Lakeland Healthcare knows what it's like to go paperless, having achieved Stage 7 on the HIMSS Analytics EMR Adoption Model. The St. Joseph, Michigan-based, three-hospital organization also strives to be in the top 10 percent nationally for compliance with 79 core measures for care delivery.

"We hold ourselves accountable for building a system that produces a perfect product. Every time we have deviations from that standard, we need to be able to adjust to reduce the holes in our safety net," said Michael Getty, Lakeland's manager of integrated analytics, during Sunday's Physician IT Symposium at HIMSS15.

To do so requires exemplary reliability, capacity and pace, he explained. EHR-based interventions guide physicians toward perfection while rapidly handling core measure compliance regardless of where care is being delivered within the organization.

Deb Wolf, RN, a former surgical nurse and now Lakeland's manager of registries, outlined four keys to success:

1. Build out strategic best practice alerts, BPAs. Within the patient chart, the system analyzes the patient's treatment and diagnosis. If a core measure is out of compliance, a pop-up window alerts providers who can make a difference in care – by providing proper discharge instructions or a needed medication, for example.

2. Include clinical decision support in order sets. "We customize the order set to the patient in front of the caregiver," said Wolf. "We make sure that we guide that provider with the right information."

3. Handle patient list reporting in real time. A green banner within the patient record identifies a core measure patient. "Sharing information is what makes the EHR work," Wolf added. "Somebody placed an order to identify the patient for a core measure. We want to make sure everyone knows that."

4. Integrate a checklist. Like a paper checklist, the digital version questions and documents appropriate criteria for a core measure. The checklist expands within the record based on the patient's diagnosis.

"In our view, if you get the bedside clinician putting this process in place, you get someone who is an expert, who understands what it takes to pass the measure – and what it takes to exclude the chart from a measure in its totality," said Getty. "That person is so valuable to engineering the perfect process."