Quality Reporting Outliers, Best Practices

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?

As we know meaningful use is done provider by provider. The other part of what MQIC will give us is individual provider reporting so that doctors will be able to look at all their measures for which we made a system determination on where they stand. I think one of the strengths going forward in 2011 with the product is providing that information to every provider using the EMR. We think that that near real-time feedback will show providers where they are on measures. I think that it’s particularly unhelpful with other vendors that say they’ll submit your measures for you. Good luck knowing where you stand. As we know meaningful use is all or none, so you really do want to know early on where you are with performance. And if you’re not doing well, show me the information that I need so I can see where I’m not doing well, and perhaps with some tips as to how I might change what I do in practice style, or prescribing style, or appropriate inputting of structured information, in such that I’m able to improve.

GE has made a commitment in their version 10, which we’ll be getting in first quarter of 2011, to include metrics performance for meaningful use measures. Right now we’re looking at other quality reports through MQIC and PQRI [Physician Quality Reporting Initiative] reports.

HCI: In the CSC report about the complexity around quality measures, it noted that hospitals really have to have more than just medication orders, to achieve meaningful use. Where does MedStar stand on that?

Basch: I think getting all those measures addressed in a timely measure is going to be challenging for most hospitals, including ours. One of the things I feel good about is in the outpatient environment, I think most of our docs are used to putting in their problems, meds, allergies all as structured data, ordering medication properly, e-prescribing, providing patient information in a timely fashion. We look at meaningful use in the outpatient arena as a rung in a ladder toward a journey that is more than meaningful use.

For example, meaningful use says, put in one problem list as structured data. Our internal minimum use requirement says, put all your problems in as structured data, and update it regularly. So we’re already asking way more of our docs than what meaningful use does. In that way we see meaningful use as a standard step along the way—and that’s not to minimize the challenge. It will be far more challenging to meet inpatient meaningful use than meaningful use for eligible providers. We’ve had a full clinical system for our clinicians for a couple of years now, whereas in the inpatient we haven’t implemented CPOE yet.

HCI: Can you tell me which quality measures you are reporting and why you chose these?

Basch: The measures we’re primarily focusing on right now include cancer screening measures and diabetes, asthma, heart failure, and coronary artery disease—the usual suspects in terms of what most people look at—where we spend a lot of money on healthcare, and where we get less than stellar results. We’re all pretty much focused on the same ones.

HCI: How has tracking these quality measures changed the quality of care at MedStar?

Basch: One of the hard realities when you look into the mirror is we do a good job much of the time, but things do slip through the cracks, either because of multi-tasking, fatigue, inattention, patients not showing up for requested follow-up, and so forth. So when we look in aggregate, what we do with our patients, our performance is often lower than we would think it to be, and certainly not always as good as our patients deserve. So when you begin to look at reporting you can trust and that’s usable, you can begin looking at the brutal truth of what actually exists. You can inch that forward and say, ‘we’ll here’s what I can do to do better.’