This document summarizes a presentation about Maintenance of Certification (MOC), quality improvement using electronic medical records (EMRs), and developing quality improvement projects. The presentation discusses how MOC can integrate professional competency maintenance with EMR-based quality improvement programs. It outlines the four parts of MOC and various pathways to fulfill the requirements. It also explains how EMRs can be leveraged as tools for quality improvement through functions like clinical decision support, computerized order entry, and reporting quality measures. The document provides guidance on developing a quality improvement project, including writing an aims statement and measure, creating a process flow, and planning the project timeline and team.

1. MOC, Quality of Care and
Your EMR
Donna M. D’Alessandro, M.D., FAAP
Professor of Pediatrics
University of Iowa
Available at Slide Share

2. Please sit at
table that is the
closest to QI
project you are
doing or thinking
about doing

3. Disclosures and Disclaimers
 “I have no relevant financial relationships with the
manufacturer(s) of any commercial product(s) and/or
provider(s) of commercial services discussed in this CME
activity.”
 I know a little bit about each– so before you do
something, please recheck with the appropriate group
to make sure doing the activity will get you what you
want/need

4. Overview
 Mini Lecture
 MOC
 EMR
 QI
 Start Planning your Project
 Write an AIMS statement
 Write a measure
 Process flow for ideas
 Handouts
 Quality Improvement Project Planner
 Resources
 URL for Handout

5. Objectives
 Learn about MOC and EMRs and how they can be used to develop quality
improvement programs
 I hope to show you that
 MOC – can be integrated into maintaining your professional competency
 EMRs – are continually advancing tools for us to use in our practice
 QI – is a continuous process to improve the care you provide
 Together they form a stalwart trio to help us provide the best care
possible so “Every Child, Gets the Right Care Every time” - AAP

6. Alphabet Soup
 ABP – American Board of Pediatrics, “The Board”
 AAP – American Academy of Pediatrics, “The Academy”
 CME – Continuing Medical Education
 CMS – Center for Medicare and Medicaid Services
 MOC – Maintenance of Certification
 QI – Quality Improvement
 EMR/EHR – Electronic Medical Records or Electronic Health Records
 MU – Meaningful Use

7. Maintenance of Certification (MOC)
 What is MOC?
 Program of activities to “maintain” professional
competency
 There is no expiration date as long as the physician is
enrolled in the program
 ABP is requiring MOC to maintain board certification
 Potentially state boards, hospitals and insurance companies could
require board certification, therefore indirectly requiring MOC

8. Basic Plan of MOC
 4 parts like Puzzle Pieces, not chronologically ordered
 Part 1 Professional Standing and Licensure: unrestricted license
to practice
 Part 2 Life-long Learning Self Assessment: participating in
knowledge self assessment tools
 Part 3 Cognitive Expertise: passing a secure examination
 Part 4 Performance in Practice: participating in quality
improvement projects

9. Basic Plan of MOC
 5-year cycle with 100 points for activities
 40 points each Part 2 and Part 4
 20 points either Part 2 or Part 4
 Part 3 – one test every 10 years (every 2 cycles)

10. Actually Doing MOC
 Check the ABP website to see your personal requirements –
www.abp.org
 If you don’t understand contact the ABP
 Website has lists of activities that qualify for each part
 All activities
 Have a expiration date
 Have a different MOC point value
 May be free or have an additional cost in addition to the ABP’s MOC
fee
 May or may not award CME

11. Part 4 Pathways- Join Other Groups
 Project sponsor
 Originates and manages a single activity
 Ex: Insurance company, organization
 Portfolio sponsors
 Originate and manage multiple activities or projects
 Ex. AAP, Institutions
 Important – the sponsor applies to the ABP for the MOC and attests
to your fulfillment of the MOC requirements
 AAP offers projects through their portfolio
 QuINN Network (Quality Improvement and Innovations Network)
 Chapter Quality Network

12. Part 4 Pathways -
Use Your Own Practice
 National Center on Quality Assurance Patient Centered Medical Home
projects
 It is considered an individual activity even if you participated as a group
(40 MOC points, $0)
 Proposed Small Group QI Projects (1-10 physicians, 0 MOC points, $0
for group)
 ABP will review the process, provide tips and resources. This helps to
ensure that your finished project will qualify for credit, but it is NOT the
actual application for MOC credit.
 Completed Small Group QI Projects – finished projects apply for credit
(1-10 physicians, 25 MOC points, $75 for entire group)
 Important – you must apply to the ABP directly and attest that you have
fulfilled the MOC requirements

13. Part 4 Pathways -
Use Your Own Practice

14. Part 4 Pathways - Other
 QI Program Development – you are a
leader of QI projects at an institution or
organization (40 MOC points, $150)
 QI Posters or Platform presentations at
national scientific meetings (20 MOC points, $75)
 QI Articles – for authors (25 MOC points, $75)

15. Electronic Medical Records (EMRs)
 Computers that store health information that then
health care personnel (and patient/family) can access
and utilize to provide care, and hopefully improve
health

16. EMRs are Not New
 Depending on how you want to define an EMR, first ones go back to late 60s or
earlier
 EMRs have improved documentation and availability = improved communication
 Holy grail is integration – getting computers to talk to each other – still have
problems but better tools and policies continue to improve integration
 Policies and standards are set by CMS for :
 “Certified” EHRs
 For “meaningful use” of the EHRs
 Reporting quality measures
 Create an incentive system for providers to acquire, use and report using EHRs

17. Meaningful Use (MU)
 Goal: to promote the spread of EMRs to improve health
care in the US, Improve quality, safety, efficiency, and
reduce health disparities
 Engage patients and families
 Improve care coordination, and population and public
health
 Maintain privacy and security of patient health information

18. MU
 Has criteria that defines
 Eligible professionals
 Eligible hospitals
 MU was developed as a progressive, staged program:
 Stage 1: Data Capturing and Sharing (began 2011)
 Stage 2: Advance Clinical Processes (began 2014)
 Stage 3: Improved Health Outcomes (begins 2018)

19. MU Stage 2
 Must use a certified EMR-
certified using specific
standards
 Standardizes reporting time
periods – basically continuous
90 day period during the
calendar year
 Reporting times – 1 year
 Report on 1 set of objectives
 Protect Patient Health
Information
 Clinical Decision Support
 Computerized Provider Order
Entry
 Electronic Prescribing
 Health Information Exchange
 Patient Specific Education
 Medication Reconciliation
 Patient Electronic Access
 Secure Electronic Messaging
 Public Health Reporting (EPs only)
 CMS regulations - https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downloads/2015_NeedtoKnowEP.pdf

20. MU Example - CPOE

21. MU Example – Secure Messaging
 Secure Electronic Messaging

22. Quality Improvement (QI)

23. What is Quality?
 Meeting the needs and exceeding the
expectations of the patients and families that
healthcare providers serve
 Delivering all and only the care that the patient
and family needs
 “Every child gets the right care, every time”
- Institute for Healthcare Improvement
- AAP

24. Improving Quality
 Requires change – every system is designed
perfectly to achieve exactly the results its gets
 Needs to be kept simple
 If you don’t, you destroy productivity and
unintended consequences results in too big a
disruption

25. Delivering Care and Making Changes
Structure
Processes
and People* Outcomes of Care
Inputs Steps Outputs
•Patients
•Equipment
•Supplies
•Environment
•Training
•Physician orders
•Nursing care
•Ancillary staff
•Coordination
•Business practice
•Physiologic
parameters
•Functional status
•Satisfaction
•Cost
*Has the greatest chance to improve care,
also the closest to the care - Modified from Institute for
Healthcare Improvement

26. What are we trying to accomplish? (AIM)
How will we know that a change is an
improvement? (Measurement)
What changes will we make that will results in
an improvement? (Ideas)
Plan: How should we modify our latest changes?
- Institute for Healthcare Improvement
Planning Steps for the Change

27. What Are We Trying to
Accomplish?
 Need an AIM statement that is SMART
 Specific
 Measureable
 Achievable
 Relevant and reliable
 Time limited
 Example: “Increase the screening rates for
dental caries in 5-year olds within 6 months”
 May have more than 1 goal, so discuss options
with the team and chose one goal to work on
 Nee

28. How will we know that a
change is an improvement?
 You need measurement. Otherwise, how
will you know how far you have come to realizing
your goal?
 Need more than 1 measure, Measures don’t have
to be perfect
 Use measures that are already developed if
possible

29. How will we know that a
change is an improvement?

30. How will we know that a
change is an improvement?
 Select changes that are the most likely to improve
outcomes
 Recognize that not all changes improve outcomes –
“Just because you can, doesn’t mean you should”
and conversely, “Just because you think you can’t,
doesn’t mean you shouldn’t try.”
 Example: “Changing the EMR to include discrete
structured data to improve reporting”

31. How will we know that a
change is an improvement?
 You will need to
 Pilot test – determine your baseline
 Collect data
 Evaluate the data and compare it– overtime, to
benchmarks, to end aim
 Evaluate regularly not just at the end

32. Measurement– Run Charts
- Minnesota Department of Health

33. PDSA Cycles - How should we
modify our latest changes?
 Run PDSA cycles to implement your
changes and see your results
 The analysis phase is imbedded in the
planning

34. Helpful Planners – Clinical Site
Diagram
 From ABP Quality Improvement Guide

35. Helpful Planners – Key Drivers
 From ABP Quality Improvement Guide

36. Helpful Planners – Process Flow
Diagram
 -From AB
- ABP Quality Improvement Guide

37. End of Part 1 – Mini Lecture
Any Questions?

38. Part 2. Planning Your Project
 Quality Improvement Project Planner- Introduction
 Write an AIM Statement
 Write a Measure
 Process Flow
 URL for Project Planner

39. Quality Improvement Project
Planner
 URL for Project Planner
 “It’s long”
 Yes it is long – but hopefully all or most of the important questions
will be there to think about, discuss and make thoughtful decisions
about so the project runs well
 “Do I really have to do fill out it out or have to fill out everything?”
 Of course not, but you might want to so you have record of the
decisions you made and why

40. Activity 1 – Write an AIM
Statement
 QI Project Planner Page 1
 1 minute on first two statements:
 The general problem we want to
improve is __________
 This is important because _________
 5 minutes on writing an AIM
statement
 10 minutes – sharing with partners

41. AIM Statement Iteration
 Improve HPV immunization rates in our practice. (7 words)
 Improve HPV immunization rates in 11-13 year olds in our practice (11 words)
 Improve HPV immunization rates in 11-13 year olds in our practice by 5% (13 words)
 Improve HPV immunization rates in 11-13 year olds in our practice by 5 % over the next 6 months (19
words)
 Improve HPV immunization rates in 11-13 year olds in our practice for the receiving the first vaccine
by 5 % over the next 6 months (25 words)
 Improve HPV immunization rates in 11-13 year olds in our practice for receive the first vaccine by 5 %
and completing the series by 10% over the next 6 months. (30 words)
 As cancer prevention is important to long term health we will improve HPV immunization rates in 11-
13 year olds in our practice for receive the first vaccine by 5 % and completing the series by 10%
over the next 6 months by implementing an EMR reminder system and screening for HPV vaccinations
at all nursing visits. (50 words)

42. Activity 2 – Write a Measure
 QI Project Planner Page 2
 5-8 minutes
 Write the measure in words
 Determine the numerator/denominator and exclusion criteria
 5-8 minutes – sharing at the table

43. Activity 2 – Write a Measure

44. Activity 2 – Write a Measure
Discussion
 Examples
 What was difficult?

45. Activity 3 – Idea Process Flow
 Need to plan what actual changes you want to make and how
you are going to do them
 8 minutes, sticky notes and back of your handout.
 Think about one part of the system that will need to change
 Write down each step on a sticky note
 Order the sticky notes so it shows the process that will need to be
performed each time, every time
 8 minutes – share with partner

46. Activity 3 Process Flow for Ideas –

47. Other planning
 Team members – page 4
 One person (rarely) can make the changes necessary. It is a system of
processes and personnel that is delivering care
 Team – can be small or large, with everyone involved in some way
 It is the actual people doing the work, not a representative for
others
 Resources – page 5
 Timeline – page 7

48. Thank you for coming
This presentation is available at:
Slide share
Handouts are available at:
AAP NCE Conference website