Standardization and Automatic Extraction of Quality Measures in an Ambulatory Electronic Medical Record (EMR)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 8, 2008, Denni McColm made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (1.4 MB).

Slide 1

Standardization and Automatic Extraction of Quality Measures in an Ambulatory Electronic Medical Record (EMR)

Denni McColm, CIO [Chief Information Officer], Citizens Memorial Healthcare

Slide 2

A map of the U.S. with Bolivar, MO, population 10,000, highlighted.

• 74 acute care beds.
• Emergency Services.
• Home Health, Hospice, Home Medical Equipment, Health Transit Services.
• Long Term Care Facilities (5).
• Residential Care Facility (1).
• Physician Clinics (16 locations, 60 providers).
• Outpatient Services.

Slide 3

EMR-cnh infoCARE diagram (starting at the top and going clockwise):

• WebMD: Insurance Eligibility.
• Lab Interfaces: LabCorp/Lab Analyzers.
• IBM: Hardware.
• Institute for HealthMetrics: Outcome Measurements and Reports.
• Park Place International: Technology Integrator.
• Kronos: Time and Attendance Software.
• MEDITECH Administrative Applications: Admissions/Registration; Abstracting & Coding; Health Information Management; Community Wide Scheduling.
  • Coding System: 3M.
• MEDITECH Clinical Applications: Emergency Department; Management; Imaging and Therapeutic Services; Physician Order Management; Operating Room Management; Patient Care System; Pharmacy Lab.
  • Pharmacy Formulary: First Data Bank.
• MEDITECH/LSS Medical Practice Management: Authorization & Referral Management; Electronic Ambulatory Record; Physician Billing and Receivables; Scheduling.
• Krames on Demand: Patient Education Software.
• Perceptive Software: ImageNow Document Management System.
• Quick Study Radiology: PACS-Digital Radiology; Horizon DX Viewer.
• Home Care Services/Home Care Manager: PTCT-Patient Care Technologies.
• HealthStream: Learning Management System.
• EMR that crosses continuum.
• 100% use of computerized physician order entry (CPOE).
• No paper charts.

Slide 4

Ambulatory Quality and Safety Project

• Standardize and integrate data capture for quality measurement into the normal documentation of care within the ambulatory EMR.
• Implementation of an automated system for data extraction including valid, reliable reports that provide actionable insight for the measurement, analysis and improvement of care.

Notes:

• Build it into workflow of typical visit (byproduct prompting for answers—reminding).
• Extract it.
• Report both to Centers for Medicare & Medicaid Services (CMS) and back to us.

Slide 5

Broad Approach—All Physician Quality Reporting Initiative (PQRI) measures applicable

• First period, July 1, 2007—December 31, 2007.
• Renewed for 2008, January 1—December 31.
• 1 1/2% bonus for Medicare fee schedule services for reporting at least 80% of the time on 3 or more measures during the period.
• 47 measures proposed initially.
• 74 measures actually used in 2007.
• 119 measures in use for 2008.
• 175 proposed for 2009 (bonus 2% plus ePrescribing bonus 2%).

Notes:

• 16% of physicians reporting in 2008.

Slide 6

A screen shot of a Coronary Artery Disease form asking for clinical information (a patient's eligibility for the measure and whether they meet or have an acceptable reason for not meeting the measure) and billing information.

Slide 7

Where are the answers?

A screen shot of the clinical information portion of the Coronary Artery Disease form.

• Demographics.
• Billing Data.
• Test Results.
• Orders.
• Health Maintenance.
• Vital Signs.
• Medication List.
• Queries.

Slide 8

Template Redesign

A screen shot of a Web template to document an individual's history with a "Current Symptoms" sub screen showing.

Slide 9

PQRI Exclusions & Exceptions

A screen shot of a Web template to document an individual's history with a "CAD-Antiplatelet not given because" sub screen showing.

Slide 10

The Institute for Health Metrics (IHM) is:

• A non-profit that helps hospitals leverage electronic systems for quality improvement.
• Assists hospitals in extracting data from the MEDITECH system for use in:
  • Physician & Departmental Profiling.
  • Quality of Care Reporting: Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Core Measures, Institute for Healthcare Improvement (IHI), AHRQ, etc.
  • Performance Improvement.
  • Benchmarking.

Slide 11

Data Extraction Process

• Hospital Health Care Information System (HCIS): Institute of Health Medicine (IHM), Virtual Private Network (VPN).
  • Nightly data extracts.
  • Monthly reports delivered within hours of discharge codes completed.
• IHM.
  • NO Software to Install and maintain.
  • No information technology (IT) resources outside initial VPN set up.
  • All CMS, JCAHO requirement updates performed by IHM.
  • All new indicators added by IHM.
• Web Based Reports.

Slide 12

• AIES: (Automated Indicated Extraction System) Automatically delivers quality performance indicators for over 300 quality measures to expedite hospital reporting and improve care.
• PQMS: (Physician Quality Management System) Provides hospital management with on-going department and physician information for reviews and credentialing across 102 procedures and 26 diagnoses.
• CPMV: (Core Measures Patient View) Preps data for submission to core measures vendor.
• Daily Infection Alert: This new daily report alerts the hospital staff to identify patients at risk for hospital acquired infections and to proactively intervene.

Slide 13

A screen shot showing a sample report in April for Citizens Memorial Healthcare for "Community Acquired Pneumonia."

Slide 14

Challenges

• Designing to be time neutral for providers.
  • Speech recognition.
  • Medication reconciliation / updating.
  • Nurse support training.
  • MUSE.
    • Make a personal connection.
    • Understand the patient's concerns and priorities.
    • Sit, see, and show the screen.
    • Engage the patient as a partner in healthcare.
  • Patient Portal.
• Hospital based providers & measures.
• Sharing templates.