Many physicians doubt that electronic health records (EHRs) improve the quality of care. But relatively few practices are mining their EHR data to see how well they’re doing or to update their care delivery processes. Most are collecting data mainly for external reporting purposes, usually with the help of automated EHR features.
According to a recent study in Health Affairs, between 2007 and 2013 the percentage of large practices that collected data on quality measures nearly doubled; that activity increased even more in small and medium-sized practices between 2009 and 2013. But the use of electronic registries to identify patient care gaps and the feedback of performance data to physicians remained confined to a small percentage of practices.
There are several possible reasons for the low interest in mining data for quality improvement. Most physicians believe they’re already doing a good job, and they may feel they’re too busy to devote time to running reports and looking at data. Especially if they’re working in small practices, they may feel intimidated by the technical requirements of data mining. It’s also difficult for providers to enter data consistently in the right EHR fields so that they have enough data to yield solid information on individual patients or populations.
With the growing use of value-based reimbursement, however, practices find themselves under increased pressure to prove that they are providing high-quality care to patients. At the same time, payers’ are emphasizing population health management, which requires practices to identify care gaps and reach out to those who need care, regardless of whether they’ve been seen recently.
Experts and doctors interviewed by Medical Economics say data mining is vital to helping practices meet those objectives. Each practice must find an approach that fits its needs and goals; but whatever that is, the sooner you get started, the better off you’ll be in the long run.
Data mining options
Health IT experts advise practices to take a close look at their EHR’s capabilities before thinking about using outside solutions or outsourcing. In many products, these capabilities include health maintenance alerts and report writers.
Health maintenance alerts, which are reminders about preventive or chronic care services that are recommended for a particular patient, pop up whenever an electronic chart is opened. While their use may not be considered data mining, when you create a new health maintenance alert, you are, in effect, mining your EHR data for a purpose.
It’s difficult to program new health maintenance alerts in most EHRs, says Ernie Hood, senior director, research and insights, for the Advisory Board Co. But Jen Brull, MD, says that her nine-provider family practice in Plainville, Kansas, customized several alerts without any trouble. The real problem with prompts, she says, is that they can be overwhelming. “If you turn on everything all at once, you don’t pay attention to anything.”
Another method of data mining is to run the reports available in the EHR or to write the reports you want and then run them. This is an area where EHRs differ widely. Brull, for example, says that her EHR includes prebuilt reports for all of the quality measures in the Meaningful Use incentive program and the Physician Quality Reporting System (PQRS). However, her practice cannot modify these reports because they’re written to meet EHR certification requirements. To produce custom reports, the practice’s IT staff developed a special web-based application that queries the EHR database.
In contrast, Michelle Holmes, MBA, a Seattle-based principal with ECG Management Consultants, says the problem with many EHRs is that they don’t offer enough prebuilt reports. Instead, they supply a “sandbox” and a variety of tools that practices can use to write their own reports.
“They provide a blank slate where you can identify the criteria or parameters of the report; you can identify the frequency with which you want to run the report, identify the target population, and so on,” she says. The vendors do this, she notes, so everyone can create the reports they want. “But there’s still a lot of setup that you have to do, and many people never get to it. So even though a lot of EHRs offer this functionality, it’s underutilized.”
Rosemarie Nelson, a Syracuse, New York-based consultant with the Medical Group Management Association (MGMA), agrees that EHR report writers are underutilized. Noting that some of these applications are not hard to use, she suggests that practices ask their vendors for advice setting up the reporting modules. They can also attend user group meetings or webinars. A report that shows how many and which diabetic patients in the practice are overdue for an HbA1c test, she says, can be written by a nontechnical person with the right training.