Utilizing Evidence-Based Order Sets To Improve Core Measures
By Greg Bengel, contributing writer
Order sets provide physicians with supporting medical evidence and narrative guidelines that help them meet best practices with core measures performance and quality metrics
A Wolters Kluwer webinar, archived on Health IT Outcomes, addresses how providers can improve core measures. The webinar suggests leveraging electronic, evidence-based order sets embedded with clinical decision support (CDS) functions, which specifically target areas of weakness.
Contributing to the webinar is Dr. Lucio Martinez of FHN Memorial Hospital, who explains the importance of improving core measures from a provider’s perspective. “The pressure is on these days to maximize measurable performance,” he says. “Value-Based Purchasing is now linking reimbursement to quality outcomes, Readmissions Reduction initiatives are levying financial penalties for high admission rates, and the Hospital-Acquired Conditions program is now levying penalties this year for certain hospital associated conditions.” All in all, with the focus in the healthcare industry turning more towards the quality of care provided and to patient satisfaction, improving core measures is becoming more important.
According to Martinez, “Even a few cases falling out can significantly impact a hospital’s quality ranking and payment.” This especially rings true to providers at smaller community hospitals like FHN. What’s more, with CMS reporting that the compliance rate is at, or very near 100 percent, and that more than half of hospitals report scores above 93 percent, the pressure is also on to be perfect or near perfect with core measure performance.
Martinez highlights the impact of evidence-based order sets on quality improvement initiatives, and explains how FHN designed their order sets embedded with CDS to influence core measure performance. He quotes KLAS Clinical Decision Support 2011 on the value of CDS tools. KLAS says that, “Similar to the adoption of a GPS by motorists, clinical decision support (CDS) tools are emerging to help healthcare providers navigate complex care situations and drive the type of positive clinical outcomes that organizations want.”
To improve core measures, FHN utilized a four step approach. First, they assessed their core measure performance to identify opportunities for improvement. Next, they identified, analyzed, and revised their existing order sets. This included evaluating the supporting evidence to ensure order sets reflect current best practices.
Third, they imbedded the CDS functionality into the order sets. This involved employing direct links to supporting evidence. By simply clicking an icon, physicians are taken to UpToDate to see suggested criteria for handling their patient. Also, FHN embedded narrative content into the order sets, which helps with clinical decision making and core measure compliance. Physicians see an electronic narrative showing risks factors, reminders and recommendations for care. Another CDS tool utilized was order set construction, which prompts physicians to document any deviations from best practice or core measure compliance.
The final step was to measure outcomes. Martinez speaks at length about FHN’s success in improving core measures, the struggles that FHN faced, and the importance of governance with the new technology.
Also speaking for the webinar is Adam Lokeh, Vice President of Clinical Development & Informatics, Clinical Solutions for ProVations, who speaks briefly about the ProVation Order Sets and ProVation’s collaboration with UpToDate.