By William Heffernan, M.D.
Family Physician
Nuvance Health

In collaboration with
Kowsilliya Ramnaresh, Ph.D.

One of the biggest challenges all healthcare organizations face is to get data out of the Electronic Health Record (EHR) system, without impact on physician workflow.  This has been an ongoing question for many.  Data capture is not only important in healthcare, but also in industries such as finance, manufacturing,  e-commerce, etc., as it is critical in improving research, outcomes, communication, processes, and helps to reduce or eliminate unnecessary investigations.  Our health system recently transitioned from one EHR system to another, requiring a new build for data reporting.

Through collaboration with physicians’ leadership and the Information Technology department, we followed a 5 step process to obtain “quality data” from our new EHR system for Patient Centered Medical Home (PCMH), Merit-based Incentive Payment System (MIPS), Comprehensive Primary Care Plus (CPC+), The Healthcare Effectiveness Data and Information Set (HEDIS), clinical pathways, and other quality initiatives. The steps we followed were:

  1. We required that all internal and external quality program leaders collaborate.
    • This was a challenge for us as each program had a different leader based upon specific data requirements both internally and externally. In addition, our EMR vendor had a different division that managed each program.  For example, the PCMH division did not align and/or work with the MIPS, CPC+, or the HEDIS division.
    • Our Solution: We developed a master grid of each program data requirement, then mapped each data requirement that overlapped. Once the grid was completed, we met with leadership for each quality program to obtain their “buy-in” and illustrated how the program’s data overlapped.  It took a few months of demonstrating the overlap and combining resources, but we finally achieved collaboration with the leadership team.
  1. We designed and built specific workflows to meet the criteria for multiple program data requirements.
    • In our current EMR system, the clinicians had multiple areas/sections to document medical information such as mammogram, smoking education, pain management and other data requirements. This was extremely challenging when developing reports to capture key data elements and in the education of clinicians.
    • Our Solution: We made a decision to have one process to document information in the new EMR system. For example, Breast Cancer Screening was a measure for MIPS, PCMH, CPC +, and HEDIS.  We had the vendor build the data requirement for Breast Cancer Screening via the method of the “actual report” whether it was scanned into the EMR or electronically acknowledged. 
  1. We required that our EMR vendor initially build the required reports in the Testing/Training domain.
    • One of our biggest challenges was that our prior EMR vendor only wanted to build the reports to capture data in the production domain. The problem was: How could we validate the data and ensure that the reports were built correctly especially regarding mapping of diagnosis code and workflows?
    • Our Solution: The decision was made that physician leaders would need to decrease patient care hours while working on this project. In addition, we required that the EMR vendor build the reports in our Testing/Training domain.  Physicians along with the practice transformation team devoted approximately 500 hours toward this goal.  It was our hypothesis that if the time was not invested now, then lead physicians and colleagues would suffer from poor quality data in the future. 
  1. We required that the vendor build the Testing and Training examples based on “actual” events
    • The examples the EMR vendor recommended were not scenarios that would occur for every physician across specialties. The data being loaded by the EMR vendor was random data that was not medically relevant.
    • Our Solution: Physician leaders worked with the practice transformation team and other physician leadership from quality and primary care to test the EMR system based on ‘actual’ examples. By testing ‘real world’ scenarios, it enabled us to see if the configuration was extracting the data correctly.  Physicians were “on board” during training and testing as the training scenarios chosen were based on “real world’ patient care events.
  1. We mandated that the reports be validated within 2 weeks of go live.
    • The EMR vendor recommended that the data be validated 90 days after go-live. We disagreed feeling that this was too long a period.
    • Our Solution: We believed that by validating the data in production within 2 weeks of go live, we could do the following:
      1. Correct physician ‘bad’ behavior quickly and in “real time”
      2. Fix or re-configure any reports that were built incorrectly
      3. Understand data trends

As the saying goes:

It takes 21 days to form a “good” habit and 3 days to break a habit.”

It is our opinion that adoption of the above steps as “best practice” is the most efficient way to ensure that data requirements for multiple programs are met in current EHR systems, especially when transitioning to a new system.

We discovered that even if a vendor has its own process in place, it may not always be the right approach, and a better “way of doing things” may exist.

Bill Heffernan is a family medicine physician practicing in Highland, New York and also the Health Quest Medical Practice (HQMP) Board vice chair. Since joining HQMP, Bill has served on every Executive team; first the Medical Executive Committee, then the Physician Leadership Council, and currently the HQMP Board of Directors.  He was the organization’s first Chairman of Operations and then Chairman of the HIM (Health Information Management) Committee which then became the EMR and Innovation Committee.  In addition, he has served as the Chief of Primary Care for HQMP and the first co-director of the CPC-I initiative.  He is currently on the Medical Board of the Marist Physician’s Assistant Program as one of Health-Quest’s representatives.

Kowsilliya Ramnaresh has over fifteen years of healthcare experience, focusing on physician relationships and Informatics.  Prior to becoming Vice President, Operations at Vocalto,  Kowsilliya worked for Health Quest Medical Practice, restructuring workflows to meet government  Quality Programs (i.e. MIPS, PCMH, CPC+), streamlining vendor relationships, project managing the Cerner Ambulatory implementation, and designing the innovation department.  Kowsilliya generated an estimated $15-20 million in quality program revenue during her 5-year tenure.

Kowsilliya focuses on CMS quality initiatives and innovative technologies that improve physicians’ workflows.