NCQA President Talks About the Promise and Challenge of EHRs

By Cindy Atoji 

May 6, 2008 | The “Patients Centered Medical Homes” initiative is the latest tool touted by the National Committee for Quality Assurance to help drive adoption of electronic medical records says Margaret O’Kane, president of the not-for-profit NCQA.

A Patient Centered Medical Home is a model of health care delivery that revolves around a primary care physician who coordinates all other care needed for a patient. Care is facilitated by registries, and health IT, to make sure patients get the care when and where they need it, from hospitals, nursing homes, home health agencies, etc. This concept, along with P4P (Pay for Performance), is trying to move physicians where they need to go, says O’Kane.

“It’s about trying to encourage the creation of registries and customized information about each patient. What IT actually makes possible now is care management at the delivery system level,” she says. NCQA is best known for its report cards that look at the nation’s health plans. Digital HealthCare & Productivity spoke with O’Kane about NCQA’s programs and the role of health IT in these accrediting and certification programs.

DHP: Your organization has a long record of measuring health care quality. How have changes in technology affected quality over the last three to five years?

O’Kane: The organizations that have adopted EHRs and made them work are really showing us what can be done. It’s become increasingly urgent to adopt technology, but it’s clear that it’s very complex to adopt an EHR. I know that Kaiser bought the Epic system and they had to re-tool a lot to make it do what they wanted it to do. Many products out there are not searchable; the data is not encoded, or you have a paper medical record concept up on a screen.

I think the difficulty of implementation and cost of EHRs is a big barrier. People are afraid they’re going to buy the wrong one or that it’s not going to work well for them. Frankly, I don’t understand why there aren’t the kinds of solutions we see in other areas where the computer is part of a package of services that basically solve your problem. Because so much re-engineering of the practice process is required, the idea that each little practice will have the time and experience to accomplish this efficiently strikes me as unrealistic.

DHP: What do you suggest?

O’Kane: To your vendor readership, I’m very impressed when I hear of companies who send representatives around to actually sit with the people who are using the product. The more time the vendors spend in practices, and really understand what the needs are, the better. There are often failures—anecdotes about people getting computers and not using them. These stories lead people who want to buy [EHRs] to become afraid they’re going to buy the Betamax version.

The industry needs to meet customers where they are and also look at what’s possible, not just trying to re-engineer around the current delivery cycle. I think that’s where the medical home makes a real contribution. It makes it very clear what’s needed and then you can re-engineer the process around that. This provides the bones of what I think the 21st century practice should look like and what the process re-engineering needs are.

DHP: What further steps are needed to make performance measurements more effective?

O’Kane: We’ve come a long way and have many performance measurements to point to these days, done by us and others in the space: the Joint Commission, the Physician Consortium for Practice Improvement, the National Quality Forum, etc. So there’s no shortage of measures. But where measurements meet a fragmented delivery system is where you have a problem, because it’s not clear who’s accountable, and that leads to narrowing the frame of accountability. So there’s no substitute for organization in the delivery system.

DHP: NCQA recently released the State of Health Care Quality, 2007. What are some of the highlights of the report?

O’Kane: This was our eleventh survey, and we found a promising upward trend in the number of accountable health plans and an increase in the number of Americans enrolled in plans that measure and report on their health care quality. There was also an increase in HEDIS (Health Plan Employer Data and Information Set, a set of health plan performance measures) reporting by PPO plans. These plans, which just two years ago reported little or no quality data, are now embracing the quality agenda. Last year, 141 plans submitted HEDIS data on 21 million of their members. This is up sharply from the 80 PPOs that reported HEDIS in 2005, a lot of progress in a short period.

So that’s kind of a watershed for us, to be moving beyond HMOs and to have a large number of PPO lives that have begun to report. The story continues to be that we see great progress in performance in a number of areas.

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