10/03/2019

Mine Your EMR for Data and Improve Patient Safety

Marta Sylvia, Senior Manager, Quality Improvement and Outcomes Research

Your patient education data is a powerful untapped resource. It can uncover gaps in care, improve patient experience, and show you how consistently your organization follows policies and procedures. Data and metrics may sound boring, intimidating, or irrelevant—after all, you're in the business of helping patients, not running numbers, right?—but what if I told you this information could help you improve patient safety and outcomes?

I recently teamed up with Vicki Maisonneuve, director of the Nursing Center for Excellence and Magnet Program at Parkview Health, for a webinar on how to use data to drive quality improvement. In it, we covered the four basic steps to creating your own QI initiative:

1. Determine your goals.
2. Identify your data metrics.
3. Gather, present, and interpret your data.
4. Use data to inform decisions.

Using these four steps, let's look at how a hospital could use their existing patient education data to improve patient safety.

1. It all starts with a goal.
   
   Haley Mullins, Healthwise's quality improvement and outcomes engagement manager, points out that people often get this process backward. "It's tempting to start at the end—to say, 'Hmm, what cool things could I do with this data I've gathered?' But if you don't begin with a goal in mind, you probably just have a lot of disorganized metrics," she explains. "Instead of trying to track everything, focus on the information that will be helpful."
   
   Identifying your goal ahead of time lets you focus just on the metrics that will help you achieve it. Getting specific about your goal will help even more. For example, maybe you know you want to improve patient safety. Don't stop there—that's a pretty broad goal, and lots of things can affect it. Narrow your focus even more by choosing one way you can make a difference. Ideally, it should be something that lets you track your progress.
   
   Each year, the Joint Commission publishes its National Patient Safety Goals (NPSGs), which focus on problems in health care and how to solve them. According to the commission, providing patient education can improve patient safety in several areas, such as health-care-associated infections and anticoagulant therapy¹.
   
   Let's say you've decided to focus on reducing the risks of anticoagulation therapy. Anticoagulation therapy involves complex dosing, and it's often further complicated by insufficient monitoring and inconsistent patient adherence. Tracking the patient education you give these patients will help you improve safety.
2. Decide what (and who) to track.
   
   Now you can figure out which metrics to look at. Start by identifying your eligible patient population: patients who have an indication of anticoagulation therapy on their medication list, problem list, or billing codes. Since anticoagulation therapy uses different types of medication, you may find it necessary to break up your population into subsets or choose to only track one of these groups.
   
   Next, decide which patient education you want them to receive. The content might cover the importance of follow-up monitoring, compliance, drug/food interactions, and the potential side effects of medication. If your current patient education solution integrates with your EMR, you already have this information, so you can gather up data from previous months to create a baseline.
3. Turn your hunches into evidence.
   
   It's one thing to think or know your quality improvement measures are making a difference. But putting the data into user-friendly dashboards will help you prove it to stakeholders. Interpret and break up the data in ways that make sense to your audience. For instance, you can show how often patient education was given out by department, facility, or specialty to identify training opportunities. You can illustrate whether patient satisfaction scores went up when patient education was used more often. You can even compare how the timing of the education (where in the care episode it was given) affected the number of adverse safety events.
4. Use it or lose it (the opportunity, that is).
   
   The data you gather is only useful if you do something with it. Address the teams who need to improve compliance rates, especially if they're also the teams with higher rates of safety events. Review the teams that have the best metrics to see what they're doing right and how you can apply that across your organization. Use your results to gain buy-in from physicians, nurses, and clinicians.

Healthcare has a long way to go to become a high-reliability industry, but consistent patient education can help you reduce the variability associated with patient safety events. Making the decision to track your data can feel overwhelming, but remember you already have a wealth of information at your fingertips. You're not starting from scratch—everything you need is already in your EMR. Just decide where you want to go and which metrics will help you get there.

Still unsure how to start? In our recent webinar, Vicki went into detail about how her quality improvement initiative played out at her hospital. By tracking the rate of usage in their EMR, Parkview raised their patient satisfaction HCAHPS scores—and had the data to prove patient education made the difference. Watch the video to see examples of how Parkview tracked their data, and how you can do the same.

¹ https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2019.pdf