A long-established federal quality-promotion program, with Medicare-funded efforts in every state, has focused much more on health information technology in just the last three years, say people close to the operations.
Quality Improvement Organizations (QIOs) are private groups — one for each state — with Medicare contracts to oversee and support healthcare quality. They have existed, in various versions and with substantial changes in focus, since 1970.
After a pilot project in which four of the organizations helped 1,000 doctors adopt electronic health records (EHRs), QIOs are now working with at least 5 percent of adult primary care physician practices in every state and territory, both to accelerate IT adoption and to make sure it is used to improve care, says Christine Bechtel, government relations director for QIOs with the American Health Quality Association (AHQA).
Justin Graham, M.D., M.S., associate medical director at the California QIO, Lumetra, which led the pilot project, says that assessment has shown these efforts not only increase IT adoption but they also drive quality improvement and care management for chronic disease.
Bechtel explains that in the work with physicians, QIOs, "do not take the place of an IT vendor, and they do not function like an IT vendor." Rather, she says, they do things like assess whether a practice is ready to adopt IT; provide independent advice on selecting a vendor, including information on which functionalities the practice needs; help redesign the workflow and care process to integrate the system; and help the practice use all the system's capabilities, not just the basic record entry.
Key to the QIOs consulting, she says, is their focus on ensuring that automation improves quality and patient safety, rather than just automating the paper process.
Graham of the California organization says that because they have added IT to their projects, "QIOs have actually staffed up with the appropriate personnel."
For example, Graham, who is trained in biomedical informatics and has expertise with EHRs in a number of settings, came to Lumetra a year and a half ago.
David Schulke, AHQA executive vice president, told a Congressional subcommittee in written testimony this spring: "QIOs offer the only nationwide field force of experts dedicated to understanding the latest methodologies in quality improvement and working with doctors and other professionals at the local level to use those techniques effectively."
Bechtel notes that for the Centers for Medicare and Medicaid Services (CMS) a key motivation for this automation, beyond quality improvement, is enhancing information for pay-for-performance. EHRs records are likely to aid information-gathering on what is done for patients, more so than what claims data can do, she says.
Although the work with physicians is QIOs' best developed IT focus, Bechtel notes they also offer hospitals help with bar coding and computer-based provider order entry, and some are helping home health agencies with telehealth technologies.
The organizations are also supposed to be used in the future to help assure quality under the new Medicare prescription drug benefit.
But QIOs have taken some serious public relations punches recently. Last summer, a Washington Post series reported abusive financial practices in some of the organizations, and questioned their effectiveness in improving quality.
As of May 12, Sen. Chuck Grassley (R-IA), chair of the Senate Finance Committee, said it was premature to increase QIO funding until there is more understanding of their operations. He said investigations are ongoing by the HHS Inspector General, the Government Accountability Office and his committee. Nevertheless, no one seems to indicate the QIO structure will not continue.
Meantime, Graham encourages HIT professionals to find out what their own state QIO is doing and to use the Internet resources developed by QIOs.
Kathryn Foxhall is a contributing writer based in Hyattsville, Md.