“Elevator Trim - Set for takeoff… Mixture - Rich… Throttle - 1700 rpm…Magnetos - Check…Engine Instruments - Green…Comm/Nav/Radios/Avionics - Set...Flaps - Set for Takeoff… Romeo Sierra 192448 ready for takeoff.” The before takeoff run-up check - it was automatic. I learned it the first day I stepped into the cockpit of the Cessna. It was not optional. My life depended on it.
When we step into the operating room, we embark upon a mission far more complex than flying a single engine aircraft. The surgical team is a multifaceted crew of medical talent and disparate resources that must operate in a highly integrated manner. The success of the procedure requires it. The patient’s life depends on it. Yet, all too often, the “before takeoff run-up check” consists simply of “Scalpel!”
Fortunately, there is growing support and demand for the use of checklists in medicine, including but not limited to such settings as the ICU and the operating room. The World Health Organization has proposed a surgical safety checklist,1 and a recent study of over 3,700 patients at eight sites worldwide documented a reduction in mortality from 1.5 percent at baseline to 0.8 percent (p=0.003) after introduction of the checklist, and a corresponding reduction in inpatient complications from 11.0 percent to 7.0 percent (p<0.001).2 Although the study did not correlate specific items on the checklist with specific complications, one item, confirming that antibiotic prophylaxis was given in the last 60 minutes, almost certainly accounted for the reduction in surgical site infections. It is difficult to understand how other items on the list such as team members introducing themselves by name, and correctly labeling the specimen could possibly reduce morbidity and mortality. Perhaps most interesting were the results at one site, where adherence to all six safety indicators was 94.1 percent at baseline and 94.2 percent (N.S.) after institution of the checklist, but nonetheless, mortality decreased from 1.0 percent to 0.0 percent (p<0.05) and complications from 11.6 percent to 7.0 percent (p<0.05).3
What accounts for this significant improvement? Perhaps more important than the individual items on the checklist is the culture change that accompanies the use of the checklist and the development and support of a team approach to the operative procedure. The acceptance of the team concept fosters a crew resource management attitude. A “time out” encourages all members of the team to stop, think and raise any issues or concerns they may have. As a vascular surgeon performing a technically challenging bypass on a critically ill patient, I fully understand that the success of the procedure depends on every member of the team functioning at the highest level. I not only welcome their input, I demand it – just as they should demand mine.
What is actually on the checklist may not be nearly as important as the fact that it exists and, more importantly, is used routinely. Developing and executing a surgical checklist transforms individual, well trained professionals into a high performance surgical team. Inclusion of a “time out” affords each member an opportunity to stop, think and speak out, without fear of interrupting the procedure or distracting others. The surgical checklist – part of every operative flight plan.
“Romeo Sierra 192448 on final approach, Over.”
– Ronald A. Savrin, MD, MBA, FACS
Medical Director
rsavrin@ohqio.sdps.org
Tools of the Trade: Process Mapping
Is your organization getting less-than-optimal results on particular clinical measures, despite having thorough and well-written policies, procedures and protocols for staff to follow? For example, your organization may have a well-thought-out approach to preventive skin care, but still be struggling with the incidence of nosocomial pressure ulcers.
Poor outcomes are often associated with poorly designed processes, but the underlying problem may be in the way staff members implement the process, rather than in the process itself. Because these implementation issues are often far from obvious, process mapping can be extremely valuable in facilitating quality improvement efforts. Process mapping can help your organization objectively define how a process is carried out while identifying specific parts of an established process that contribute to poor outcomes.
Benefits
Process mapping is a quality improvement tool endorsed by such industry leaders as the United Kingdom’s National Health Service (NHS) Modernisation Agency, which describes it as a “key starting point” for quality improvement efforts, and the Agency for Healthcare Research and Quality (AHRQ), which notes that process mapping can help “mistake-proof” an organization’s processes.
Used properly, this tool enables each team member to freely discuss their actual steps in day-to-day processes (even if they don’t quite adhere to official policies and procedures), allowing for the identification of previously unknown or unresolved issues. It fosters a culture of ownership, responsibility and accountability, and offers such benefits as:
A clearly defined overview of a specific process
An effective aid in planning and testing quality improvements, and
A highly visual, easy-to-understand end product.
Getting Started
Process mapping is a quality improvement tool endorsed by such industry leaders as the United Kingdom’s National Health Service (NHS) Modernisation Agency, which describes it as a “key starting point” for quality improvement efforts, and the Agency for Healthcare Research and Quality (AHRQ), which notes that process mapping can help “mistake-proof” an organization’s processes.
The task can be rather complex, but building a good process map involves three basic steps:
Defining the current process.
Write out each step as everyone agrees it is carried out.Analyzing the current process.
Decide how often each step is carried out the right way, by the right person, at the right time.Making improvements.
Determine what changes need to be made to improve performance at each step.
An abbreviated example of a process map is illustrated in Figure 1.
reflect how often each step is carried out completely and accurately.
Tips for Success
In addition to an environment of complete honesty, team engagement and participation are essential to the success of process mapping. Group leaders can help foster positive team dynamics and productive discussion by:
Staying focused.
Other important issues are often uncovered through process mapping, but these should be set aside for discussion in separate meetings.Being the group’s conscience.
Reinforce and encourage honesty among all participants by asking questions such as “Are we sure that’s what really happens?” and “How often does that step happen completely and accurately?”Allowing time.
Allow sufficient time for all team members to discuss the steps in a process.Establishing a safe environment.
Complete honesty can only be possible in a blame-free environment that is free of accusation and retribution.
More Process Mapping
This article describes a very simple approach to process mapping for healthcare organizations; the concepts behind this tool originated in the manufacturing industry in the Ford and Toyota Motor Corporations. From these concepts came two process mapping models now commonly used in quality improvement efforts in healthcare and other industries: Value Stream Mapping (Lean Enterprise Institute) and Material and Information Flow Mapping (Toyota Production System). More information on these models is available at the Lean Enterprise Institute (http://www.lean.org) and Toyota (http://www.toyota.co.jp/en/vision/production_system/index.html) Web sites.
Other valuable resources:
The NHS Modernisation Agency
Process Mapping, Analysis and Redesign Improvement Leaders’ Guide 1.2.
Available at: www.institute.nhs.uk/index.php?option=com_content&task=view&id=134&Itemid=351Agency for Healthcare Research and Quality (AHRQ)
Mistake-Proofing the Design of Health Care Processes
Available at: www.ahrq.gov/qual/mistakeproof
Regardless of which approach you take, troubleshooting processes can facilitate quality improvement efforts at your organization. Commit to improved care for your patients and staff by using a process map as your next quality improvement intervention!
– Leasa Novak, LPN, BA
Quality Improvement Project Coordinator
lnovak@ohqio.sdps.org
– Ann Fitzsimons, RN, MBA
Quality Improvement Specialist
afitzsimons@ohqio.sdps.org
Help for Providers and Beneficiaries
As Ohio’s Medicare Quality Improvement Organization, Ohio KePRO works with healthcare providers to improve patient outcomes and reduce medical errors throughout the healthcare system. As part of our contract with the Centers for Medicare & Medicaid Services (CMS), we provide Helpline services to Medicare beneficiaries, and process beneficiary discharge appeals cases initiated by healthcare facilities throughout the state.
The Helpline is accessible seven days a week during working hours (8 a.m. to 4:30 p.m.) at 800-589-7337. Staffed by administrative personnel, it serves as a triage of sorts, from which calls are forwarded to the appropriate personnel or agency. Over the past ten years, we’ve processed and acted upon nearly 30,000 Medicare medical review cases initiated through the Helpline. These cases include those related to discharge appeals, Diagnosis Related Group (DRG) review, and beneficiary complaints. Misdirected calls (such as those regarding billing issues or plans other than Medicare) are referred to the appropriate agencies.
Discharge Appeals
We perform patient-initiated appeals for all Medicare beneficiaries, including those enrolled in a Medicare Advantage plan. We also perform appeals for patients in hospitals, skilled nursing facilities, home health agencies, comprehensive outpatient rehabilitation facilities, and long-term acute care hospitals. For each appeal, our staff requests medical records from the provider(s) involved and sends the records to a Board-certified physician for review. If the notice is upheld, beneficiaries or their representatives have the opportunity for reconsideration.
DRG Reviews
DRG reviews are performed on all medical records for which the hospital has billed at a higher DRG. Ohio KePRO requests the medical records from the provider and performs an initial screening of the chart. If the stay meets InterQual criteria and the higher DRG is justified, the case is approved. If the stay fails InterQual criteria and/or the medical record lacks the documentation to support the higher DRG, the medical record is sent to an independent, Board-certified physician reviewer. Based on the determination made by the reviewer, the provider and practitioner may be given an opportunity for discussion. The provider and/or practitioner then submit the billing rationale in writing, and this response is sent back to the same physician reviewer for consideration. If the reviewer still feels that the stay did not meet medical criteria, or disagrees with the higher DRG, the stay is denied. The provider and practitioner are then given an opportunity for reconsideration. When this occurs, the medical record is sent to a second, independent physician reviewer. If the second physician reviewer upholds the decision made by the initial reviewer, there is no further opportunity for discussion. Alternatively, if the second physician overturns the original decision, the hospital is reimbursed for the stay.
Quality of Care Reviews
Quality of care reviews are performed on all cases submitted to Ohio KePRO, regardless of the review type (appeals, DRG reviews, or utilization reviews). All beneficiary complaints undergo a quality of care review. These calls are directed by the Helpline operator to a nurse reviewer, who then requests the medical records and sends the chart to a physician reviewer. For such cases, we are careful to perform a specialty and like practice match, meaning that we always ensure that the physician reviewer has the same area of specialization as the physician under review, and we attempt to select a reviewer who also practices in a like setting. In order to facilitate the most accurate review possible, we try to avoid, for example, sending a chart from a tertiary medical center to a small town practice, and vice versa. As with other reviews, the provider and practitioner are given an opportunity for discussion, and an opportunity for reconsideration when appropriate.
When a quality of care concern is identified, Ohio KePRO initiates action with the provider or practitioner, which can range from a simple letter with suggestions for future care to a complete quality improvement plan (QIP). In cases calling for QIPs, we work with the provider or practitioner to formulate a corrective action plan, and monitor the implementation through self-reporting mechanisms.
Last year, Ohio KePRO conducted 2,441 quality of care reviews. Details are provided in Figure 2.
– Jennifer Bitterman, RHIA, MBA
Review Director
jbitterman@ohqio.sdps.org
Ohio has been struggling economically for the past decade, but has been particularly hard-hit by the recent economic downturn. Our state ranks 7th in foreclosures, and as of December 2008, Ohio saw an increase of 9 percent in Food Stamp program recipients and an increase of 2 percent in the unemployment rate over the previous year.1 With these grim statistics, it may come as no surprise that fewer Ohioans are making non-emergent care such as preventive services a priority.
Seniors are no exception. Of Ohio’s 1.8 million Medicare beneficiaries, more than a third are low income (at or below 200% of the federal poverty level).2 Because some preventive services such as breast cancer screening and certain colorectal cancer screenings require a payment from the beneficiary, many forgo these services.3,4 Influenza and pneumococcal immunizations are fully covered by Medicare, but because these services are sometimes administered during office visits for which beneficiaries are required to make a financial contribution, many have failed to obtain recommended immunizations as well. Nearly 12 percent of Ohio’s Medicare population are minorities identified by CMS as being “underserved” in the healthcare system, including African Americans, Hispanics/Latinos, Asians/Pacific Islanders, and American Indians/Alaska Natives.5
African Americans, who comprise 85 percent of Ohio’s underserved population,6 are at higher risk for colorectal cancer,7 the fourth most common cancer among men and women in the state.8 More than 6,000 Ohioans are affected by colorectal cancer, and nearly 2,500 die each year,9 but despite concerted efforts by the Ohio Department of Health (ODH) and federal agencies such as CMS and the Centers for Disease Control and Prevention (CDC), colorectal cancer screenings are declining. The senior population is at the highest risk, but the majority of Ohio’s Medicare beneficiaries fail to get regular screenings—and unfortunately, this rate has continued to decline. From an already low rate of 49.1 percent in December 2007, statewide screening rates dropped to just 48.5 percent as of June 2008. Rates have dropped in every region in the state (See Figure 3).
Many Medicare beneficiaries may not be aware of their risk factors, so it is incumbent upon all healthcare providers to help increase awareness. Ohio KePRO’s efforts have focused on increasing preventive services as one of the best means of safeguarding the health of Ohioans. We continue to work on educating physician practices on how to most effectively incorporate recommendations, patient education, resource identification, and follow-up in the daily workflow to improve screening rates. Providers and their healthcare teams can aid in these efforts by talking with Medicare beneficiaries about:
Individual risk factors.
These include racial/ethnic background, and personal and family history.Medicare-covered services.
Breast cancer screenings and colorectal cancer screenings are covered by Medicare.
Ohio’s economic climate will be a challenge for all of us as we strive to meet our goals in improving patient care, but we encourage you to remind your patients of the importance of preventive services. Visit our Web site (www.ohiokepro.com) to access no-cost tools and interventions, or look for resources from community-based services such as Susan G. Komen for the Cure, regional organizations, and county health departments.
If you have a particular area of interest and would like help in identifying community-based services in your region, contact Erica Stanton, quality improvement specialist, at estanton@ohqio.sdps.org or 440-321-2929.
MRSA Surveillance Systems: Then & Now
Methicillin-resistant Staphylococcus aureus (MRSA) hasn’t exactly been a household name, but MRSA infections have been in the U.S. for the past four decades.1 And, with recent coverage in local and national news publications such as The New York Times2 and The Washington Post3 identifying the infection as a “staph superbug,” it’s clear that the public’s interest is increasing.
In contrast, epidemiology surveillance of MRSA has been going on for many years. In 1974, MRSA infections accounted for just 2 percent of the total number of healthcare-associated staphylococcus infections in U.S. Intensive Care Units (ICUs), but this rate increased to 22 percent in 1995 and 63 percent in 2004.4 In this time, MRSA has been monitored by the Centers for Disease Control and Prevention (CDC) as part of the agency’s surveillance of drug-resistant organisms. The CDC has established several monitoring systems for this purpose, in an effort to obtain the information needed to prevent the incidence and transmission of such infections.
One of the early systems created for this purpose was the National Nosocomial Infection Surveillance (NNIS) system, which monitored the incidence of healthcare-associated infections and the risk factors and pathogens associated with those infections.5 Developed in the early 1970s, NNIS was the only national system for tracking healthcare-associated infections at that time. Its objectives were to detect and monitor adverse events, assess risk and protective factors, evaluate preventive interventions, and provide information and partner to implement effective prevention strategies. The NNIS database was used to study the epidemiology, associated antimicrobial resistance, and aggregate rates to be used for interhospital comparisons. Because the use of this voluntary participation system was limited to hospitals meeting the infection control staff and bed size requirements, the number of reporting facilities was never very large, reaching approximately 300 at its peak.6
In 1995, the Active Bacterial Core surveillance (ABCs) system was established as a collaboration between the CDC, state health departments, and universities.7 Initially established in just four states, participation has increased to 10 state sites. This active surveillance system monitors six pathogens including MRSA, and uses case reports sent to the CDC and reference laboratories to collect demographic information and bacterial isolates. These samples and data are used for research in studying disease trends, identifying risk factors, evaluating vaccine effectiveness, and monitoring the effectiveness of prevention policies. Lessons learned from research stemming from ABCs served as the impetus for the development of a program to assist state and local health departments with surveillance for MRSA and drug-resistant Streptococcus pneumoniae.8
In addition to this collaborative system, the CDC took advantage of innovations made possible in this digital age to establish the National Healthcare Safety Network (NHSN) as the Internet-based successor to NNIS. Participation was restricted when the system was originally established in 2005, but by 2007, enrollment was open to any hospital or outpatient dialysis center in the U.S.9 Using information technology for secure data collection and for selective data sharing when appropriate, NHSN monitors adverse events, adherence to prevention practices, trends, interfacility comparisons and quality improvement, patient or personnel safety problems, prompt interventions, and collaborative research. The system allows for timely data sharing between a facility and public health agencies, with other facilities, or for research or quality improvement activities.10
NHSN’s latest addition is the Multi-Drug Resistant Organism (MDRO) module, which will be used for surveillance of the many drug-resistant organisms we deal with today, including MRSA. Not surprisingly, the NHSN system and the new MDRO module are being utilized in the current Quality Improvement Organization (QIO) project related to tracking MRSA cases in hospitals in each state. The facilities participating in this project in Ohio will be contributing to the national surveillance database of MRSA cases and allow for a sample of Ohio data to be compiled. The aggregation of this data will be compiled on a monthly basis and will be available to be shared with the participating facilities.
The prevalence of MRSA may be on the rise, but tools such as these make it possible for us to more effectively study this and other infections, and work to prevent their spread. Our ability to collect data and share it for analytic purposes on a nearly real-time basis is a significant epidemiological advancement, giving us better, more current information to fight MRSA and other “superbugs.”
– Linda Stokes, MSPH, ABD
Senior Scientist
lstokes@ohqio.sdps.org
Nursing Home Disparities Project
In the current Quality Improvement Organization (QIO) contract cycle, the Centers for Medicare & Medicaid (CMS) has directed QIOs to examine issues and factors that are pertinent to the state’s population and that may have an influence on healthcare disparities in the nursing home population. QIOs will submit reports to CMS every six months throughout the duration of the 9th Statement of Work (SOW). Ohio KePRO plans to focus on a different factor or aspect of care that may identify a disparity in each of the reports. The following is a summary of the analysis conducted by Ohio KePRO in the first reporting period.
Background
This initial report is focused on determining if there is any disparity seen in the quality of care in nursing homes, as represented by Quality Indicator/Quality Measures (QI/QM) between urban and rural facility locations in Ohio. Previous research has examined a number of possible factors as potential indicators of disparity of care in rural versus urban settings. An issue paper published by the National Rural Health Association (2001)1 voiced concerns about the quality of care found in nursing homes in rural areas, and studies conducted by Coburn et al (1994)2 and Phillips et al (2000, 2001, 2004)3,4,5 found no significant difference in the quality of care between urban and rural nursing homes for the indicators examined. With 12 percent of the population, 17 percent of nursing homes, and 14 percent of total nursing home certified beds being located in rural areas in Ohio, it seemed appropriate to determine what quality disparities, if any, could be identified between the state’s rural and urban nursing facilities in the state.6
Methodology
Ohio KePRO extracted 3rd Quarter 2008 QI/QM data from CASPER for all Ohio nursing homes in ten selected measures (See Table 1). These measures were selected due to their similarity to those referenced in the studies by Coburn et al and Phillips et al. In order to incorporate OSCAR survey results, Nursing Home Compare Five-Star ratings for Ohio nursing homes were extracted (on January 22, 2009) to include ratings through September 2008. Nursing homes were classified as rural or urban, based on the county location and Core Based Statistical Area (CBSA).7 The study examined a total of 924 nursing homes; 155 were classified as rural and 769 were classified as urban. Facilities with missing data in multiple measures were excluded from this study.
The analysis included conducting a t-test comparing each of the QI/QM measures for the urban and rural groups to determine if a significant difference existed. QI/QM scores were also compared to the state average score for each measure. Nursing homes with a QI/QM score greater than the state average were considered to be exceeding the state average in that measure. The average for each of the QI/QM measures was calculated and then used to determine the difference of the measure average score and the state average score. Also determined were the maximum and minimum scores, the percentage of facilities that were exceeding the state average in each measure, the number of measures (0-10) exceeding the state average per nursing home, and the percentage of nursing homes per number of measures exceeding the state average.
Five-Star ratings (1-5 stars) were shown as a percentage of the total facilities per rating. These ratings were also aggregated to “above average” (4-5 stars), “average” (3 stars), and “below average” (1-2 stars), and shown as a percentage of total facilities.
Results
There were no significant differences found in the QI/QM measures examined between urban and rural nursing home facilities in Ohio in this time frame. No significant difference between urban and rural facilities was found in facility average scores for the selected measures. In a review of the minimum and maximum scores for each measure for each facility (except for three outlier urban facilities with high maximum scores), high and low scores for both urban and rural nursing homes were found to be comparable (See Table 1). In the t-test comparing QI/QM measures, none of the measures showed a significant difference (p<0.001) between the urban and rural groups.
As shown in Figure 4, of the urban facilities, 77.2 percent exceeded the state average in five or fewer QI/QM measures, compared to 73.5 percent of rural facilities. Rural nursing homes (2.6%) had a greater percentage with no measures exceeding state average than urban nursing homes (0.5%).
There was no significant difference (p=0.1706) seen between the urban and rural groups in the Five-Star ratings. Although Five-Star comparisons showed rural facilities to have 56 percent of the facilities scoring 3 or more stars (average and above average), urban facilities had 48 percent scoring 3 or more stars.
Conclusion
This study revealed no disparity between urban and rural nursing homes in the state of Ohio for the 4th Quarter 2008 QI/QM measures selected. Despite these findings, there is reason to consider further subdivision of the urban facilities (i.e., “suburban” and “true urban”) to determine if disparities are seen between the more finely grouped locations. A possible differentiation in the suburban area is expected because factors that were previously considered to be rural issues—such as higher unemployment, lower literacy and lack of medical treatment—are now prevalent in urban areas as well. This will be examined in the next reporting period.
Other factors will be examined in subsequent reports in this series, including ethnicity/race, facility characteristics, environmental factors, and socioeconomic factors.
– Rikki Gruden, BA
Health Data Analyst
rgruden@ohqio.sdps.org
– Linda Stokes, MSPH, ABD
Senior Scientist
lstokes@ohqio.sdps.org
Reminder of upcoming reporting, deadlines and events.
Click here to view and print.
Retired Quality Measures
(Effective with 1Q09 Discharges)
PN-1 – Pneumonia Patient with Oxygenation Assessment
This measure was found to be consistently at 100% compliance.PN-5b – Pneumonia Patients who Receive Their Initial Antibiotics Within 4 Hours of Hospital Arrival
The National Quality Forum (NQF) has withdrawn its endorsement of this measure.AMI-6 – Acute Myocardial Infarction Patients Without Beta-Blocker Contraindications who Received a Beta-Blocker Within 24 Hours of Hospital Arrival The American College of Cardiology (ACC) and the American Heart Association (AHA) withdrew their endorsement of this measure in November 2008, and CMS has removed AMI-6 from Hospital Compare as of January 15, 2009. However, data abstractors are required to continue to submit data on AMI-6 through the end of the 1Q09 discharges. For background on the retirement of AMI-6 and details about data collection and submission requirements, please refer to the AMI-6 fact sheet, available in the “Downloads” section of the Hospital Quality Initiatives page of the CMS Web site (www.cms.hhs.gov/HospitalQualityInits/).
QualityNet
Quest
The QualityNet Quest online question and answer system is now available, with recent upgrades to enhance performance and stability. Users may now access Quest to submit questions regarding SDPS applications, quality measures, communications partnerships, and other Theme-specific issues, as well as to perform searches of past Q&As based on keyword or topic.
QNet SAs
Each facility should have more than one designated QualityNet Security Administrator (QNet SA).
Having a backup QNet SA allows work related to CMS’ public reporting initiative to continue uninterrupted if the primary contact is not available.
APU Dashboard
This new monitoring tool will help assess your organization’s status in terms of meeting RHQDAPU program requirements. The dashboard provides a “real-time” status report with links to specific QNet reports providing greater detail. Contact your internal QNet SA if you cannot currently access this dashboard report, and would like to be able to do so.
Contact Fran Hober at fhober@ohqio.sdps.org or 216-447-9607, ext. 2115 with any questions about CMS public reporting program changes and deadlines.
Other Updates
Hospital Compare
Data on Medicare’s Hospital Compare site (www.medicare.gov/hospital) were updated in March.
The Mortality Measures data were not updated, as this information is updated annually; the next update of these measures is scheduled for June 2009.
PEPPER
Review activity and reports – Support for the Program for Evaluation of Payment Patterns Electronic Report (PEPPER) activity is no longer a component of the QIO Program in the 9th Statement of Work. However, providers may access valuable information on this topic at the Hospital Payment Monitoring Program Web site(www.hpmpresources.org), including:
- Hospital Payment Monitoring Program Compliance Workbook (updated March 2008)
- National payment error data (updated January 2009), and
- Information on PEPPER – summary statistics of administrative claims data for CMS target areas(areas likely to have payment errors due to billing, DRG/coding, and/or admission necessity issues).
CMS announced on February 2 that the parties involved in protesting the award of contracts in the Recovery Audit Contractor(RAC)Program settled their protests. The stop work order has been lifted, and CMS will now continue its implementation of the RAC Program. Information on the program is available on the CMS Web site at www.cms.hhs.gov/RAC/.
Primary care practices throughout the state have joined with Ohio KePRO on an important health project: the Medicare-funded Prevention Electronic Health Record (EHR) Initiative. Over the next two years, our quality improvement specialists will work with targeted practices to maximize the capabilities of their EHR systems in delivering patient care by increasing efficiency, engaging patients in self-care, and proactively evaluating practice performance in four preventive care measures: mammography, colorectal cancer screening, and influenza and pneumococcal immunizations. By taking advantage of the capabilities of their EHR systems, participants will also be able to prepare for upcoming pay-for-performance initiatives, as well as those focusing on increasing transparency and accountability.
Of the nearly 100 practices involved, 62 are active participants, and 35 have agreed to act as a “reference group” to set the benchmarks for their performance in this project. As part of the Prevention EHR Initiative, our quality improvement specialists will visit with participants, and use internal and external resources to provide:
A comprehensive assessment of office workflow and EHR reporting capabilities
Care management education and training
Review of quality data reports for accuracy
Assistance in identifying focus areas for improvement
Appropriate clinical topic interventions
Implementation of follow-up protocols, and
Identification of community-based services for patients to receive free or low-cost screenings and/or immunizations.
With recruitment finalized in January, we are still in the early stages of this project, and participating practices are working through the unique challenges of optimizing an EHR system. One challenge faced by many participants is in proper data entry; because data has not been entered into the appropriate field in the EHR, the information is not captured in the resulting population reports. For example, some practices have scanned test results indicating that a service has been performed, but because this documentation is not captured in a reportable field, the data does not show up in the reports. As many practices have found, missing information or lack of documentation in the EHR may demonstrate less-than-desirable results
As we move forward with the Prevention EHR Initiative, it is our goal to assist participating practices in improving these processes in the daily workflow of the practice so that they can accurately capture data for reporting, and help improve patient care and health outcomes.
– Bonnie Hollopeter, LPN, CPHQ, CPEHR, CPHIT
Project Manager
bhollopeter@ohqio.sdps.org
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