear on the promise of improving (dare I say “transforming”?) the US healthcare system with health information technology (HIT) via ARRA funding for meeting “Meaningful Use” criteria.  Here at Elsevier I have the privilege of leading and collaborating with a team of experts on clinical decision support (CDS) who are committed to supporting our customers and HIT vendor partners with value-added products and services to successfully achieve “meaningful use” of their HIT investments.

What do you see when you study the most recently approved HIT Policy Committee’s recommendations for “Meaningful Use” (Meaningful Use Matrix)?

The most logical way to approach this for meeting the ultimate goal as well as achieve funding across the spectrum is to follow that old Stephen Covey leadership principle…. “Begin with the end in mind”.

The end is all about Clinical Outcomes, Efficient Care, Safe Care, Patient/Family Engagement, Clinical Summaries, Care Coordination, Population Management, and Surveillance Measures.

These outcomes call for the marriage of HIT and advanced CDS supporting evidence-based practice as key enablers for every healthcare profession to utilize in their daily practices at the point of care.  They call us to think critically and in new ways about the goals and measurements of each meaningful use criteria to achieve the end in mind!

Stay tuned for deeper exploration of key considerations and successful steps meeting the latest HIT Policy and Standards Committees efforts to achieve true “Meaningful Use”.