#MEQAPI – Tweetchat June 1st 2017 3:00ET: Speaking Up

Topic:  “Speaking Up” vs unprofessional behavior

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

Fear of repercussions and scapegoating is a major impediment to safety, and frequently results in increased waste and lost lives.

A basic principle of quality improvement is the establishment of a “no-blame” culture in which every stakeholder feels an obligation to report quality risks or issues, but also knows that the response will be to focus on the problem and a solution rather than on blaming the individuals.

The need for “Speaking Up” is applicable to every healthcare facility and specialty, regardless of whether they are public or private institutions. The idea that if you “see something, say something” is very important no matter your “position” at the facility. Advocating for the patients is very important, and often times people will keep quiet because they are afraid of repercussions if they do speak up.

Deming included “Drive out fear” in his list of 14 Points for quality. He exhorted organizations to encourage effective two way communication as a means  to drive out fear throughout an organization. This enables everybody to work effectively, productively, and safely.

This chat is based largely on the BMJ paper by Martinez et al “Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents

Recent articles from Physician’s Weekly on unprofessional behavior in healthcare:

We will take a QI approach, and discuss the  topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.

Speaking Up

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies
    • Machines (equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Access Control
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes to technology, adoption vs resistance, bullying, supporting
      • Fatigue (especially alert fatigue)
      • Values and traditions
      • Friends and family
      • Role Models
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Internet sources
      • Employment Handbook
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Traditions

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What METHODS increase or reduce unprofessional behavior or ability to speak up
  2. What MACHINE factors increase or reduce unprofessional behavior or ability to speak up
  3. What PEOPLE issues increase or reduce unprofessional behavior or ability to speak up
  4. What MATERIALS increase or reduce unprofessional behavior or ability to speak up
  5. What MEASUREMENT factors increase or reduce unprofessional behavior or ability to speak up
  6. What ENVIRONMENTAL factors increase or reduce unprofessional behavior or ability to speak up

… and the numbers:

June 1 MEQAPI numbers

Attendees:

MEQAPI Participants June 1

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

 

 

 

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#MEQAPI – Tweetchat May 25th 2017 3:00ET: Burnout

Topic:  Quality Improvement vs Care Burnout

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

In the March 30th MEQAPI we discussed the serious and growing problem of Clinician Burnout. Since then, even more papers and articles have been written, and even more harm has emerged – For example, burnout has been shown to be leading to a sharp increase in physician suicide.

Recent articles from Physician’s Weekly:

The effects of burnout can be seen in decreased physicians job satisfaction, increased numbers of clinicians leaving healthcare, and increased physicians suicide. It also Negatively Affects Quality, Safety.

Burnout is also happening all across the different roles in healthcare. At a very fundamental level, the combination of burnout and low wages is driving a shortage of home health workers. Without sufficient and motivated home health workers, fewer patients can be safely discharged from hospitals, more will find themselves in the ED or readmitted, and the mortality rate after discharge will climb.

Some additional materials courtesy of the Rocky Mountain Mental Illness Research, Education and Clinical Centers (MIRECC).

We will take a QI approach, and discuss the  topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.

MEQAPI burnout

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Insurance Models, payer systems
      • Vendor policies and processes
      • Home visit support
    • Machines (equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Medication dispensing systems
      • Personal Health Record and encounter ploanning systems
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes to technology, adoption vs resistance
      • Fatigue (especially alert fatigue)
      • Values
      • Friends and family
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • Internet sources
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What METHODS increase or reduce Burnout
  2. What MACHINE factors increase or reduce Burnout
  3. What PEOPLE issues increase or reduce Health Burnout
  4. What MATERIALS increase or reduce the risk of Burnout
  5. What MEASUREMENT factors increase or reduce Burnout
  6. What ENVIRONMENTAL factors increase or reduce Burnout

The Numbers

meqapi number May 25

Participants May 25Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

 

 

 

#MEQAPI – Tweetchat May 18th 2017 3:00ET: Health Literacy

Topic:  Quality Improvement vs Health Literacy

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

A core and foundational part of moving from fee-for-service to value-based care, reducing healthcare costs, and reducing medical errors, is the idea that patients can become active players in their own care. That includes the self-management that goes hand in hand with “architecting” a healthy lifestyle, reducing health risks, and accessing healthcare services in a selective and judicious manner. It also implies that the average, or at least many, healthcare consumers will play an active role in medical decisions, and be partners with their (many) providers in order to prioritize and select the goals and components of their care plan.

A key assumption in achieving this activated patient role, is that the person has a high degree of health literacy – that they understand the concepts, are familiar with the terrain, and can speak the language of healthcare. They will know what HbA1c, BP, Resting Heart Rate, BMI, HDL, LDL, Triglycerides, etc are, what they mean, where they stand on each, and what they need to do about them.

It is by no means clear that we are anywhere near having most people in a position where the terminology is familiar, where they understand the implications, and where they have clear health goals prioritized to lead them to the healthiest life that they can afford, are willing to maintain, and is feasible given their history, health status, and environment.

In fact, Health.gov paints a fairly dismal picture:

Only 12 percent of adults have Proficient health literacy, according to the National Assessment of Adult Literacy.  In other words, nearly nine out of ten adults may lack the skills needed to manage their health and prevent disease.  Fourteen percent of adults (30 million people) have Below Basic health literacy.  These adults were more likely to report their health as poor (42 percent) and are more likely to lack health insurance (28 percent) than adults with Proficient health literacy.6

Health.gov describes health literacy dependencies and implications thus:

Health literacy is dependent on individual and systemic factors:

  • Communication skills of lay persons and professionals
  • Lay and professional knowledge of health topics
  • Culture
  • Demands of the healthcare and public health systems
  • Demands of the situation/context

Health literacy affects people’s ability to:

  • Navigate the healthcare system, including filling out complex forms and locating providers and services
  • Share personal information, such as health history, with providers
  • Engage in self-care and chronic-disease management
  • Understand mathematical concepts such as probability and risk

Low health literacy can result in many sub-optimal outcomes, including reduced ability to comply with treatment plans, poorer healthcare choices, and ineffective or expensive utilization.

Health.gov again:

Low literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services (see Fact Sheet: Health Literacy and Health Outcomes). Both of these outcomes are associated with higher healthcare costs.

Some supporting reading for the chat comes from Physician’s Weekly and the Leapfrog Group.

Educational materials from Leapfrog:

Articles from Physician’s Weekly:

We will take a QI approach, and discuss the  topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat. Unlike most Ishikawa diagrams we have used in past chats, Healthcare Literacy feeds itself – Low health literacy causes continued low literacy, while high health literacy can cause greater health literacy.

MEQAPI Health Literacy

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Insurance Models, payer systems
      • Vendor policies and processes
      • Home visit support
    • Machines (equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Medication dispensing systems
      • Personal Health Record and encounter ploanning systems
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes to technology, adoption vs resistance
      • Fatigue (especially alert fatigue)
      • Celebrities
      • Friends and family
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • Drug information sheets
      • Self-care guides
      • Internet sources
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Monitoring of home-care
      • Adverse Effects reporting
      • Home monitoring
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What METHODS increase or reduce Health Literacy
  2. What MACHINE factors increase or reduce Health Literacy
  3. What PEOPLE issues increase or reduce Health Literacy
  4. What MATERIALS increase or reduce the risk of Health Literacy
  5. What MEASUREMENT factors increase or reduce Health Literacy
  6. What ENVIRONMENTAL factors increase or reduce Health Literacy

meqapi numbers may 18 2017

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

 

 

 

#MEQAPI – Tweetchat May 11th 2017 3:00ET: Malta #eHealthWeek

Topic:  Joint #MEQAPI and  chat

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

Chuck Webster M.D. blogged on the joint #MEQAPI  and #eHealthWeek chat, but from a Quality Improvement perspective, we could keep the following in mind while looking at the topics:

 

    • Methods
      • Policies: office, organization, or national policies, including MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Insurance Models, payer systems
      • Vendor policies and processes
      • Home visits
    • Machines (equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Medication dispensing systems
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes to technology, adoption vs resistance
      • Fatigue (especially alert fatigue)
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • Drug information sheets
    • Measurement
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc.
      • Monitoring of home-care
      • Adverse Effects reporting
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient

Participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. #Malta has a national patient ID. Advantages? Disadvantages? Should US do the same?
  2. Europe healthcare is predominately single payer. What are/would be, implications for health IT?
  3. EU has 28 nations & 24 languages. US is becoming more diverse. How does culture influence HIT?
  4. Do any US based #MEQAPI regulars have questions for any #eHealthWeek attendees? Visa-versa?
  5. #MEQAPI regulars, quick, look at recent #eHealthWeek tweets, your favorite? Visa-versa?
  6. Workflow is a global & universal healthcare concern. It’s also incredibly localized. Discuss!

 

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

 

 

 

#MEQAPI – Tweetchat May 4th 2017 3:00ET: Medication Errors

Topic:  Quality Improvement vs Medication Error

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

Medical error is arguably the third leading cause of death in the US, and while many arguments can be made that the underlying research is imperfect, it is clear that medical error is still one of the leading causes of untimely death. One of the primary causes of the high death rate is medication errors.

Medication errors result in missed opportunities, injury, and death. When the incorrect dose, incorrect medication, or wrong patient are in play, harm often results. Harm can also occur when incompatible combinations of drugs are administered – either because one drug reduced the efficacy of another, or because they worked similarly and resulted in an effective overdose.

In an attempt to reduce drug-related harm, vendors and providers have tried many different fixes – ranging from making the fonts more readable, to electronic drug-drug interaction checks, to dispensing robots. The results have ranged from inconclusive to significant, but as yet no approach or combination of approaches has yet removed medication errors from the list of top causes of medical error resulting in harm.

Some supporting reading for the chat comes from Physician’s Weekly:

An additional resource is the report by the LeapFrog group on the use of bedside barcoding for medication dispensing.

We will take a QI approach, and discuss the  topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.

MEQAPI Medication Error

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Insurance Models, payer systems
      • Vendor policies and processes
      • Home visits
    • Machines (equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Medication dispensing systems
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes to technology, adoption vs resistance
      • Fatigue (especially alert fatigue)
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • Drug information sheets
    • Measurement
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc.
      • Monitoring of home-care
      • Adverse Effects reporting
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What Methods increase or reduce the risk of medication errors
  2. What Machine factors increase or reduce the risk of medication errors
  3. What People issues increase or reduce the risk of medication errors
  4. What Materials increase or reduce the risk of medication errors
  5. What Measurement factors increase or reduce the risk of medication errors
  6. What Environmental factors increase or reduce the risk of medication errors

MEQAPI Numbers May 4 2017

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

 

 

 

#MEQAPI – Tweetchat April 27th 2017 2:30ET: EHR Success Story

Topic:  Quality Improvement vs EHR Success Story with James Legan MD

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

This chat is about using an EHR to improve practice and patient experience.

The HITECH, ARRA, and Meaningful Use programs greatly accelerated adoption of electronic health record (EHR) systems by providers. Adoption by office-based providers rose from 21%  in 2004, to 87% by 2015. Many will, however, say that the cost was too high, the results too poor, and that it has potentially soured an entire generation of providers to the idea of Health IT solutions in general and EHR in specific.

While this may be true, there is considerable variation in outcomes and realized value, and wherever there is variation, there is opportunity for quality improvement. For some, the EHR is a frustrating waste of time that is added to an already cramped schedule, and represents an additional burden of several hours of duplicitous administrative work at the end of each workday. For many, the EHR is just another administrative chore. For a few, the EHR has reduced administrative work, improved efficiency, and supportedthe ability to serve patients.

This week the #MEQAPI topics relate to a specific healthcare provider’s experience that may be seen as a positive outlier. Dr. Legan has put together a solution that pairs an EHR and a CRM, and has seen improvements that many would envy. Dr. Legan is an Internal Medicine Physician, in his 23rd year in Private Practice in Great Falls, Montana.Great Falls is in the North Central Montana region, and has approximately 50,000 population, served by two large multi-specialty hospitals. The practice is outpatient-only, and consists of eight physicians: three Internists, four Family Practice, and one Pediatrician, each with approximately 1,200-2,000 patients. Ancillary staff includes five shared in-house billing staff, and each physician has one to three additional support staff.

Dr. Legan has a patient-facing display so that the patient sees everything in the EHR as it is being reviewed or entered.

legan

Dr. Legan describes his outlook on EHR as follows:

I am convinced the electronic health record (EHR) needs to be shared as a visual interactive medium at the point of care.  The primary role of the EHR should be educational, all other uses secondary.  I discuss this approach #ProjectedEHR on twitter.

Videos of #ProjectedEHR I Periscoped to You Tube

  1. https://www.youtube.com/watch?v=moTXADdpHtU (me being interviewed)
  2. https://www.youtube.com/watch?v=HOlKbl1dAWE(interviewing a patient)
  3. https://www.youtube.com/watch?v=EA5X_LP5_PQ (Wall mounted TV/chromebook)
  4. https://www.youtube.com/watch?v=kz9rVtRpuI0 (Dual monitored desktop/chromebook in office carried to exam room)

#ProjectedEHR–User friendly EHR that projects well, 14 inch Chromebook, 24 inch TV, 10 foot HDMI cord, 8 inch HDMI extender, wall mount, remote access application made for chrome & encrypted (VNC viewer made for Chrome, Enterprise Version).  The chromebook simulates my dual monitored desktop, so I take my “virtual desktop” into the exam room and plug in the HDMI cord to extender and the learning begins.  Always check with your IT support to make sure everything is HIPAA compliant and secure.

Some supporting reading for the chat comes from Physician’s Weekly:

We will take a QI approach, and discuss the  topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.

MEQAPI EHR

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Insurance Models, payer systems
      • Home visits
      • Charting – automatic vs manual
    • Machines (equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes to technology, adoption vs resistance
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
    • Measurement
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc.
      • Monitoring of home-care
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: ergonomic requirements of system- maybe leading to cramped, uncomfortable work space etc.
      • Time: Too little time per patient, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient

Dr. Legan will be responding to the following topics with regard to his own system, and will field questions from other participants. Participants are also invited to respond with regard to their experiences of EHRs, and offer their insights and observations.

Topics

  1. What risks, issues, opportunities, or observations did you have related to Methods and your EHR/CRM solution
  2. What risks, issues, opportunities, or observations did you have related to Machines and your EHR/CRM solution
  3. What risks, issues, opportunities, or observations did you have related to People issues and your EHR/CRM solution
  4. What risks, issues, opportunities, or observations did you have related to Materials and your EHR/CRM solution
  5. What risks, issues, opportunities, or observations did you have related to Measurements  and your EHR/CRM solution
  6. What risks, issues, opportunities, or observations did you have related to Environment issues and your EHR/CRM solution

 

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

 

 

 

#MEQAPI – Tweetchat April 20th 2017 3ET: Quality Improvement vs Patient Readmission

Topic:  Quality Improvement vs Patient Readmission

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

This chat is about patient readmission.

Re-admissions within 30 days of  discharge often result from patient harm, and may result in payment clawback from insurance providers, Medicare, Medicaid, etc. Readmission may reflect a quality issue,  and as such, readmission often acts as a signal that something went wrong – something was missed, something caused harm, etc.

There are many different risks, issues, and opportunities related to patient readmission, including patient knowledge deficits, home care, weekday vs weekend discharges, self-care, and dealing with complex patient comorbidities and home/work environment.

This week the #MEQAPI topics relate to Physician’s Weekly articles related to readmission::

The period immediately following discharge is associated with several heightened risks, and has a very high need for patient or carer participation – if the patient doesn’t fully understand their post-discharge duties, needs, and risks, there can be significant harm, resulting in readmission or even post-discharge mortality. Readmission may also be due to indirect issues, such as self-harm. The period immediately following discharge carries a high risk for suicidality.

Standardizing the patient discharge process and making it a “no interruption” activity can reduce readmission risk, but readmission may be due to a wide range of causes, including the patient or carer not having the knowledge or means to carry out ongoing care. 

Quality Improvement approaches can greatly reduce readmission risk by identifying what works and observing what doesn’t work, and intervening in an effective and timely fashion to refine the discharge process and remove risks.

We will take a QI approach, and discuss the  topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.

MEQAPI Readmission

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

  • Methods
    • Policies: either unit, office, organization, or national policies
    • Workflow: how things are done that might increase risks of errors, or harm the patient, or create gaps self-care, etc.
    • Insurance Models
    • Home visits
    • Transportation option
  • Machines (equipment, EHR)
    • Medical or office equipment that might increase risk: old, broken, poorly installed, etc.
    • Home equipment specific to the patient condition
    • Software systems (especially EHR?), that might lead to duplicate work, frustration, cause medical errors like wrong pt, wrong site, wrong meds, and create hours of extra work per day.
  • People
    • Staffing: insufficient or unqualified staff
    • Training: insufficient base training, incorrect training, insufficient CME, etc. or insufficient patient or carer training
    • Attitudes: staff attitudes e.g. paternalism, rudeness, and workplace bullying.
  • Materials
    • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
    • Supplies: medical or office, inferior fax paper, lack of coffee(!)
    • Data? – sent to wrong recipient, not shared with pt or specialist, etc.
    • Patient self-care materials including checklists and how-to instructions, contact information for questions, and slef-care consumables
  • Measurement
    • KPIs: operational metrics that focus on the wrong things, or are poor measures, and that drive wrong behavior
    • Poor quality and safety metrics
    • Targets: improper or unachievable performance targets
    • Incentives: improper, biased, or discriminatory rewards, conflicting or perverse
    • Monitoring of home-care
  • Environment
    • Noise: distracting noises, sound levels too high, etc.
    • Space: cramped, uncomfortable, slippery surfaces, etc.
    • Time: Too little time per patient, too little time in a day, too many demands
    • Location: things not where they should be, too much movement of staff, pt, or equipment needed, etc.
    • Readiness of receiving point of care to cater to patient needs

The aim of this chat is look at each of these dimensions of causation, and discuss what we have seen before that has been a risk or developed into burnout, or that we anticipate is likely to become an issue.

  1. What Methods (policies, workflow, etc) have you seen or anticipate may increase risk for a readmission
  2. What Machines (med/office equipment, EHR/SW) have you seen or anticipate may increase risk for a readmission
  3. What People issues (staffing, training, bullying) have you seen or anticipate may increase risk for a readmission
  4. What Materials (forms, supplies, data?) have you seen or anticipate may increase risk for a readmission
  5. What Measurements (KPIs, targets, incentives) have you seen or anticipate may increase risk for a readmission
  6. What Environment issues (noise, space, time) have you seen or anticipate may increase risk for a readmission

 

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.