Ultimate Blogging Championship

Tag: Members Only

  • EMR data quality – Data quality actions

    Updated as of January 22, 2016

    Estimate impact of data quality

    The data are almost certainly not a definitive estimate of your team’s actual performance. However, they might be “good enough” to help you decide if your team needs to improve or not. To determine if the data are “good enough” for that, estimate how likely it is that one or more of the issues outlined in the interpretive notes are a problem with your team. Then, run the “imperfect data impact calculator” to see if the issue(s) could lead to a different decision related to the need for improvement. To do this, work with your clinical leaders and staff to establish an approximate impact of data quality – i.e. is the data quality issue causing your performance to look like TWICE or HALF or 10% (or other number) less or more than it actually is? Plug that number into the “imperfect data impact calculator”. It will show you whether the data quality issue(s) you think you have would change your initial decision regarding the need to improve. Click here to access the Imperfect Data Impact Calculator. You may find it hard to generate consensus about the impact of data quality issues on the level of performance shown in the D2D 3.0 report. In that case, consider the following options:

    • Track the next 10 (or 20 or other small number) encounters to get a better estimate of the extent of the data quality issue. Perhaps the rate among these patients will shift your team’s overall rate to be TWICE or HALF or 10% (or some other number) of the rate in the report. Plug that number into the “imperfect data impact calculator” and proceed accordingly.
    • Estimate how many of your patients eligible for cervical or colorectal cancer screening have tests or labs recorded properly in the EMR. Perhaps the rate among these patients will shift your team’s overall rate to be TWICE or HALF or 10% (or some other number) of the rate in the report. Plug that number into the “imperfect data impact calculator” and proceed accordingly.
    • Estimate how many of your patients have a smoking status coded in a consistent manner in your EMR. Perhaps the rate among these patients will shift your team’s overall rate to be TWICE or HALF or 10% (or some other number) of the rate in the report. Plug that number into the “imperfect data impact calculator” and proceed accordingly.
    • If none of the above is helpful, consider instead experimenting with possible “error” rates to see how much error (i.e. TWICE or HALF or 10% of some other number) would be needed to change the decision made on the basis of the performance of the indicator in D2D 3.0. If, in the opinion of the team, such an amount of error is reasonable, then it may be worth considering efforts to improve data quality. Alternatively, if that amount of error is considered to be unlikely, then the data are likely good enough to support the initial decision regarding the need to improve, based on the performance shown in D2D 3.0.

    If the “imperfect data impact calculator” points to the same decision (e.g. a need to improve or NOT) even after data quality issues are considered, the data are likely “good enough” to base your decision on regarding the need to improve. The next step is to consider strategies to improve, assuming the area of care measured by the indicator is a priority for your team. If your data are not “good enough”, you may then consider taking action to improve your data quality, before or at the same time as you try to improve processes of care.

    Increase quality of the data

    …if the “imperfect data impact calculator” shows that the issues in your data may point you to a different decision than suggested in D2D 3.0.

    • The goal of this indicator is to inform and motivate action to improve data quality in the EMR and also serve as a measure to monitor progress for actions to improve data quality such as those described for all the other D2D indicators.
    • The actions to improve data quality do not need to be limited to cancer screening data or smoking status data, although these might be of immediate interest. Accurately identifying deceased patients could be a focus, or accurately recording lab results in appropriate fields and in appropriate language, or coding diagnoses consistently are other areas
    • Patients served data: confirm which patients are alive and active (by whatever definition you use in your EMR/team) as rates of indicators based on incorrect denominators (i.e. all patients ever seen vs just the patients who are alive and who are active) will be incorrect.
    • Provide feedback to clinicians:
    • Consider hiring a student to help you clean up your data (see suggestions in this handbook for cleaning up your roster and smoking/alcohol status)
    • Participate in the EMR communities of practice and join your peers in developing new tools and processes for standardizing access to EMR data. Contact improve@afhto.ca to get connected.
    • Tap into external resources to support clinical process changes using PDSAs from HQO or others (also check with your QIDSS).

     

       

  • Data to Decisions: Advancing Primary Care

    Data to Decisions: Advancing Primary Care is a membership-wide report on performance in primary care. It helps local teams see where they stack up against their peers on a small number of measures. QIDS Specialist Host & Partnership Forum: The September 1st, 2015 forum was attended by over 90 QIDS specialists and QIDS specialist host and partner Executive Directors.  The purpose was to celebrate our collective progress via analysis of D2D 1.0 vs. 2.0 data and preparing teams to move forward faster further. For more information check out the presentation slides or watch a recording of the webinar. Why participate in D2D? Click here for a video to help EDs, physicians, Boards and QIDSS start discussing D2D and how your team can participate. 

    Past Reports

    The submission/historical data forms for D2D 1.0 and D2D 2.0 are temporarily unavailable while we prepare for the launch of D2D 3.0 on December 3, 2015.

    The D2D journey continues – getting started on the next iteration of D2D

    Measures will continue to be refined to become more and more meaningful to providers and their patients, and acted upon to improve care. Calling all clinicians! Make sure D2D makes good clinical sense – join the conversations by July 24, 2015 to come up with better indicators for Emergency visits, 7-day follow up and other clinical measures.

    Stay up to date on D2D – The eBulletin is released bi-weekly to help members keep track of upcoming D2D deadlines and share updates and information about manageable meaningful measurement.

    Resources and Links

    For more information about D2D contact Carol Mulder, QIDS Provincial Lead, carol.mulder@afhto.ca.

  • Data to Decisions 2.0 is here! Join the orientation webinars today at 12:00 PM or 4:30 PM

    D2D 2.0 - colour logo for website

    Data to Decisions (D2D) 2.0 is here!

    D2D is a ground-breaking report on performance in team-based primary care in Ontario.

    • AFHTO members are leading the way to advance manageable and meaningful measurement across primary care.
    • This work is critical. Robust measurement is a mandatory ingredient for strengthening comprehensive primary care as the foundation.
    • AFHTO members are keen to step up to show the value that primary care teams deliver to patients, communities and the health system.
    • Teams can compare their results to their peers, however individual team results remain confidential to that team.

    D2D 2.0 demonstrates significant progress in this journey:

    • More than 100 family health teams and nurse practitioner-led clinics have voluntarily submitted their data.
    • This gives insight into the care of over 1.7 million Ontarians.
    • Comparative analyses indicate the results are representative of the full AFHTO membership of Family Health Teams (FHTs) and Nurse Practitioner-Led Clinics (NPLCs).

    The D2D journey is revealing how to get better at measuring what matters most:

    • AFHTO members are shaping implementation of Health Quality Ontario’s Primary Care Performance Measurement Framework (PCPMF) – in identifying priority measures for system and practice level and in refining these measures.
    • Working with the Institute for Clinical Evaluative Sciences (ICES), AFHTO members are leading the way to measure the average cost of all health care received by the panel of patients served by each team, adjusted for the characteristics of that patient panel.  This measure is highly important since it:
      • Can be calculated for the panel of patients in any type of primary care practice in the province.
      • Enables cost to be monitored over time to better understand the impact of improvements in quality of primary care and the health of patients on the sustainability of health care system.
    • To better reflect the many facets of comprehensive primary care that matter to both patients and providers, AFHTO members have completed their first iteration of a composite measure of quality.
    • Working across such a large number of primary care teams is enabling innovation to simplify data extraction from EMRs and improvement in data quality.

    D2D 2.0 shows encouraging results for AFHTO members and provides guidance for further improvement (click here for table):

    • Overall, AFHTO members are performing better than the provincial average on same day/next day access (40% better), cancer screening (10% better), and patient satisfaction with their involvement in decision-making (4% better).
    • There are preliminary indications that patient satisfaction with the courtesy of office staff has improved over the past 3 years (20% improvement).
    • Most teams rank high on some indicators and lower on others. D2D enables teams to compare themselves to their peers and pinpoint their improvement activity.

    The D2D journey continues. Measures will continue to be refined to become more and more meaningful to providers and their patients, and acted upon to improve care. Thank you to all AFHTO members who participated in D2D 2.0.  We hope you will all consider participating in the next iteration, to be reported in January 2016.

  • Data to Decisions eBulletin #13 – June 11, 2015

    Be there for the launch of D2D 2.0: Orientation webinars on June 18, 2015, register now. Tell us how your team works together to improve primary care: Complete the pre-D2D survey by June 18, 2015 to add your voice to the AFHTO story about teamwork. Do you really know what QIDSS can do? Watch the video for ideas (but by no means all!) of the things your QIDSS can do for you. QIDSS learning more about how to help teams use data: QIDSS and QIDSS-like people are invited to a Knowledge Translation and Exchange day on June 22, 2015. Contact Denise Pinto for more information. Do you want to invite others to get the eBulletin? Invite them to sign up online. What is D2D? Data to Decisions (D2D) is a member-wide summary of performance on indicators that are both possible for members to measure and that are meaningful to members. See the D2D page on AFHTO’s website for more information.

  • Letter from President: AFHTO submission to Minister on optimizing the value of team-based primary care

    Dear board chairs, EDs and Lead MDs/NPs of AFHTO-member organizations: I am forwarding to you the briefing note AFHTO has produced to inform the Minister and ministry’s thinking as they develop plans for moving toward “comprehensive regionally governed, population-based primary health services for Ontarians.” True to our mission to work with and on behalf of members to provide leadership in supporting and expanding high-quality, comprehensive, team-based primary care, AFHTO has completed a literature review to identify the critical ingredients to gain optimal results from a primary care team, and across a population. In order to inform the Minister and ministry’s thinking as they develop plans, AFHTO’s board of directors has distilled this evidence into a set of principles for optimizing the value of teams, and an initial set of recommendations for moving forward. These are presented in the two-page briefing note. This briefing note is a starting point for further discussion – with AFHTO members, our colleague associations in the Ontario Primary Care Council, as well as MOHLTC – on how to spread access to high-quality, comprehensive team-based primary care. Your input is most welcome. Please e-mail info@afhto.ca to submit your thoughts on this briefing note and where we need to go from here. All comments received from members will be considered by AFHTO’s Physician Leadership Council and ED Advisory Council in their meetings in July. These two groups will also meet jointly in early September, leading up to the annual Leadership Session for all board chairs, EDs and Lead MDs/NPs, immediately before the AFHTO conference in October. We look forward to hearing from you. Sincerely, Randy Belair AFHTO President and Executive Director, Sunset Country FHT (Kenora)

  • Sign up for June 18 D2D 2.0 release webinar and check out the new QIDSS video

    Over half of AFHTO’s membership has contributed data to D2D 2.0! June 18 is the report release date. Sign up for the webinars to learn how to navigate the report and see how you compare to your peers.  In the meantime, Executive Directors will be invited to complete a pre-D2D 2.0 survey. This survey will help AFHTO members measure, demonstrate and improve the impact of teams, the QIDS program and D2D on comprehensive, interdisciplinary team-based primary care. EDs – watch for a follow-up email. QIDS Specialists – a key force in advancing meaningful measurement – are the subject of a new video. Three minutes was not nearly enough time to showcase their complete range of skills and competencies, but it does illustrate a few of the ways they’re making a big difference. 

    Check in with your QIDS Specialist to find out more about how they can help your team – or contact Carol Mulder for more information. For more information about D2D 2.0 you can visit the relevant page here in the Members Only section.

  • Do you really know what QIDSS can do? Watch the Video for ideas

    This short video highlights a just few of the activities QIDSS (Quality Improvement Decision Support Specialists) provide but not all of the range of skills and competencies that can be taken advantage of. QIDSS are flexible. They do different activities for diverse teams depending on where the team is on their Quality Improvement (QI) journey.  It’s not one size fits all!

    Want to see what a QIDSS can do for YOUR team, watch the video for some ideas.

    Contact your QIDSS for more information or if you’re not sure how to contact your QIDSS, e-mail improve@afhto.ca  for assistance.

  • EMR queries for D2D 2.0

    EMR queries to assist members to participate in D2D 2.0 Childhood Immunization Data Telus PS EMR: If your team is billing for vaccines and documenting them in the IMMU field in the patient profile, the Preventive Care Summary report can be used. If this is not the case, you might consider using the searches (.srx files) contained in this folder that will extract data for the numerator and denominator for all children and rostered children with up-to-date immunizations. Save these searches to your desktop and import into your EMR. You might need the help of your QIDSS, IT staff or other person who usually runs queries in your EMR. For more details about the searches and instructions on how to import them into your EMR click here.  Please contact Marg Leyland if you have any questions. Accuro EMR: If your team is billing for vaccines the Cumulative Preventive Care Bonus report can be used. This will give you data for an individual physician for rostered children only (not all children). If you are not consistently billing for vaccines you might consider building you own queries for childhood immunization rates. Please check out this guide for information about the criteria to use in your queries. You might need the help of your QIDSS, IT staff or any other person who usually runs queries in your EMR. Please contact Marg Leyland if you have any questions. Nightingale EMR:  Teams using Nightingale may not be able submit childhood immunization data. The criteria used in the Health Maintenance Compliance Report does not match the D2D 2.0 definition which is based on the MOH preventive care bonus schedule. To the best of our knowledge a query in Data Miner is not available. The vendor is aware of this situation and we will continue discussions with them. Please contact Marg Leyland if you have any questions. OSCAR EMR: Two queries have been created for teams using OSCAR. One query generates % of all active children with up-to-date vaccines, the other generates % of active rostered children with up-to-date vaccines. The queries and criteria used can be found here. Please contact Marg Leyland if you have any questions.  P&P EMR:  Queries are being finalized – please check back soon or contact Marg Leyland with any questions. EMR Data Quality Indicator – Cervical and Colorectal Cancer Screening Telus PS EMR: The Preventive Care Summary report can be used to generate data for your cervical (Pap) screening rates. Unfortunately this report cannot be used for colorectal screening rates because the criteria used does not match the SAR criteria. You might consider creating your own search for colorectal screening data – click here to see an example of the colorectal screening search. Please contact Marg Leyland if you have any questions. Accuro EMR: Unfortunately the Cumulative Preventive Care Bonus reports cannot be used to generate data for your cervical or colorectal screening rates. The criteria used in the EMR reports do not match the SAR criteria. You might consider creating your own searches for cervical and colorectal screening data – click to see examples of how to build these searches for colorectal screening searches and cervical screening searches. Please contact Marg Leyland if you have any questions. Nightingale EMR:  Teams using Nightingale may not be able submit cancer screening data. The criteria used in the Health Maintenance Compliance Report does not match the SAR definition for cervical cancer screening (age range differs) or colorectal screening (exclusions differ). To the best of our knowledge a query in Data Miner is not available. The vendor is aware of this situation and we will continue discussions with them. Please contact Marg Leyland if you have any questions. OSCAR EMR:  Two searches have been created to generate data for the cervical and colorectal screening rates. Please find both searches here. Contact Marg Leyland if you have any questions. P&P EMR:  Queries are being finalized – please check back soon or contact Marg Leyland with any questions. EMR Data for Expanded Data Submission for Quality Roll-up Indicator Telus PS EMR: The Telus PS searches (.srx files) available in this folder will extract data for the EMR-based quality roll-up indicators (high priority indicators only). Save these searches to your desktop and import into your EMR. You might need the help of your QIDSS, IT staff or other person who usually runs queries in your EMR. For more details about these searches click here. Please contact Marg Leyland if you have any questions. Note: Searches for the other EMRs are not yet available. Please consider creating your own searches using similar criteria in the Telus PS notes.            

  • Data to Decisions eBulletin #12 – May 28, 2015

    EXTENDED deadline: D2D data submission due JUNE 1, 2015 Click here for data submission instructions and here for webinar recording or contact Greg Mitchell. EMR queries to collect data for D2D core indicators Click here to access queries for childhood immunization and EMR data quality or contact Marg Leyland. Want to know more about the quality roll-up indicator? To know more about how this indicator better reflects comprehensive primary care in a way that also considers what is important to both patients and providers, click here or contact Carol Mulder. D2D impact assessment starting soon – watch for survey next week A survey will be released to EDs next week to estimate the impact of D2D and to support planning for D2D 3.0. Patient experience surveys by phone? Click here to find out how teams are seeing an improvement in patient survey response rates using the patient contact system pilot or contact Marg Leyland. Do you want other people on your team to get the eBulletin? If you think others on your team might also want the eBulletin invite them to click here. What is D2D? Data to Decisions (D2D) is a member-wide summary of performance on indicators that are both possible for members to measure and that are meaningful to members. See the D2D page on AFHTO’s website for more information.

  • Patient Contact System – Pilot Project

    The goal of this project is to make it easier for teams to administer ongoing, consistent, patient experience surveys and otherwise engage patients in their care in meaningful ways. 10 teams are currently piloting the system. For more information check out the pilot project announcement and the FAQs or contact Marg Leyland. Keep an eye on this page for updates and success stories.

    Sept. 10, 2015: Data are starting to come in

    Five pilot teams have successfully implemented the automated patient contact system (all use Telus PS EMR) – 3 more teams (Accuro and Telus PS users) are scheduled to go live in the next 3 weeks. The system runs automatically from the EMR and is configured to contact 10 patients with recent appointments by phone a day. Typically 4-5 survey questions are asked per patient. To-date 1,842 patients have been contacted with an overall survey completion rate of 37%. If necessary, the system contacts each patient twice, with 66% of the first attempts being successful. For some reason, Thursday also seems to be a good day to get a complete survey. We are continuing to gather team and patient feedback this week to summarize the lessons learned and potential value of the system for other teams.

    May 28, 2015: Patient experience surveys by phone?

    Patients are responding nicely to surveys administered by the patient contact system being piloted by 10 of our teams. Preliminary results from 1 team indicate a 50% survey completion rate – an improvement over the 30% rate typically expected for surveys administered inside the practice.