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Quality Reporting Outliers, Best Practices

September 28, 2010
by Jennifer Prestigiacomo
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Interview: Peter Basch, M.D., Medical Director of Ambulatory EHR and Health IT Policy, MedStar Health

MedStar Health, a regional healthcare system with a network of nine hospitals and 20 other health-related businesses across Maryland and Washington, D.C., has been using GE Healthcare's Medical Quality Improvement Consortium (MQIC) to report and analyze quality measures. Peter Basch, M.D., MedStar Health’s medical director of ambulatory EHR and health IT policy, spoke to HCI Associate Editor Jennifer Prestigiacomo about the exciting new project his system is undertaking to identify quality measure outliers to globalize best practices.

Healthcare Informatics: When did you start using GE Healthcare's Medical Quality Improvement Consortium (MQIC)?

Peter Basch, M.D.: We’ve been using MQIC for a good number of years, and we have begun to be more robust MQIC users in the last year or two. Our health system has matured use of the EMR [electronic medical record]; and our doctors and staff have been much better in entering information and structured data, and thus engendering in our end users a deeper sense of trust and reliability in the reports. One of the common experiences of clinicians in getting reports on [clinical] data is to discount it in the sense of, ‘well this doesn’t even look remotely correct.’ We’ve had a different experience with our MQIC reports, as it is populated with our clinical data. And as mentioned before, our doctors are better about reporting things that need to be reported as structured information. The reports that you can deliver via MQIC now are much more reliable, and thus trusted and looked at as useful to our clinicians and our managers. We look at our MQIC reports as our regular, sometimes annual or quarterly reporting, in terms of helping to drive our quality improvement agenda.

HCI: Are you using MQIC in all nine hospitals and all physician practices?

Basch: The use of MQIC right now is really dependent on which clinicians we have using the EMR and what particular reports are relevant to those clinicians. So, at this point our primary users of MQIC reports are particularly primary care and a couple of medical subspecialties like endocrinology and cardiology. That does not cross over into all of our hospitals. Five hospitals and one non-hospital entity— our primary care group—have clinicians that use the MQIC reports.

Prior to us going electronic we had a group within MedStar, which still exists, called the Ambulatory Best Practice Group, comprised of representatives of each of our MedStar units that conduct outpatient care. And the work of that group up until recently was essentially commissioning and conducting clinical reporting. And it would be done by manual chart abstraction. So the entire year of work for that group would be to look at all the metrics we want to look at, take 40 or 50 charts per clinician, and spend a year to do the chart abstraction. At the end of the year, we’d look at our reports, and compare it to where we were the previous year.

Since going electronic and our robust use of MQIC, the decision of our reporting is typically done in our first meeting, and then the running of the reports, broken down by practice, and by individual provider, takes maybe a couple of hours. So what we used to do in the course of a year is now done almost in real time. We spend the rest of the year looking at what we can do to improve care, or which operational measures can be applied and how they are working in practices instead of in theory. So, it’s really changed the focus of the group.

HCI: Are you currently tracking all 15 quality measures specified by the meaningful use Stage 1?

Basch: I assume it’s going to primarily be an offering through MQIC that’s available to us, and we have other reporting tools as well. But we look at the MQIC reporting as giving us clear guidance at a rolled-up level, so we know as a health system, a hospital entity, and a primary care practice group where we are in aggregate. Do we have e-prescribing implemented in such a way that our docs just don’t get it?