Compliance with the Centers for Medicare & Medicaid Services (CMS) core measures is a quality target for many hospitals. The discharge summary is an approved data source for auditing compliance with CMS core measures. Our health system performed below national averages with core measure compliance for the standard six component heart failure discharge instructions (activity level, diet, followup, weight monitoring, symptom management, and accurate medication reconciliation). We aimed to improve heart failure core measure compliance by modifying the discharge summary within the EPIC electronic health record.
The EPIC electronic health record (summer 2009 release) was installed separately at each of five hospitals within a single healthcare system in a rolling fashion from November 1, 2010 to September 1, 2011. On July 1, 2011, we introduced a modified default discharge summary template into EPIC containing an interactive checklist prompting physician users to address the heart failure core measures, including discharge instructions, medication reconciliation, and use of an angiotensin converting enzymeinhibitor (ACE)/angiotensin II receptor blocker (ARB). Core measure compliance was measured independently by trained CMS chart abstractors. Compliance rates were collected at each site preEPIC (12month baseline), postEPIC (from date of EPIC implementation at each hospital to June 30, 2011), and postEPIC with the checklist tool installed (July 1, 2011 to September 30, 2011). Results were then pooled to represent data across the entire five hospital health system.
Compliance with heart failure discharge instructions was 80.8% (668/827), 88.4% (160/181), and 91.3% (169/185) for preEPIC, postEPIC, and postEPIC with the default discharge template respectively. After the discharge template was installed, the reason for core measure noncompliance was medication discrepancy in 13 of 16 cases, and lack of followup instructions in 3 out of 16 cases. Retrospective analysis showed that in 43% (7/16) of the noncompliant charts, the physician neglected to use the default discharge summary and/or checklist tool. Compliance for the ACE/ARB core measure was 96% (262/273), 95.6% (66/69), and 98.1% (52/53) for preEPIC, postEPIC alone, and postEPIC with the checklist tool, respectively.
The introduction of EPIC has a positive impact on heart failure core measures. However, providing physicians with a standard discharge summary template including accurate medication lists and an interactive checklist further enhances compliance with heart failure core measures, particularly the discharge instruction measure and a trend toward improving ACE/ARB compliance as well. Future directions include ongoing targeted physician education on usage of the default discharge template and improving medication reconciliation.
To cite this abstract:Hu C, Breger K, Cummings P. Improving Heart Failure Core Measure Compliance Within the Epic Health Record. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97599. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/improving-heart-failure-core-measure-compliance-within-the-epic-health-record/. Accessed September 19, 2019.