EHR and Health IT Consulting
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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration

What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration | EHR and Health IT Consulting | Scoop.it

Participation in pay-for-performance plans like MACRA’s Quality Payment Program (QPP) poses new challenges for resource-strapped healthcare organizations. Many provider sites lack the time and technical expertise needed to retool their EHR implementation to document new metrics under value-based reimbursement models like the Merit-based Incentive Payment System (MIPS).

Nonetheless, that is precisely what clinicians must do to deliver on quality reporting requirements. When using EHR documentation tools, many factors must be considered for a provider to get credit on having met clinical quality measures (CQMs). How that information gets stored in the EHR directly affects reporting. Many healthcare organizations are finding that customizing an EHR to recognize when a measure has been met—preferably in a manner that poses as few interruptions to patient engagement as possible—is easier said than done.

 

Overcoming EHR Limitations

Many outpatient and inpatient settings still struggle with common EHR data management headaches. As clinicians bring new quality measures into the EHR, those underlying data management issues can foil even the best-laid reporting plans.

Discrete Data Capture

The push to better document clinical quality is causing a transition in EHRs to focus more on structured or discrete data that is easier to trend over time. Unfortunately, many healthcare providers still receive patient data from healthcare affiliates via fax. Those faxed documents show up as attachments in the patient chart and are not fully integrated into the patient data file. If that information was sent via HL7 interface instead, details on the care rendered by that hospital or other healthcare entity would flow into the EHR as discreet data variables. For many providers today, capturing that information in a manner that makes it usable in reporting and analytics still requires timely, manual data entry.

Documentation and Data Consistency

Provider sites with multiple clinicians may also encounter issues related to the slightly different way that each EHR user documents care. MIPS and other quality programs require consistency and a high degree of specificity in clinical documentation. If a clinician does not get diagnosis specifics into the patient chart, that patient may not be included in the CQM calculation they need to be included in. Many clinicians are having to modify their documentation process during patient encounters so they and the staff can capture all the necessary information in the EHR.

Clinical documentation will have even bigger repercussions under the Cost component of MIPS, which is slated to be factored into performance scores in coming years. Take, for example, a patient that is in for the flu. That patient has a certain anticipated cost impact (the average Medicare spending per beneficiary), calculated based on past medical history and services rendered. If a patient goes to a physician and has the flu but also has diabetes, heart failure, and asthma, that flu patient is probably going to cost more to care for. If the physician only submits the flu diagnosis and fails to document patient co-morbidities then the healthcare organization will not get the same allowance under the MIPS Cost category and could be labeled as “higher cost” than a comparable provider encounter for a patient that required fewer resources to care for.

Clinicians, coders, and staff need to make a mental transition away from “we’re submitting claims” to “we’re submitting data” to better serve clinical reporting initiatives and patient care analysis.

 

Making Informed CQM Selections

Beyond adapting to new data management processes, clinicians reporting under value-based programs also have a great deal to learn as they layer in additional quality measures under MACRA. One of the biggest challenges clinicians and administrators face is selecting the best measures for their specific healthcare organization. With limited spare time on their hands, many healthcare teams are leaning on outside expertise to help them evaluate the implications of various measure selections.

Measures Without Benchmarks

Many quality measures under MACRA are carry-overs or “relics” from other reporting programs. For these CQMs, providers can look to prior performance averages to evaluate the likelihood of success should the healthcare organization elect to report on those measures. That data does not exist for some CQMs, which are referred to as “measures without benchmarks.” On measures that have no benchmark data available, providers will be limited to a maximum of three reporting points instead of the ten points available on measures with benchmarks established.

To further complicate things, details on the availability of some benchmark data will not be calculated until after the March 2018 QPP reporting deadline. Providers may wish to further diversify or report on additional measures that could help offset low point earnings on measures without benchmarks.

Topped Out Measures

Another CQM caveat that providers should be aware of relates to “topped out” measures. These relic measures from other reporting programs are very engrained in many healthcare settings. Medication reconciliation, for example, was a requirement under Meaningful Use. Widespread adoption and universally high compliance rates on that measure makes it more difficult for clinicians to out-perform peers. Achieving maximum points on such measures requires a perfect or near-perfect score.

Keep average performance thresholds in mind when evaluating CQM selections, not just the healthcare entity’s individual performance track record. Look at a broader set of measures to maximize MIPS score potential. Clinicians could earn more points by scoring 70 percent on a non-topped out measure than they would earn scoring 95 percent on a topped out measure. Some topped out measures will likely be eliminated in future years to help diversify CQMs, as was the case under Meaningful Use.

Understanding the intricacies of CQM selection and EHR data management will be vital to success under value-based payment programs. Healthcare administrators and clinicians who proactively work to better understand the impact of various measures and streamline EHR processes will be best positioned to maximize program incentives.

 

Does your organization have the resources it needs to successfully navigate MIPS? Learn how Pivot Point can help with your value-based strategy.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

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Top 10 Steps to Health IT Implementation and Long-term Success

Top 10 Steps to Health IT Implementation and Long-term Success | EHR and Health IT Consulting | Scoop.it

Successful implementation of information technologies in a clinical environment often involves dozens of key stakeholders, hundreds of clinical and technical considerations, and thousands of end-users. With this many factors and technical details to manage, it’s easy to forget the fundamentals. From articulating a clear vision for your organization, to tracking the right metrics, to prioritizing training and education, it can be difficult to know just where to begin. To help you with the process, here are 10 steps to health IT implementation and long-term success.

  1. Create a culture of collaboration and partnership. Ensure that each member of the vendor and customer teams understands that both parties will either succeed or fail together. In a culture of cooperation and shared priorities, the vendor helps the customer reach the highest level of success, and the customer helps the vendor earn the highest reputation for the work they do.  
  2. Clearly identify key leaders. One of the most important investments any healthcare organization can make is in its leadership team. The customer team members must include (at the very least) an administrative champion, physician champion, and technical champion.
  3. Select and empower a physician champion. Formally select a qualified physician champion based on his/her excellent communication/teaching skills, commitment to the mission, and leadership capability.
  4. Document team mission, vision, and values. Have all team members contribute to and sign-off on these foundational documents. Together, they will help to establish the direction, priorities, and guiding principles that will keep everyone on task and on the same page.
  5. Establish rules for communication and decision-making. Set a rule from the outset that all communications are shared among key stakeholders. Document each implementation task, assign a responsible owner, and create a due date to ensure that each person is accountable and appreciates that an incomplete task means a project delay.
  6. Establish clear objectives, success measures, and timelines. Success often requires changes in technology, processes, and personnel. Start by identifying important benchmarks and metrics that best match your values and project domain.
  7. Training. A training team should be established at the start of the project, including a lead trainer from the vendor, the physician champion, and other appropriate customer personnel. And remember, training is an ongoing process. It doesn’t end upon implementation.
  8. Standardize implementation to boost quality and efficiency. Strongly consider creating an imaging-centric master file of procedure types rather than just adopting what was used in the previous system.  Think of the procedure list as the DNA of your imaging IT implementation. (Ideally, it should include less than 1,000 procedures.)
  9. Agree on white-glove inspection requirements. Clearly delineate the system and personnel tests that must be completed before you go live and before you complete on-site training. For example, set up a checklist that specifies pre-go­live system validation testing, including best practice default configurations, master-file setup, and emergency procedures.
  10. Measure, compare to benchmarks, and market the benefits. Use technology and the patient visit to communicate with your patient population and continuously solicit their feedback. Applicable technology may include your patient portal, your website, or patient hand-outs. Similarly, let your referring staff and contracted payers understand and appreciate your achievements. Don’t be afraid to make bold claims now that you have the data to back them up.
Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

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