“What impact will meaningful use have on the EpiCenter application?  Has there been exploration to determine if the system will meet the criteria for meaningful use?”

— Julie, Kane County Illinois

EpiCenter is a syndromic surveillance system used by state and local public health departments.  The optional meaningful use criteria leaves it to public health to determine if and how syndromic surveillance is conducted in their region.

Certification applies to electronic health records (EHR).  There is a lot of discussion about this topic, as well as the process and meaning of certification.  There are multiple stages of certification that apply to EHRs and those stages align with the implementation of Meaningful Use criteria.

Since EpiCenter is not an EHR, the Certification Commission for Health Information Technology (CCHIT) certification process does not apply to it.

The Centers for Medicare & Medicaid Services (CMS) published the Final Rule on July 28, 2009.  A PDF version of the Federal Register is available from Health Monitoring Systems website. –kjh

The Centers for Medicare & Medicaid Services have posted materials for states giving direction regarding what is necessary for meaningful use.  This information is not specific to public health, but it provides insight into the overall requirements.  Here is an article from their website that gives an introduction. — kjh

States may voluntarily offer the Medicaid EHR Incentive Program to their Medicaid eligible professionals and eligible hospitals. This page provides resources for states to understand the program and learn more about what is required to offer the programs.

Health IT Documents

To qualify to receive 90% federal matching funds for administering the Medicaid EHR Incentive Program, states must develop:

• Health Information Technology Planning Advance Planning Document (HIT PAPD) – A plan of action that requests federal matching funds and approval to accomplish the planning necessary for a state agency to determine the need for and plan the acquisition of HIT equipment, services, or both.
• State Medicaid Health Information Technology Plan (SMHP) – A document that describes the state’s current and future Health IT activities, as well as the path between, in support of the Medicaid EHR Incentive Program (see the SMHP template in the “Downloads” section below).
• Health Information Technology Implementation Advance Planning Document (HIT IAPD) – A plan of action that requests federal matching funds and approval to acquire and implement the proposed SMHP services, equipment, or both.

The HIT PAPD, SMHP, and HIT IAPD lay out the process states will use to implement and oversee the Medicaid EHR Incentive Program. These documents help states construct a Health IT roadmap to develop the systems necessary to support providers in their adoption and meaningful use of certified EHR technology.

• States are required to submit these documents in order for CMS to approve receipt of the 90% Federal match.
• Prior approval is required for the HIT PAPD and HIT IAPD. The SMHP is the deliverable resulting from the HIT PAPD. The SMHP will be reviewed and approved before implementation funds are authorized under the IAPD. The APD and SMHP processes allow states to update their Advance Planning Documents and SMHP when they anticipate changes in scope, cost, schedule, etc. This allows states to add additional tasks to the contract which they may have not thought of at the time the HIT PAPD was written, as they worked through the original tasks on the original submission.

As states begin developing their SMHPs, they can also begin receiving the 90% federal matching funds to be used to support their initial Medicaid EHR Incentive Program planning activities, as long as the relevant Advance Planning Documents are approved. For example, initial planning regarding the design and development of the anticipated SMHP may be eligible for the 90% federal matching funds as an expense related to the administration of the Medicaid EHR incentive payments and, more broadly, for promoting health information exchange.  Read more here…

Summary

Health Monitoring Systems conducted a pilot study of the MediCenter medication reconciliation system that showed improved medication list accuracy, increased nursing efficiency, and demonstrated clinical significance while offering a potential return on investment of $300,000.

Pilot Study

Numerous healthcare quality organizations have identified medication administration as an area of improvement for patient safety. The Joint Commission has led the way with Patient Safety Goal #8, Medication Reconciliation. Although this quality initiative is of value to hospitals, implementation has been difficult.

The MediCenter service automates compilation of the patient’s home medication list by accessing prescription history from payers and pharmacies.

Are automated home medication lists effective in a clinical environment? A formal MediCenter study, conducted from January to March 2010 at a pilot hospital, demonstrated that they were. MediCenter improved medication list accuracy, increased nursing efficiency, and demonstrated clinical significance during the pilot period.

Improving Medication History Accuracy

The goal of compiling patient medication history is to avoid Adverse Drug Events (ADEs) and support diagnosis and treatment.

MediCenter achieves this goal. Nurses using MediCenter receive medication history for 75% of visits. For these patients, 95% of their current medications were correctly identified.

In contrast, a nurse following best practices and using a patient’s previous medication history from the hospital only identified about 70% of home medications.

When conducting a medication history interview with MediCenter, clinical staff members can uncover nearly 35% more medications for each patient, improving medication history accuracy.

Increasing Nursing Efficiency

The challenge facing the Joint Commission’s Patient Safety Goal #8 has been the inefficiency hospitals faced while implementing a thorough medication reconciliation process.

Anecdotal evidence describes 20, 30, and 40 minutes to compile medication history per patient. A 2008 survey conducted by Health Monitoring Systems of 40 hospitals indicated that the process could take 15 minutes.

Performing consistent medication history interviews at each entrance to a hospital has been identified as a best practice. Hospitals implementing this practice have struggled with a trade-off between efficiency and accuracy.

To achieve the same level of accuracy as with MediCenter, approximately 20 additional minutes of nursing time would need to be spent with each patient, following up with calls to family members, physician offices, and pharmacies.

As an additional confirmation of MediCenter’s utility, in-patient complied home medication history was compared against MediCenter results. The level of agreement between these two sources was comparable to what was observed with lists compiled in the ED and MediCenter.

Demonstrating Clinical Significance

MediCenter routinely provides an accurate medication history to clinicians efficiently, but are the results meaningful? 

When asked, physicians are clear.  Having knowledge of each and every medication is important.  It is equally clear that a trade-off is made, balancing time to gather data against the value it provides.  In general, all of the additional medications discovered with MediCenter are significant. 

Specifically, MediCenter identified NSAIDs, controlled narcotics, cardiac drugs, anti-depressants, and antibiotics at rates greater than the 35% average.  The following table illustrates the improvement in reporting when using MediCenter:

Substance	Reporting Improvement
NSAIDs	67%
Controlled Narcotics	67%
Cardiac Drugs	11%
Anti-depressants	29%
Antibiotics	50%

Another concern are ADEs due interactions with commonly administered treatments.  Of the medications uncovered by MediCenter, 2 in 5 patients had an unreported medication that had a potential severe interaction with the most common treatments. 

MediCenter results demonstrate that significant categories of medications are underreported and that ADEs can be reduced establishing clinical significance.   

 

In 2008, Health Monitoring Systems had connected its 300th hosptial to the EpiCenter System.  At the time, this was the largest health information exchange in the country. 

While explaining this milestone to Kimberly Lyons-Neel, a hospital executive, lightening struck.  Ms. Lyons-Neel immediately grasped the significance of Health Monitoring Systems’ large health information exchange.  “You know what would be really great?  If you could get information to the nurses about patients’ medication.  These new JCAHO requirements are really hard on nursing.”

With that conversation, MediCenter was born. 

MediCenter provides valuable health information at the point of care.  Here, where the information is needed most, it can positively affect clinical decision making and the quality of care.  By leveraging the infrastructure already established at Health Monitoring Systems, MediCenter is a demonstration of effective, affordable health information exchange. 

MediCenter represents a significant step forward in how healthcare thinks about health information exchange.