“You have got to get it right up front,” Greg Maynard, MD, UCSD, told hospitalists at SHM's HM14 annual meeting when discussing how to leverage the electronic health record (EHR) to perform active surveillance for quality and safety deficits. “This method can be labor intensive up front, but [it] leverages the EHR and has the potential to disseminate improvement efficiently,” Dr. Maynard said. He went on to provide many specific tips and techniques for providers to use in order to design successful clinical decision support strategies.
• You need to be willing to redesign the system to go beyond current process measures to achieve optimal care. Currently, there can be a poor association between process measures and outcomes measures;
• You need real-time data to be able to perform a “measure-vention,” or measurement with concurrent intervention. You need to be able to collect data and then act on it for a particular patient that day;
• You need to determine who is going to act on the quality or safety deficits that are discovered once you develop measure-ventions, or real-time measures. There needs to be someone tasked with reviewing and acting on these daily reports; and
• Some institutions have developed “dynamic dashboards” that highlight active, ongoing surveillance of multiple quality improvement metrics. These help to create shared situational awareness for all providers involved in a patient’s care.
James O’Callaghan is a clinical assistant professor of pediatrics at the University of Washington and a member of Team Hospitalist.