HIMSS: Panel discerns how to measure quality for EHR adoption, usage

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ORLANDO, Fla.—The message of the HIMSS11 Physician IT Symposium panel discussion about meaningful use requirements was that EHR adoption is worthwhile--eventually. And when it comes to measuring quality, "trying to do this is a lot harder than it seems," said Dean F. Sittig, PhD, of the University of Texas Memorial Hermann’s Center for Healthcare Quality and Safety in Houston. “The only way to improve quality is to measure it, but it’s really hard to measure quality,” he said.

The discussion about meaningful use is really a discussion about how to get this system of measurements to work, and the first tool for that is a certified EHR, according to Sittig. “The idea of a certified EHR is really to make sure you’re not using Word to report what’s happening … if you don’t put it into the computer in a coded format, you can’t extract anything, and if you can’t extract, you can’t make your quality measures. It’s all about getting some data out into a form that you can add up in Excel,” Sittig said.

The meaningful use measurement journey doesn’t end there, either. Once data is in the computer that doesn’t mean quality is going to improve: “The computer has to do something at the point-of-care and that’s the idea of decision support,” he said. “You need these coded data. The computer needs to know the data are in there and trigger an alert to fire.

“It’s harder to write down logic. You need to get the decision maker right to the computer system,” Sittig said.

Sittig’s fellow panelist, Anthony F. Berliner, MD, associate medical director, clinical decision and information systems support at Allina Healthcare in Minneapolis, described two EHR implementations in the organization—the first of which proved to be a learning experience for the second.

The first implementation, at Abbott Northwestern Hospital in Minneapolis, struggled from several factors:

  • The idea that EHR use was optional;
  • A leadership change at the facility; and
  • The opening of a new heart and vascular center.

“We didn’t know what we didn’t know," Berliner said. As a result, the hospital suffered through six months of hybrid charting, piecemeal implementation, separate clinical documentation and computerized physician order entry (CPOE) rollouts.

Allina decided to “rip the bandage off,” with stronger leadership in place and committed to getting out the right message, that “the EMR is the patient chart and everything happens here, including documentation to support billing. We made sure to listen, build and rebuild with no physician left behind,” said Berliner.

In the process, Allina saw “tremendous resisters to EHR usage, [but] six months later, they’re your champions,” he said.

Berliner took this and other lessons to United Hospital in St. Paul, where the provider went live with a facility-wide big bang implementation, with one physician clinical documentation and CPOE. Minimal hybrid charting (two weeks) was allowed. Today, the rate of CPOE usage is 70 percent to 85 percent, depending on site culture, he added.

When it comes to meaningful use, “you need to bring them to the water and make them drink – or make them want to drink the water," he said.