Transforming healthcare amid staffing shortages: A case study of Southern Ohio Medical Center’s e-prescribing initiative
Southern Ohio Medical Center sought to improve its overall rate of electronic prescribing, and it used data to focus training efforts.
Many healthcare organizations face staffing shortages – but it’s the response to these shortages that separates success from failure. Are these shortages viewed as an excuse to put off important quality improvement efforts, or as an opportunity to develop innovation to help reduce staff burden.
At Southern Ohio Medical Center (SOMC), its mission is to pursue projects that can make a difference in the lives of patients, employees and the surrounding community. The organization focuses efforts on five strategic values — these include achieving and sustaining exceptional results in safety, quality of care, service, teamwork and financial performance.
Through many of its projects, SOMC found that by incorporating innovations in automation, clinical decision support and analytics, it could improve both quality and efficiency.
Seeking improvement in e-prescribing
One important element in providing high-quality patient care is the widespread adoption of e-prescribing. While many healthcare organizations may leverage e-prescribing, only 62 percent of office-based physicians reported using e-prescribing of controlled substances often, according to a 2022 report from the Office of the National Coordinator for Health Information Technology.
The value of e-prescribing for controlled substances was reinforced with the 2018 Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). This act generally mandated schedule II-V controlled substances under Medicare Part D and Advantage plans be prescribed electronically.
Along with state prescription drug monitoring programs (PDMPs) that track controlled substance prescriptions, this act aimed to improve patient safety and reduce the risk of drug diversion, duplicative prescribing and overdoses among patients.
SOMC reports electronic prescribing data under several quality programs, such as Medicare’s acute Promoting Interoperability Program, the ambulatory Merit-based Incentive Payment System and the Leapfrog Group’s Hospital Safety Survey.
As an important measure of quality for these programs, SOMC elevated the monitoring of e-prescribing performance to the Quality Strategic Value Dashboard beginning in fiscal year 2022.
Improvement strategy
To improve its performance, SOMC started with identifying comparative performance so that it could better measure its scores compared with other healthcare providers. Clinisync, the Ohio Healthcare Information Exchange, provided a de-identified regional comparison group. At the start of fiscal 2022, SOMC’s electronic prescribing rate was 87 percent at discharge from the acute setting, putting SOMC at the 76th percentile rank regionally.
Some initial quality improvement strategies proved successful, increasing SOMC’s electronic prescribing rate to 90 percent with a corresponding 90th percentile rank by the end of the fiscal year. However, general physician and advanced practice provider (APP) education didn’t provide additional improvement in fiscal 2023.
One of the problems identified was limitations with SOMC’s reporting approach and its use of static reports. Electronic prescribing reports provided individual physician and APP rates, but no ability to drill down further for patient-level examples. Manual auditing to identify patient-level insights was deemed inadequate and draining to available resources. However, SOMC’s quality leadership team recognized that to further improve results, it would need to identify the causative factors of provider non-compliance.
Increasing data analysis
To establish more actionable insights for process improvement, SOMC began working with its EHR vendor’s professional services to develop interactive dashboards for monitoring physician/APP electronic prescribing results. These dashboards would include patient-level instances of failed, attempted and successful prescription drug transmissions.
SOMC also collaborated to evaluate its CMS-reportable electronic prescribing data to align the methodology and provide insights consistent with reportable data. The detail and insights available enabled SOMC leaders to generate provider-specific electronic prescribing rates and reports that showed trends and highly detailed patient-level examples of non-compliance.
This information was used to initiate a discussion with some lower-performing providers. Based on their feedback, the SOMC clinical information systems team rounded one-to-one with clinicians to visualize workflow barriers, correct misconceptions about drugs appropriate for transmission via electronic prescriptions, and develop and document a prescribed physician/APP workflow for success.
Beginning with January 2023 data, SOMC’s performance improvement department began sending compliance letters to physicians/APPs with electronic prescribing rates of less than 75 percent. For the first time, PI was able to include not only an overall prescribing rate, but patient-level examples of failures, insights on failure trends and instructions on successful prescribing rates workflow.
The combination of actionable insights and education had an immediate effect. By February 2023, SOMC’s prescribing rate increased to 96.5 percent, with a correlating regional percentile rank of 95.6. SOMC aims to continue this process to further improve these results.
This example of garden-variety process improvement is even more impressive because of the efficiencies achieved through the power of analytics. The same insights via manual processes would have taken hundreds of man-hours and still likely would be sampled representations of the whole data set.
With increasing demands to produce quality and safety results with fewer resources, manual data abstraction, audits and analyses become less and less viable. Quality improvement leaders must leverage EHR systems to quickly identify the root causes of problems to develop educated, targeted solutions. These tools and trusted partners give SOMC leaders the confidence to tackle complex problems affecting patient care.
David Richard is administrative director of performance improvement and clinical information systems at Southern Ohio Medical Center.