Standard quality measures are one of the cornerstones of building a value-based health care system. Most Wired hospitals are twice as likely as all respondents to use information technology to identify patients for whom core measures are unmet. Nearly half of Most Wired organizations capture Centers for Medicare & Medicaid Services quality indicator data in the electronic health record, allowing them to automate compliance alerts. Having key health information entered into the EHR as structured data lets staff at Syringa Hospital & Clinics, Grangeville, Idaho, "easily determine benchmarks and improvement goals for patient safety, quality measures and more," says Darla Anglen-Whitley, foundation executive director. — Suzanna Hoppszallern

Each month, H&HN will provide continuing coverage of the annual Most Wired Survey and Benchmarking Study and other IT issues. The survey is made possible through a partnership among H&HN, the American Hospital Association, the College of Healthcare Information Management Executives and McKesson Corp. AT&T and CareTech Solutions provide additional support.


Mike Mistretta, vice president and CIO at MedCentral Health System, discusses the importance of incorporating quality measures into an EHR.

Why is it important to build quality indicators into an EHR?
By building quality indicators into an implementation, you ensure that the processes required to impact them are built into the care model, or at least the capture of the respective data required to measure quality is. It should become second nature to caregivers and be a natural part of their everyday work. Once that is achieved, you really have impacted quality.

How do the indicators actually influence patient care?
We build the data capture into a workflow process engine as much as possible, which provides prompts on clinician work lists ensuring that they perform the necessary tasks to capture the information to measure, or it may automate the data capture entirely. Prior to implementing any new workflow, we define the proper metrics and sample where we are prior to implementation, then measure/report regularly once implemented. Keep in mind that you can't improve what you can't measure, so capturing the requisite data as a part of the natural daily workflow of patient care will improve success.

How do you guard against alert fatigue?
We have several committees with heavy clinician involvement during the design sessions of our workflows. It is still extremely difficult to get alerts correct during design, however; what sounds like a great idea at that point in a workflow may not be practical during actual implementation. To deal with this aspect, we run reports on alerts listing what has been overridden or ignored to understand what the clinicians in the field are actually doing. If an alert is consistently bypassed, we bring it forward to our physician advisory committee to determine if it is something we should continue to prompt and, if so, develop an action plan to provide additional education regarding the edit.