- In the right hands, EHR technology can serve as a platform for innovative uses of clinical data to improve patient outcomes.
For the most recent recipient of 2015 HIMSS Ambulatory Davies Award, innovation built on EHR use came after cutting down the time it takes to capture clinical quality measures and report back to clinicians their effectiveness in tracking these data points. In particular, the IT team at The Wright Center developed a web-based system for presenting information on clinical quality measures from a central database.
"This is something that we have developed internally," Jignesh Sheth, MD, Senior Vice President of Mission Accountability, tells EHRIntelligence.com. "The technology may not be new — SQL databases are not new — but what is new and unique here is how we have connected all these measures and how we are actually reporting back to the consumer — physicians, residents, MAs in this case. That whole concept and process of doing that is what is unique."
The Wright Center actually tracks scores of clinical quality measures — 30 alone for diabetic patients, another 10 for heart disease patients, and several more for asthma patients. " These are the top chronic diagnoses in the country," says Sheth.
Additionally, clinicians at the healthcare organization capture measures for screenings as well as those necessary for demonstrating meaningful use.
Much of the success at The Wright Centers with clinical quality measures comes down to its ability in appropriately differentiating between the types of measures being tracked and accounting for the significant amount of data overlap across these various initiatives. According to Sheth, close to one-third of requirements span these initiatives, so avoiding redundancy is key.
Likewise key is the ability of clinicians to view quality data from disparate sources in a single place.
"As a physician, I would like to log in once and see everything on one page," he explains. "Until now, everything was in different places. To look at your productivity, go to finance. To look at your billing information, go to the billing department. To see how many patients you saw, go to your practice manager."
Enter the unique health IT approach taken by The Wright Center.
From grassroots to enterprise
The maturation process in terms of EHR use at The Wright Center took several years and truly turned a corner as more resources were brought inside the organization.
"It all started with having an electronic health record super user onsite in our clinics," says Clinical Innovation Specialist Courtney Dempsey. "This evolved into hiring IT programmers and eventually an IT department. Now they work simultaneously to run the reports and trend measures over time to find the areas for improvement. We then also use rapid PDSA cycles — which are assigned to staff, faculty, and residents — for our work."
The centralization of health IT resources is especially important given that The Wright Center maintains primary care sites throughout northeastern Pennsylvania (Scranton, Clarks Summit, Jermyn) as well as its residency program that spans these various sites. Moreover, the organization must make use of limited resources as a non-profit medical group that relies in many cases on grant funding.
Dempsey credits the organization's physician with pushing The Wright Center in the right direction regarding health IT innovation.
"We had a strong physician leadership that recognized the importance of having strong IT innovators. That took our practice to the next level," she adds.
One need look no further than Dr. Sheth as proof of this claim. He himself played a role in the organization's earliest efforts at clinical quality reporting.
"We had very grassroots operations where all of this data was on an Excel spreadsheet," he observes. "Data was updated on a monthly basis and the only way to share that data was to share the Excel file. If you didn't have the most updated file, you were pretty much looking at the wrong data."
But for Sheth credit is truly due to the architect of The Wright Center's web-based clinical quality technology — Vice President of Information Technology and Innovation John Janosky — who translated the organization's vision into a mature platform.
"We started taking all these data points from the organization and be able to graph them for management to see," Janosky describes. "Also, it turned into something even bigger, something we call a PACE card. It's basically a report card for all the providers and residents so they can see at a glance what their daily visits are and also works with the empanelment. Every provider and resident is on a team and they can see what each person is doing on their team."
Most importantly, Janosky and the IT team has cut down the turnaround time for pushing quality data back to clinicians, which entails getting information out of the organization MEDENT EHR technology.
"We can do it instantaneously — we just have to run a report from MEDENT," he continues. "We schedule them weekly. Since MEDENT runs on an HL7 database, there is no open source involved with it. We always need to manually export them from MEDENT and then import them into the interface I made."
What's more, de-identification of patient data and user controls allow The Wright Center to share information from the central database safely and securely to other members in the organization.
Moving toward accountable
As The Wright Center works to mature its work on clinical quality measures, the focus will turn to extending accountability throughout the enterprise rather than limiting it to the clinic. According to Sheth, what's next is the development of a corporate scorecard.
That said, clinical quality will remain at the forefront of the organization's work.
"This is going to make the whole organization accountable. It is going to help people work at the top of their license because they know exactly what they are aiming for. Unless you give them a report card, they don't know what to look for for the next 6 months of their job," he concludes.