The Transition to eMeasures

Added on Mar 1, 2016

The Transition to eMeasures
By Elizabeth McConville, RN
From Industry Edge February 2016

The transition to electronic clinical quality measures (eCQMs) as mandated by federal quality reporting requirements may seem daunting, but the process can be eased by adopting some of the proven practices of those who have successfully made the switch.

While the shift must be carefully planned and deliberately managed across the organization, the long-term payoff of a robust, standardized process will be a system through which measures are consistently defined and implemented, enabling the delivery of safer, higher-quality and better-coordinated care. Further, the transition will ultimately allow members of quality teams to redirect their efforts from dedicated chart abstraction toward proactively intervening with clinical caregivers to make sure that appropriate care is delivered and documented to improve patient outcomes and health care reliability.

With 100% of a hospital’s inpatient annual payment update and 4% of the Physician Fee Schedule annual update at risk based on successful participation in the EHR Incentive and Hospital Inpatient Quality Reporting programs, there is a fiscal imperative to transition from manual to electronic capture of clinical quality data.

In addition to the financial implications, a smooth transition to eCQM data will accelerate progress toward the aim of improving the patient experience and reducing patient suffering, but only if the data are accurate and complete. Ensuring this requires a high-reliability, quality data system and strategic integration of eCQM data elements into the EHR.

The transition process should progress through three phases: accepting the technology, which requires identifying stakeholders and building the eMeasures team; modifying workflows to support accurate, reliable data capture; and establishing trust in the data by validating it and continuously monitoring progress.

Phase 1

Identify Stakeholders

  • Identify a quality professional as the process change leader.
  • Initiate a working relationship with the EHR and quality data vendor representatives.
  • Involve all disciplines (including less tech-savvy staff and those most resistant to EHR documentation) that use the EHR as early as possible in the planning phase when developing the electronic presentation of information referred to as an “electronic workflow.”

Build the Team

  • Cross-train team members and have IT and quality personnel present on current practices and regulations to the larger group to inform each party of the expertise of the other and improve the understanding of data points and back-end mapping.
  • Define the role of each member.
  • Involve the cross-functional team in every step of the process.
  • Prepare for the potential need for additional FTEs to counter any lost productivity during the transition.
  • Prioritize care delivery over documentation. Let caregivers demonstrate clinical processes and the documentation process that best supports their efforts. This will result in greater compliance with documentation over time.
  • Set goals and deadlines. Define the scope of the project and measures of success for individual accountability and trending over time.
  • Classify areas of opportunity as process, documentation or standard of care to guide improvement activity.

Phase 2

Capture Data

  • Identify where and how existing documentation (electronic and paper) captures eCQM data elements. This will guide discussions with programmers when determining where the elements should appear in the electronic workflow.
  • Identify all areas in which data are currently collected—eliminate redundancies causing contradictory data.
  • Use hard stops—requiring data entry in a certain field before allowing any further documentation. This function is valuable for capturing all components of an element or linked elements in an algorithm, but should be used judiciously to avoid slowing and frustrating clinicians.
  • Apply process automation functions that use diagnostic results or assessments—such as venous thromboembolism risk assessments—to trigger content displayed in related order sets and protocols.
  • Provide ongoing EHR technical support to all staff and EHR implementation team members.
  • Provide educational outreach to inform staff and physicians of the quality-improvement strategy and the importance of valid data capture to support that strategy.

Phase 3

Validate Data

  • Ensure that the captured data are consistently complete and accurate by evaluating each data element to verify that the format and definition are the same in both the sending and receiving systems.
  • Assess the mapping of data elements from the EHR into the Quality Reporting Data Architecture (QRDA) eMeasure files by reexamining content within the files against content in the EHR element by element.
  • Run baseline reports early in the process to evaluate reporting capabilities and ensure that a reliable method exists for analyzing data.

Monitor Progress

  • Compare trends of validated eCQM data with chart-abstracted measures of the same name in run charts.
  • Closely monitor patient survey scores for early identification of any negative impact that EHR-implementation practices may have on the patient experience.
  • Celebrate successes throughout the project. This is a major accomplishment requiring a substantial team effort.

To successfully manage the shift from abstracted to electronic clinical quality measures, organizations must embrace a disciplined, collaborative approach for eCQM reporting, not only for the initial transition but also over the long term, to maintain and make necessary adjustments as eCQMs evolve.