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A Paradigm Shift on Quality Reporting

May 19, 2010
by David Raths
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CIOs grapple with challenges of moving quality reporting to electronic health record systems.

Hospital CIOs have identified quality reporting from electronic health record (EHR) systems as one of their greatest challenges related to meaningful use compliance under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act. In March, David Muntz, senior vice president and CIO of the Baylor Health Care System in Dallas, told the federal Office of the National Coordinator Standards Implementation Workgroup that the most significant impact of meeting meaningful use on his health system’s existing plan has to do with the required quality reporting. Baylor eventually would like the activities of documentation and ordering to produce the data it currently collects manually through chart abstraction. But he added, “If we rush to meet the Stage 1 criteria before we have deployed our enterprise-wide designed EHR in our hospitals and ambulatory settings, we will have to sub-optimize our processes to gather some of the numerators and denominators required to compute the proposed metrics.”

Muntz was one of several CIOs to appear before the workgroup on that occasion. One of his colleagues, Chuck Christian, CIO of the Vincennes, Ind.-based Good Samaritan Hospital, told the workgroup that all of his 232-bed hospital’s quality reporting is currently done manually by a retrospective review of the clinical record. “For us, having to go back now to look at what we need to do in order to produce these electronically, there is a significant amount of change that we’re going to have to implement,” Christian said.

Mike Sauk, CIO for the University of Wisconsin Hospitals and Clinics in Madison, echoed their concerns, telling those assembled that “A lot of the data that’s being requested isn’t in any EHR right now, so that, for us, will probably be the biggest challenge if that’s a hoop that we have to jump through before release of meaningful use funds.”

One industry leader finds herself encouraged

Yet despite these CIO misgivings, Carol Diamond, M.D., managing director of the Health Program at the New York City-based Markle Foundation, summed up a meeting last week in Washington, D.C., at the Brookings Institution’s Engelberg Center for Health Care Reform, by saying that she’s encouraged that a paradigm shift in quality reporting is already underway.

After hearing impressive presentations from leading integrated health systems such as the Danville, Pa.-based Geisinger Health System, and from researchers from the Oakland, Calif.-based Kaiser Permanente organization, health information exchange (HIE) leaders and CIOs, Diamond noted that when information is paper-based, it is difficult to do any quality reporting, and getting meaningful results back to clinicians usually takes way too long. If a typical physician in a practice with 2,000 patients has paper files, “you can’t walk in and say, how many of your diabetics had their eyes checked this year?” she said. “Even finding the diabetics is a challenge in paper records.”

When quality reporting is done at the health plan level, she added, armies of people go out to physician offices, select a random number of paper charts, abstract the information, record it on paper and then aggregate it. “The complexity and the difficulty and the cost of doing that has really gotten us away from quality improvement,” Diamond said, “because we spend all our time on quality measurement and reporting.”

The goal should not be the reporting of the quality measure, but instead to allow better decisions to be made to improve health and health care, she added. “And without information systems, we have only been able to do the first step or the second step in that full cycle of information that needs to move back and forth. What we’re seeing now is getting closer and closer to having that capacity to change the way we’ve traditionally done quality and research.”

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