To SCIP Core Measure compliance that looks like this?
It all starts with the documentation in your OR! How are the nurses, surgeons, and anesthesiologists documenting the data and information they collect throughout the patient visit as he/she moves from Holding to Pre-Op to the OR to PACU? The most critical aspect of high core measure compliance, whether its SCIP in the OR or Pneumonia, AMI, and HF in the ED, is electronic, discrete data capture.
One of the biggest problems in healthcare is the free-text field available in most healthcare applications, also known in the data and IT worlds as the “catch-all bucket”. Whenever users can’t find the right location within an application to put the information they’re documenting, they by default chose a “memo” field, or “case note” or just free text area for any and everything that could be typed from a computer keyboard. The problem is, this information can’t be mined and reported automatically. So what happens, nurses and other medical record professionals are paid to simply do chart abstraction which is a more professional way of saying “paper chasing”. The last 3 hospitals I consulted with paid nurses with 25+ years experience and a deep domain knowledge of core measure compliance over $70k / year to chase paper and make sense of free-text documentation. What a waste of expertise, skills and money. Wouldn’t these same resources be infinitely more valuable finding ways to improve the dips in core measure compliance instead of spending the significant majority of their time just chasing down the 10-12 different places SCIP data can end up (case notes, discharge summary, case record, op notes, paper chart, order sets, etc.)?
First Steps Towards Higher Core Measure Compliance
So now we know the main problem, what steps can you take to change the nature of clinical documentation to naturally improve your ability to report SCIP compliance and heighten your performance?
- Make sure your end users know, “the [OR] applications are as good as they help make them”. No one should be locked into user interfaces, drop down fields, and data points that can’t be changed to accommodate clinical workflows. If you can’t change now, wait until the next upgrade or version release, collect the nursing feedback and address changes later on. And if your vendor rep says there’s nothing he/she can do, slap them! These are CMS mandated measures and the systems need to help in raising compliance in every way they can.
- Build values that CMS mandates directly into the documentation – make being compliant a default behavior. If CMS says that for SCIP-3 the only acceptable reasons for continuing an antibiotic past 24 hours are: “Infection”, “Possible Infection”, or “Documented spillage of fecal contents during abdominal surgery” then make those values options in your drop down menu. Don’t make it easy for users to be non-compliant.
- Create communication standards for feedback and accountability: OR Directors and Nursing Managers must have a consistent way for communicating breakdowns in compliance. This makes a strong case for Data Governance; there must be a way for you to have conversations with your clinicians that may not be easy or popular, but must be done nonetheless. No surgeon wants to be told he/she has done something wrong, it hurts their ego’s…but as my mother once told me, “you don’t always get what you want”.
- Equate high core measure compliance with benefits that relate directly to clinicians top priorities – Patient Care, Patient Satisfaction, Reputation, and Financial Incentives (in that order). The diagram below depicts the tremendous benefits realized when an institution can achieve high compliance consistently over time.
Unfortunately for you, these first steps are the easiest in any organizations quest towards higher core measure compliance or a move towards electronic documentation in general. I promise, there will be frustration before there is elation. Lucky for you, Edgewater has done this plenty of times with a high degree of success with healthcare providers of all shapes and sizes because we know the proper way in which to achieve these goals. So, when you’re ready, give us a call and we can help get you started or move you on to the next step because I promise, it’s much easier than it looks.