"The connection between primary care and especially ophthalmology is not as tight as it could be. Most of the practices that we report on do not have ophthalmologists on site. That ends up being a structural barrier to doing better," Cebul said.
"We need to make certain that our ophthalmologist colleagues have electronic health records [and then link] those electronic health records to the practices. The fact that somebody out five miles or even a mile from you where you're practicing has electronic health records is very nice, but if they're not connected then that information is siloed."
If a doc doesn't know a patient has received an eye exam or a foot exam and doesn't document it in the record, he or she can't assume that it's been done, Cebul said. And you don't get credit for improving quality if it's not documented.
Share best practices as well as data
Under National Institutes for Health guidelines, anyone at risk for diabetes should get the pneumococcal polysaccharide vaccine. The MetroHealth System in Cleveland has adopted the standard but was having limited success meeting it, says David Kaelber, MD, MetroHealth's chief medical informatics officer. The organization, which is part of the Greater Health collaborative, got a bump in vaccine rates after it added EMR alerts for docs. The numbers jumped again with some physician education, but MetroHealth still wasn't meeting its goal of compliance in the 90th percentile.
In the end, taking doctors out of the picture was the change that made the difference. Making the vaccine part of the standard orders and empowering nurses to deliver them without asking for a doc's permission pushed MetroHealth’s compliance levels into mid- to high-90s.