I used to get quality reports once a year, then once a quarter. They were long, opaque, boring, and too detailed to digest. I was usually looking at them when I was too tired (at the end of a long day) and away from the battlefield. As a result, nothing much changed.
So, our team decided to provide "just in time" quality feedback to physicians at the point of care, and only for diabetes, and only for 8 quality indicators (there are dozens competing for my attention). The hope was that by giving feedback as the physician was about to see the patient, then she could take action and address the issues of concern. Here's what we built:
Here's a closer view of just the bottom of the dashboard showing the Quality Performance Indicators (back then, the Medicare Quality Program was called "PQRI"):
I call the little red, gray, and white circles "idiot lights". A more socially acceptable term is "traffic lights". They alert the physician to the actionable items for the task at hand: "Change the medications or diet to lower the blood sugar, order the cholesterol tests and annual urine micro-albumin test, and send the patient to the eye doctor."
Does this approach work?
Yes and no.
It is much easier to see what needs to be done. The effort to navigate around to find these 8 items used to take 60 clicks and about 6 minutes to find all 8 measures in our EHR. With the dashboard, it takes 6 clicks and a minute or two. That's a huge gain in efficiency and reduction in cognitive load. It's also safer and more accurate, because, frankly, most physicians would stop looking for that last item or two (the foot exam and eye exam are hardest to find) before wasting the the whole 6 minutes.
Do physicians improve their quality scores by making this more available?
Not necessarily. It's not a required view, and it's on page 2. If my nurse prints it out, circles the items needing attention, and thrusts it in my face (we are a finely-tuned team), then things happen. Otherwise, the 15 other details may get in the way. Information helps, but system processes need to change to get results.
So, our team decided to provide "just in time" quality feedback to physicians at the point of care, and only for diabetes, and only for 8 quality indicators (there are dozens competing for my attention). The hope was that by giving feedback as the physician was about to see the patient, then she could take action and address the issues of concern. Here's what we built:
| Fig 1. Diabetes Dashboard |
Here's a closer view of just the bottom of the dashboard showing the Quality Performance Indicators (back then, the Medicare Quality Program was called "PQRI"):
| Fig. 2 The "quality panel" of the Diabetes Dashboard |
I call the little red, gray, and white circles "idiot lights". A more socially acceptable term is "traffic lights". They alert the physician to the actionable items for the task at hand: "Change the medications or diet to lower the blood sugar, order the cholesterol tests and annual urine micro-albumin test, and send the patient to the eye doctor."
Does this approach work?
Yes and no.
It is much easier to see what needs to be done. The effort to navigate around to find these 8 items used to take 60 clicks and about 6 minutes to find all 8 measures in our EHR. With the dashboard, it takes 6 clicks and a minute or two. That's a huge gain in efficiency and reduction in cognitive load. It's also safer and more accurate, because, frankly, most physicians would stop looking for that last item or two (the foot exam and eye exam are hardest to find) before wasting the the whole 6 minutes.
Do physicians improve their quality scores by making this more available?
Not necessarily. It's not a required view, and it's on page 2. If my nurse prints it out, circles the items needing attention, and thrusts it in my face (we are a finely-tuned team), then things happen. Otherwise, the 15 other details may get in the way. Information helps, but system processes need to change to get results.