As one of the ONC Beacon Communities featured in this brief, we have focused on better understanding what it takes to improve data quality so that information can be used to improve care across New Orleans. This post describes a few of the many lessons learned in this area that we hope will be useful to others.
Using Electronic Health Records to Make Data More Reliable in Crescent City
The Crescent City Beacon invested a lot of time and energy to ensure the reliability and validity of electronic clinical data. Our effort was essential to supporting chronic care management interventions such as:
risk stratification, and
clinical decision support.
One of the lessons we learned was that lack of consistency in data entry is a problem. Because data is often entered in multiple places within electronic health records and only certain fields were ‘reportable,’ providers were often unsure which fields were the correct fields that they should be using.
Practices also often lack dedicated data managers who are proficient in the reporting modules of their electronic health records – all of which contributes to provider distrust in their clinical data and quality reports.
Crescent City Beacon staff worked to turn these issues around through provider outreach and by providing technical assistance on data quality. This includes identifying errors and providing rapid feedback to clinicians and their staffs in an effort to trouble-shoot data errors and quality measure miscalculations.
We also co-host quarterly data workshops with EMR vendor representatives, and generate comparative performance feedback reports that allow for performance comparisons at the practice, community, and nationwide level. This encourages providers at every level to compare their performance, because before we can improve outcomes, we must measure and set benchmarks.
Our focus on electronic clinical data quality led to a significant reduction in data reporting errors (from 33% to 13%, p<.05) over a 9-month period, which led physicians to begin to trust in their data. Not just the doctors, but patients in our community have also recognized the value in their caregivers having access to accurate clinical data.
The brief outlines our experiences along with those of other Beacon Communities and explains the vital importance of capturing clinical performance through electronic quality measures embedded within the electronic health record.
The brief also highlights the challenges we faced and the practical solutions we developed and employed to address data quality and performance measurement issues.
Care managers in the Bangor Beacon Community collaborated with the IT department to create customized electronic health record forms that would support standard data collection and support their unique workflow needs.
In the Rhode Island Beacon, providers and quality improvement teams developed comparative data reports to facilitate viewing and tracking of performance, and benchmarking with peers.
The Central Indiana Beacon encouraged providers to buy-in to quality measurement activities by participating in the Quality Health First program— a collaborative effort of multiple providers, health plans, and employers— that provided payment incentives based on performance on select quality measures.
All stakeholders engaged in community-based health system transformation can identify with the topics described in this brief. Communities attempting to tackle these issues will discover that there is a sequence to establishing a foundation for assessing data quality and learning how to use data to drive improvement.
As Beacon team members ourselves, we know that this work is not easy – but it is essential to building and facilitating exchange of health information that people can trust to inform decision-making and work toward improving patient outcomes – which requires commitment and dedication from all levels of the health care community.
We also understand that having valid, reliable data provides a strong foundation for creating what the Institute of Medicine refers to as a ‘ Learning Health Care System ¹,’ to continually generate evidence to improve patient care.
Where to Learn More About the Beacon Communities’ Experiences in Improving Electronic Clinical Data for Quality Measurement
After reading this brief, we hope that you find yourself wanting to work to improve data collection using electronic health records and other health IT tools and analysis in support of care. We hope our experiences and those of the other Beacon Communities’ will inform your own work.
In the coming months, the Hawaii Beacon Community, as part of the Beacon Nation project, will unveil a Learning Guide: “Capturing High Quality EHR Data to Support Performance,” which will include the key considerations to mull over.
The guide also lays out the strategic steps communities must follow if they seek to improve the quality of data stored in electronic health records.
The goal of all of this is to support a diverse set of performance improvement activities, to coordinate services to control costs, and to help patients receive better health care and live healthier.
¹National Research Council. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press, 2012.