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Improving EHR Data Quality, Clinical Workflows for MIPS Success

USF Health joined forces with an IT partner to boost EHR data quality, improve care delivery, and fulfill MIPS requirements.

A USF Health leader advises healthcare organizations about succeeding under MIPS.

Source: Thinkstock

By Kate Monica

- Optimizing EHR data quality is top-of-mind as healthcare organizations continue to adjust to the regulatory changes that accompany healthcare’s transition from fee-for-service to value-based care.

Eligible clinicians participating in the Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP) must ensure quality data transmitted from their EHR systems to regulatory bodies is representative of their performance to earn incentive payments.

While many providers have struggled with the administrative burden associated with fulfilling reporting requirements in recent years, over 91 percent of eligible clinicians participated in MIPS during the first year of QPP. 

One of those healthcare organizations was Tampa-based University of South Florida (USF) Health. But meeting reporting requirements was not an easy feat for the academic health system of more than 900 providers.

USF Health Chief Quality Officer Terri Ashmeade, MD, recently spoke to EHRIntelligence.com about how the health system overcame initial challenges with their Epic EHR system to successfully earn incentive payments under MIPS and improve care quality in the process.

USF Health first went live with their Epic EHR system August 1, 2015.

“We noticed—based on our work with some of our commercial payers—that we were having some difficulty with the generation of quality data code that accurately reflected our performance in order to submit to our commercial payers,” Ashmeade told EHRIntelligence.com.

READ MORE: Certified EHR Technology at Center of Debate Over MIPS Updates

To investigate the issue, build up codes in Epic, and successfully fulfill MIPS reporting requirements, USF Health began looking for an IT partner.

“We looked at a couple of different organizations and talked to some different groups,” she said.

USF Health found an IT partner — SPH Analytics — and leveraged a quality clinical data reporting (QCDR) tool to submit for the first year of MIPS reporting as part of QPP.

The health system selected SPH Analytics based primarily on their QCDR tool’s high degree of usability, as well as USF Health’s existing relationship with the health IT solutions provider. The health system had utilized SPH Analytics or other IT projects in the past.

After selecting an IT partner, USF Health began the process of MIPS reporting.

“It was a long process,” said Ashmeade. “The first thing we had to do was work to make sure that we were reliably pulling all the data that we needed out of Epic and getting it to SPH Analytics on a regular basis, and that they were getting all of the data that they needed.”

“Once we did that initial kind of download of data to SPH Analytics, we were able to work together to look at that data, and to determine what MIPS eligible measures were going to be appropriate for us to report on,” Ashmeade continued.

USF Health leadership made decisions about which MIPS measures to report on according to the data their IT partner was able to pull, the disease processes USF Health providers were actually treating, and the measures they expected would be most meaningful to USF Health providers and patients.

“That was really that first step,” said Ashmeade. “Once we were able to select our measures—that’s when the real work began.”

Ashmeade and other members of USF Health leadership then began engaging with clinicians to familiarize them with selected measures.

“And then really getting started on improving our performance,” said Ashmeade. “Because that was our real goal in terms of participation. Not just to find some data we could send to CMS—because they made it fairly easy to participate in the first year.”

“We wanted to participate fully and in a meaningful way,” she added.

USF Health leaders went into clinical practices and engaged all members of each care team to optimize clinical performance.

As part of this optimization effort, Ashmeade and her team worked with medical assistants to review their clinical workflows and ensure staff members understood how their workflows needed to be modified. The team also helped medical assistants standardize their workflows to meet quality measures.

READ MORE: How MIPS Changes in the 2019 Quality Payment Program Proposed Rule

“We addressed what the templates were going to look like, when we were going to fire clinical decision support tools, when we were not, what those support tools would look like, who they would fire for, and when in the visit they would fire,” Ashmeade explained.

“We really tried to make it work in their workflows and not just be there as another click or another step,” she added.

Streamlining clinical workflows helped to reduce administrative burden for both medical assistants and providers by cutting down on clinician EHR use.

USF Health leaders also showed medical assistants how to perform EHR clinical documentation tasks within Epic and queue patients for providers.

“We showed them how to appropriately capture the measures they needed to capture,” said Ashmeade. “They were able to help the providers identify gaps in patient care that could be closed during that visit by ordering the appropriate tests or doing the appropriate screening.”

Enlisting the help of an IT partner, optimizing clinical workflows, and involving clinicians in the reporting process helped USF Health successfully fulfill MIPS reporting requirements without seeing a decline in physician satisfaction.

Recommendations for healthcare organizations to succeed under QPP

Overall, Ashmeade highlighted clinician engagement as integral to the health system’s success.

“See if they can be part of the process of identifying measures to target,” said Ashmeade, “The sooner you engage providers, and the more input they have, the more likely they’ll be to engage with the process from beginning to end.”

Offloading administrative responsibilities to different members of the providers’ care team can also help to ease the burden of reporting and maintain levels of physician satisfaction.

“All of the burden can’t be on the providers,” said Ashmeade. “It has to be a care team approach to this. So, your medical assistants, your LPNs, your RNs in your practice also need to know what measures you’re targeting.”

READ MORE: Congress Urges CMS to Lower MIPS Exclusion Thresholds

USF Health primarily divvied up responsibilities between medical assistants.

“Anything the MA could do, we made sure they had standard protocols for screening questions and standard places to document answers to that,” said Ashmeade. “That they were trained to do smoking cessation counseling, that they were trained to ask every patient that came into the clinic about flu vaccinations, or other outstanding vaccinations.”

Medical assistants also reviewed patients for specific gaps in care and identified patients in need of diagnostic testing including mammograms, colonoscopies, and other tests.

“Some of the time we did have reminders for providers just to signal when something had been missed by the rest of the care team,” said Ashmeade. “So they could close that gap and go back and make sure that the care team was appropriately trained to do all the things that they were supposed to be doing.”

Using these reminders, providers could reeducate members of their care team or inform members of the IT team of any existing problems with workflow templates.

Finally, Ashmeade emphasized the importance of establishing a level of data transparency with providers.

“Be very, very transparent with your data,” she continued. “Providers want data to be right, but if you can have them participate in the data validation and improvement process, you’ll get your data better, more quickly.”

Engaging clinicians with the reporting process, involving all members of the care team in clinical documentation and reporting, and maintaining data transparency can help to set eligible clinicians up for success during MIPS reporting.

“It's got to be a team effort,” maintained Ashmeade.

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