Using EHR data to focus on quality improvement in the new AHRQ handbook

AHRQ publishes a new handbook for primary care health IT consultants, and practice facilitators to help improve quality through the use of clinical electronic health record data.

The Agency for Health Care Research and Quality (AHRQ), within the Department of Health and Human Services, is the lead federal agency responsible for improving the safety and quality of health care for all Americans. AHRQ develops the knowledge, tools, and data needed to improve the healthcare system and help consumers, healthcare professionals, and policy makers make informed health decisions.

On May 31, AHRQ published the guide, “Access and Use of Data in Practice Improvement: A Guide for Health IT Consultants and Practice Facilitators,” with strategies for primary care practice trainers to support improved care through health information technology.

AHRQ declared the handbook “focused on mentoring trainers as they assist primary care practices in collecting and extracting high-quality clinical data from electronic health records to support quality improvement, practice transformation and efforts to implement new evidence-based clinical interventions.”

Daniel Miller, MS, a social science researcher at AHRQ’s Center for Evidence and Practice Improvement (CEPI), explained the purpose of the brochure in an email interview with medical economics.

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

Miller: While recent policy and payment changes have led to the widespread adoption of electronic health records, the potential of EHRs in quality improvement work is yet to be fully realized for a number of reasons.

Working with practice facilitators in this area, we’ve heard time and time again that challenges with electronic health records make it difficult for primary care practices to do things like accurately and reliably enter EHR data, and extract data to create quality and other metrics. We have heard that many electronic health records lack the functionality to produce reports that can help improve patient care practices. The large number of different EHR platforms and the differences between them also present challenges.

So, the time was right to develop this resource. The new handbook aims to support the work of people already in the field working with practices related to quality improvement efforts – such as practice facilitators (also called practice trainers) and HIT consultants as well as the practice’s internal quality improvement team. The purpose of the handbook is to provide a practical approach to integrating EHR data into efforts to improve care delivery and patient outcomes.

Over the past decade, AHRQ has developed extensive training resources for practice facilitators including a comprehensive curriculum for practice facilitation and most recently, practice facilitation training modules. Our new handbook aims to be a companion resource for these practice facilitation training resources for those looking for a more technical treatment of how EHRs can be used in quality improvement work.

Medical Economics: How does this handbook apply to small-scale practices, or in rural or underserved communities, where they may not have an external health IT advisor?

Miller: We took the volume of the training and the location into account when designing the brochure. In the guide there are examples and case studies that show how public EHR strategies can be applied across different types of practices serving different populations.

The handbook assumes that users have basic knowledge of using electronic health records but does not cover content that is inaccessible to non-IT professionals. In general, the handbook describes the functions included in EHRs rather than more advanced data management and analysis methods that require programming or knowledge of the basic EHR data structure. For example, the handbook describes how to generate reports and metrics using functionality built into EHR platforms rather than how to extract raw data and program reports. The handbook can be a valuable resource for any practice looking to improve their EHR capabilities.

Medical economics: Doctors have complained, and studies have shown, that electronic health records can be a barrier between clinicians and patients, especially in primary care. Should clinicians take and think of a new approach to electronic health records as a quality improvement tool?

Miller: It is true that the effective use of EHRs requires an upfront investment in training as well as potential changes to the training workflow. We have also found that many practices need additional help and resources to implement these changes and this is one of the main reasons why we developed this handbook. While there are important considerations for getting started with electronic health records, there are also many potential benefits to the practices. The handbook provides direct and practical strategies that practices can adopt to improve the quality of their EHR data and develop measures and reports that allow them to better understand treatment history and patients’ health.

Medical Economics: Can you discuss some of the practical advice included in the brochure? What are some practical actions or steps that clinicians can take to improve their experience with EHRs and use EHRs to improve patient outcomes?

Miller: The handbook emphasizes data cleaning and management. Obtaining accurate data in electronic health records is one of the essential tasks of using electronic health records successfully. The handbook presents a framework for continuous monitoring of EHR data quality with strategies to standardize and improve data entry quality. This is an area of ​​great interest to many practices so that they can make better use of their electronic health records.

The handbook provides a tour of basic EHR functions – from explaining common areas within a typical EHR to more advanced topics such as clinical decision support tools, dashboards, reports and stabilization.

In addition, the handbook provides a detailed set of case studies that demonstrate how electronic health records can support a wide range of quality improvement initiatives. One of the aims of the handbook was to show not only how EHRs work, but also to provide specific approaches that practices can use to achieve their quality improvement goals.

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

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