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Using electronic health records (EHR) to automate publicly reported quality measures is receiving increasing attention and is one of the promises of EHR implementation. Kaiser Permanente has fully or partly automated six of 13 the joint commission measure sets. We describe our experience with automation and the resulting time savings: a reduction by approximately 50% of abstractor time required for one measure set alone (surgical care improvement project). However, our experience illustrates the gap between the current and desired states of automated public quality reporting, which has important implications for measure developers, accrediting entities, EHR vendors, public/private payers, and government.

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Abstract:Improving quality and safety across an entire healthcare system in multiple clinical areas within a short time frame is challenging. We describe our experience with improving inpatient quality and safety at Kaiser Permanente Northern California. The foundations of performance improvement are a “four-wheel drive” approach and a comprehensive driver diagram linking improvement goals to focal areas. By the end of 2011, substantial improvements occurred in hospital-acquired infections (central-line–associated bloodstream infections and Clostridium difficile infections); falls; hospital-acquired pressure ulcers; high-alert medication and surgical safety; sepsis care; critical care; and The Joint Commission core measures.

A quality improvement initiative across 21 hospitals incorporated a multidisciplinary approach, breakthrough collaborative methods, evidence-based improvement methods and care guidelines, front-line rapid improvement cycles, consistent process-of-care documentation, and real-time incidence data. Statistically significant decreases in both all-stage and stages III, IV, and unstageable hospital-acquired pressure ulcers rates have been sustained for 5 years.