Financial rewards are being used as the carrot for healthcare providers to adopt electronic health records, achieve meaningful use and include quality reporting and tracking in outcomes measurement. And while dollars from federal economic stimulus grants and the Physician Quality Reporting Initiative are creating more interest in using IT for those purposes, specialists in the field say money shouldn’t be the primary impetus.

“Our rationale is not the money, but to move forward and provide demonstrably better care,” said Peter Basch, MD, medical director of ambulatory EHR and health IT policy at Columbia, Md.-based MedStar Health. “As a physician, I have become a convert about using IT to make care better and safer and am now accused of being a bit of a zealot.”

With more than 30 years in practice, Basch said he became interested in IT and electronic health records because manual processes were too cumbersome.

“I travel between offices and I would lug charts back and forth and many times I would have to call and fax people to get missing chart information,” he said. “Even before I heard the word ‘data,’ I knew there had to be a better way to access information.”

Over the past decade, Basch helped MedStar introduce electronic medical records into ambulatory care sites.

“Getting capital for ambulatory care projects was difficult because they were not first in line for spending,” he said. “Then around 2007, MedStar embraced the mission across the enterprise. We’re now almost done with the project – with another year to go, we have 50 sites live on EMRs, including 70 specialties and 1,000 staff members.”

Waukesha, Wis.-based GE Healthcare’s MQIC consortium and Quality Reporting Services has been an integral tool for the process. Throughout the implementation, Basch said, he has learned that “the looking glass of quality is a difficult thing to do.”

The hardest part, he said, is getting consensus among clinicians about data compilation and characteristics.

“We get quality reports from payers and physicians that will typically look at them, say they are wrong and shred them,” he said. “What we have to do now is quit griping and become part of the solution. We need to actually look at it and if there is something wrong, don’t throw it out – explain why it is wrong. Once we reach a point where all agree it is right, the magic will happen.”

Stakes are higher

Because reimbursement is tied to quality metrics, “the price of the poker game has gone up,” said Bob Gift, director of operations improvement at Chadds Ford, Pa.-based IMA Consulting.

The purpose of quality reporting and tracking is to provide a weighted scale of clinical measures that are factual about outcomes. The Centers for Medicare and Medicaid Services has listed 17 outcomes it wants in place for 2012, to measure clinical impact along with patient experience and satisfaction ratings. The reports are to be filed on the CMS website.

Because President Barack Obama’s healthcare reform act is budget-neutral, the proposal is to reduce all base operating Medicare DRG payments by 1 percent by 2013. The difference is made up with quality measures.

“Is the return worth the investment? No, but it’s not as if you have a choice,” Gift said. “There is potential to lose significant revenues. Those who went through the pilots haven’t seen the kinds of payoffs with the speed and volume they expected. And as the system for quality reporting becomes more focused on outcomes, it’s going to be tougher and tougher to comply. In 2014, they will add another 21 measures. The numbers will continue to accelerate.”

The challenge for hospitals, Gift said, is not just whether they have the technology necessary to compile and report the data, but “whether they can get the data at a granular enough level so that they can do something to improve performance.”

Gift said the metrics are “based partly on how we’re currently doing and in the future and how much we have improved.” And while the concept of quality comparisons has been questioned by some in the physician community for not being “apples to apples” in scope, Gift said the comparisons can be made with the right distinctions.

“Instead of being ‘apples to apples,’ it is more like ‘Jonathans to Granny Smiths,’” he said.

Proactive approach

As a physician, Darren Schulte, MD, vice president of clinical strategy at San Diego-based Anvita Health, appreciates providers’ need to understand “the new lay of the land and new rules of the game” when it comes to quality reporting and tracking.

“With the advent of meaningful use and EHR adoption, it crystallizes the IT effort because there are dollars attached,” he said. “With meaningful use, hospitals see issues related to decision support and don’t know how to go about doing it. These things are typically not in their sweet spot.”

Quality measurement should be part of the daily workflow, and clinicians need to understand how to work with the data they capture, Schulte said. Generating and reporting results is part of a new “proactive” approach to healthcare, he said, which shifts 180 degrees away from the traditional “reactive” method.

“Historically the medical model has been to understand the problem, diagnose and treat,” he said. “Quality measurement involves thinking about patients, their conditions and what evidence-based medicine says is addressing them. Proactive medicine means addressing issues before they become something more significant. Using quality measures and reporting is a fundamental change in the way medicine is practiced so that you can understand issues for the entire practice. Medicine will never be optimized until you have that holistic view of what their patients need.”

Patient outreach

Green Bay, Wis.-based Prevea Health has made strides with diabetes research using Dallas-based Phytel’s Proactive Patient Outreach system. Under the direction of Ashok Rai, MD, the organization has built a registry of patients who require preventative and chronic care, while the technology triggers automated messages to patients who are due for office visits, tests and other services.

Prevea’s recently completed study shows that an automated patient identification and outreach program “can be an effective means to supplement existing practice patterns to ensure that patients with chronic conditions in need of care receive the necessary treatment,” Rai said.

The health system found that patients who received automated telephone messages were more likely to have both a chronic care office visit and an appropriate test than patients who were not contacted. Compared to a control group of non-contacted patients, about three times as many diabetic patients who were successfully contacted had both a chronic care visit and an HbA1c test within six months of the date when they were classified as noncompliant with recommended care. Also in comparison to the control group, about twice as many patients with hypertension who were successfully contacted had both a chronic care visit and a systolic blood pressure reading within six months of their non-adherence date.

Bottom line: Better medicine

Hunterdon Healthcare Partners in Flemington, N.J., has an active quality tracking and reporting system in place, and the effort has yielded $120,000 in incentive payments to date, said Robert Murry, MD, medical director for informatics.

Adopting the Health Quality Measures reporting module from Horsham, Pa.-based NextGen in 2009, Hunterdon can now track more than 20  PQRI quality measures, with more added each year. In use by 22 practices and 12 providers, the reports offer an overall pass-fail rating for the Hunterdon enterprise and practice. To date, the organization has generated reports for 36,000 patients and 107,000 patient measure combinations recommended by CMS.

Murry sums up Hunterdon’s progress this way: “The whole reason for the pain of going to electronic records is so you can turn around and use the information to take better care of people. So where are we? We are taking better care of people with electronic records than we could on paper, but we’re not at the point where we are using it at its fullest – very few people are. We still have a lot of work to do.”

Murry said he can’t wait for the capability to feed information into a dashboard so that whenever a patient’s chart is opened, the clinician gets an instant report card on the patient’s status.

“What we’d like in terms of technology is to organize all the information to take care of the patient and present it to the clinician who needs it at that moment,” he said. “Electronic records can do so many things and as they become more entrenched and hold more data, it becomes more difficult to find what you need. We must find a clearer view.”