An interesting article from a known expert appeared a little while ago:
Do you really know the effect you're having on all your patients?
Analysing performance, practice trends and patient management is becoming more and more important
31st August 2021
By Associate Professor Chris Pearce
Delivering effective care is a complex task, but broadly speaking there are two new things you need to understand.
First, you need insight into the care of the practice population, not just individual patients.
Second, you need insight into the ways individual GPs, and the practice as a whole, contribute to providing that care.
In days gone by, that was hard to do, but with the rise of digital exploration tools that analyse what is happening to patients and practice trends, the obstacles are being overcome.
These tools are growing in number. They include programs such as POLAR, the extraction tool my company, Outcome Health, has developed, but there are others such as Doctors Control Panel, Pen CS and MedicineInsight.
A feature common to all of them is the way they offer access to ‘business intelligence’ dashboards.
These dashboards can show a breakdown of your patients according to a particular condition and age, and then show further breakdowns listing those with high blood pressure, those who smoke, those with significant levels of alcohol consumption and so on.
It means you can find out how many patients have recorded a high blood pressure in the past six months, and how many are too high despite being on medication. From this, you can generate a practice-level list of those patients.
In effect, the software allows a practice to capture a performance outcome and combine it with standardised quality interventions.
Outcomes
Take hepatitis, for instance.
Many practices based in urban centres have a significant problem with hepatitis because they are caring for high-risk populations from, say, migrant backgrounds, or with a history of IV drug use.
By combining demographic and clinical data, the ability to flag those who should be screened and, should they screen positive, to keep track of the ongoing care (ultrasounds, regular bloods) becomes possible.
This type of information is growing dramatically in importance.
Federal Government policies such as Practice Incentives Program Quality Improvement (PIP QI) are now driving GP interest in a broader view of the health of a practice’s population.
Health policy in Australia does not yet directly link quality care of a practice population to remuneration as it has elsewhere in places like the UK.
For the time being, PIP QI payments are made simply for providing deidentified practice data.
But there is no doubt in my mind this will change.
This may unsettle some, but it is not an unreasonable expectation that quality of care, not just throughput, is used as a means to incentivise individual practice as well as practice ecosystems.
Don’t put rubbish in
So how best to ensure the software benefits you and your practice and
ultimately your patients? Here are some suggestions:
Ensure the data the tools analyse is coded correctly. For example, allergies not in the allergy part of the electronic medical record means the software won’t be able to check.
Is the coding clear? A diagnosis of ‘COPD’ is not ‘presented with COPD, low oxygen’.
Is there a tool installed at the practice to analyse the data? Do you know how to access it?
Is someone monitoring the tool? How often? Like any software, it needs to be updated and checked regularly.
Is there a systematic data-based quality improvement process within the practice? Do you look at the data, assess gaps and set targets?
Remember, the people who generate the data should see benefit from using it. Then they will make sure the data is good.
Do you compare the performance activity within the practice? Which GPs do more management plans? Which do more procedures? This allows for resource planning within the practice.
Do you compare the performance of your nurses? This is a whole-of-practice activity, and nurses are important parts of the care team and important generators of data.
Does your practice have open conversations about all of the above? It is important to see this data as a helpful tool, not a threat.
Good coding underpins good electronic medical records. It’s the ‘rubbish in, rubbish out’ principle.
Coded records allow the software to process information to assist you in managing your patient load. Accurately coded diagnoses are also important for decision support and event reporting.
As all doctors know, the clinical software allows you to record a diagnosis, usually in a structured way, during the consultation.
More here:
https://www.ausdoc.com.au/practice/do-you-really-know-effect-youre-having-all-your-patients
There are a few things that come from this for me.
1. Data quality and coding of diseases are crucial.
2. There is a great deal of value that can be derived from practice information that can really make a difference to the understanding of the patients seen by the practice.
3. EHR systems will be used more fully and carefully if real time reports, using their own data, are provided back to practitioners that add value to their understanding of what they are actually achieving.
4. The aggregate data provided to PHNs and the Government will only be improved if the practitioners on the ground are seeing value from their data collection and coding efforts.
Incidentally understanding their data should also make them more careful about what is sent ‘up the line’ to Government keeping an eye on potential exploitation and misuse of their data. There is precious little reason for anything other than aggregate anonymised data to leave the practice and this approach would be welcomed by privacy advocates. Additionally it would be sensible to let all patients know how their information is being used and the improvements it is encouraging and to obtain consent for its use.
The understanding of the value of internal data for the overall practice and its patients clearly can add real worth to the work done in using the practice EHR.
David.
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