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Apr 4 2013   11:11AM GMT

Going beyond meaningful use attestation to improve care quality

Posted by: Jenny Laurello
CMS, EHR, EHR Adoption, EHR implementation, EHR incentives, EHR systems, EMR, Meaningful use, meaningful use attestation, MU

Guest post by: Anita Karcz, M.D., chief medical officer, IHM Services Company

Meaningful use is the phrase of the decade in healthcare. Federal incentive payments have been a powerful motivator to attest as rapidly as possible. Hospitals are challenged by constantly changing requirements and threat of audits as they scramble to meet meaningful use requirements. Many simply don’t have time to accomplish the goals of the program itself — to change care delivery processes and support improved care standards — amid the ongoing race to meet attestation standards. Gathering data for meaningful use has become “teaching to the test,” a mechanical exercise that consumes time and energy without obvious benefits for care delivery.

Meaningful use not solely an IT initiative

Meaningful use qualification is impossible without an IT infrastructure. However, complying with the core and menu measure thresholds and the clinical quality measures requires coordination from historically independent hospital departments. Consider, for example, one stage 1 measure requires that a patient who requests an electronic copy of their record must receive it within three days of the request. The request may be made to a nurse at the time of hospital discharge, with the medical records department charged with fulfilling the delivery. Documentation and notifications touch multiple individuals in nursing and medical records departments. Creating multidisciplinary teams for planning workflow and monitoring performance is essential for compliance, since every core and menu measure and every clinical quality measure have similar criteria.

Using real-time data to guide care

While retrospective data is important to identify trending and overall process compliance, changes made based on retrospective analysis only affect care in the future. While this can certainly be useful, hospitals need to go beyond retrospective reporting and trends to access information in real time, guiding the delivery of care toward when the patient can receive the most benefit.

More immediate information allows for delivery of better care while the patient is still hospitalized, which is key to enhancing patient safety, treatment quality and outcome.

Real-time data needs to be easily and consistently accessible to front line staff. Keeping hospital staff engaged with ongoing patient care data is critical for incorporating best practices into everyday routines.

Delivering best practice care

The journey from identifying and understanding existing gaps in care to meeting meaningful use standards is challenging. The goal is to improve care performance by helping hospital staff quickly and efficiently find the gaps in care. Daily review of real-time data can also point managers to the reasons behind failure to meet the requirements. For example, one hospital’s data may show that the third floor is not documenting all vital signs on all patients during the evening shift. Rapid cycle improvement through staff education and/or workflow changes can then be implemented, with results measured immediately.

Meaningful use isn’t going away

Meaningful use is a program that will become more intensive and pervasive as time goes on. Involvement and engagement of all hospital staff now, in the early stages, will provide a strong base for continued future compliance. Delivering data in real time engages staff and provides the important link to clinical care from a high level regulatory mandate. This is key to meeting and sustaining compliance and having meaningful use mean something more than just checking a box.

Saying goodbye to manual abstraction?

Hospitals have been reporting compliance to CMS for years by manually abstracting data from patient records. Abstractors diligently go through file after file to see if patients meet the required standards. This practice cannot be utilized for meaningful use because reports require codified and structured data that is collected electronically and extracted from the electronic medical record (EMR) system itself.

This shift from a manual to a fully electronic process has led to a burdensome workload for hospitals. There are mountains of regulatory documents that must be reviewed in detail just to understand what meaningful use requires. From an IT perspective, those requirements then need to be translated into a series of  programming queries to extract appropriate data out of the EMR system prior to incorporation into the patient record for analysis and, ultimately, creation of the reports.

Next comes the most challenging phase — data mapping. In order to create the reports, hundreds of thousands of data elements must be created and/or modified in the electronic record to create the meaningful use reports and all too often, just when a hospital believes the data mapping is complete, they run their reports only to find meaningful use thresholds are not being met and that more modifications are required. This is a major problem for most hospitals because it’s often difficult to find the specific reasons behind the failure to meet thresholds and information on how to change processes to improve results. Identifying a specific attestation issue is often like finding a needle in a haystack. Even if problems are found, hospitals still have to make modifications to the reporting system, processes and workflows to be sure that data used to create the reports is entered accurately.

The process is truly exhausting. Unfortunately, in the race to meet deadlines, and with so many other competing priorities, process improvements and changes to care management fall to the bottom of the list. Hospitals must find a way to attest while also doing what meaningful use was intended to do: Improve care quality.

Dr. Anita Karcz is chief medical officer and co-founder of the Institute for Health Metrics. She is responsible for clinical research and supporting product development goals. She has prior experience with research and product development in clinical outcomes and decision support and was vice president of clinical product development at InterQual Inc. She holds a B.S. and an M.D. from the University of Massachusetts and an MBA from Northeastern University.

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