AHRQ releases a new manual for primary care health informatics advisors, practice facilitators to help improve quality through the use of EHR clinical data.
The Agency for Health Care Research and Quality (AHRQ), of the Department of Health and Human Services, is the primary federal agency charged with 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 decision-makers make informed healthcare decisions.
On May 31, the AHRQ published the guide “Obtaining and using data to improve practice: a manual for health informatics advisers and practice facilitators,with strategies for primary care practice coaches to support improved care through health information technology.
The AHRQ announced that the manual “focuses on guiding coaches as they help primary care practices collect and extract high-quality clinical data from EHRs to support quality improvement, transformation of practices and efforts to implement new evidence-based clinical interventions”.
Daniel Miller, MS, social scientist at AHRQ’s Center for Evidence and Practice Improvement (CEPI), explained the purpose of the manual in an email interview with Medical economics.
Medical economics: why has this textbook been published now? What is the purpose of this manual? Why is it necessary?
Miller: While recent policy and payment changes have led to the widespread adoption of EHRs, the potential of EHRs in quality improvement work has yet to be fully realized for a number of reasons.
From our work with practice facilitators in the field, we have heard repeatedly that EHR challenges make it difficult for primary care practices to do things such as accurately and reliably capture EHR data and data mining to generate quality metrics 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 their variations also present challenges.
The time had therefore come for the development of this resource. The new manual is intended to support the work of people who are already working in the field with practices on quality improvement efforts – such as Practice Facilitators (also called Practice Coaches), HIT Advisors as well as the internal practice QA staff. 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, the AHRQ has developed extensive training resources for Practice Facilitators, including a hands-on entertainment program and more recently, practice facilitation training modules. Our new manual is intended to be a complementary resource to these practice facilitation training resources for those seeking a more technical treatment of how to use EHRs in quality improvement work.
Medical economics: How does this manual apply to practices that are small or located in rural or underserved communities, where they may not have an outside health informatics advisor?
Miller: We considered the size and location of the cabinet in the design of the manual. Throughout the manual, examples and case studies show how general EHR strategies can be applied to different types of practices serving different populations.
The manual assumes that users have a basic knowledge of using EHRs, but it does not cover content that would be inaccessible to non-IT professionals. In general, the manual describes the functionality built into EHRs as opposed to more advanced data management and analysis methods that would require programming or knowledge of the underlying EHR data structure. For example, the manual describes how to generate reports and metrics using built-in functions in EHR platforms instead of describing how to extract raw data and program reports. The manual can serve as a valuable resource for any practice seeking to improve its EHR capabilities.
Medical economics: Doctors have complained, and studies have shown, that electronic health records can be a barrier between doctors and patients, especially 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 initial investment in training as well as potential changes in practice workflow. We have also found that many practices need additional support and resources to implement these changes and this is one of the main reasons we have developed this manual. While there are important startup considerations with EHRs, there are also many potential benefits for practices. The handbook provides simple, practical strategies that practices can adopt to improve the quality of their EHR data and develop metrics and reports that will allow them to better understand the treatment history and health of their patient population.
Medical economics: can you discuss some of the practical advice included in the manual? What are some practical actions or steps that physicians can take to improve their own experience with the EHR and use the EHR to improve outcomes for their patients?
Miller: The manual emphasizes data cleaning and management. Getting accurate data in EHRs is one of the fundamental tasks for successfully using EHRs. The manual presents a framework for ongoing monitoring of EHR data quality with strategies for standardizing and improving the quality of data capture. This is an area that many firms are keenly interested in to better utilize their EHR.
The manual provides a guided tour of basic EHR functionality – from an explanation of common fields in a typical EHR record to more advanced topics such as clinical decision support tools, dashboards and reports and the constitution.
Additionally, the handbook provides a detailed set of case studies that show how EHRs can support a wide range of quality improvement initiatives. One of the goals of the manual was to show not only how EHRs work, but also to provide specific approaches that firms can use to achieve their quality improvement goals.
Getting staff buy-in is often one of the biggest challenges in implementing EHR changes. The manual covers strategies for working with firm personnel to implement EHR improvements, including developing a value proposition and identifying consensus goals within the firm, addressing resistance to changes, implementing improvement plans and communicating progress to staff.
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