Rather than wait for EHR vendors to incorporate quality measures into their software, researchers from Evanston, Illinois-based NorthShore University HealthSystem created a quality improvement and practice-based initiative in neurology using their EHR. 

The study focused on 10 neurological disorders, such as brain tumors, epilepsy, migraine, Parkinson's disease and restless leg syndrome. The results were successful enough that the researchers are licensing for free the use of the 11 structured clinical documentation support (SCDS) toolkits they built that standardize office visits, write progress notes, and capture data. Users must agree to join the Neurology Practice-based Research Network (NPBRN) and agree to share deidentified data.

“Traditional clinical trials enroll selected patients, use surrogate measures, follow patients for short periods and generalize poorly to clinical practice,” wrote the authors, led by Demetrius Maraganore, MD, medical director of NorthShore’s Brain Insitute. “Data captured in the EMR could be used to identify eligible patients, assign treatments and measure outcomes at the point of care."

The study was published in Neurology Clinical Practice, a medical journal of the American Academy of Neurology.

“There are several approved treatments for common neurologic disorders but it is unknown which are superior in efficacy and tolerability and for which patient subgroups,” the authors wrote. But, “data captured in the EMR could be used to identify eligible patients, assign treatments and measure outcomes at the point of care.”

To build buy-in for their quality improvement project, they regularly communicated benefits of SCDS, including (1) care navigation, (2) note writing, (3) timely communications, (4) value-based payment, (5) patient safety, (6) quality improvement, (7) comparative effectiveness, (8) personalized medicine, (9) scholarly activities, and (10) innovation. “We engaged the neurologists in the design, building and implementation of toolkits and the related reports and quality improvement initiatives and met regularly to improve tools and processes. We incorporated bonuses for group performance in quality goals into our compensation model.”

The researchers also encouraged neurologists to pilot test the SCDS toolkits in the EMR development environment and then share their optimizations post implementation. 

They expect to improve quality by standardizing office visits using SCDS toolkits and by regularly reviewing enrollment, data quality, descriptive cohort and quality improvement dashboard reports. And, they hope "EMR vendors will incorporate SCDS toolkits similar to ours and make them broadly available to clients as part of their standard products. Once common data elements are extracted, transformed and loaded into a data warehouse (regardless of the EMR platform), the same enrollment/encounter, descriptive and quality reports can be used and the quality improvement initiatives can be the same."