STAGE 7 SPOTLIGHT Sansum Clinic: Collaborating to Improve Patient Care and Prevent Financial Risk
The electronic medical record adoption model (EMRAM) was developed as a guide to measure and standardize patient care improvements through technology within healthcare organizations. The EMRAM is globally recognized as the gold standard for health IT maturity and countless organizations have utilized the model on their journey toward better patient care, lower costs and improved overall health for populations.
Achieving Stage 7 EMRAM is a notable accomplishment — so what does Stage 7 actually look like? Let's examine the implementation process at Sansum Clinic in Santa Barbara.
Sansum Clinic is a mid-size, multi-specialty clinic located on the Central Coast of California. There are 200 providers, 1,000 employees and 22 different clinic locations in Santa Barbara County. In addition to primary care, they offer over 30 specialties and care for 50% of the city and 25% of the county. They achieved EMRAM stage 7 status in 2017.
A significant challenge faced by healthcare organizations in recent years has been navigating quality measurement and reporting systems to ensure smooth transitions for patients and the organization into the new Medicare payment systems — MIPS and MACRA. Historically, Sansum Clinic used third-party organizations to calculate and report on measures such as PQRS, P4P and HEDIS. The reports were retrospective, inhibiting the ability to work with data in real time.
To proactively address this problem, their goal was to develop internal mechanisms to measure and react to quality data in real time, thereby improving patient care through technology.
Their objectives included:
- Developing a primary care scorecard that is analogous to how MIPS would measure an individual provider. This involved developing a method to compile the data internally and then develop a way to communicate these to the operational staff.
- Working with an EMR team, operational executives and managers to develop methods for deploying the scorecards in the primary care departments.
- Capturing the data to enhance quality measure reporting, ensure continued revenue stream through changing reimbursement systems, and improve patient care.
Additionally, they had specific concerns around transparency between providers and departments, engagement of support staff, and awareness of physician stress and burnout.
The EMRAM Implementation
Keeping the MIPS measures and thresholds in mind, 15 quality measures were chosen and used as the basis for the scorecard. The scorecard displays a visual to relay whether or not the specific measure is met based on the organization’s goal, the provider’s percentage, the numerator and denominator for that provider’s population, and the points for each measure contributing to the total score. The scorecard included sections on resource utilization and patient engagement.
The scorecard was shared with each primary care provider and their score was compared to their peers' in different locations via a blinded distribution curve.
Sansum encouraged data transparency during the initial steps of the process. It was their ultimate goal to enable providers to improve their scores, thereby improving patient care through technology. They partnered with the Patient-Centered Medical Home (PCMH) to incorporate the quality measure project into the workflow in primary care departments.
Sansum used Epic’s long term plan-of-care system and created a huddle report for the primary care teams to use so they can see their patients’ information at a glance on the schedule screen. To maintain engagement and reward the hard work the teams were doing, a financial incentive plan was implemented in 2016 for both providers and staff when certain thresholds were met. A truncated version of the scorecards was later released to specialty departments which focused on three key measures — depression screenings, blood pressure control, and BMI.
As part of their daily huddle, the care teams were able to address the quality measures, and the support staff was empowered to discuss health maintenance with the patients.
Since the program began, Sansum has noted a steady increase in the quality measures reported for PQRS, P4P, and HEDIS. The primary care departments met or exceeded 6 of the quality measure goals in 2016, and were on track to meet or exceed 11 of these goals in 2017. Sansum Clinic is now 1 of 8 Epic customers to successfully meet Stage 3 Meaningful Use thresholds.
The project created a culture change within the clinic, particularly in the primary care departments where the staff became a vital part of the patient care team. Rather than just taking vitals and rooming the patients, they started to engage in promoting health and wellness for their patient populations. The support staff has reported more job satisfaction due to this change. The providers became more engaged in the population health aspects of their practice, resulting in improved patient care through technology. Overall, the program created awareness and responsiveness to the importance of the quality of healthcare Sansum was providing.
Sansum learned it was essential to have active, ongoing participation from every member of the healthcare team to accomplish the project. Without the backing of the physicians, mid-level providers, nurses, and support staff, the initiative would run the risk of not being adopted. It was critical that the metrics were viewed as opportunities for growth, rather than criticisms.
The teamwork displayed by the entire organization, from the CEO to the front desk staff and everyone in between, contributed immeasurably to Sansum’s initial implementation and continues to add to ongoing success.
The implemenation project was a growth opportunity for their organization and allowed them to collaborate across disciplines for the betterment of their patients and their processes. Like Sansum, hospitals around the world can use the EMRAM stages as a guide to continuously innovate and improve diagnosis, treatment and care outcomes for their patients.