Reliability, capacity and pace key to meeting core measures

CHICAGO—Lakeland HealthCare a Davies Award winner, strives toward perfection in all 79 core measures through “exemplary reliability, capacity and pace,” said Michael Getty, speaking during a session of the Quality Symposium held during the 2015 Annual HIMSS Conference & Exhibition.

While Lakeland has put technology to good use to achieve reliability, Getty said it can be a double-edged sword. “As you become better and more advanced at having EHR-based interventions guide you toward perfection, when it does fail it becomes the EHR’s fault. ‘Why did you let me order the wrong antibiotic? Be aware that eventually the finger will turn around and point to you.”

For capacity, Lakeland designed a system that can handle the monitoring and compliance of those 79 core measures as well as analyze any failures.

Pace has been changing, Getty said. Lakeland has been able to reduce the time to perfection but, “looking back, we even that it’s too slow. What we did in a year we have to do in a quarter now.”

It was so difficult to implement changes with a paper chart, said Deborah Wolf, Lakeland’s manager of registries. Reminders floated around and everyone relied on memory-based process checks. In Lakeland’s ongoing pursuit of perfection, Wolf cited several steps.

Strategic best practice alerts provide just-in-time learning, she said. “With best practice alerts we can tell them exactly why they need to think about or perform some action.”

Order sets have clinical decision support. “We customize it to the patient in front of us and make sure we guide the provider to pick the right information.”

Real-time patient list reporting shows where a patient is at any point in time. “Information available in different workflows gives us the opportunity to pull that information for many different disciplines to look and see how well the patient is cared for.”

Sharing makes the EHR work, Wolf said. “We don’t just hit it from one angle. We make sure everybody knows who are our core measure patients.”

Lakeland set up its orders to accommodate the vast majority, said Getty. So, for example, orders put moderate first and then high and low. “Physicians don’t approach order sets like a multiple choice test. They are looking for what they need. By putting what they should most commonly use at the top, you’re going to get more compliance. Don’t make it harder. Don’t make a doctor wait to make the right decision.”

Lakeland also worked to make it easier for clinicians to document contraindications. The action was usually correct but the organization failed the measure because the reason wasn’t documented. Now they are at 99 percent for flu vaccine.

While documentation needs to flow to other places in the chart where others will view that information, Getty said it’s also important to realize that not everyone looks at the chart with the same view. “Really understand all of the pieces and places where this information is available and make sure the information gets there and is being updated.”

Lakeland is working on pace through the new core measure for the sepsis bundle. The organization implemented it in 90 days and will start measuring at the 90^th day, Getty said. Providers need to understand the rules of the game, he said. The bedside clinicians are the experts in the rules of the game. “That person is so valuable to engineering the perfect process.”

He also recommends that providers engage EHR analysts—“someone who really gets what you’re trying to do. They can think outside the box.”

Getty also advised that organization celebrate as much as they punish. “Have as big a carrot as you do a stick. People are much less likely to push back if you are congratulating more than punishing. Quality departments often seem like quality cops but they should be welcomed because they come to tell people how great they’re doing. That’s our data approach—‘you’re not so good on this measure but great at these other things.’ It’s worth it to spend time on that.”

Getty said it costs about $15,000 to be complaint with each measure so having one person dedicated to making sure they’re getting it right is worth the expense.

“Make the juice worth the squeeze,” he said. “When you just document for compliance’s sake, you’ll get more resistance. But, I think that some of these efforts by CMS to make data public and tie this to reimbursement has given us a joint motivation to make this real.”