CMS eHealth Summit: Apps, technology driving better quality improvement efforts

To maximize health IT to improve quality improvement efforts, the Arkansas Foundation for Medical Care looks at what’s going on in rural parts of the state, said Rhelinda McFadden, RN, CPHIT, CPEHR, quality specialist, speaking during a panel at the May 19 CMS eHealth Summit.

Of 75 counties in Arkansas, 52 are considered underserved. The state has 1,200 identified physicians but only 715 are actively practicing and of those, only 429 serve the rural areas. “These are the providers we want to focus on to make sure the majority of the state population gets the healthcare services they need.” EHRs within these practice should have staff that function at the top of their license so they can capture data necessary at the point of care, she said. The state is preparing for its future with their efforts because by 2025, it will be the fifth leading state in the nation with the highest volume of geriatric patients.

Meanwhile, there are four major areas of activities organizations can do to better align their quality improvement efforts, said Rosemary Kennedy, PhD, RN, MBA, president and CEO of eCare Informatics:

1. Start with evidence-based medicine. Change doesn’t start with health IT but with guidelines for population healthcare.
2. Define roles. “We’re finding as we discuss quality measures that we’re amazed at what different caregivers do that other caregivers may not know about."
3. Understand data flow including where data come from and how information flows through the system. Most entities have disparate systems.
4. Understand workflow. Where are the data captured? "That applies to every quality measurement initiative where we're trying to use health IT."

One of the biggest drivers for quality alignment work is the fact that “we have much more patient communication than we’ve ever had before,” said Darryl W. Roberts, PhD, MS, RN, evaluation scientist for Econometrica. Younger people are pushing the environment and older people are gloaming onto that, he said.

The Office of the National Coordinator for Health IT last year awarded three companies for their apps. Roberts talked about how the American Nursing Association would like to incorporate the data collected by one, a handheld pressure ulcer measuring tool, into a quality measure. The app captures data at the point of care using a camera capable of measuring the wound.  “These are the types of innovations that are going to drive healthcare forward, he said. This particular app is just one example of these tools’ “extreme value that can provide a database by which other measures will be built in the future.”

Health IT also is impacting risk tools and care coordination, said Kennedy. Research is showing that most of these tools fall into two categories—those targeted to certain subpopulations and social and economic factors tied to hospital readmissions. When tracked using one of these tools, she said 76 percent of readmissions are related to social and economic issues such as lack of transportation, inability to fill a prescription and housing concerns. “These tools are moving to the next level to include these important data elements.”

Roberts cited a pilot conducted by the Visiting Nurses Association and New YorkPresbyterian Hospital which started rounding together. VNA nurses would do discharge rounds with the medical team which resulted in much better transitions of care, he said. “They found that patients on whom they rounded were significantly less likely to be readmitted than patients not rounded on but with similar diagnoses.” At first it was much more expensive for the VNA to bring in those nurses but eventually saved both organizations time and money. Unfortunate, the project ended along with the funding but “these are types of things that ought to become part of our learning healthcare system and things we do regularly.”

The panel talked about the growing importance of telehealth moving forward. Arkansas has more than 75 access points for telehealth, said McFadden, but they run into issues with reliable connectivity.

Roberts said the overall attitude regarding telehealth must change. Some people see using Skype, the phone or a portal as a lower level of care. “That is something we need to change because care provided by an expert is care provided by an expert regardless of the medium. As the technology improves, we’re finding it is very excellent care. There needs to be a cultural shift at the provider level around that.”

An audience member asked the panel how they can engage in providing input on new standards development. Kennedy said Health Level 7 is not all “geeks and engineers. We spend 75 percent of our time talking about healthcare delivery.” She also cited the Standards & Interoperability Framework and the 1-800 number that allows for public comment at government meetings. “There are lots of open meetings but often there are no comments. That shouldn’t be happening,” said Roberts.