How to Ease Clinicians in Capturing Quality Data Every Day
Topic: Measuring Impact and Value
Prospective quality measurement is critical to the delivery of high quality palliative care and value-based payment.
The foundational work of Measuring What Matters (Kamal AH, et al. Adherence to Measuring What Matters Measures Using Point-of-Care Data Collection Across Diverse Clinical Settings. J Pain Symptom Manage 2016;51:497-503) and the Joint Commission (JC) Advanced Certification in Palliative Care has led the way in establishing a set of national quality palliative care metrics. However, there remains a limited understanding of how to implement palliative care quality measures into routine real-world clinical settings and merge seamlessly into clinician workload. We would like to share our experience of integrating the Quality Data Collection Assessment Tool (QDACT) into the electronic health record (EHR) to facilitate the process for other colleagues interested in utilizing a national quality data collection system in a practical and efficient manner for clinicians.
1) Review the national quality measures in palliative care that are critical to healthcare reform across care settings.
2) Discuss QDACT as a template for local and national data collection.
3) Describe the process of integrating QDACT into the EHR.
4) Identify lessons learned one-year after integration of national quality metrics into the EHR.
To streamline the clinician workflow, QDACT flowsheets were placed under the shared Palliative Care navigator button in the EHR to allow clinicians from different disciplines easy access to the flowsheets. The flowsheets were designed in a point-and-click format, which was determined by the clinicians to be the most desirable and easiest to complete. The creation of point-and-click format limited flowsheets to 80 rows.
As the data list contained well over 130 elements, two flowsheets were required. The first flowsheet was labeled QDACT Part 1 and contained all the data elements which were priority to the palliative care team to collect on each encounter. Flowsheet QDACT Part 2 contained the remaining data elements that were not necessary to capture at each encounter. Key elements of data were selected to auto-populate into clinicians notes to improve efficiency and decrease duplication of entering information in the EHR.
Five guiding principles were identified for the integration of national quality measures into the EHR (Epic) that can be adapted to other EHR systems. Data reports were built to facilitate quality improvement projects, data reporting, outcomes and lessons learned.
The five guiding principles for the EHR-QDACT integration were:
1) data would be entered by the clinician at each patient encounter;
2) the final product would be user friendly;
3) different disciplines could access QDACT for improved efficiency and integration into the clinical workflow;
4) data would auto-populate into clinical notes for improved efficiency; and 5) Epic reports could be built to fulfill The JC mandatory performance measures reporting requirements.
QDACT was successfully integrated into the EHR, streamlined into clinician workflow to improve efficiency of data collection and clinical charting, and fulfilled the documentation and tracking of The JC Advanced Certification in Palliative Care mandatory measures.
- Jeanie Youngwerth, MD
- Director of Palliative Care Service
- University of Colorado Anschutz Medical Campus
- 12605 E. 16th Ave
- Aurora, CO 80045
- Arif Kamal
- Jean Kutner
- Nancy Robertson
- Robert Peskind