IMPROVING EMR INTEROPERABILITY:

A Quality Improvement Perspective

Kirti A. Patel, MD!Health Alliance—UMass Memorial HC

Problem Statement

Numerous and disparate EMR systems with poor interoperability result in needless duplication, waste, poor communication between providers and patients, delayed decision-making, and medical errors, all of which are unacceptable as we strive for excellence in patient-centered care.

Critical Challenge

The focus of my critical challenge has been on working with the IT team at my organization, Health Alliance Hospital, to promote and improve network connectivity between the main hospital’s EMR system and the EMR systems at the various office practices.

IOM Six Aims of QualityHigh functioning health IT can

foster:!❖ Safety: decrease medical errors!

❖ Effectiveness: aid clinicians in evidence-based decision-making!

❖ Patient-centeredness: improve communication with patients and encourage participation!

❖ Timeliness: decrease delays in transfer of vital information!

❖ Efficiency: reduce labor and supply costs, and reduce duplicative testing!

❖ Equitability: helps to standardize care

Change Drivers

❖ Regulatory: Affordable Care Act, HITECH Act!

❖ Financial: Meaningful Use, efficiency gains!

❖ Technology: tech advances push healthcare to keep pace !

❖ Culture: cultures of safety, transparency & patient-centeredness

Chin & Benne Change Strategies

❖ Rational-Empirical: Presenting evidence regarding improved quality, safety, and decreased costs with high functioning EMR systems!

❖ Normative-Reeducative: Sharing positive experiences with EMR interfaces and relating advantages; word-of-mouth from those providers who have had positive implementation experiences!

❖ Power-Coercive: Disincentives and penalties that arise out of failure to implement effective EMR systems

Principles of QI

❖ Systems-thinking: HIT requires a systemic approach, as it cuts across many different facets of an organization!

❖ Reliability: ensure data is accurate, accessible, minimize downtimes, and try to prevent shut downs!

❖ Accountability: ensure that there is ownership for the data that is collected and an appropriate response!

❖ Measurement: set metrics and assess performance

Performance Measures❖ Outcome measures:!

❖ medical errors!

❖ clinical quality measures: favorable outcomes, complications, mortality rates!

❖ satisfaction surveys!

❖ Process measures: !

❖ redundant testing!

❖ billing process: charge and capture process, billing errors!

❖ labor costs: chart pulls, data transfers, transcription!

❖ Structural measures:!

❖ overhead costs: paper/ink, fax/phone and storage costs!

❖ malpractice costs

–Genise Patterson

“There’s no such thing as perfect or complete…only continuous improvement.”