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Emergency Medicine Informatics Section Newsletter - March 2017

21st Century Cures Act and its Impact on HIT


Letter from the Editor

Carrie Bkaer_2016Welcome to the March 2017 EM Informatics Section Newsletter.  This edition contains articles on the following... 

21st Century Cures Act, New Regulation Impacts Ordering of Diagnostics Tests: “Appropriate Use Criteria via Clinical Decision Support”, Fast Healthcare Interoperability Resources (FHIR) Standards for ED Information Systems, Clinical Informatics Education and Fellowships, CEDR and E-QUAL: More on ACEP’s Qualified Clinical Data Registry, and the Emergency Quality Network, Spotlight on Quality and Informatics at ACEP and more! 

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Informatics Q&A: Protecting Access to Medicare Act of 2014 - Appropriate Use Criteria via Clinical Decision Support for Advanced Diagnostic Imaging Services

 JT Finnell, MD, MSc, FACEP, FACMIQuestion:

Our radiology department called a meeting to discuss a federal mandate to utilize Clinical Decision Support based on the American College of Radiology's Appropriate Use Criteria. Apparently, this is already live in the ambulatory world and is coming to EDs later this year. 

Todd B. Taylor, MD, FACEP

The requirement is to choose a supported indication using computer assisted technology. I have heard EMR implementation of this requirement often fails, due to no logical choice being presented.

The whole thing sounds absurd. Has anybody else caught wind of this or implemented yet? What steps have you done to mitigate the negative impacts to your ED?

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Clinical Informatics Education and Fellowships

Ben Slovis, MDFellowship training in Clinical Informatics has continued to grow since 2014 when the Accreditation Council for Graduate Medical Education (ACGME) began to accredit programs training in the subspecialty. There are now 24 ACGME accredited programs spanning institutions across the country, with many more anticipating accreditation in the coming year. At least four of these programs are sponsored by, or affiliated with a department or division of emergency medicine.

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Quality and Informatics at ACEP

Pawan Goyal, MD, MHA, PMP, MS, FHIMSS, CPHIMS_2017As part of its ongoing commitment to providing the highest quality of emergency care, ACEP is developing Quality as a new line of business. Under the leadership of Pawan Goyal, MD, FHIMSS, FAHIMA, ACEP’s new quality portfolio envisions becoming part of national quality movement to redefine and rebrand emergency care. 

The quality portfolio is structured to provide cross-functional member interaction and best practice development-related Quality data tracking and reporting, Quality Collaboration, Policy, Patient Safety, Informatics, Performance Measurement, Quality Improvement, Health Information Technology, Analytics, Research, Innovation, Education, Training, and Quality Strategy. Here are some of the key components of ACEP’s quality portfolio. 

Clinical Emergency Data Registry (CEDR)
CEDR is a qualified clinical data registry, designated by CMS, designed to measure healthcare quality, outcomes, practice patterns and trends in emergency care. CEDR will also facilitate emergency care research through the identification of practice patterns, trends and outcomes in emergency care which will allow for physician groups and hospitals to identify areas of improvement.

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Greetings From the Board Liaison

Jon Mark Hirshon, MD, MPH, PhD, FACEP_2017Greetings Section Members!

As you can see by perusing the contents of your newsletter, we are living in interesting times. Whether it is the implementation of new federal regulations, such as the 21st Century Cures Act, or ACEP’s response to the Medicare Access & CHIP Reauthorization Act (MACRA) through our Qualified Clinical Data Registry (CEDR) and the Emergency Quality Network (E-QUAL), the environment for clinical care and medical informatics could hardly be more turbulent, challenging and exciting.

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Shout out to the EM Informatics World

Submit your idea, question, article or Letter to the Editor for the next EM Informatics Newsletter to Dr. Carrie Baker. Thanks!

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Landmark 21st Century Cures Act

Jason Shapiro_2016On Tuesday, December 13, 2016, President Barack Obama signed the $6.3 billion 21st Century Cures Act into law. The bill received overwhelming bipartisan support, and is aimed at helping “modernize and personalize health care, encourage greater innovation, support research, and streamline the system,” according to its mission statement.

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FHIR Standards for ED Information Systems

James McClay, MD, MS, FACEP_2017Wouldn't we all like a custom built EHR system that lets us manage our patients the way we want? Imagine something as simple and intuitive as the iPhone, with all the patient information available from wherever they’ve been seen. I'd add in little smarts like Amazon's Echo to answer those hundreds of questions I have every shift. Ideally, this system could anticipate what I'm going to need, like a good scribe, and record everything in a nice neat package. 

Well, we don’t have anything like that, yet. However, members of the clinical and emergency informatics community know that making these innovative solutions work in healthcare means we need to develop standards. 

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CEDR and E-QUAL: More on ACEP’s Qualified Clinical Data Registry, and the Emergency Quality Network

Nicholas Genes, MD, PhD_2017ACEP’s qualified clinical data registry, called CEDR, continues to grow - both in membership and capabilities. The Clinical Emergency Data Registry was designed to facilitate ED quality reporting, enhanced reimbursement under MIPS (the merit-based incentive payment system) and can provide performance feedback to participating EDs and individual physicians. In 2016, 42 measures were supported, and this year the number has risen to 44. These measures of throughput, resource utilization, or performance on patient safety initiatives, are automatically extracted from electronic health records, and made available to participants to compare their performance among colleagues and across EDs. Sixty EDs are already contributing, and that number is expected to more than triple in 2017.

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Update: American Medical Informatics Association (AMIA) 10 x 10 course in conjunction with ACEP

Carrie Bkaer_2016Approximately 200 emergency physicians have completed the American Medical Informatics Association (AMIA) and ACEP 10x10 (“ten by ten”) course since it was first offered in 2008. Thirty-five students participated the first year. Nicholas Genes, current ACEP Emergency Medicine Informatics Section Chair-elect, was in the first class. The ACEP 10x10 has always been based on the Oregon Health & Science University 10x10 curriculum, so it is a broad survey of clinical informatics. Over time, the course has transitioned from “what is an electronic health record and how do you get one installed,” through Meaningful Use, to optimizing systems and determining what to do with all the data that is generated (registries, Big Data, quality improvement).

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Upcoming ACEP Informatics Ground Rounds Series 2017

The ACEP Informatics Ground Rounds has been an exciting forum for education and discussion. We are eager to start up again soon for this year.  We are seeking presenters and welcome individuals who can present on topics in which they are an expert, even those who work in industry.  As in the past, we look forward to excellent lectures from a variety of section members and others.  The intention is to begin the series on Tuesday, March 21st.  Lectures will start at 3pm eastern (1 hr. earlier than prior).  Contact Dr. Jeff Nielson for questions or volunteer opportunities. 

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