Session Information
Title: Health Services Research, Quality Measures and Quality of Care - Innovations in Health Care Delivery
Session Type: Abstract Submissions (ACR)
Background/Purpose: Lower back pain (LBP) is a common complaint in the general population and accounts for 2.5% of all outpatient office visits. Critical assessment and documentation of the clinical features of LBP are essential for accurate diagnosis and proper care. Medicare has established physician quality reporting system (PQRS) guidelines for back pain. An incentive is given to clinicians who successfully report 3 or more PQRS measurements for a minimum of 50-80% applicable Medicare Part B FFS patients from January 1 to December 31. Clinicians not compliant with reporting system will receive a service penalty that will be applied in 2015. Electronic medical records (EMR) are promoted as tools for performance improvement. We investigated the impact of education and conversion to a comprehensive EMR (EPIC) on physicians’ documentation and compliance with the quality reporting system guidelines.
Methods: We initiated a performance improvement project by retrospectively reviewing 100 charts (20 from each of 5 clinicians) for Medicare PQRS guidelines for low back pain. Content of the PQRS documentation assessed includes initial comprehensive assessment using standardized assessment tools for pain, functioning status, warning signs, prior treatment response and employment status, physical examination including straight leg raise and neurological exam, advice for normal activities, and advice against bed rest. Results were reviewed with the clinicians, in conjunction with a didactic review of the PQRS guidelines. A comprehensive EMR system (EPIC) was launched shortly after the first chart review. Subsequently, 100 (20 from each of 5 physicians) charts were reviewed to measure change in documentation. An additional plan-do-study-act cycle was performed after working with the software development team to embed PQRS measurement guidelines within the EMR system.
Results: The overall percentage for prior lecture documentation was 36.75%, post lecture and EMR/EPIC system implementation was 19.59%. The compliance rate for pre-lecture comprehensive initial assessment was 34%, physical exam 46%, advice for normal activity 55%, and advice against bed rest 12%. The post-lecture/EMR comprehensive initial assessment was 23.3%, physical exam 27.5%, advice for normal activity 23.95%, and advice against bed rest 3.61%. Documentation declined significantly after education and EPIC implementation. A standard template for documentation (“smartphrase”) was developed to facilitate physician documentation. The impact of this EMR enhancement on documentation is being measured and will be reported.
Conclusion: Initial implementation of the EMR had a significant negative impact on physician documentation of back pain for PQRS reporting in spite of physician education. An electronic template with built in PQRS guidelines may improve physician documentation and quality of care.
Disclosure:
M. Chen,
None;
W. E. Davis,
None;
A. Fraser,
None;
J. M. Zakem,
None;
E. Scopelitis,
None;
K. Collins, MD,
None;
T. A. Webb-Detiege,
None;
R. Quinet,
None.
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