To promote quality patient care, healthcare information should deliver meaningful statistics for determining the health status of the community, as well as measuring quality from a patient and provider perspective.
The transition to Electronic Medical Records (EMRs) has enabled routine data collection for quality improvement, research, and chronic disease management.
However, we know that poor data quality impedes our ability to transform information into meaningful knowledge.
We spoke to Briar De Finney, Quality Improvement Decision Support Specialist, and Christine Truong, Clinical Pharmacist, to learn about an initiative at North York Family Health Team (FHT) aimed at improving the collection and use of EMR data.
What was the impetus for starting this work?
In a large FHT like ours, comprised of 88 family physicians, interdisciplinary healthcare professionals, and over 89,000 patients, the quality of collected EMR data may not always be optimal due to the lack of consistency, quality and integrity of the data entered in the charts.
Using QI tools such as brainstorming benefits, surveys and PDSA cycles, we determined there was a lack of consistent and accurate data entry in the different EMRs used by our offices. This resulted in difficulty tracking information, performing searches and doing quality work. As a result, we identified the need to create a centralized process to review, update, and standardize existing EMR forms, flow sheets and templates.
How can standardizing documentation support high-quality care?
Let’s say we wanted to send a list to our physicians including all patients that are eligible for cancer screening. If patient lists are not updated consistently (for example, changing a patient status to ‘deceased’, ‘moved away’, etc.), the Data Manager may generate inaccurate lists, which can interfere with the quality of data extraction used to identify gaps and opportunities in patient care. We want to be able to run searches and queries with accurate, up-to-date data.
How did you decide to tackle these issues?
A Data Standardization Committee was formed to promote and support standardization of EMR data entry. The team consists of the medical director, family physicians, nurses, pharmacists, dietitians, our data manager and Quality Improvement Decision Support Specialist. Bi-monthly meetings are held to review and update templates such as the periodic health review, diabetes flowsheet, vaccination list, and family history.
How did you decide who should be on the Data Standardization Committee?
Involving team members from a range of disciplines and engaging Senior Management are critical steps that will help improve patient care through standardization. We ultimately wanted representation from all areas and everyone who uses the EMR.
Can you give an example of something the Data Standardization Committee worked on?
For us, a big issue was that our FHT uses two different EMRs and one of our biggest accomplishments is a new diabetes flowsheet–in both EMRs– that allows clinicians to document the same way and allows us to collect data. This diabetes flowsheet was created by a small working group consisting of the nurses and pharmacist on the committee and was tested by a larger group of providers. Feedback was gathered and modifications were made accordingly. This provided one standardized, evidence-based flowsheet for all providers to view and utilize allowing for excellent continuity of care.
Additionally, multiple drop-down menu items for tasks existed in the EMR, which made it confusing for the whole team. Finding the most accurate and useful items through a survey and making the changes accordingly led to increased patient safety while sending information across various team members.
How have these and other changes impacted practice?
For example, now everything diabetes related is in one spot. There is consistency with documentation. The diabetes flowsheet has allowed all clinicians to document in a similar format. It collects all the information in one spot. We can see a trend for a1c and when their next health checks are due (eg. foot exams, ECG, eye exams, mental health screen, etc.)
What advice do you have for other FHTs interested in improving the collection and use of EMR data?
A Data Standardization committee that engages different health care professionals and senior leadership can be a useful tool to implement in a FHT. It can allow members to prioritize which quality improvement initiatives are relevant based on patient population, location, resources etc., If we’re not using tools and best practices to standardize and clean our data, the quality of our data will be poor – I think a data standardization committee is a feasible first step for FHTs to improve the collection and use of their EMR data.
Gathering input from all users is important. For example, with our diabetes flowsheet, it was going to be used by specialists, like our diabetes education team as well as the general practitioners.
Being flexible is also important. It can be hard for everyone to agree to a certain way of documenting/charting but having flexibility helps.