Merry Medisolving: Featuring Niki Seling

Featuring: Niki Seling from Upper Chesapeake Health

Name: Niki Seling
Job Title: Nursing Information Systems Analyst
Hospital: Upper Chesapeake Health

“This is the way it should have always been,” Niki Seling from Upper Chesapeake Health said. “Quality takes care of the eCQM auditing and IT takes care of the technical changes.”

“But you know, in the beginning, IT had to figure out this whole eCQM thing and make sure it was going to stick. It looks like it has stuck, so it’s time to move on!”

In our last episode of Merry Medisolving, we feature Niki Seling, Nursing Information Systems Analyst at Upper Chesapeake Health and long-time Medisolv client. Here we learn about Upper Chesapeake’s eCQM transition from a strictly IT initiative to a shared project between Quality and IT.

What is your job title and can you explain a little bit about what you do?

My job title is Nursing Informatics System Analyst and I am in charge of supporting advanced clinical applications for the inpatient side of nursing, outpatient and any of the ancillary departments such as respiratory or rehab and of course, eCQMs and Meaningful Use. I work in the hospital’s IT department and  part of my job is to make sure all of the departments that I work with are set up to have successful electronic data capture for eCQMs.

In this role, I send all change control requests to our hospital’s Change Control Committee.  The request is discussed in order to decide if it would affect any other areas of the hospital. Once the request is approved, I take care of making that documentation change electronically.  Throughout this process, I have to monitor change requests that may impact our eCQM results.

I work very closely with the nursing administration and the director of nursing to ensure we are up to date with all of the measures that we have to document.

Did you always work in IT? How did you get involved?

No, I was actually a floor nurse, and when our hospital updated from MEDITECH Magic to 6.07, I was pulled into a project. As time went on, a position was created for me under nursing administration. I did this job under them for about a year and at that point, it was absorbed under IT, which tends to be the way that big updates happen. I’ve been in this current position under IT for about three years.

Upper Chesapeake has Medisolv’s ENCOR software product. Tell us about your history with ENCOR. How did you get started and what prompted your hospital?

I was brought in right at the beginning when Meaningful Use first started. I worked with Kristen Beatson from Medisolv to set up our eCQM program. In those days, we would discuss easier ways to implement the process because we found that some Meaningful Use initiatives didn’t make a lot of sense to our end users. Many of the end users didn’t like that we had to ask certain questions, so we had to find ways to make the process easier for them. Medisolv helped a lot in the beginning to get the mapping done correctly. This included understanding which dictionaries to use to ensure proper measure mapping. MEDITECH didn’t really have the support needed for that, so that’s where Medisolv came in and made my job a lot easier.

Was mapping difficult in the beginning? How does that compare to now?

It was very difficult. No one really knew what to do and I had very little support. It was basically trial and error. I thought I’d be able to lean on MEDITECH to help with the interfaces, but I learned that it had nothing to do with them at all. I really relied on Medisolv at the time to guide me and say, “Here’s what we know. This is where you need to go.” If it weren’t for Medisolv, then I don’t know if it would have been done as smoothly as it was.

Nowadays, it’s a lot easier. I still lean on Kristen because she updates us when mapping specifications have changed or the measure is retired.

Can you tell our readers a little bit about what specifications are?

Sure.  At our hospital, we chose certain eCQMs to submit to CMS. Each eCQM has a specification that includes logic that is pretty complicated but also “describes” how the measure works.  Each measure has many data elements which have an associated code (SNOMED, RxNORM, etc.). These codes must be mapped to our documentation and are needed for the data to be captured and evaluated electronically for eCQM qualification. The specifications, data elements and codes can change from year to year.

These annual specification updates are what Kristen helps me understand and account for. Once there is a change, I need to update that in our system and we have to do this on an annual basis.

And if you don’t update them?

Nothing really breaks per se, but your measure numbers won’t pull in correctly or at all. Your dashboard definitely won’t be accurate. So you have to study the measure. I know that if we would normally be at 10 percent on a certain measure and we’re only pulling in seven percent, then I need to look at the mapping.  Perhaps there is a specification update I missed or that was done incorrectly.

Tell us about your hospital’s plan to deal with yearly specification updates.

Kristen and I come together once a year to review the specification updates from CMS. She was actually out at our site a few weeks ago to go over the changes.

I don’t know that we have a regular plan right now because of the way CMS and The Joint Commission have been changing each year. For instance, next year we have to plan to submit eCQMs for the Meaningful Use and IQR programs and now The Joint Commission requires eCQMs as well.

It seems like the data element, workflow and mapping changes are going to have to be completed on January 1^st. This year appears to be a bit more difficult because we have such a specific time frame. We really need to begin monitoring our first quarter results on January 1^st. It also seems like there are more mapping changes as compared to last year.

And this year we have Quality coming in to help with the eCQMs. They are going to be doing a lot more spot checking, which means much of the work will come off of my plate and I’ll be able to focus more on just the mapping changes.

You mention that the eCQM auditing responsibility will be transitioning to the Quality department. Tell us about that transition.

In the beginning, IT was the one who took the eCQM initiative under our wing. We decided which measures we would submit and then mapped them out. We were very much involved in the clinical workflow and how it would affect the end users. I was also in charge of auditing our eCQMs. I would look at our dashboards to make sure that our numbers were right. It was just something we kept really close to us because it was an IT function.

In about the last six months, things have changed and Quality has become more involved. When Kristen came in a few weeks back, we got together with the Quality department and we “passed the baton.”

Now Quality will go in and review our measure results. If, for instance, we have somebody that looks like they shouldn’t be in the denominator or that they should be excluded, then Quality will dig down to figure out what happened. They’ll determine if there was a process change or if something needs to be adjusted on the IT piece.  If it’s a job for IT, they’ll pass it along to me.

How do you imagine the balance will be distributed in years to come?

I don’t see that IT will ever take a 100% step back because we will always be involved in the mapping. If Quality noticed our numbers were low for, let’s say, anti-coagulation not being received at discharge, and they discover it’s a specific group of physicians that aren’t doing electronic medications at discharge, then that’s something they would take to the physician group. If it’s something that they find out is mapping related, then they’ll bring that to me. So it’s going to be divvied out appropriately based on whatever the issue is. As opposed to IT trying to figure out what’s going on and working with the other groups. It’s going to be more Quality managed now.

I don’t know that it could change more. I don’t see Quality ever doing the mapping piece and I don’t see IT ever taking back the auditing part of it.

Do you think the quality of patient care has improved since implementing electronic quality reporting?

I think it has. I think there’s something to be said about the fact that we can now see our patients that have gone home with electronic medication orders and know that those patients were sent home with the appropriate medication. Before, we didn’t have that information and you didn’t really know. It was all paper. These requirements have pushed us to make things more electronic and our patient outcomes and patient satisfaction can only be made better because of that.

Final question. What is the one thing you couldn’t live without in ENCOR?

Kristen. Because without her knowledge and patience, I wouldn’t have been as successful. She had to explain things more than once because often times, you don’t get it the first time. And she’s very patient. She never made me feel like I’m putting her out. It’s not just about having the right documentation to help you understand the process; when you are able to have that personal touch, you can’t beat that.