The failure in quality improvement is that health IT applications have not been designed to simplify the complexity of value-based contracts into automated and easy-to-use workflows for physicians and care managers. The administrative burden of quality improvement should never fall on physicians and other care providers.This exact problem is why I founded Able Health, which is focused on building software that simplifies quality reporting and improvement for all stakeholders. I have written about the need to meet the needs of clinical users in quality improvement through the use of 'design thinking' methods:

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Quality reporting's toll on physician practices in time and money
By Dr.Mahboob Khan Phd
Noting that the thousands of clinicians in its multispecialty group were worn out by
the hundreds of quality measures they have to track, Quality Health embarked on a
multiyear effort to streamline the measures that front-line providers are expected to
worry about. The information reported to Quality and insurers is intended to help
monitor and improve the quality and safety of healthcare. But collecting it also
saps resources.
“It's a lot of time and effort spent at the computer documenting things that don't
impact patient care,”I think, I also contends it's impossible for an organization to
carry out focused improvement efforts when too many measures are tracked at
once.
Researchers teamed up with the Medical Group Management Association to put a
price on the time providers spend to enter the data into the electronic health record,
keep track of newly introduced measures and create protocols to track and report
them.
The answer is about $15.4 billion a year, according to their study published
Monday in the health policy journal Health Affairs. That's “a large amount of
money being wasted on checking this box and that box,” I think “It's time
physicians could spend on not rushing a patient, or thinking about a diagnosis more
carefully.”

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Patient safety leaders have said not having enough time for clinical
reasoning could be one factor leading to high rates of diagnostic errors, a problem
deemed a “persistent blind spot” in the movement to make care safer in the
hospitals.In the new study, the researchers surveyed 394 leaders from four
specialties: cardiology, orthopedics, primary care and general internists.
They asked about how much time specialty clinicians spend on tasks associated
with collecting quality and safety data. They then converted those hours into costs,
based on how much specialists get paid.
Across all specialties, licensed practical nurses and medical assistants spent the
most amount of time.For example, between 2014 and 2015, licensed practical
nurses and medical assistants employed in primary care settings spent an average
of 7.8 hours per week on tasks related to reporting on external quality measures. In
dollars, that's about $9,119 a year for each clinician. Primary care doctors said they
spent about 3.9 hours per week on the tasks. In salary, that tallied to roughly
$22,049 per physician each year.The authors note several limitations of the study.
Practices with stronger negative feelings about quality measures may have been
more likely to respond, which could distort the estimates. Also, tracking how much
time individual clinicians spend on tasks is not easy to do.
While there have been anecdotal reports about the burden of quality reporting, few
studies have attempted to quantify the impact. “And it is enormous,” I think after
reading the study. New measures can reduce redundancy. I think EHRs need to be
more user-friendly and efficient, “so that data are captured in the background while
physicians deliver care, rather than requiring additional work.”

3. 3
The health system set up “mission control” in a conference room, where the
clinical economics committee keeps track of what measures get reported, by which
department or specialists, and what new penalties or rewards they face on the
horizon for certain measures. For clinicians, however, the team is striving to boil
down all of the measures to the basics. By the beginning of 2017, Health plans
need to cut the number of measures specialty doctors will have to track to about 10
or less. The system did the same for its hospital measures last year, cutting the
number of inpatient metrics clinicians input down from 199 down to 10.
“Someone needs to pay attention,” I think. “But we want our doctors and nurses to
focus on measures that contribute directly to the welfare of the patient.”
The consolidated measures for office-based physicians are likely to focus on
patient experience, such as on how well the clinician communicates and the ease of
access to care for the patient. “In the office setting it's not always about the
procedure, but about the interaction,” I reiterate.

4. 4
“Each small change made to reporting wastes extreme hours,” wrote one family
practice leader. Consistency is needed, “otherwise we are always training on
reporting, rather than improving care.” An orthopedist said certain reporting
requirements for that specialty were “a complete waste of time.” An internal
medicine specialist feared that eventually the small practice would be “forced out
of business due to all the requirements.” The latter comment could be one factor
driving the rapid pace of physicians selling their practices to hospitals and health
systems. Facing a barrage of reporting requirements and performance incentives,
many “just throw up their hands and say 'I give up,'”. The jury is still out, I assert,
on whether the consolidation is beneficial. Of the practices that responded to the
survey, 81% reported that they spent more or much more effort dealing with
external quality measures than three years ago. Only 27% said the current
measures are moderately or very representative of the quality of care.
Conclusion:- The failure in quality improvement is that health IT applications
have not been designed to simplify the complexity of value-based contracts into
automated and easy-to-use workflows for physicians and care managers. The
administrative burden of quality improvement should never fall on physicians and
other care providers.This exact problem is why I founded Able Health, which is
focused on building software that simplifies quality reporting and improvement for
all stakeholders. I have written about the need to meet the needs of clinical users in
quality improvement through the use of 'design thinking' methods: