So you spent all that time and effort to gather meaningful use data, and now you’ve shown that your use is… meaningful. Now what do you do with this wealth of information and the system that produced it? One health system is showing that meaningful use strategies can be used to measure and improve quality.
Providence Health & Services, a not-for-profit Catholic healthcare ministry that provides services in Alaska, California, Montana, Oregon, and Washington, with its system office located in Renton, WA, achieved 100% compliance with meaningful use in 2014 but didn’t want to just set aside the accumulated data. Providence’s Director of Government Programs, Ray Manahan, says Providence leaders wanted to capitalize on not just the data itself but the infrastructure that had been created to collect it.
By applying the data and methodology to other projects, meaningful use information helped the 34-hospital system start collaborating around data, Manahan says. With such a large health system, collaborating around data to improve quality can be a challenge, he says.
“Meaningful use was our springboard to a lot of data coordinating and also collaboration across our very large system. Meaningful use is not going away, but it really has teed us off as an organization to be successful with other quality programs,” Manahan says. “With a system of this scale, trying to streamline how we obtain, interpret, and disseminate data can get very complex. One region may be doing it completely different than another region.”
The core measures and menu measures of meaningful use have now become the core measures in other quality programs, Manahan notes, so Providence has been able to leverage the meaningful use data in areas such as payer contracting and accountable care organizations. “We got them on our radar because of meaningful use, but now we’re expanding them to these other areas that are so reliant on data,” he says.
BENCHMARKS ESTABLISHED FOR OTHER CONCERNS
The effort began five years ago when Providence developed a scorecard to track meaningful use measures. One goal of that effort was to create a simplified snapshot for senior executives to indicate each hospital’s progress toward meaningful use. Green, yellow, and red notations told the executives that hospitals were on target, struggling, or way behind. With transitions of care for stage 2 meaningful use, for example, providers had to create 10% of records electronically. That was challenging for Providence, Manahan says, but the job was made easier by the scorecards that told each hospital where it stood on that measure. Red meant the hospital was below 10%, yellow meant 10-15%, and green meant more than 15%.
That scorecard concept was then applied to other top concerns, such as hospital-acquired conditions, value-based purchasing, and readmission reduction.
Providence established benchmarks for each of those concerns, monitoring them with weighted quality measures and tracking progress just as it had done with meaningful use data. Providence now tracks about 300 quality measures for the areas of concern. The tracking can yield some useful information immediately, before any long term analysis can be completed. For instance, tracking the quality measures can reveal that certain information or prompts should be added to the EHR, as well as whether information is being gathered because it helps improve quality or because there is a potential penalty for not gathering that data.
“We wanted to be able to see a snapshot of where we stood on these issues, which regions might be doing well and which regions aren’t, and then have that dialogue,” Manahan explains. “When we see that Oregon is doing well with this issue and Washington isn’t, we can go to Oregon and ask what they’re doing differently to get those good results. Having that discussion at a granular level was very useful to us, but in order to get there we had to have a good analysis of the data.”
The effort arose partly from the way Providence hospitals relied on the health system’s leaders to guide them through the meaningful use requirements, Manahan explains. Meaningful use is an all-or-nothing proposition, with health providers either achieving the required measures completely or failing, so hospital leaders often wanted to cut through all the details of the requirements and just know where they stood: “Where am I coming up short and what do I need to do to fix it?” he says.
“Our technical folks read the hundreds and hundreds of pages from CMS, but what people needed at the hospital level was an understanding of the best practices that would get them across that threshold,” Manahan says. “We ran the reports and held a meaningful use summit where we could exchange information among regions. If the California region went from red to green, we would ask them to share how they turned that around, to uncover what they did that made the difference.”
DATA MUST BE TIMELY AND CLEAR
Several lessons emerged soon after adopting the meaningful use strategy. First, the data must be timely, clear, and transparent if it is to be useful in improving quality. The data also should identify areas of risk and produce specific goals for improvement. System leaders must clarify ownership with regard to those goals, Manahan says, in order to facilitate collaboration across the many institutions. Providence leaders also learned that applying the meaningful use model to other topics can be tricky. Much of the data needed for meaningful use could be obtained through Providence’s electronic health record (EHR), but even there the system had three versions. That necessitated additional data collection steps to accommodate the differences, and that challenge was even greater when the same approach was applied to other concerns. Obtaining and massaging data for the clinical issues required more cooperation from parties throughout the health system, especially quality professionals.
“We had to take into account that a public health department in California may differ in their requirements for syndromic surveillance versus the health department in Oregon,” Manahan says. “I stressed that we needed a project manager who understands the rules related to this given measure, where we can dive into it but understand the variability of it from state to state.”
In addition, the benchmarks for quality in patient care can change more often and more rapidly than did similar measures in EHR adoption, Manahan says. A system-wide clinical quality measure crosswalk helps keep track of the factors that apply to each clinical concern, listing all clinical quality measures across provider and hospital quality programs.
Time has proven the value of applying the meaningful use framework and data to other concerns, but Manahan notes that not everyone in the Providence system was enthusiastic about the idea initially. Some criticized the scorecard system as simplistic and providing an incomplete assessment of progress in the areas of concern. Most of those critics have come around after seeing that the format does help keep Providence facilities on track with quality measures, he says.
“What was hugely hard for us was transitioning ownership of this EHR incentive program from an IT system project mode to an approach that involved the rest of Providence just as directly and hands-on,” Manahan says. “Although the foundation was laid through the meaningful use experience, the lesson learned was that we need boots on the ground to continue the success when we expand the approach from meaningful use to quality overall.”
