Evaluating Clinical Quality: A Case Study

Evaluation is an integral part of any project. It is key to assessing progress midway in order to correct any mistakes, it is also the surefire method to avoid past pitfalls in a future undertaking.

Considering the scenario of evaluating a system after two years, first it must be remembered that there will be crossover, points and factors where both quality and cost will meet. Hence, the possibility for redundancies. There are quite a few features in an EMR from which this assessment can be made they will be mentioned appropriately as we look at how performance and impact can be gauged in quality, cost and patient satisfaction.

The last of these patient satisfaction does not have any clear-cut methods or features within an EMR itself to evaluate

Features to be evaluated will include: medication features (CPOE, interaction alerts, allergy lists, guidelines and references); laboratory features; diagnosis features (decision support systems, evidence-based guidelines); clinical encounters (provider notes, clinical helps and guidelines); aggregate reports. This category encompasses both quality of care but also “quality of work life” (Wager, Lee, & Glaser, 2009). The latter is measurable using surveys (with targeted and/or open ended questions) of system users on how the EMR has improved or worsened their productivity, satisfaction and so on (Rahimi & Vimarlund, 2007). An optimal system will allow for less medication errors, meaning a better outcome for most patients. These errors arising most of the time from duplication, incorrect dosages for example. Although there are new errors that will appear, results are promising in general (Wager, Lee, & Glaser, 2009). A study had found that such a feature reduced by about half the major errors in medication at the Brigham and Women’s hospital (Wager, Lee, & Glaser, 2009). We will also expect better care through the use of more standard approaches to disease management thanks to a solid Decision Support System (DSS) if it exist in this configuration (Rahimi & Vimarlund, 2007); quicker access to lab results. Accuracy of data entry can be assessed by comparing the quality of physician notes in paper form versus

It is related to almost all the features used to evaluate quality, added with billing features, security, and IT infrastructure (which determines part of the maintenance costs). To summarize what will follow, this IT project will require a cost/benefit analysis where investment and maintenance cost will be measured up to any revenue and reduced costs linked to the use of the electronic system, which would then warrant a comparison to a similar time frame using the old paper based system. From the experience of other organizations and many studies, it was found that use of an EMR system generally increases revenue, by dismissing many billing errors, loss of files needed to process a claim or face an insurance related event (Wager, Lee, & Glaser, 2009). There is also reduction of the cost of supplies (paper for example), reduction in employees needed (archivist for example), reduction of wasted resources (elimination of duplicate lab tests, duplicate prescriptions) (Wager, Lee, & Glaser, 2009). The return on investment of an EMR is generally positive, thought differences exist due to maintenance cost of different operating systems and infrastructure. The benefits fall into the categories of: payer-independent, capitated and fee-for-service, and within each category often as much as 30% or more reduction of cost can be identified (Rahimi & Vimarlund,