How Can a Dermatology EHR Help Promote Population Health?
Focusing on Triple Aim and what that means for population health management
Good health. It’s one of our most prized possessions and shouldn’t be taken for granted. When it comes to healthcare, there has been an increasing effort to improve the health of the population as a whole. Some of that effort comes from the federal programs through the emphasis on using health IT technology to ensure interoperability and the seamless exchange of data throughout the different healthcare settings. Other efforts come from public health programs through initiatives such as Healthy People 2020.
Most importantly, the last decade has witnessed an increased shift towards incentivizing providers’ efforts in improving the quality of care of the population they serve by creating programs like the Quality Payment Program. All these initiatives make it really important for modern practices to have all the tools necessary to achieve better population health and allow providers to spend more time focusing on what is good for their patients.
Defining Population Health
According to the Centers for Disease Control (CDC), population health is defined as:
An interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally. This approach utilizes non-traditional partnerships among different sectors of the community – public health, industry, academia, health care, local government entities, etc. – to achieve positive health outcomes. Population health “brings significant health concerns into focus and addresses ways that resources can be allocated to overcome the problems that drive poor health conditions in the population external icon.”
Kindig and Stoddart (2003), define population health as “The health outcomes of a group of individuals, including the distribution of such outcomes within the group.” It has three components: patterns of health determinants, policies and interventions that link the two.
So what population health management strategies does your dermatology practice have in effect today? Are you working with population health management software that helps you with your patients and the healthcare system as a whole? Can you improve your focus on population health analytics? What can your practice do better to improve patient care and overall experiences?
Regardless of your answers, it may be a great time to evaluate your current initiatives and other areas to focus on.
In this article, I’ll focus on a concept known as the Triple Aim Initiative by the Institute for Healthcare Improvement and look at how a dermatology electronic health record (EHR) system could aid both your practice and the bigger picture of population health management.
The Six Aims for Healthcare
The IOM report Crossing The Quality Chasm: A New Health System for the 21st Century was among the first attempts to address the need for a fundamental change in the healthcare delivery system. The report focused on providing a strategy to achieve the goal of providing better quality of care. For that reason, the committee proposed six aims for improvement to the health care systems:
- Safe: avoiding harm to patients from care that should help
- Effective: using science-backed medical knowledge to help make decisions and avoiding both underuse and misuse
- Patient-centered: focusing on and respecting patient needs for all clinical decisions
- Timely: decreasing wait times and treatment delays that could cause harm
- Efficient: limiting waste, which includes physical items such as equipment as well as energy
- Equitable: providing care that is equal for all patients
In 2006, the Institute for Healthcare Improvement (IHI) identified that these six components mainly focused on the individual’s need during the time of care, but there was a gap in addressing the needs of the population as a whole. There was a need to look at patient care holistically in terms of the healthcare system, patient health outcomes and the total cost of care. Population health should be looked at under a wider lens that puts the patient front and center. Queue the IHI Triple Aim framework.
According to the IHI, the Triple Aim has three components that relate to population health:
- Improving the patient experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita cost of healthcare
The three-pronged approach was designed with the goal to “optimize health system performance.” However, the implementation of these three aims is dependent on the doctors and the medical staff. Provider burnout is an issue that needs to be taken into consideration as well. From that understanding, there has been a voice to suggest adding a fourth aim to “improve the work life of healthcare providers.”
Health IT vendors can play an instrumental role in this mission to address the Triple Aim while reducing provider burnout, including dermatology electronic health records (EHR) systems. In this article, I’ll highlight some specific examples of dermatology population health and where a health IT vendor fits into the mix.
A Dermatology EHR and the Triple Aim Initiative
1. Improving the patient experience of care, including quality and satisfaction.
The first aspect of the Triple Aim concept highlights the overall patient experience. While there are various components that contribute to the patient experience, I want to focus on the technology aspect.
Since the passage of the HITECH act and the movement towards digitizing healthcare through the use of electronic health records, many physicians reported that they have been spending a lot of time facing away from their patients during the clinical encounter and spending most of the time entering data in a web-based computers. As iPad-based dermatology EHR systems have become more prevalent, physicians can spend more time facing patients during the clinical encounter versus computer screens. It also provides the ability to show patients before and after photos concerning their medical problems, and provide patient education in the exam room. The result? A more personalized and hopefully improved experience during the patient encounter.
Next, think about how your dermatology office communicates with your patients and how your patients communicate with you. Staff will often call patients for upcoming appointments. This is a time-consuming and often inefficient process for your practice and there are more efficient means to get in touch with patients. Leveraging the digital patient engagement tools like automated appointment reminders allows patients to receive texts, emails and/or phone calls to remind them of upcoming visits.
Many practices still capture patient intake with a stack of paperwork on a clipboard. Again, not the ideal patient experience and one that can be improved by using an iPad kiosk to both check patients in while allowing them to fill out their health information more easily and seamlessly. Plus, it helps increase the patient’s engagement by placing them at the helm of their health information. The provider can always reconcile information as needed based on what the patient provided.
Digital tools like an iPad dermatology EHR, automated patient reminders, a kiosk and patient portal are all factors behind improving the entire experience of patient care while saving you and your staff time to focus on patient care. It’s truly about using the right technology and tools to help bridge potential gaps in care.
2. Improving the health of populations quality of care.
There have been many federal initiatives to move away from fee-for-service to value-based payment model that would incentivize providers performance in improving the quality of care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) required CMS to implement the quality payment program (QPP). The Merit-Based Incentive Payment Program (MIPS) is one of the two tracks of the QPP and it streams line three legacy programs: The Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VM) Program and The EHR Meaningful Use program, into one program. During a given performance year, providers performance in four categories (Quality, Promoting Interoperability, Cost and Improvement Activities) is scored out of 100 points.
Using a dermatology EHR system that provides a built-in dashboard to track MIPS performance which displays providers’ scores in near real-time can help identify where improvements can be made in quality care. A MIPS dashboard built directly into an EHR provides the medical team with performance indicators and in turn can help with population health management.
Working with the right population health management software can help you track your quality measures and estimated MIPS composite score from within your dermatology EHR. These types of tools can help you streamline the process from automated data collection to easy submission of your data to CMS at the end of the performance year. This eventually enables you to spend more time with your patients.
Let’s look at a quality measures as an example: Quality Measure 137 Melanoma Continuity of Care-recall System. The description of the measure includes the percentage of patients, regardless of age, with a current diagnosis of melanoma or a history of melanoma whose information was entered, at least once within a 12 month period, into a recall system that includes:
- A target date for the next complete physical skin exam, AND
- A process to follow up with patients who either did not make an appointment within the specified timeframe or who missed a scheduled appointment.
Say you are a dermatologist that treats many patients with melanoma and perform biopsies. Are you communicating that information to the patient and scheduling a target date for the next physical skin exam? Do you have a process to follow-up on patients who didn’t make an appointment within the time frame or missed their scheduled appointment?
The measure steward explained the rationale of such follow-up within the the measure specification:
“Lack of follow-up with providers is noted in the Institute of Medicine (IOM) report on patient errors. Follow-up for skin examination and surveillance is an important aspect in the management of patients with a current diagnosis or a history of melanoma. The presence of a recall system, whether it is electronic or paper based, enables providers to ensure that patients receive follow-up appointments in accordance with their individual needs.”
Additionally, a dermatology, cloud-based EHR that captures structured data can support analytical benchmarking. Your EHR may even enable you to compare outcomes with peers across the network of specialty physicians using the system. This in turn, can help you understand how you’re performing and what you could do to improve.
3. Reducing the per capita cost of healthcare.
It’s no secret that the cost of healthcare continues to grow exponentially. Many parties in both the federal and private sector are continually working to decrease the cost of care. Population health is all about driving quality care, improving overall health for a population while reducing the cost.
By combining a dermatology EHR powered by structured data and analytics platform, it can help to identify at-risk patients, manage those with specific conditions and help make data-driven decisions resulting in more efficient treatment plans and options. Access to such data can also help identify areas in the office where staff efficiencies can improve, such as reducing wait times and reducing the gap in care by addressing the missed follow-up appointments.
For example, within a dermatology analytics platform you could use use clinical targeting reports to proactively screening for high risk melanoma patients, which could potentially prevent much more expensive care down the road.
A healthcare analytics platform can help give you insight into how the cost of the healthcare services provided compares to national benchmarks. Having access to information like this can help make data-driven decisions when it comes to providing care for your individual patients and then taking a step back to look at it from a macro level. It’s all about using and analyzing data to help identify areas where improvements such as reducing costs and improving the quality of care can be made.
Technology such as software and analytics platforms will continue to play a strong role in population health management. It’s all about collecting and reporting quality data to help make more informed decisions at both an individual patient and a population level before, during and after the episode of care. Diving into data that your dermatology EHR captures can help you uncover the most used diagnoses and the frequent procedures to understand the population you serve and consequently, improve the population’s health.
Educating physicians, staff and patients on how to decode and really understand such data will be a strong factor in improving patient and population health outcomes. Having access to all this actionable data at our fingertips is a relatively new resource and one that will evolve overtime and provide us with the tools needed to help improve population health.
*Information relating to our EHR certification, including certain costs and limitations, can be found at modmed.com/costs-and-limitations
Hayder Hussein, MPH, CPHQ, CMHP
Associate Product Manager
Hayder Hussein joined Modernizing Medicine in November 2017 as an associate product manager where he focuses on EHR regulatory compliance and population health management. He's a current healthcare quality and patient safety professional and a former physician. Hayder holds a master's degree in public health from DePaul University in Chicago, IL.
Centers for Disease Control and Prevention (CDC). What is Population Health? https://www.cdc.gov/pophealthtraining/whatis.html. Updated July 23, 2019, Accessed September 12, 2019.
Triple Aim – The Best Care for the Whole Population at the Lowest Cost webpage. Boston, Massachusetts: Institute for Healthcare Improvement; 2019. Available on www.IHI.org. http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx. Accessed September 12, 2019.
Watts CG, Cust AE, Menzies SW, Coates E, Mann GJ, Morton RL. Specialized Surveillance for Individuals at High Risk for Melanoma: A Cost Analysis of a High-Risk Clinic. JAMA Dermatol. 2015;151(2):178–186. doi:10.1001/jamadermatol.2014.1952. Accessed September 12, 2019.
Kindig, D., & Stoddart, G. (2003). What is population health?. American journal of public health, 93(3), 380–383. doi:10.2105/ajph.93.3.380. https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.93.3.380. Accessed September 12, 2019.
Bodenheimer, Thomas, MD and Sinsky, Christine, MD. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. http://www.annfammed.org/content/12/6/573.full. Published November/December 2014. Accessed September 12, 2019.
The Institute of Medicine. Crossing The Quality Chasm: A New Health System for the 21st Century. https://www.nap.edu/catalog/10027/crossing-the-quality-chasm-a-new-health-system-for-the. 2001. Accessed September 12, 2019.
Centers for Medicare & Medicaid (CMS). 2019 Clinical Quality Measure (CQM) Specifications Release Notes. Page 1. https://qpp-cm-prod-content.s3.amazonaws.com/uploads/339/2019+CQM+Specifications+and+Supporting+Docs.zip. November 20, 2018. Accessed September 12, 2019.
Centers for Medicare & Medicaid (CMS). 2019 Clinical Quality Measure (CQM) Specifications Release Notes. Page 2. https://qpp-cm-prod-content.s3.amazonaws.com/uploads/339/2019+CQM+Specifications+and+Supporting+Docs.zip. November 20, 2018. Accessed September 12, 2019.