Leveraging EHR Functionality for QI

Transcription

1 Leveraging EHR Functionality for QI Patty Kosednar, PMP, CPEHR Health Technology Services 9/24/ MHA HTS: Who We Are Health Technology Services (HTS) is a department of Mountain-Pacific Quality Health (MP). MP is the QIN/QIO for MT/WY/AK/HI HTS has been the Regional Extension Center for Montana and Wyoming since 2010 helping facilities implement EHRs and reach Meaningful Use. Focusing on assisting healthcare facilities with utilizing and leveraging their Health Information Technology (HIT) to improve health care, quality, efficiency and outcomes. We support the work of the QIO by providing technical assistance and quality improvement support. 1

2 ecqi electronic clinical quality improvement; optimizing health information technology (HIT) and standardized electronic data to achieve measureable improvement in quality of care Webinar Objectives Review options for leveraging existing EHR functionality to support and advance ecqi projects Discuss best practices for accessing data in EHRs to create baseline measures for ecqi projects Review the basics of the PDSA quality improvement cycle Identify quality program alignment (QI, MU, PCMH, PQRS, IQR, etc) opportunities Present a recommended high level ecqi project plan 2

3 The Next Stage 5 Health Care: Current Future Do More = Get Paid More Do Better = Get Paid Better (payment reform) 6 3

4 Definition: Payment Reform Payment methods that reflect or support provider /organization performance, especially the quality and safety of care that is delivered, and is designed to spur efficiency and reduce unnecessary spending. (Catalyst for Payment Reform ) Pay for Performance Bundled Payment Shared Savings Global Payments PCMH, Value Based Modifier, ACO, Value Based Purchasing, etc. 7 Quality Improvement Payment/reimbursement will be based on improvement of quality outcomes. Payment/reimbursement will be based on quality data submitted Quality improvement initiatives must use DATA as a foundation Quality improvement can be advanced by leveraging the functionality of EHRs 8 4

5 Utilizing the correct workflows of your EHR can ensure you get paid based on the actual quality of the care you are delivering HTS ecqi Framework Leverage health information technology (HIT) Clinical best practices Plan Do Study Act (PDSA) project improvement methodology Standard QI data collection tools PMI Project Management Methodology 5

6 ecqi Inputs: Results: Meaningful Use of E.H.R Clinical best practices and guidelines Data analytics, reporting, and sharing Education, training, project management and facilitation Continuous process improvement (PDSA) Improved patient outcomes Improved care processes Reduced healthcare costs Increased revenue Repeatable/standardized approach for ecqi Quality and data program alignment (MU, PCMH, ACO, IQR, UDS, PQRS, etc) 11 Utilize EHR functionality to support/advance ecqi CPOE (computer provider order entry) Patient Portals Clinical Decision Support Patient Education Patient Reminders Lab interfaces HIE/Transition of Care /Discharge info/public Health Registries (coordination of care/patient engagement) 12 6

7 EHR Functionality for ecqi CPOE data points can be retrieved from CPOE to effect care improvement CPOE enhances use of clinical decision support rules or guidelines at the point of care Patient Portals Can provide direct, outside the office access to and for patients Use it for patient education Engaging patients in reporting their own measurements for blood pressure or blood sugar online, real time monitoring 13 EHR Functionality for ecqi Clinical Decision Support (CDS) Target conditions and standardize treatments Data Display: flow sheets, patient data reports and graphic displays Workflow Assistance: task lists, patient status lists, integrated clinical and financial tools Data Entry: templates to guide documentation and structured data collection Decision Making: access to resources rule based alerts, clinical guidelines or pathways, patient / family preferences, and diagnostic decision support 14 7

8 EHR Functionality for ecqi Patient Education Provide credible source of information Encourage patient engagement Patient Reminders Proactive preventative care Follow up and care coordination Lab interfaces (or lab results as structured data) data points can be retrieved from lab results to effect care improvement Lab results (structured data) enhances use of clinical decision support rules or guidelines at the point of care 15 EHR Functionality for ecqi HIE/Transition of Care /Discharge info/public Health Registries improve communication between providers and/or facilities. Provide and enhance continuity of care delivery. Data collection and analytics Population health data 16 8

9 Review of PDSA Cycle Plan: identifying a goal or purpose, formulating a theory, defining success metrics and creating a plan Do: components of the plan are implemented Study: outcomes are monitored to test the validity of the plan for progress and success, or problems and areas for improvement Act: closes the cycle, integrating the learning generated by the entire process, or create a new PDSA Cycle; change methods/ reformulate the theory Stabilize/Spread roll out and spread to other areas. 17 Plan Identify scope of QI project What are we trying to accomplish How will we know that a change is an improvement What changes can we make that will result in an improvement Identify SMART goals for QI project (specific, measureable, attainable, relevant and time based) Establish and document baseline measurements (based on QI project goals) Create standard/customize reports and verify accuracy (based on clinical best practices for QI topics) Create and document QI plan 18 9

10 Implement ecqi Plan DO Review and configure E.H.R Functionality Revise workflows based on clinical best practices (based on clinical best practices for QI topic) Provide training for staff Collect Data (utilize QI data collection tools pareto chart, swim lane diagrams, flow charts, histograms, etc) 19 Monitor progress Study Create data reports/graphs Analyze data Identify areas of needed improvement 20 10

11 Act Create new PDSA cycle using data and revise as necessary until goals are met Keep creating new PDSA cycles for this QI project until goals are met, scope is revised or project is canceled. Or If all goals are met, continue to Stabilize/Spread phase. 21 Stabilize and Spread Phases Stabilize new processes - verify changes have been implemented, staff are performing new tasks, train or coach Create ongoing data collection, tracking and reporting to insure changes continue to meet original goals. Identify areas to improve the newly established standard process Propose new QI project based on new possible improvements 22 11

12 Align QI Initiatives Aligning QI initiatives may: Reduce administrative burden of quality reporting Reduce duplication of effort Focus QI efforts on biggest ROI Review MU, PQRS/VM, IQR/VBP, MT PCMH, ACO and other programs for measure alignment. Report on fewer overall measures, and focus QI attention EHR functionality used in ecqi needed also for MU Data Sources and Info Consider the source of the data for each metric needed to assess performance. The EHR cannot collect every kind of data needed for QI. Ensure EHR collects the data as structured data. Data stored in free text fields or document images will not automate data collection. Establish targets and benchmarks. The results of a QI analysis are meaningless if no data exist for comparison. (use standardize measures when possible, NQF, CMS, PQRS, IQR) Conduct periodic data quality audits. Ensure that the EHR is producing accurate and complete denominator and numerator data. 12

13 QI requires full participation Quality Improvement Department Nursing/Patient Services Compliance Information Technology 25 ecqi possible challenges 1. IT Workforce shortages 2. EHR ease of use 3. EHR access restrictions 4. Non- standard data 5. Difficult data report writers 6. Alert fatigue and workflow challenges 7. Others?????? 26 13

14 Keys to Success ecqi involves the whole organization, not just IT, quality, etc. Use SMART goals and scope management Standardize your data goals (use NQF/PQRS/IQR, etc) Implement EHR workflows/changes that make sense for your organization and your ecqi goals Use standardized data collection tools 27 Keys to success Use data for decision making Provide necessary training for all staff Fully test theories before full implementation Align programs/projects to reduce administrative burden Don t give up keep the PDSA cycle going until the data proves a new approach, continue to monitor progress after the end of the project

15 Current ecqi Projects HTS is working with the MHA Performance Improvement Network (PIN) 25 CAHs - to utilize ecqi (funded by MT DPHHS) HTS is working with MT DPHHS to assist their programs with implementing ecqi HTS is supporting the QIO contract by utilizing ecqi methodologies (MT/WY) HTS is working with the MT PCMH clinics to assist with validating data and improving their performance to the required measures (funded by DPHHS) 29 Questions? 30 15

16 Health Technology Services Patty Kosednar