Health IT Enabled Clinical Quality

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2 Health IT Enabled Clinical Quality Improvement (ecqi) Mountain Pacific Quality Health Foundation Quality Innovation Network-Quality Improvement Organization (QIN-QIO) since 1973 QIN/QIO Regions include; Montana, Wyoming, Hawaii, Alaska and the U.S. Pacific Territories of Guam and American Samoa and the Commonwealth of the Northern Mariana Islands Health Technology Services, a department of Mountain-Pacific was the Regional Extension Center (REC) for Montana and Wyoming A nonprofit corporation that partners within our communities to provide solutions for better health

3 Session Presenter Patty Kosednar Patty Kosednar, PMP, CPEHR, CPHIMS Executive Director of Regional Extension Center MT/WY 7 years working with facilities on MU, PQRS, IQR, MIPS/APM, PCMH and ecqi 26 years IT Project Management and software implementations 3

4 Presentation Topics Overview of ecqi Benefits of ecqi and alignment of programs EHR Functionality and ecqi Review of our ecqi Methodology Proven ecqi Results How to Get Started with ecqi Q & A Resources

5 Work Along Hand Out

6 Polling Questions What Task orders (or conditions/programs) are you working on that require quality or performance improvement? What barriers to quality/performance improvement do you run into?

7 Overview of ecqi

8 Current Situation The introduction of EHRs, electronic data and other health information technology has changed the role of quality improvement for healthcare organizations (especially rural/small) No longer are clinical best practices and clinical expertise enough to successfully drive quality improvement and improved outcomes Clinical quality improvement now requires both clinical and health information technology expertise

9 Current Situation: Side Effects May Include; Some quality programs are not using standardized clinical quality measures so manual abstraction may still required Inconsistent workflows and data entry processes Quality Reports in EHR may not be accurate Quality and IT department not on same page or don t have the experience needed EHR Vendor unresponsive or unsupportive Healthcare staff overwhelmed (to much on their plates) You may experience a strong desire to run away (and join the circus)

10 A New Approach The transition to pay for performance has introduced a need for specialized approaches to quality improvement As a result we have created an approach to working with healthcare facilities that combines clinical best practices and technology expertise Electronic clinical quality improvement ecqi

11 ecqi electronic clinical quality improvement; Optimizing health information technology (HIT) and standardized electronic data to achieve measureable improvement in quality of care Incorporating the data and functionality of the EHR into quality improvement projects. Health IT enabled Clinical QI (healthit.gov)

12 ecqi A Combination Of: EHR functionality: Computer Provider Order Entry (CPOE) Clinical Decision Support (CDS) Patient Portal/Engagement Patient panels/tracking/risk stratification Health Information Exchange (HIE) Interfaces and registries Report utilities/population analytics Evidence based clinical best practices Data tracking and analytics data driven projects Proven quality improvement methodologies

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 13

14 EHR Functionality for ecqi Patient Education/discharge instructions/summary of care docs Provide credible source of information Encourage patient engagement Assist with medication reconciliation Assist with transition of care and care coordination Patient Reminders Proactive preventative care Follow up and care coordination Lab interfaces (or lab results as structured data) Data points retrieved from lab results Lab results (structured data) enhances use of clinical decision support rules or guidelines at the point of care 14

15 EHR Functionality for ecqi Patient Panels/Risk Stratification Track and monitor high risk patients Use patient panels or risk scores to identify care coordination priorities Track performance based on panels/risk scores HIE/Transition of Care /Discharge info/public Health Registries improve communication between providers and/or facilities Provide and enhance continuity of care delivery/ seamless care delivery for patients Data collection and analytics Population health data 15

16 Focus on Structured Data Structured Data; If it is not documented in the right field, the right format and at the right time in your EHR, the system does not know it happened and cannot trigger the next event or report! PATIENT SAFETY!!!! This requires the use the recommended workflows and data entry points for the CQM reports from your EHR Vendor Structured and standardized data is the foundation to interoperability and seamless patient care Improve care coordination Improve transition of care Assist with risk stratification and reduction in total cost of care

17 Important Note!!! Utilizing the correct workflows in the EHR can ensure reimbursement is based on the actual quality of the care being delivered

18 Enhanced use of EHR: Side Effects May Include; Leveraged EHR for advanced functionality to support clinical best practices/protocols Reduction of manual tracking/chart abstraction Advanced point of care advice and guidelines Seamless flow of data through EHR Increased patient safety Being able to talk techno smack with your kids

19 Our ecqi Methodology Mountain Pacific created a ecqi toolkit, funded by the MT Department of Public Health and Human Services

20 Our ecqi Process includes: Leveraging EHR functionality and evidenced based clinical best practices Standardizing data tracking and analytics Performing workflow analysis/review Incorporating proven quality improvement methodologies (PDSA) Managing the process with a certified project management structure Focusing on small bite size manageable projects

21 Streamlined Approach for QI Streamlining quality reporting wherever possible Incorporates Agile (scrum) iterative delivery model which focuses on achieving value added changes quickly and efficiently Incorporates PDSA (plan, do, study, act) cycle of improvement Resources that include; a detailed plan of action for QI projects, templates and educational resources 21

22 ecqi Tasks Identify Project Scope and Team Create and prioritize Change Backlog Create Sprint/PDSA Perform/complete Sprint= PDSA cycle(s) Perform sprint review and update Change Backlog Repeat

23 Streamlined ecqi Process Model 23

24 Choose an ecqi Project 1. Review current quality program requirements, align project for biggest ROI or alignment across programs

25 Choose an ecqi Project, cont. 2. Run the required CQMs (or other evaluation measure) reports (min 90 day period) to establish current performance 3. Compare current performance to benchmarks or goals 4. Prioritize list and Identify your first ecqi project

26 Create a Project Scope Answer this question: What are we trying to accomplish: Establish a goal (make it a SMART Goal) S specific M measureable A actionable R- relevant T time bound Define evaluation measures Identify project constraints 26

27 Project Scope Example Improve CMS 165 (HTN Blood Pressure Control) above 76% by 12/31/17 For all payers, all patients, all clinic locations Take a minute to choose your own ecqi project (hand out) What project did you choose??

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29 Create a Change Backlog; Identify possible changes Answer this question: What changes can we make that will result in an improvement to the project goal selected Brainstorm ideas for possible changes that will ultimately improve the project goal/outcome measure

30 Identify possible changes Identify possible EHR functionality changes How can EHR support best practices/protocols? Review staff use and workflows (based on clinical best practices for QI topic) Computer provider order entry (CPOE) Care coordination and transition of care Determine available options, decide on applicability (based on clinical best practices for QI Topic) Clinical Decision Support (CDS) Patient Portal/eSecure messaging Patient Education materials Care Coordination Interfaces Etc.

31 Identify Possible Changes Cont: Review the workflows: What is the EHR vendor s recommended workflow for correct population of the CQM (ASK the VENDOR!!!) What process need to be analyze further that will have the biggest impact on the measure outcome? Is it electronic, physical or a data flow or all of the above? Physical - Includes environmental layout of patient room, equipment, devices, supplies, etc Electronic - How is the work documented? What screens and fields are used? Data - Where does the information documented go? Why does it go there (triggers or reports)? How does it get there (interfaces, uploads, etc) 31

32 Create Change Backlog Prioritize your Changes and Choose first Sprint (PDSA cycle)

33 Change Backlog Example Train all staff on correct electronic workflow for CMS 165 Train staff on accurate BP measurements Implement HTN protocol Make sure HTN is addressed at each patient visit See HTN patients with BP >140/90 every 6 months Etc.. Take a minute to create a change backlog for your ecqi project (handout) Think about EHR Functionality and workflows What are some of the changes you identified?

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35 Identify the Sprint/PDSA plan Prioritize your change backlog and choose your first sprint from the list of possible changes Identify a measureable goal for the sprint Use standard data measures, easily accessible and repeatable Establish baseline data, if one is not already available (make step one of plan if needed) Determine a target goal for improvement Tasks to keep in mind for PDSA plan: Reviewing electronic, data entry and physical workflows Leveraging EHR functionality whenever possible Implementing clinical best practices/protocols to support improvement

36 First Sprint (PDSA) Recommendation If data in CQM report is not accurate, make your first sprint (PDSA cycle) all about determining accurate electronic workflow, training staff on accurate workflow and validating that data. That will be your immediate improvement and allow all the other functionality in the EHR to work correctly with the structured data

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38 Streamlined ecqi Process Model 38

39 ecqi Tasks Identify Project Scope and Team Create and prioritize Change Backlog Create Sprint/PDSA Perform/complete Sprint= PDSA cycle(s) Perform sprint review and update Change Backlog Repeat

40 Proven ecqi Results

41 ecqi Proven Results 41

42 ecqi and Quality Programs ecqi can improve tracking and performance quality reporting requirements for: Merit Based Incentive Payment System (MIPS) Comprehensive Primary Care Plus (CPC+) Care Coordination/Transition of Care Inpatient Quality Reporting (IQR) Antimicrobial Stewardship Programs (ASP) ACO or other payment models NCQA or other PCMH Certification

43 Technical Assistance We Provide with ecqi Methodology Assist with ROI and alignment process Provide ecqi structure education Provide tools and resources on website Provide project management lite Facilitate and record meetings and assignments Create and maintain project and data tracking documents Cheerlead and motivate

44 Our ecqi Methodology: Side Effects May Include; Improved consistency on workflows and use of EHR Aligned quality improvement efforts for greatest ROI and resource use Rapid improvement gains on PDSA goals (PDSA cycles or sprints average time 30 days) Reliable quality data in EHR Trained staff on a repeatable QI process for ongoing use Value Based payment/reimbursement based on true quality of care Improved clinical outcomes for patients and reduced total cost of care You may become a super hero (REMEMBER: with great power comes great responsibility)

45 Polling Question What 11 th SOW Task Orders might you use ecqi for?

46 ecqi How to Get Started Crosswalk the facilities quality reporting requirements Identify highest ROI measures/programs Compare current performance to benchmarks Choose the first ecqi project Create a project scope (SMART) Create a change backlog Choose the first sprint Be prepared to be awesome!!!

47 ecqi Resources ONC- Healthit.gov: Mountain-Pacific: ecqi Resources and Toolkit: Patty Kosednar, ecqi Consultant;

48 Q & A

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