With EHR adoption, there is an opportunity to improve the health of your patient population. There are certain tasks that become more accurate when the processing power or formatting of an EHR is leveraged. This is one in a series of articles that explains how the “Holy Grail” of improving quality at the point of care is achieved with MediTouch EHR®.

The other day as I was leaving for work, my wife asked me to look in the refrigerator and pick up any of the usual staples that we might need on my way home that day. “Of course,” I replied, took a quick look (but did not make a shopping list), and out the door I rushed on my way to work. On my way home, I parked the car at the local supermarket, and with the best of intentions, I walked into the market ready to re-stock our fridge. Then the mobile phone rang; it was an important work contact that I had been playing “telephone tag” with. I took the call as I walked into the store and began to multi-task. I was focused on the call, but I was sure that I could recall the inventory of our refrigerator, fill the shopping cart, and most importantly, complete this important call. It should come as no surprise that when I returned home, my recollection of our food inventory proved to be incorrect. I had missed some items, and it was too late, I was now miles away from the store. When I was at the store, I was focused on the urgent task, the important phone call, and I realized that as well intentioned as I was, I did not complete all of what I set out to do. What I really needed was a computerized food inventory system and what would have even been better was an automated way for the groceries to miraculously appear in my cart. That seems like a magical idea, and it may be impossible with regard to grocery shopping, but with MediTouch® Health Maintenance, computerized quality measure inventory and management is not just possible: it is finally here.

Every Patient is Unique – There is never enough time!
Every patient has his or her own unique “inventory” of Health Maintenance Measures that are keyed to quality healthcare. Sometimes, patients are specifically scheduled for “well” visits, but most of the time, patients are seen for either an acute healthcare concern or the treatment for one or more chronic conditions. When the patient presents for care, the practitioner may be focused on the chief complaint in the same manner that I was focused on my phone call. From a time and accuracy perspective, it is challenging for providers to squeeze the health maintenance analysis into the appointment slot allotted for a typical encounter, especially when that encounter is focused on the treatment of an acute complaint. Yet, according to most P4P (Pay for Performance) programs such as PQRS or Meaningful Use, it is the provider’s responsibility to provide health maintenance analysis and advice if one of the E/M (Evaluation and Management) codes for acute or chronic care is billed. Even if the provider has the time, since many quality measures could apply to a single patient, providers need help performing the analysis. As an example, a 65-year-old diabetic female could have at least 15 distinct measures to track. Tracking measures is not as simple as a Yes / No checklist, since many factors contribute to how a specific measure is applied to the patient’s unique medical profile. In the example of the 65-year-old diabetic female patient, understanding each quality measure in not enough; the provider needs to process what medications the patient is taking, the medical problem list, what tests or procedures have already been performed, and then apply them to each measure. Many measures support one or more reasons for medical exclusion. Medical exclusion means that there is a documented medical reason (in the chart) as to why the patient did not meet any of the measure values. Without help, it is almost impossible to track, document, and order the proper procedures to meet the growing list of quality measures that may apply to a specific patient.

How Do Providers Meet the Challenge?
I have asked providers how they were meeting the challenge of performing and documenting Health Maintenance. Some providers just skip participating in P4P programs because the time and effort required to comply will never equal the incentive dollars paid. Another group of providers has a team of nurses that perform chart audits that help them report on compliance with quality benchmarks at the end of each reporting year. Finally, there are providers that choose a small group of patients and report via a Web-based tool, also usually at the end of the reporting year. Not one of these common solutions meet the standard of the “Holy Grail” for quality; analysis and action at the point of care – when the patient is in the exam room. In my shopping list example, it was too late to pick up the required groceries once I returned home from the market.

Who Formulates These Quality Measures?
Quality measures, benchmarks, and decision support statements are formulated by organizations that are widely recognized as experts on the measurement of provider performance with regard to the scope of healthcare and service. These experts include the AMA, NCQA, and NQF, and their measure formulations are published nationally. In addition, CMS as part of the Medicare PQRS and Meaningful Use programs, choose measures published by these experts and include them in their incentive programs. As I have stated in other blog posts, every provider should keep in mind that these “incentive programs” eventually morph into “penalty programs.” Unless you are retiring soon, your practice cannot afford the pay decrease associated with those “penalties.”

Recap

  1. Patients have their own unique “inventory” of Health Maintenance opportunities.
  2. Providers are challenged to perform Health Maintenance during encounters for acute care.
  3. Quality measures are keyed to P4P incentive / penalty programs.
  4. The analysis of how measures are applied to a specific patient is complex.
  5. This complexity makes it difficult to track, document, and provide guidance at the point of care.
  6. Providers need an automated system to assist them with Health Maintenance.

The MediTouch® Solution
The MediTouch Health Maintenance module “gently” reminds the provider when there is an opportunity to complete one or more quality measures. The MediTouch system uses coding performed by the provider and/or data captured via interfaces to automatically match the metrics of the quality measure to the unique treatment and medical exclusions for a specific patient. This data is calculated on-the-fly so that the data is accurate and up-to-date. MediTouch Health Maintenance works with the standard quality measures published by respected quality organizations and adopted by influential P4P programs such as PQRS and Meaningful Use. In fact, our system will automatically format reports in a manner that makes it easy to participate in those P4P programs (see our blog post on PQRS). Most importantly, the system is fast and allows the physician to provide health maintenance guidance at the point of care. Now, even if there is an acute problem that is the major focus of your attention, it is simple to include the appropriate health maintenance advice as part of the encounter.

When shopping for an EHR solution, make sure your vendor has an easy way for your practice to track health maintenance measures and report them to P4P programs. Remember, it should be as simple as throwing a loaf of bread into your shopping cart.