> Understand that risk adjustment, quality measures and payment may be dependent on documentation quality and accuracy, including the use of HCC codes and comprehensive problem lists. The care-planning process must include both medical and social problems to have the greatest impact. Risk-based APM’s may depend on managing non-medical problems.
Data Quality and Documentation Quality
Data quality and documentation quality are related but present different challenges. When performance measures drive compensation, the baseline data is critical and must be accurate. The care team relies on both clinical documentation and quality assessors in the EHR. Yet everyone agreed clinical documentation often is of poor quality, generally from cut-and-paste behaviors and redundancy. Dr. Stetson suggested the use of the Physician Documentation Quality Instrument (PDQI) as a simple means of assessing quality and providing feedback for improvement. Dr. Michelle Lauria suggested that physicians be required to do note-review on peers to identify issues and foster improvement. Dr. Jerry Osheroff described a new checklist tool to ensure that quality-measure data are accurate and trustworthy (recently published within a guide to improving care processes and outcomes). Dr. Alan Weiss said that part of the problem is the physician hasn’t defined data quality based on purpose—purpose related to influencing medical decision-making and clinical value.
Lessons Learned: How CMIOs/CHIOs can Advance CDS
1. Stress documentation reform to make records medically meaningful for the patient benefit. Change data documentation and collection from a reimbursement focus to a patient outcome focus.
2. Synthesize the experiences and strengths from the organizations within the Scottsdale Institute to identify what the future of CDS could look like.
3. Articulate the value proposition of the CDS Informatics Team to lead to role clarity and improved collaboration.
4. Develop a maturity model for CDS levels, along with a recommended staging process and a corresponding benchmarking process facilitated by the Scottsdale Institute.
5. CMIO/CHIOs should take a critical role in translating health reform such as MACRA and other value-based contracting efforts into a value platform that leverages people/process/technology best practices.
6. Teach responsible clinical documentation skills and etiquette in medical schools as a requirement for delivering quality care.
7. Apply pressure to vendors to standardize CDS tools and maintain CDS as a core function of the EHR. Knowledge management and analytics to ensure CDS reliability should be part of the standard EHR CDS package from vendors. Informatics teams should be able to easily report on alert fatigue and gaps in the annual review process with subject-matter experts.
8. Continue to expand CMIO/CHIO and Informatics resources and personnel in health systems, with senior-level decision-making, to realize the ROI on CDS.
9. Build a culture of innovation throughout the health system.
10. Build informatics capability that includes ongoing review and prudent development of CDS alerts. This process should include assessment and monitoring of CDS effectiveness against negative factors like alert fatigue.
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