When Will Health IT Support Quality Improvement? NCQA / HL7 Digital Quality Summit November 1-2, 2017 Peter Basch, MD, MACP Senior Director, IT Quality and Safety, Research, and National Health IT Policy
About MedStar Health Largest not-for-profit distributed healthcare network in the Maryland DC region Clinical care 200,000 admissions / observation stays 1,600,000 outpatient office visits 270,000 home health visits Research MHRI Ranks in the top 10% of organizations funded by NIH > 1000 open concurrent research studies Education 1100 residents and fellows Medical education and clinical partner of Georgetown University About Me General internist, Washington, DC Senior Director, Health IT Quality and Safety, Research, and National Health IT Policy 2
Progress on Goals YTD Projected Progress (Based On 1 st Round of Enhancements YTD and for Q4 CY 17 Reporting) Projected 3
4
When Will Health IT Support Quality Improvement? (it already does!) 5
When Will Health IT Support Quality Improvement? ( and it has for some time) 6
When Will? Health IT (EHRs) Better and Consistently Support Quality Improvement? Quality Measures / Measurement Support Quality Improvement? 7
When Will Health IT (EHRs) Better and More Consistently Support Quality Improvement? 8
When Will Health IT (EHRs) Better and More Consistently Support Quality Improvement? 9
When Will Health IT (EHRs) Better and More Consistently Support Quality Improvement? 10
When Will Health IT (EHRs) Better and More Consistently Support Quality Improvement? 11
When Will Health IT (EHRs) Better and More Consistently Support Quality Improvement? 12
Administrative Burdens I spend more time on paperwork than I do with patients! By the early 1990 s this was a common refrain and the primary cause of physician dissatisfaction with medical practice Administrative burden is a pre-existing condition As the introduction of computers / IT in other aspects of the business world reduced paperwork, it was widely believed that the key to reducing physician dissatisfaction in medical practice was the EHR What were those paperwork burdens? Prior authorizations Formulary management Documentation 13
Solutions to Administrative Burdens 14
Regulatory Burdens: EHR Certification Rationale EHR voluntary certification prior to MU was considered to as preservation of the status quo Functional / modular certification would: Reduce uncertainty for buyers Open the market to new companies / innovation Increase competition Reduce costs What Actually Happened Market consolidation Almost no use of modular solutions Prescriptive requirements One-size fits all (none) EHR Usability / efficiency 15
Regulatory Burden: Meaningful Use The EHR as Foundational to Safer and Better Care Initial thinking by CMS how can EHR adoption be incentivized? Maturation of thinking it s not the EHR per se, but how its used Pay-for-adoption pay-for-use If pay for use applies to all doctors / a pay-for-use program must come up with a single definition of meaningful use 16
Regulatory Burden: Meaningful Use Advancing Care Information (ACI inside of MIPS) Meaningful Use why not just declare victory and move on? Measure quality and cost use health IT in whatever ways are appropriate (acknowledging that it should look different based on specialty and scope of practice) 17
Regulatory Burden: Documentation 18
Regulatory / EHR Burden: Documentation 19
EHR Burden Documentation Messages Report review / communication to patients, other providers Prescriptions Referrals Sharing of information with patients / patient education 20
Suboptimal Implementation 21
Inadequate Training 22
Design (Solving Yesterday s Problems) {guaranteed to make no one happy} What Problem Are We Trying to Solve? (hint NOT digitizing paper) Example every time I view a lab result for a patient with HTN, I always want to see Results in context Med list, see if renewals needed, and if so, renew according to patient preference Communicate results and next steps to the patient, other providers if appropriate, etc. 23
Vision of Ideal Health IT (EHR) Use in Support of Better and Safer Care (Quality / Value) Most information entry done prior to being seen by clinician by patient or staff Some or most of visit will include collaborative viewing of information Friction in health IT should disappear in most instances where it exists now; and it should occur where attention to a serious error is needed (commission or omission) 24
When Will Quality Measures / Measurement Support Quality Improvement? What is behind the quality chasm? Quality measurement Quality measures Quality payment programs 25
What Did / Does this Quality Chasm Actually Mean? 26
Quality Measurement What Does A Distribution of Quality Measure Scores Really Mean? 27
Quality Measurement: Integration with Team-Based Care 28
Quality Measures: ecqms 29
Quality Payment Programs: Choice of Measures Doctors can choose their measures based on specialty and what they believe they do or can perform well on and thus present an accurate (and best) face to patients ACO measures prescribed by regulations MIPS program 6 measures, one of which is an outcomes or high priority measure Measure selection for all members of the group Unless a doctor is in solo practice or in a single specialty group measure choice is pretty much limited to generic process measures And the measures don t have to be even remotely related to the expected competencies of the group 30
Quality Payment Programs Is a Score of 69 Really Different than a Score of 70? MACRA legislation mandates linear scaling All but guarantees that there will be intense focus on learning how to best game the scoring system ( Money-ball for Medicine) 31
Where Does This Leave Patients? Would you just stop talking PLEASE! I m trying to input the right data to score well on all quality measures. Sorry doc let me know when I can tell you about the crushing chest pain I am having right now!!! 32
Summary 33
Questions peter.basch@medstar.net 34