Recent findings from an 18-month study conducted by researchers from the Department of Healthcare Informatics and Information Management at College of St. Scholastica has highlighted the challenge that critical access hospitals (CAHs) and rural health centers face in using their electronic health record (EHR) systems to report clinical quality measures
(CQMs) for meaningful use
Why are quality measures so important? CQMs are a crucial aspect of the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Programs
. As part of Stage 1 Meaningful Use
, eligible hospitals must report 15 CQMs to demonstrate meaningful use. As a result of the final rule for Stage 2 Meaningful Use
, these hospitals will have to report on 16 of 29 CQMs electronically. For CAHs, meeting these requirements has revealed a number of obstacles resulting from lack of consistency in how clinical data is captured.
The study, Quality through EHR Standardization and Quality (QUEST), found four keys areas where CAHs need to make improvements, all of which deal with managing health data:
1. Standardization of CQM data
2. Usability of CQM data
3. Reporting CQMs electronically
4. Aggregation and sharing of CQM data with clinician
Quality reporting depends of an organization having a standard method for capturing these data. Without According to Trina Lower, RHIA, of Mercy Hospital and Health Center (Moose Lake, MN), which participated in the QUEST study, variation in data capture is the normal among physicians and across sites. Lower offered a simple equation: multiple hospitals + multiple cultures = standardization difficulties. To remedy this problem, providers must reach a consensus. “The goal is to develop a repeatable process for standardization of clinical data content and format for collection with the EHR,” observed Lower.
The solution to this variation comes in the form of increased clinician involvement in the implementation of EHR systems, chiefly the design of templates for clinical documentation. Unless the EHR system itself reflects a deep understanding and consideration of clinical workflows, data capture, and the electronic quality reporting environment, it’s unlikely that the health data that are recorded will have enough integrity to prove meaningful in improving healthcare through health IT. For small organizations with limited resources, health IT professionals must commit the necessary amount of time to ascertaining the needs of clinicians and using this feedback to make meaningful health IT decisions.
On top of the technological challenges facing CAHs, federal initiatives concerning CQMs carry with them their own share of problems. According to Brooke Palkie, MA, RHIA of St. Scholastica, many of these problems originate from variations in the definition and interpretation of quality metrics measures. The solution is to stay ahead of the curve in order to “standardize as much as we can” and “ensure that data capture is a natural byproduct of clinical workflows,” argued Palkie.
The move toward standardization begins with convincing physicians of the CQMs and similar quality improvement programs. However, getting clinical staff to buy in is the problematic because of the small volume of patients seen by physicians in CAHs. The large amount of work for a small volume of information has many CIOs and health information managers coming to terms with how they are going to sell the electronic reporting of CQMs to their staff, noted Palkie. For EHRs and CQMs to improve the care of patients no matter their location, CAHs and rural providers need to increase their efforts to educate clinicians, particularly “explanations of why it’s required though it appears clinically irrelevant as to the value of something that,” Palkie explained.
On the surface, these latest findings may not be “new.” However, they reiterate an important component of the improving healthcare through EHR and health IT systems. The successful implementation of these systems begins and ends in the clinic. Physicians and clinical staff will only use systems that make sense and demonstrate knowledge of how the clinical side works. The alternative is anything but meaningful.
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