Successful Adoption of an Electronic Health Record Completed:

Now how do we get accurate reports out of it?

A case example: Southwest Internal Medicine (SWIM) - St. George, Utah

In February 2008, Southwest Internal Medicine was highlighted in the UMA Bulletin by HealthInsight after they successfully adopted an Electronic Health Record (EHR) system going paperless in their office. Since this time Southwest Internal Medicine (SWIM) has continued to fine tune their use of the EHR.  In particular they improved their ability to produce reliable reports. SWIM is involved in several  HealthInsight projects that have facilitated this process - the Medicare Care Management Performance Demonstration (MCMP), the Centers for Medicare & Medicaid Services Prevention project, and they have also recently signed up to receive support from the HealthInsight Regional Extension Center.

When SWIM received their first report card from the MCMP project they questioned the accuracy of the Colorectal Cancer Screening numbers. The numbers seemed low. This began an investigation and gap analysis. According to Sandee Stevenson, their office manger they discovered "we were not recording the results [in our EHR system] in a way that could be queried for reporting purposes.  The information was there but wasn't where we could access it."

HealthInsight has found this is a common problem in many clinics where results are buried in a progress note, pdf of results, or in a field that cannot be pulled up on a report. In addition, orders and results need to be matched appropriately. It will be increasingly important to clinics to be able to fine tune this process of putting results in the right field and matching orders in the EHR as the nation moves toward "meaningful use."

Leadership at SWIM chose to move on this issue with input from HealthInsight and their vendor (eClinicalWorks). The clinic identified which fields were the "critical fields" for the reports of interest.  During a staff and provider meeting these fields were explained and the importance of consistent documentation across providers was emphasized. Sandee stated "the medical assistants and front office were trained on how the orders needed to be entered and how important it was to document the results in the correct field....Now there is a check and balance process in place." The clinic now has a process in place so that results would be in the proper fields going forward.

Nevertheless, they still had a database full of results in wrong fields. In response to this issue, the medical records staff along with others began an effort to clean up their records. Patient specific reports on the measures were run by HealthInsight staff.  Next, SWIM staff manually queried these patients for the proper results in progress notes, order fields, result fields, and other fields.  The proper result was then copied to the correct field.  Sandee described the process, "The task was divided between a couple of staff members.  The searching and correcting was time consuming and tedious but worth it in the long run." 

HealthInsight ran overall reports at regular intervals to see their progress.  In August 2009, their Colorectal Cancer Screening measure rate was reporting at 0.2%. They progressed dramatically quarter by quarter and as of August 2010 their rate reported from their EHR was 61.5%. For the Breast Cancer Screening measure in August of 2009 their reported rate was 1.9% and as of August 2010 their more accurately reported rate was 61.1%. Similar results and improvements have been seen in diabetic foot exams and eye exams among other measures.  These dramatic results were achieved with a clean database and correct documentation moving forward will keep them accurate.

The clinic now believes their reports are accurate and reflective of care. There are still some minor issues with documentation which they continue to improve and correct. Their rates will continue to go higher. Nevertheless, they have more confidence in the accuracy and are situated to maximize the use of their EHR reports as the health care world moves towards pay for performance and "meaningful use."  This ability will be critical for all clinics in the future.

All of the work they have engaged in relative to these quality improvement projects has positioned them for an easy transition into Meaningful Use.  SWIM providers have begun their 90-day reporting period and are working towards attestation in early August.  Congratulations to a wonderful team at Southwest Internal Medicine!