Qualitative
Qualitative analysis of PF contact notes from practices scoring the
lowest on both Software Capability and HIT Skill Set (n = 40) revealed
three dominant themes: reporting challenges, a mistrust of their data,
and a willingness to try to make improvements. (Table 4)
- Reporting challenges. Limited staffing resources, access to
data, and EHR capabilities presented challenges. Practices described
inability to report, lack of HIT expertise or staff with only basic
skills, and limited time to run reports. Other barriers included no
interface between practice management and clinical data and difficulty
mapping diagnostic codes to the problem list. Variations in data entry
and data quality were often significant. For some practices a parent
health system, network, or hospital controlled and limited access to
the data. Limited reporting ability often reduced enthusiasm for
engaging in QI.
- Mistrust of data : Providers and staff seemed to mistrust or
lack confidence in their data accuracy and EHR, which undermined
motivation to use data for QI.
- Willingness to try : Despite challenges, practices scoring low
on the PHITA seemed eager to make improvements using rapid process
improvement cycles and alternative data sources for QI. Some purchased
registries, upgraded their EHRs, or transitioned to EHRs that promised
better capabilities or a registry function.
Examination of PF contact notes for practices scoring highest on both
sub-scales (n = 43) revealed three themes: an ongoing need for
assistance, a focus on data accuracy, and engagement with QI activities.
(Table 5)
- On-going need for assistance : High performers had resources and
skills to run reports, but faced remaining challenges and needed
assistance from their PF, EHR vendor, or parent organization.
Challenges were often related to non-familiarity with the complexities
of quality reporting, competing priorities, and staff turnover.
Specific barriers included limited date range reporting and inability
to produce data at the provider or practice level.
- Focus on data accuracy : High-scoring practices focused on
improving data accuracy through better data capture and report
validation. Improved data quality was viewed as a prerequisite to
using it for quality improvement. Understanding information flow for
reporting encouraged care teams to standardize data capture to improve
reporting accuracy. Quality reporting methodology was new to some
providers, including data definitions for clinical concepts and
understanding population metrics.
- Engagement with QI : High-scoring practices were engaged in
understanding how reports were created and were willing to use them to
guide patient care. They engaged their PF, their EHR vendor, and used
other resources. These practices engaged all staff, including
providers and leadership in using data for practice improvement.