How Public Quality Reporting Spurs EHR Optimization, Improvements

Negative feedback from public quality reporting programs can help spur EHR optimization among hospitals, according to a study published in JAMA Network Open.

Hospitals that received negative feedback from a patient safety quality reporting program improved their clinical decision support (CDS) quality 8.4 percentage points more than those that received positive feedback in the subsequent year, the study found.

In other words, that negative feedback was a successful motivator for hospitals to adopt technology that could improve healthcare quality, the researchers said.

Healthcare has long measured quality, with experts saying this could help low-performing hospitals adopt best practices to improve outcomes. But not every quality reporting program is good fit for offering up actionable information, the researchers said, in part because clinical quality isn’t always in the control of hospitals and because hospitals can sometimes be selective about which patient populations are included in clinical quality reporting.

But the Leapfrog CPOE Evaluation Tool measures process quality by evaluating whether the system sends an alert to the clinician when best practices indicate an order may cause an adverse drug event (ADE), the researchers explained.

“While process quality evaluations do not directly measure patient harm, they do accurately measure an aspect of care almost entirely within the control of the hospital,” the researchers explained. “Therefore, hospitals are more likely to be able to respond to feedback and improve, rather than having incentive to simply select patients less likely to negatively impact their scores.”

The CPOE tool also differs from other quality evaluations because it focuses on one aspect of clinical quality performance, the authors noted. Many broad quality programs, like the Joint Commission, are composite measures of various aspects of quality. The authors suggested that feedback on a targeted aspect of quality may allow hospitals to make organization-wide improvements more nimbly.

“Hospitals that received negative feedback may have allocated more organizational resources on improving EHR medication safety or enabled stricter CDS alerting, thereby realizing nearly immediate quality gains,” the researchers wrote.

The nonrandomized controlled trial of 1,183 hospitals that participated in the Leapfrog Hospital Survey’s CPOE Evaluation Tool from 2017 to 2018 showed that public quality reporting can be a key motivator for improvement initiatives.

Hospitals that received negative CPOE feedback improved the quality of their CDS systems by adding basic capabilities, rather than advanced applications such as daily drug dosing contraindications, the authors noted.

“Our results showing that the mechanism for improved performance was basic decision support, which may be easier to build or enable within a single year, may support this hypothesis,” they continued.

The study’s results suggest that publicly reported feedback on specific dimensions of quality may lead to patient safety improvements through EHR optimization.

Policymakers designing quality reporting programs may wish to consider targeted measures of process quality, such as the CPOE tool, the researchers noted.

The study authors also called for future research to examine whether process quality improvements translate into improvements in outcome quality measures, including patient experience, ADE rates, and mortality.