As providers develop and refine their eCQM solutions, supporting the quality of patient care should be a priority consideration
Hospitals and physicians face intensifying pressures to achieve measurable performance standards that demonstrate the quality of patient care. CMS, private payers, the Joint Commission, acute care registries and other regulatory bodies are now mandating that more and more of this evidence be submitted in the form of electronic Clinical Quality Measures (eCQMs). A recent Joint Commission survey found that 86% of hospitals expect to submit eCQMs to meet a CMS program deadline in February 2017.
As with electronic health records (EHRs), implementing technologies and processes to capture, validate and submit data has been extremely difficult. Given these challenges, hospitals will need to have focused all their efforts on meeting various eCQM reporting requirements.
This emphasis on reporting, however, too often overshadows the fact that eCQMs ultimately are not about mandates or quality scorecards but developing effective ways to leverage information to improve the quality of care. The greatest potential value of eCQMs will be their use in combination with real-time patient-level data analytics to support evidence-based clinical decision-making at the point of care.
As providers develop and refine their eCQM solutions, supporting the quality of patient care should be a priority consideration. Ideally, these solutions should:
- Provide meaningful, timely and actionable information to clinical professionals
- Ensure the quality and accuracy of the data
- Enhance, not diminish, clinicians’ productivity
- Facilitate collaboration between any number of clinical professionals
- Be easy to learn and use
EHRs Alone Are Not the Answer
To transition to eCQMs, most hospitals and physicians have relied on their EHR systems. To date, however, most solutions have not been as effective as planned. According to an American Hospital Association (AHA) case study, even hospitals well situated for success with eCQM adoption and committed to its implementation were “unable to use their EHRs to efficiently implement the eCQMs and achieve accurate results.” These findings were consistent with an American Medical Informatics Association (AMIA) report, which stated that “healthcare providers generally lack faith in the accuracy and completeness of eCQMs.”
Current solutions also are falling short in terms of supporting complex clinical care needs. The AHA study found that the eCQM implementation process at these hospitals with advanced EHR systems negatively affected clinicians by adding to their workload with no perceived benefit to patient care. It concluded that “eCQMs must be redirected so that the EHRs are working for the clinicians rather than the clinicians spending extensive amounts of time working for the EHRs.” Another survey by Nielsen Strategic Health Perspectives noted that about half of physicians using EHRs can’t get the information they need to coordinate care or share patients’ records electronically with clinicians outside their practice.
First Step: Offload Documentation Burdens for Clinicians and Staff
A good first step towards getting eCQM solutions to work for clinicians is recognizing the limitations of current technology and its adverse effect on physicians, nurses and staff.
The most important function of an eCQM solution is ensuring data quality. EHRs, however, are not designed to capture unstructured or inter-departmental information at the level of detail needed for eCQM reporting, especially for clinical data registries that can include hundreds of data elements. Since data often is missing, inaccurate or unavailable for use at the time of abstraction, clinicians and staff are spending inordinate amounts of time tracking down, reviewing and validating information in eCQM reports. This cuts into the time physicians and nurses could spend with patients and often leads to reporting backlogs.
To address this issue, many providers are outsourcing some or all of their eCQM abstraction and review responsibilities to quality experts. For example, many hospitals work closely with Q-Centrix clinical teams, who help them review charts in real time to identify and resolve problems before the patient leaves the hospital. This not only eases documentation burdens for clinicians but adds a layer of oversight to make certain eCQM reports are accurate, complete and properly formatted.
Leveraging New Technology to Empower Clinicians
The development of eCQM technology has been driven by its primary function, i.e., the reporting of quality metrics. But as eCQMs become more expansive, ubiquitous and integral to everyday healthcare practices, eCQM solutions must adapt to better support and empower clinicians and quality managers. From a clinical perspective, these solutions should have three key attributes: Flexibility, transparency and concurrent review capabilities.
Flexible eCQM technology allows hospitals to align data capture with current workflows without disrupting clinicians’ practices. Flexibility also enables the integration and interoperability of clinical data, both structured and unstructured, so that it can be easily shared across hospital department systems and physician practices.
Transparency enables providers to identify data quality fallouts and practice outliers, from patient admissions to discharge. Concurrent review empowers the caregiving team with real-time information to manage the entire patient chart while the patient is still in the hospital.
Advanced eCQM solutions with all three attributes enhance the productivity of physicians and staff while providing them with accessible and actionable data for patient care. For many hospitals, eCQM solutions require a combination of technology and outsourced abstraction/review services. As eCQMs play an increasingly important role in the clinic, they should select partners with in-depth clinical knowledge who understand the workflow challenges of implementation and offer practical tools that can help physicians, nurses and quality managers get the most value from eCQM information.