The Client
The client is a leading Healthcare ISV in the U.S providing technology solutions to on-demand healthcare practices and primary care clinics worldwide. The company’s client solutions are used by 50% of the US urgent care market.
The Challenges
1. Electronic Medical Records (EMR)
- The electronic prescription functionality was not compliant with NCPDP (National Council for Prescription Drug Programs). Furthermore, compliance with guidelines issued by the National Committee of Quality Assurance was needed.
- Automation payment facilities and functionality to store patients’ health concerns and suggested goals in the application were not available.
- Before the development of the RTPB (Real-Time Prescription benefit) Standard, patients relied exclusively on their pharmacy to determine their financial responsibility for a prescription.
- Details of implantable devices were not stored in the application.
- Providers were not getting recommended diagnoses based on the patient’s vitals.
- Synchronization of providers’ details with third-party applications and real-time synchronization with patient appointment applications was not available.
- For high-alert medications, there was a possibility of harmful human errors before they reach patients.
- Appropriate use criteria of procedures by providers for Medicare patients were not present.
2. Electronic Clinical Quality Measures (eCQMs)
- The users were required to use the most current version of eCQMs (updated every year) to report according to program-specific updates as per CMS quality reporting program sites.
The Objective
The client is a leader in the U.S urgent care market and had the vision to bring a patient-centric revolution and desired to scale their solution powered by innovation and efficiency. There was a need for:
1. Modernization of Electronic Medical Records (EMR):
- Work on enhancements, customizations, performance improvements, and integration with third parties using REST APIs.
- Introduce new features for the convenience of healthcare providers and patients.
- To comply with the US healthcare standards.
- Implementation of CARE PLAN functionality that keeps records of the patient’s health concerns and proposed goals for improving health conditions and tracking progress.
2. Implementation of Electronic Clinical Quality Measures (eCQMs):
- To be Certified Electronic Health Record Technology (CEHRT) is required to capture, track, and report electronic clinical quality measures (eCQMs) and electronic quality data to measure the quality of healthcare as per the program eligibility requirements available on the Centre of Medicare and Medicaid Services (CMS) quality reporting sites. If clinics are unable to implement the latest standards, they may be at risk of monetary penalties.
The Solution
JK Tech’s IT team provided the best guidance and created IT strategies to overcome the challenges.
The below functionalities were introduced in the EMR Application:
- The application was updated in compliance with the guidelines of NCPDP (National Council for Prescription Drug Programs) and the National Committee of Quality Assurance to improve the exchange of healthcare information.
- An automatic billing facility was added to charge patients using their credit card details.
- A telemedicine functionality was introduced so that providers and patients can interact via Zoom and required medications can be suggested.
- Healthcare providers can have cost, source, and supply options at their fingertips from the very first conversation, offering the patients a transparent view of price implications, using RTPB (Real-Time Prescription Benefit) functionality implemented in EMR.
- Implantable devices module is added to enhance patient care.
- Problem alerts are added so that providers can select recommended diagnoses based on the patient’s vitals.
- Synchronization of providers’ details with third-party applications and real-time synchronization with patient appointment applications.
- Dual sign-off for high-alert medications is implemented to reduce the risk of human error while prescribing these medications.
- An interactive electronic mechanism (CDSM) is added which providers can use to verify whether the procedure they are ordering is appropriate for the patient’s condition or not.
To overcome the challenges of storing patients’ health concerns and suggested goals in the application, a new module CARE PLAN module was created, consisting of 4 sub-modules:
- Health Concerns – To keep track of patients’ health concerns, the health-related details were stored.
- Goals – As per the health conditions of the patient, goals would be suggested and tracked for any improvement.
- Interventions – If some suggestions are not improving a patient’s health, then the physician can suggest new ways to achieve goals.
- Outcomes – This was to evaluate the progress of the patient’s health. After analyzing a patient’s health conditions, setting goals, and suggesting options to achieve goals, physicians can track the results achieved.
Electronic Clinical Quality Measures (eCQMs)
- JK Tech provided a user-friendly screen that generates the eCQM report for various CQMs (Clinic Quality Measures) as per the eCQM version and measurement period in the form of PDF, QRDA1, and QRDA3 XML.
- Each year upgrade the eCQM as per the latest version released by CMS.
- Check the Technical Release Notes to align with current clinical guidelines and code systems so, they remain relevant and actionable within the clinical care setting.
- Check the eCQM Logic and Implementation Guidance that provides general logic along with detailed information on topics including measure versioning and time interval calculations.
eCQMS Process:
The Benefits
Electronic Medical Records (EMR)
- Improvement in the process of exchange of healthcare information.
- An automatic billing facility led to faster payments.
- A patient can consult any physician from any location/time in the pandemic with telemedicine.
- Real-time, direct prescription benefit and price information at the point of care.
- Improvement in patient satisfaction in the care setting.
- Increase in real-time data due to synchronization of data among various applications.
- Clinical Decision Support Mechanism (CDSM) complements and elevates the ordering provider’s diagnostic practice, strengthens the Medicare patient experience, and reduces unnecessary advanced image testing.
- Risk-free prescription process for high-alert medications.
- Application handles COVID workflows and provides better patient care in terms of diagnosis, tests, prescriptions, etc.
- Care Plan aids in the creation of a treatment plan for the patient as well as the evaluation of the ongoing progress. Physicians can apply the same recommendations to other patients who have similar health problems. Also, this will yield better results in terms of improving the health of patients.
Electronic Clinical Quality Measures (eCQMs)
- eCQMs use detailed clinical data to assess the quality of treatment by healthcare providers and organizations and drive clinical action. It fostered the goal of access to real-time data for quality improvement and clinical decision support (CDS).
- Value-based programs to reward healthcare providers increased quality of service by offering incentive payments for the quality of care.
- eCQMs lower costs by reducing preventable readmissions and decreasing medication errors.
- The new reporting interface is used to generate the eCQM reports based on different selection/filter criteria.
- By implementing the latest standards of eCQM, the monetary penalties are avoided.
