Quarterly Reports

I'm going to veer off the path a bit this evening to talk about the quarterly reports that are sent out to departmental chairs, division chiefs and medical directors. I suspect that a number of you are hear of these results and have been encouraged by them. Others of you might not be so sanguine.

It is fair to say that being a reports analyst can be a thankless job. In fact, in spite of hours of work and an elegant product, Mark Proulx has had to juggle email replies containing critique of all kind, from the constructive to the undignified. In spite of this, the reports reveal the remarkable progress we have made with CIS utilization.

As you know, Baystate Health's goal is to become paperless by the end of this decade. While this might seem a fantastical goal, the truth is that Baystate has recently been recognized as being in the top percentile of over 5000 US hospitals in terms of adoption and integration of the electronic medical record. We are on a trajectory of success.

The so-call quarterly metrics reports that we generate for distribution and review are reports, and just that. They are sent as a means of revealing areas of both engagement and reluctance. They are not measures of merit, productivity or compensation. Understandably, the included calculations ought to be straight forward: see a patient, create a PowerNote, next patient... and so on. Well, now that I have an insider's view, I know that it just ain't that simple.

Think of these reports as the final product of an intricate cascade of technical events. Much like the coagulation cascade, if a single factor is missing or defective, the outcome may be useless. And so we see unders and overs, distortions and disappearances.

If a document is created on the wrong chart encounter, the visit will be counted, but the PowerNote won't. If the patient is in your schedule, but is seen by a PA, NP or another doc in the practice, then the visit may be attributed to you, but the signed document will be attributed to its author. It's even more painful when hundreds of scheduled visits occur, yet zero documents are counted, a rare though frustrating occurrence. And how about the few who had ZERO scheduled visits and ZERO documents reported? That really is a particularly unpleasant outcome. We have been giving careful examination to reports just like these.

Dictated notes confound the calculations to an even greater degree. In an ideal world, all notes would be easily and efficiently created online using structured templates, aka PowerNotes. Why, you're asking? Because it widely understood that using a structured template improves documentation as well as patient care. Decision support, health maintenance cues, and medication review are just a few reasons why templates are often better than handwritten or dictated documents.

Unfortunately, structured templates have not caught on for a host of reasons, most related to the entry of data. While we continue to refine them, a number of physician practices, primarily in the specialty world, use dictation. Dictated documents do indeed upload into CIS. However, capturing these documents for reporting is tough. This is due to the fact that the aforementioned cascade is made more complex by additional factors and interfaces. We are much closer to achieving accurate calculations, but we continue to learn from the shortfalls.

Yesterday, I worked with a team of IS analysts to redefine the logic used to track and calculate the number of documents as well as the number of times the chart is accessed for prescriptions, results reviews, and other routine events. I expect that our next reports will be provide better data. The numbers look great and we are hoping to be able to share better looking news at the end of this quarter. In the meantime, if you've got questions about how the data are collected and reported, feel free to email me or to use this blog as a forum for commentary.