Using EHR data for quality improvement focus of new AHRQ handbook

The Agency for Healthcare Research and Quality (AHRQ), in the Department of Health and Human Services, is the lead federal agency charged with improving the safety and quality of healthcare for all Americans. AHRQ develops the knowledge, tools, and data needed to improve the healthcare system and help consumers, healthcare professionals, and policymakers make informed health decisions.

On May 31, AHRQ published the guide, “Obtaining and Using Data in Practice Improvement: A Handbook for Health IT Advisors and Practice Facilitators,” with strategies for primary care practice coaches to support improved care through health information technology.

AHRQ announced the handbook “focuses on guiding coaches as they help primary care practices collect and extract high-quality clinical data from EHRs to support quality improvement, practice transformation and efforts to implement new, evidenced-based clinical interventions.”

Daniel Miller, MS, social science researcher in AHRQ’s Center for Evidence and Practice Improvement (CEPI), explained the purpose of the handbook in an email interview with Medical Economics.

Medical Economics: Why was this handbook published now? What is the purpose of this handbook? Why is it necessary?

Miller: While recent policy and payment changes have led to widespread adoption of EHRs, the potential of EHRs in quality improvement work hasn’t yet been fully realized for a number of reasons.

From our work with practice facilitators in the field we have repeatedly heard that challenges with EHRs make it difficult for primary care practices to do things such as accurately and reliably enter EHR data, and extract data to generate quality measures and other metrics. We’ve heard that many EHRs lack the functionality to produce reports that could help practices improve patient care. The large number of different EHR platforms and variations among them also present challenges.

So, the time was right for the development of this resource. The new handbook is intended to support the work of the people that are already in the field working with practices on quality improvement efforts – such as practice facilitators (also called practice coaches), HIT advisers as well as practices’ own internal QI staff. The purpose of the handbook is to provide a practical approach to incorporating EHR data into efforts to improve care delivery and patient outcomes.

Over the last decade AHRQ has developed extensive training resources for practice facilitators including a comprehensive practice facilitation curriculum and most recently, practice facilitation training modules. Our new handbook is intended to be a companion resource to these practice facilitation training resources for those who are looking for a more technical treatment of how to use EHRs in QI work.

Medical Economics: How does this handbook apply to practices that are small in size, or in rural or underserved communities, where they may not have an outside Health IT Advisor?

Miller: We took practice size and location into account in the design of the handbook. Throughout the handbook there are examples and case studies that show how the general EHR strategies can be applied across different types of practices serving different populations.

The handbook assumes that users have a basic familiarity with using EHRs but it does not cover content that would be inaccessible to non-IT professionals. In general, the handbook describes functionalities that are built into EHRs as opposed to more advanced data management and analysis methods that would require programming or knowledge of the structure of the underlying EHR data. For example, the handbook describes how to generate reports and measures using built-in functions within EHR platforms instead of describing how to extract raw data and program reports. The handbook can serve as a valuable resource to any practice that is looking to improve its EHR capabilities.

Medical Economics: Physicians have complained, and studies have shown, that electronic health records can be a barrier between doctors and patients, especially in primary care. Should doctors take a new approach to EHR and think of it as a tool for quality improvement?

Miller: It is true that effective use of EHRs does take an upfront investment in training as well as potential changes in practice workflow. We have also found that many practices need additional help and resources implementing these changes and this is one of the key reasons why we developed this handbook. While there are significant start-up considerations with EHRs, there are also many potential benefits to practices. The handbook provides straightforward and practical strategies that practices can adopt to improve the quality of their EHR data and develop measures and reports that will allow them to have a better understanding of the treatment history and health of their patient population.

Medical Economics: Can you discuss some of the practical tips included in the handbook? What are some practical actions or steps physicians can do to improve their own experience with EHR and to use EHR to improve their patient outcomes?

Miller: The handbook emphasizes data clean-up and management. Getting accurate data into EHRs is one of the foundational tasks to successfully use EHRs. The handbook presents a framework for continuously monitoring the quality of EHR data with strategies for standardizing and improving the quality of data entry. This is an area that many practices have a strong interest in so they can make better use of their EHRs.

The handbook provides a tour of basic EHR functionality – from an explanation of common fields within a typical EHR record to more advanced topics such as clinical decision support tools, dashboards and reports and empanelment.

Additionally, the handbook provides a detailed set of case studies that show how EHRs can support a wide range of QI initiatives. One of the goals of the handbook was to show not only how EHRs work, but also to provide specific approaches that practices can use to meet their QI goals.

Getting staff buy-in is often one of the biggest challenges to implementing EHR changes. The handbook covers strategies for working with practice staff to implement EHR improvements including developing a value proposition and identifying consensus goals within the practice, addressing resistance to changes, implementing improvement plans and reporting on progress to staff.