Tap IT resources for patient care quality improvement initiatives

IT tools to improve patient care quality start with analyzing phone traffic and using CPOE to make arguments for appropriate testing.

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Radiologists presenting at the Radiological Society of North America Inc.'s 2011 annual meeting shared their experiences on how IT projects figure into patient care quality improvement initiatives, primarily through improving patient access to care as well as improving appropriateness of care.

Some of the projects, such as analyzing phone traffic and optimizing staffing to handle peak call times, can be done by almost any physician group. Others are more appropriate to specialists who get the lion's share of their patients through referrals from primary care.

These more complex projects require IT support from referrers -- in radiology's case, primary care physicians and hospitals -- and that support might not be available until later stages of meaningful use compliance require more robust information exchange.

Still, their ideas can get CIOs connecting with clinical informatics staff and brainstorming their own plans for using in-house resources to apply simple analytics, evidence-based standards and information exchange channels to patient care quality projects.

Don't hold the phone. Keith Hentel, M.D., emergency/musculoskeletal radiology chief at NewYork Presbyterian Hospital and Weill Cornell Medical Center, said one low-hanging fruit for any medical practice that has a PBX phone system -- and most do -- is to examine data on customer hold times. When patients wait too long, they hang up. At best, they are inconvenienced and call back later. At worst, they seek out competitors or even give up on getting needed tests and treatment.

Hentel's organization took call data to heart, adjusting staffing to meet higher-demand times, which greatly reduced hold times and dropped calls. One might assume that would involve more bodies during vacations and holidays, since that's when staffing is short and patients have more time to follow up on calls. Actually, no. "When we broke it down, we found hourly variations to be more problematic," Hentel told SearchHealthIT.com after the session. "We changed lunch hour breaks."

Leverage computerized physician order entry (CPOE) for referrals. For specialists, hooking into electronic health record (EHR) systems at referring hospitals and physician practices not only saves support staff bandwidth -- not to mention trees, considering the previously paper-intensive workflow. It also helps gather basic demographic data required for meaningful use reporting and provides more granular case data that can help radiologists make arguments for curbing high-cost or higher-radiation imaging studies when they're not needed.

Use clinical decision support with evidence-based standards. Continuing on that theme, radiologists (and any specialists) are up on the latest information within their specialty. They sometimes have alternate or more appropriate tests or therapies to suggest to a referring physician for a patient. It helps to open such a discussion, especially when it means spending less, when there's documentation to support that specialist's patient care quality instinct.

Enter evidence-based standards, fed through the patient record. In radiology, for example, a lot of debate surrounds the cost of imaging studies such as MRIs. Moreover, an emerging patient safety concern for radiologists is tabulating -- and minimizing -- a patient's lifetime radiation exposure.

Primary care physicians or hospitalists might not get specific training on these issues in medical school, so it falls on the specialists to offer little bits of education when feasible. EHR systems offer such an opportunity.

There's a difference between utilization and appropriateness, or [patient care] quality.

Keith Hentel, M.D., emergency and musculoskeletal radiology chief, NewYork Presbyterian Hospital and Weill Cornell Medical Center

Recommending a different test from the one the referring physician requested becomes more authoritative, especially if the standards data can be pushed upstream from the radiologist to the referring physician at the time of the order via CPOE. In effect, showing physicians standards-based recommendations can address practice habits "before they get out of hand," as Hentel put it in his presentation, and provide real-time clinical decision support.

"There's a difference between utilization and appropriateness, or [patient care] quality," Hentel said." I'm not here to talk about utilization; what I'm really interested in is quality." That being said, in some cases, double-checking which patients are getting which radiology tests can both cut costs and improve appropriateness.

Communicating critical test results: Getting test results to patients in a timely fashion isn't just part of meaningful use. In his presentation, Brigham and Women's Hospital radiologist Luciano Prevedello, M.D., pointed out that it's also part of The Joint Commission's 2011 National Patient safety goals.

His department developed a software tool called Alert Notification of Critical Results (ANCR, pronounced "anchor") to keep radiologists and physicians communicating with patients. ANCR generates red, yellow and green alerts based on how serious a patient's test results. It also includes a monitoring system to ensure that referring physicians acknowledge the receipt of test alerts and that patients get their results within the time frame prescribed by hospital policy.

The tool, which includes a smartphone interface offering a dashboard view of alerts, is freely distributed for any facility to use, complete with documentation for both radiologists and referring physicians.

Of course, it's not the IT staff improving care with ANCR, it's simply a tool that can nag physicians about test results and documents their response times. But it helped boost compliance with hospital policy up over 90%, which was far lower before ANCR went online.

"IT alone cannot solve it all," Prevedello said. "It's also very important to have a solid policy to build this application on top of."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

This was first published in January 2012
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