Use of EHR data for quality improvement focus in new AHRQ handbook

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

The Department of Healthcare Research and Quality (AHRQ), in the Department of Health and Human Services, is the leading federal agency dedicated to 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 healthcare 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 coaches to support improved care through health information technology.

The AHRQ announced the handbook “focuses on mentoring 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, documented clinical interventions.”

Daniel Miller, MS, social science researcher at 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 changes in policy and payment have led to widespread use of EHRs, the potential for EHRs in quality improvement work has not 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 like accurately and reliably enter EHR data and extract data to generate quality metrics and other metrics. We have heard that many EHRs lack the functionality to produce reports that can help practices improve patient care. The large number of different EHR platforms and variations among them also present challenges.

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

Over the past decade, AHRQ has developed comprehensive training resources for internship facilitators, including a comprehensive internship facilitation curriculum and most recently internship facilitation training modules. Our new handbook is intended to be an accompanying resource to these practice-facilitating training resources for those 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 external health IT advisor?

Miller: We took into account practice size and placement 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 that serve different population groups.

The handbook assumes that users have a basic knowledge of the use of EHRs, but it does not cover content that would be inaccessible to non-IT professionals. In general, the handbook describes functionalities built into EHR 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 goals using built-in features of EHR platforms instead of describing how to extract raw data and program reports. The handbook can serve as a valuable resource for any practice that wants to improve its EHR capabilities.

Medical Economics: Physicians have complained, and studies have shown that electronic medical records can be a barrier between physicians 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 requires a prior investment in training as well as potential changes in practice 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. Although there are significant start-up considerations with EHRs, there are also many potential benefits to practice. The handbook provides straightforward and practical strategies that practices can apply to improve the quality of their EHR data and develop measures and reports that enable them to gain a better understanding of treatment history and the 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 doctors can take to improve their own experience with EPR and use EPR to improve their patient outcomes?

Miller: The handbook emphasizes data cleanup and management. Getting accurate data into EHRs is one of the fundamental tasks of successfully using EHRs. The handbook presents a framework for ongoing monitoring of the quality of EHR data with strategies for standardizing and improving the quality of data entry. This is an area in which many practices have a strong interest in making better use of their EHRs.

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

In addition, the handbook provides a detailed set of case studies showing how EHRs can support a wide range 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 meet their QI goals.

Getting employee acquisitions 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 practice, addressing resistance to change, implementing improvement plans, and reporting on staff progress.

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