Health Care Quality Improvement Priorities

The American Recovery and Reinvestment Act of 2009 (ARRA), also known as the economic stimulus act, contains provisions for Medicare to begin paying incentives to health care practitioners “for meaningful use of electronic health records.” This is a cornerstone of current efforts at health care reform, but what does it actually mean?

The website of the Certification Commission for Health Information Technology (CCHIT) at http://www.cchit.org/ has some answers.

CCHIT, under contract to the US Department of Health and Human Services, establishes electronic health record standards for functionality, interoperability, and security. It tests and certifies EHR software against these standards, which are derived from the DHHS Health Outcomes Policy Priorities and Care Goals.

The following is excerpted from the CCHIT Meaningful Use Matrix. The policy priorities are in bold face, and the related care goals are bullet points.

Improve quality, safety, efficiency, and reduce health disparities.

· Provide access to comprehensive patient health data for patient’s health care team.

· Use evidence-based order sets and CPOE.

· Apply clinical decision support at the point of care.

· Generate lists of patients who need care and use them to reach out to patients

· Report to patient registries for quality improvement, public reporting, etc.

Engage patients and families

· Provide patients and families with access to data, knowledge, and tools to make informed decisions and to manage their health.

Improve care coordination

· Exchange meaningful clinical information among professional health care team.

Improve population and public health.

· Communicate with public health agencies.

Ensure adequate privacy and security protections for personal health information

· Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law

· Provide transparency of data sharing to patient

Evaluating whether or not a practitioner, a practice, or the health care industry achieves these goals requires the compilation of objective, quantitative measures. The CCHIT Meaningful Use Matrix shows that the bulk of the measures are to be addressed in certified EHR systems by 2011, with additional requirements going into effect in 2013 and 2015.

It must be understood that the priorities, goals, and measures are directed at the health care industry as a whole; electronic health records will make it more convenient to calculate and monitor them.

The measures, which are also known as Key Performance Indicators (KPI), are created from structured data. EHR systems make it easier to collect and organize a broad array of patient and practice data in a structured form that supports aggregation and reporting for quality-of-care and clinical decision support purposes.

But using an electronic health record system, particularly in the patient encounter setting, is very different than working with paper charts. There is a learning curve that must be accommodated in order to successfully integrate EHR into the practice. To minimize this learning curve, a practice must be very thorough in evaluating which EHR product to buy. The implementation of that product must be equally thorough, with adequate user training, workflow redesign, and phasing the system into the practice methodically and logically.

Medicare is to begin paying incentives for meaningful use of certified electronic health records in 2011, to allow practitioners and institutions adequate time to select and implement EHR. An EHR project can take a minimum of nine months, and could extend up to two years for very large health care entities.

By 2015, EHR will be effectively mandatory, since it substantially reduces the cost of processing health care claims, and the demand for measurement and monitoring of health care quality from government, private insurers, and consumers can be expected to intensify.

The Worcester Group, Inc.

The Worcester Group, Inc. has been a provider of information systems consulting services since 1995. We work with our clients to identify and prioritize their needs; in evaluating vendor offerings in relation to those needs; and integrating the selected product into the business processes. We provide on-going user support, supplemental training, and other consulting services to insure the success of the information systems project.

Electronic Health Records Systems

Benefits of EHR, and Barriers to Success

“…[T]he path to quality improvement and financial benefits lies in getting the greatest number of physicians to use the EMR (and not paper) for as many of their daily tasks as possible.”

This was the “key insight” offered in a paper by Robert H Miller and Ida Sim appearing in Health Affairs Volume 23, Number 2, March/April 2004. The authors identified eight activities supported by EMR/EHR that lead to both quality improvement and financial benefits:

· Viewing (reports and charts)

· Documentation

· Care Management

· Ordering

· Messaging

· Analysis and Reporting

· Patient-directed functionality

· Billing.

They also identified a number of barriers to EMR adoption:

· High initial cost

· Uncertain financial benefits

· High initial physician time costs

· Technology

· Difficult complementary changes

· Inadequate support

· Inadequate electronic data exchange

· Lack of incentives

· Physician Attitudes.

Since 2004, when this study was published, there have been a number of significant changes affecting these barriers. The Certification Commission for Health Information Technology began issuing standards and certification to EMR/EHR products in 2005 that have gone a long way toward addressing the data exchange issues. Furthermore, health data exchange organizations are now forming in metropolitan areas like New York/New Jersey to promote efficient, effective and secure data sharing.

Technology has been evolving steadily. There are now over 300 EMR/EHR products on the market, all of which approach the usability issues in different ways, including handwriting and voice recognition, and better interface designs for capturing structured data. Also, the costs for investing in these products vary widely, including many that are provided inexpensively on a software-as-a-service model.

While significant practitioner incentives are still lacking, there are signs they will emerge shortly, as the American Recovery and Reinvestment Act of 2009 (ARRA) will provide incentives for “meaningful use of certified electronic health records” beginning in 2011, and the government’s health care reform plans place an emphasis on continuously monitoring and improving quality of care.

Physician attitudes are influenced by their perception of the benefits to be obtained versus the difficulty of using EMR. The more comfortable a physician becomes with a product, the less daunting the technology becomes, and there is greater likelihood of realizing significant benefits.

Successful EMR implementation ultimately hinges on overcoming the issues of complementary practice changes and adequacy of support. Large practices may have an in-house IT department that can address these issues, but small firms having from one to five practitioners generally have to rely on their in-house EMR Champion. As Miller and Sim point out, this takes significant time away from his practice of medicine to provide support and encouragement to the rest of the firm.

“EMR champions in small practices spent much time arranging for EMR installation, receiving and assisting with EMR training, and encouraging EMR use among their colleagues and staff. … [They] also had to patch together and deploy technical support from the various software, hardware, networking and service vendors when technical glitches occurred … [and] work with their staffs to summarize and enter patient data from existing paper charts into the EMR. All physicians spent substantial time customizing their own visitor disease-specific electronic forms and documentation shortcuts to speed visit documentation. Moreover, physicians had to redesign their workflow (how they worked in the exam room) and office workflow (who did what tasks).”

The Worcester Group, Inc. provides support for complementary changes, training, software customization and system maintenance. Working with your implementation committee and EMR/EHR Champion, we help you overcome these barriers cost effectively and help your practice on the path to the quality improvement and financial benefits of EMR/EHR adoption

Business Intelligence, Data Warehousing, Decision Support, DSS, Electronic Health Records, EHR, CCHIT, Certified Electronic Medical Records Systems