Optimizing Office EHRs Principle 3: See Your EHR as a Practice Improvement Activity

Principle 3 of a 12-part series on Optimizing Office EHRs

Where do we begin?

Start with practice improvement activities...

Satisfied patient with a happy doctor.
A successful practice improvement activity will improve satisfaction for both physician and patient.

Do you find yourself with an EHR that is more of a yoke around your neck than an asset?  In fact, do you consider it a "P.I.A. "  (or pain in your backside.)?  It's time to answer the question, "Where do I begin?" I will make a case that you use a different connotation for PIA - a clinical Practice Improvement Activity (CPIA).

"Where do I begin" assumes that you want to do something different and get different results. My hope is that you are completing the Action Plan for each principle.  In part one, you prioritize your four improvement goals around efficiency, productivity, profitability and patient safety.  In part two, you set some measureable goals for achievement. You determine the biggest obstacle holding you back.  In part three, let's use some process improvement thinking to start formulating an action plan around the value(s) you want to achieve.

If you're a Medicare provider, focus on the Quality Payment Program (QPP) incentives.

If you are a Medicare provider, I am assuming you know about the Quality Payment Program (QPP) that started January 2017. I would recommend that you find an area of your practice that you cannot only improve, but use as a basis to earn points under the merit-based payment system (MIPS) as a clinical practice improvement activity (CPIA).  In 2017 CPIA accounts for 15% of your MIPS points.

You already can get points under MIPS as you count your certified EHR under the Advancing Care Information (ACI) category of MIPS (which replaced the Meaningful Use criteria in 2017 for Medicare). ACI counts for 25% of your 2017 MIPS points.

In addition, you can submit your patient care outcomes, which count as Quality measures under QPP.  Quality counts for 60% of MIPS in 2017.

As you leverage your EHR to develop CPIA, you not only are avoiding reductions in your Medicare reimbursement, but you are gaining points for your MIPS submissions which can earn you actual bonuses on future payments.

If you are confused about MIPS and the QPP, then visit the numerous resources on HealthITAccelerator.com or on the qpp.CMS.gov website.

Principle #3: See your EHR as a clinical Practice Improvement Activity

(CPIA, or the other PIA)

Under MIPS there are over 90 choices from which physicians can pick for their clinical practice improvement activities (CPIA).  These fall into nine categories:

  1. Expanded patient access
  2. Patient engagement
  3. Achieving health equity
  4. Population management
  5. Patient safety and practice assessment
  6. Emergency preparedness and response
  7. Care coordination
  8. Participating in an APM, including a PCMH
  9. Integrated behavioral and mental health

Depending on your specialty, and the nature of your clinical practice, you should be able to determine your best options.

Let's get specific on clinical practice improvement activities

CMS has already posted over 90 specific activities that qualify as a clinical practice improvement activity.  It makes sense to leverage your EHR for many of these.  Let me share some examples:

  1. Determine a significant cohort of patients that you can identify from your problem/diagnosis lists in your EHR.  Target specific interventions.  This could be disease monitoring, group education, or visit recalls.  Develop a hypothesis on what you can improve about these patients. Leverage analytic reports from your EHR to show baseline compliance and design an appropriate practice improvement activity. Implement and monitor your results.  Adjust your interventions until you get significant results.  You can also report your positive outcomes as Quality MIPS points.
    • Some cohorts to consider include patients with:
      • Diabetes,
      • COPD,
      • Childhood asthma, or
      • Other chronic conditions
  2. Determine a care process that you can improve in your practice and use your EHR to create templates and clinical decision support (CDS) rules, such as:
    • Anticoagulant management,
    • Glycemic management,
    • Care coordination of patients with chronic disease, or
    • Preventive health maintenance activities.
  3. Utilize information from patient surveys to improve patient satisfaction scores.
    • When I first deployed an EMR in my office in 1993, I had data and patient feedback that allowed me to change how I scheduled patients in my family practice office.  I shifted to a modified-wave scheduling template that allowed me to better manage patient flow, decrease wait times, created the capacity to see at least one walk-in per hour and allowed me to keep on schedule each day.
      • As a pleasant unexpected consequence, my after-hour calls went to essentially zero, since my patients were ensured that I could accommodate them with a same day walk-in appointment.  I learned that patients are less likely to call after-hours or go to the Emergency Department if they feel they can see their personal physician the next morning and not spend hours in the waiting room.
  4. Create care coordination processes for high-risk populations.
    • Most doctors have at least one high-risk group in their practice that they can tag in their EHR. You can use templates and CDS rules to improve care coordination, self-management education, and follow-up.
  5. Implement analytics capabilities to manage total cost of care of a patient population.
    • This will serve you well if you participate in a patient-centered medical home (PCMH), accountable care organization (ACO), or when negotiating new contracts with your largest payor.

Even if you do not see Medicare patients, you probably can find a practice improvement activity that can improve your office throughput, create personal satisfaction and improve quality care.  As you start to view your EHR as a practice asset rather than the other PIA, you can create value.

Action plan for Principle #3: See your EHR as a practice improvement activity.

Take some time and write out your answers to the questions below:

  1. What will be my first EHR CPIA?
    • What clinicial practice improvement activity will yield the best benefit for my patients and my practice?
    • Is there a quality component as well?
  2. What aspect of my practice is this going to improve?
  3. What is my baseline?
  4. What activities are my staff and I going to do toward our goal.
  5. What are my 30-day, 90-day, and 1 year objectives?
  6. What is the biggest obstacle to overcome?

And then you can repeat the cycle for each initiative you tackle.

Have questions?  Email me at psmith@healthITaccelerator.com.


Catch the Introduction for this series:


More on the 12 Principles for Optimizing the Office EHR (Published weekly):

  1. Know what you want. See First, do no (EHR) harm
  2. Commit to moving forward. See Don’t look back
  3. See your EHR as a practice improvement activity.  See Where do we begin? on this page.
  4. Is your EMR an EHR?
  5. A penny saved, is better than a poke in the eye
  6. Know thyself
  7. “Saved time” will keep us together
  8. Whenever I call you “friend”
  9. Read between the lines
  10. First measure the cost
  11. Eating the elephant one bite at a time
  12. Nothing’s “gonna” stop us now

The 10 Myths of Office EHR

Myth #1:  I don't own my EHR, so I cannot fix it.

Myth #2: We have the wrong EHR for my practice.

Myth #3:  There is no way the EHR can save me time.

Myth #4:  I just need to go back to paper charts.

Myth #5:  EHR office notes are never going to be usable.

Myth #6:  The EHR cannot make my patients safer.

Myth #7: I don't have the time to fix my EHR.

Myth #8:  It's not up to me to fix my EHR.

Myth #9:  To use my EHR, I have to see less patients.

Myth #10: You don't understand, my practice is different.

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