Using EHR data to improve quality is the focus of the new AHRQ manual

AHRQ Releases New Handbook for Primary Care IT Advisors and Practice Facilitators to Improve Quality by Using Clinical EHR Data.

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

On May 31, AHRQ released Obtaining and Using Data in Practice Improvement: A Handbook for Health IT Advisors and Practice Facilitators, which provides strategies for practice coaches in primary care to support improved care through health information technology.

AHRQ announced that the handbook “focuses on guiding trainers to help collect and extract high-quality clinical data from EHRs to advance quality improvement, practice transformation, and efforts to implement new, evidence-based clinical interventions support.”

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

Medical Economics: Why is this handbook published now? What is the purpose of this guide? 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 has not been fully realized for a number of reasons.

From our work with practice facilitators in this space, we’ve heard repeatedly that challenges with EHRs make it difficult for primary care practices to do things like accurately and reliably input EHR data and extract data to generate quality measurements and other metrics. We’ve heard that many electronic medical records lack the functionality to generate reports that could help practices improve patient care. The large number of different EHR platforms and their variations also pose challenges.

So the time was right for the development of this resource. The new manual is intended to support the work of those who are already working with practices on quality improvement efforts in practice – such as practice supporters (also known as practice coaches), HIT consultants and practice-internal QI employees. The purpose of the handbook is to provide a practical approach to incorporating EHR data in efforts to improve care performance and patient outcomes.

Over the past decade, AHRQ has developed extensive training resources for trainers, including a comprehensive trainer curriculum and, more recently, trainer training modules. Our new guide aims to be a companion resource to these training resources to facilitate practice for those looking for a more technical treatment of using EHRs in QI work.

Medical Economics: How does this guide apply to small practices or in rural or underserved communities where they may not have an outside health IT consultant?

Miller: When designing the handbook, we took the practice size and location into account. Throughout the manual there are examples and case studies showing how the general EHR strategies can be applied to different types of practices serving different populations.

The guide assumes that users are familiar with the use of EHRs, but does not cover content that would be inaccessible to non-IT professionals. In general, the manual 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 manual describes how reports and actions are generated using built-in functions in EHR platforms, rather than describing how to extract raw data and code reports. The handbook can serve as a valuable resource for any practice looking to improve their EHR skills.

Medical Economics: Physicians have complained, and studies have shown, that electronic medical records can be a barrier between physicians and patients, particularly in primary care. Should physicians take a new approach to EHR and see it as a quality improvement tool?

Miller: It is true that effective use of EHRs requires an upfront investment in training as well as potential changes in practice. We have also found that many practices need additional help and resources to implement these changes and this is one of the main reasons we have developed this guide. While there are significant initial considerations with EHRs, there are also many potential benefits for practices. The handbook provides simple and practical strategies that practices can use to improve the quality of their EHR data and develop actions and reports that allow them to better understand the treatment history and health status of their patient population.

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

Miller: The manual emphasizes data cleansing and management. Getting accurate data into EHRs is one of the fundamental tasks to use EHRs successfully. The handbook provides 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 that they can make better use of their electronic medical records.

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

In addition, the handbook provides a series of detailed case studies showing how EHRs can support a variety of QI initiatives. One of the goals of the handbook was not only to show how EHRs work, but also to provide specific approaches that practices can use to achieve their QI goals.

Gaining employee buy-in is often one of the biggest challenges in 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, managing resistance to change, implementing improvement plans, and reporting progress to staff.

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