Main Discussion Post
In 2011, the Centers for Medicare and Medicaid Services (CMS) began implementing Stage 1 of the meaningful use (MU) objectives. Stage 1 involved data capture and sharing, Stage 2 advanced clinical processes, and Stage 3 improved patient outcomes. Although, the main purpose of MU was to persuade hospitals and medical professionals to convert to from paper charting to electronic health records (EHR) by offering financial incentives to those who achieved the specific goals of MU (What Is Meaningful Use? | HealthIT.gov, n.d.). Eventually, MU became a way for CMS to deny reimbursement to hospitals and other medical professionals if their facility was not compliant with the guidelines. Because of the financial ramifications of non-compliance, EHRs began to gain popularity and paper charting began to fade out. One of the largest positive outcomes from the implementation of EHRs is the ability to filter out specific patient populations based on diagnosis, lab values, and any other pertinent information. As one of two staff nurses within this clinic, the first task in the process would be identifying all patients with a diagnosis of Type I or Type II diabetes.
Taking into consideration that this clinic has only had their EHR for a short time, patients who have been seen in the clinic since its integration should already have their records within the electronic system. For these patients, filtering out the ones with diagnosed diabetes should be easy through the EHR program. Patients who have not been diagnosed with diabetes, but have lab work that shows an elevated A1c and glucose levels, should be flagged as well, and brought in for additional blood work.
For those patients who have not been to the clinic since the addition of the EHR, manually going through their charts will be required. As with the EHRs, patients with previously diagnosed diabetes should be flagged and brought in for an appointment. Special attention must be given to any patients with elevated lab work related to a possible diagnosis of diabetes and to those who may have been lost to follow-up meeting the same criteria.
Once all patients have been identified, those without an upcoming appointment should be contacted and advised to schedule a visit with their doctor. When the patients comes in for their appointment, the doctor will be able to assess each component of the HEDIS Comprehensive Diabetes Care (CDC) measure. These measures include Hemoglobin A1c testing, performing a retinal eye exam, checking kidney function and medically treating nephropathy, assessing for non-healing wounds or foot ulcers, and uncontrolled hypertension (Comprehensive Diabetes Care, 2022). If not all objectives are being met, the treating physician should order the necessary tests and emphasize the importance of controlling their illness.
By moving to electronic health records, the National Committee for Quality Assurance (NCQA) has been able to put into place the Healthcare Effectiveness Data and Information Set (HEDIS) comprehensive care measures. HEDIS is a performance improvement tool which collects data through plan enrollments of more than 200 million people (HEDIS Measures and Technical Resources, 2023). Through data collection, HEDIS has developed comprehensive, evidence-based effectiveness of care guidelines, including that for CDC.
References
Comprehensive Diabetes Care. (2022, June 3). NCQA. https://www.ncqa.org/hedis/measures/comprehensive-diabetes-care/
HEDIS Measures and Technical Resources. (2023, January 9). NCQA. https://www.ncqa.org/hedis/measures/
What is meaningful use? | HealthIT.gov. (n.d.). https://www.healthit.gov/faq/what-meaningful-use
Government-funded health plans (examples: Medicaid and Indian Health Service) are required to participate in measuring specific health issues of the patients they serve. The HEDIS is a measurement project that addresses a range of healthcare and customer issues. HEDIS is an acronym for Healthcare Effectiveness Data and Information Set. One of the issues that must be addressed is diabetes care, along with breast cancer screening, asthma medication use, and control of high blood pressure amongst other issues (Spath, 2018).
Diabetes is the inability of the pancreas to keep up with the glucose the body is making for regulation which sends the amount of glucose in the body to unsafe levels. Either the pancreas is not producing any insulin (diabetes type I) or the pancreas is not making enough insulin to control the glucose amount in the body (diabetes type II) (Centers for Disease Control and Prevention, 2022).
HEDIS requires specific healthcare information about diabetes to be present in the health charts of patients that are experiencing this situation. Hemoglobin A1c Control (frequent checks), Eye exams checking for retinopathy exam within two years and every two years after, Kidney functions, and blood pressure control and regular checks (Premera, Blue Cross, 2022). Having an EHR (electronic health record) makes looking through charts easier depending on how it is organized.
If working in an organization that has a history of manual charts up until last year and quality control is to be implemented for diabetic care, I would want to put hands and eyes on each chart in the EHR and the manual ones (utilizing the other nurse, and staff as well). There would be a standard procedure for each patient that comes into the facility starting daily. There would be a checklist of questions to ask in the intake procedure assessing if the patient is diabetic and what procedures have been taken in the last 2 years. I would ask the IT department to have a tab entered in the records specifically for diabetes information and tracking logs. I would monitor the patients each day and 30 days to get through the rest of the records there should be a total of 50 records being organized daily including the records that are being accessed that day. This would make all 1000 records updated within four weeks/ five working days each week. If there is information missing in the manual chart, phone calls should be made to the patient or to the Dr./ facility that performed the duty. If the Dr./ facility can not be accounted for then the patient should be scheduled for whichever quality measure that is missing. This would get the clients charts updated for the quality control measure.
Reference
Centers for Disease Control and Prevention. (2022, July 7). What is diabetes? Retrieved January 18, 2023,
from https://www.cdc.gov/diabetes/basics/diabetes.htmlLinks to an external site.
Premera Blue Cross (2022, April 13). How to successfully complete Comprehensive Diabetes Care Documentation. Retrieved January 18, 2023, from https://www.digitaldiagnostics.com/newsroom/how-to-successfully-complete-comprehensive-diabetes-care-documentation/
Spath, P. (2018). Introduction to Healthcare Quality Management (3rd ed.). Health Administration Press.