Lessons from EHR Use for Quality Reporting and Measurement What Providers Need to Know

1. Lessons from EHR Use for Quality Reporting and MeasurementWhat Providers Need to Know Barb Regan, RN Director of Business Development HealthBridge

2. Aligning Forces for Quality Initiative

3. AF4Q Background • 2006 Cincinnati one of 15 regions in the nation selected for the Robert Wood Johnson-Aligning Forces for Quality initiative • Goal - National effort to align critical components of the health sector to advance and improve quality outcomes

4. Collaborative Effort • Lead by Health Improvement Collaborative • AF4Q Leadership and staff • HIT Workgroup- comprised of community leaders (physicians, staff, practice managers, VPs, CIOs) • HealthBridge partnered and assisted in several phases of data extraction from EHRs.

5. Phase 1-Primary Care Innovative Group • Primary Care Innovative Group • Deployed and provided training and support for a disease registry for use by practices in the Primary Care Innovation Group • Implemented electronic data extraction and registry feed for 2 EHRs • Coordinated efforts with the AF4Q Health Information Technology Work Group

6. Phase 2-HealthMeasures • HealthMeasures • Physician-led quality measurement in Greater Cincinnati • Recognition of the need for a fair and accurate approach to physician quality measures using clinical data • Kicked off in 2009 • Public reporting 2010 • HealthBridge partnered to extract data directly from an EHR for submission to HealthMeasures. • Goal-alleviate the administrative burden on practices by leveraging the data in the EHR

7. Phase 3-Patient Centered Medical Home • AF4Q Leadership and Health Improvement Collaborative • National model to transform primary care • PCP is responsible for coordinating care with specialists • Proven track record for improving outcomes • Proven reduction in health care costs • Leads to higher quality healthcare • Use of quality reporting is essential

8. Common Thread • Use technology to facilitate the extraction of data to • Improve quality of care • Improve outcomes

9. How Did HealthBridgeAccomplish • Worked with a third party vendor to create a data extraction tool • Read-only access into EHR • Data extracted • Quality review with practice • Made necessary changes to interface • Final extract delivered to practice • Practice submitted the data to AF4Q

10. The Challenges • Most EHRs are developed for billing and have trouble “getting the data out” • Inability to produce aggregated data reports by condition which is essential for improvement • EHR vendor charges high fees for add-on modules • Customizations for a practice can help or hurt (templates created for free text and not codified fields) • EHR queries often miss information in textual fields for scanned documents • Inconsistent use of fields in EHRs (eye exam checked with note: Patient going to have eye exam. No documentation in chart

11. Lessons Learned-The 3 C’s • When implementing an EHR for quality reporting: • Consistency- consistent use of EHR is essential for capturing critical data (values, dates, vital signs, scanned documents) • Codified fields- if encounter data is not captured in codified fields there are limitations on quality reporting • Connected- practices connected with an HL7 interface to HealthBridge more successful for extracting data (HL7 interface allows for more discrete, codified data

12. HealthBridge-Advancing Technology to Improve Care • Implementation of disease registry • Look for gaps in care • All data in codified fields • Consistent with data input • HL7 interface connection to HealthBridge • Aligned with AF4Q Initiatives • Provides real-time physician dashboard for monitoring and patient outreach • Assist community partners to meet Meaningful Use

13. Patient Centered Medical HomeUse of disease registry • Beta testing with The Family Medical Group • Reusable interface for use buy multiple EHRs • Integrating data from Clinical Messaging to supplement EHR data extraction • Developing Personal Health Record within the registry • Patient outreach

14. Let Us Help- Tri-State Regional Extension Center • Not in this alone • Help you select EHR or registry produce • Best practices for implementing quality reporting • Assist with training • Create learning consortiums • Collaboration is necessary to achieve the promise of higher quality, lower cost health care

15. NPRM Meaningful Use (MU) Requirements Today • Use computerized order entry. • Implement drug-drug, drug-allergy, drug- formulary checks • Maintain an up-to-date problem list of current and active diagnoses • Generate and transmit permissible prescriptions electronically • Maintain active medication list. • Maintain active medication allergy list • Record demographics. • Record and chart changes in vital signs. • Record smoking status for patients 13 years old or older • Incorporate clinical lab-test results into EHR as structured data. • Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach. • Report ambulatory quality measures to CMS or the States. • Send reminders to patients per patient preference for preventive/ follow-up care • Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules.

16. Meaningful Use Requirements Today (cont.) • Check insurance eligibility electronically from public and private payers • Submit claims electronically to public and private payers. • Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request • Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) • Provide clinical summaries to patients for each office visit. • Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. • Perform medication reconciliation at relevant encounters and each transition of care. • Provide summary care record for each transition of care and referral. • Capability to submit electronic data to immunization registries and actual submission where required and accepted. • Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice. • Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities. (privacy & security)