Case Study: Fort Worth Endoscopy Leverages the Power of ProVation® Software to Track Outcomes for Improved Quality

Customer Profile: Fort Worth Endoscopy Center

Based in Fort Worth, Texas, Fort Worth Endoscopy Center (FWEC) is an ambulatory surgery center (ASC) designed for outpatient gastrointestinal endoscopy procedures. Its affiliated physicians perform approximately 15,000 colonoscopies and esophagogastroduodenoscopies (EGDs) each year.

Co-owned by the physicians of the Fort Worth Endoscopy Center Partners, LP and Surgical Care Affiliates (SCA), FWEC seeks to provide excellent care that is safe, high-quality, convenient and cost-effective. This is demonstrated by the fact that, since opening in 1995, FWEC has maintained accreditation by either The Joint Commission or the Accreditation Association for Ambulatory Health Care Inc. (AAAHC).

Tracking Quality and Outcomes

FWEC's mission is to achieve continuous performance improvement in every area, including clinical, operational and financial. Key to that mission is the center's commitment to ongoing monitoring of quality and safety within its endoscopic services, including regular recording and evaluation of quality metrics and outcomes for those procedures.

Although the commitment and momentum for quality improvement exists, FWEC discovered that monitoring in a paper-based environment is labor-intensive. Handwritten or dictated reports often resulted in inconsistent or incomplete data collection. Further, extrapolating specific data elements to evaluate performance on key indicators such as cecal intubation or quality of bowel prep was time-consuming and complex.

"Time-consuming work is the biggest challenge to tracking key performance measures," said FWEC Medical Director Tom Deas, Jr., M.D. "For the most part, it is a manual process whether you record data at the time of the procedure or collect data by reviewing charts. When data is collected manually, there is a loss of consistency and objectivity. It is a constant effort to assure the right information is getting to the right place so physicians will trust the data and reporting. If they don't have confidence in the reporting, the effort is wasted."

Thus, when the decision was made in 2009 to deploy procedure documentation and coding software, the final choice in product hinged on an application's ability to collect and report on key quality and performance measures. It was imperative that the software be capable of streamlining documentation so that data was consistent, thereby enabling comprehensive monitoring and valuable feedback. With accurate data collection and credible analysis in place, physicians would have confidence that changing practice behaviors based on performance metrics would improve outcomes, quality and safety.

"Most endoscopists perform in a vacuum," said Dr. Deas. "We don't work with other physicians, so we cannot know how our performance compares to others. Many believe that they always get to the cecum, and that their preps are always good. But objective measuring gives them feedback to generate improvement where it's needed."

After careful evaluation, FWEC chose to deploy ProVation® MD Gastroenterology, which eliminates dictation and transcription and allows physicians to efficiently document procedures at the point of care. It produces complete, coding-ready and image-enhanced documentation and ultimately results in higher profitability and clinician satisfaction.

Importantly, ProVation® MD provides rigorous data capture and reporting capabilities for quality initiatives, benchmarking and other reporting statutes. It drives structured and compliant data capture and then pairs it with robust reporting and analysis capabilities that simplify quality reporting, clinical research and audit preparation. Each data element captured by ProVation MD, which includes a standard package of more than 100 prebuilt data reports and customized query-writing tools, can be queried for research purposes.

"ProVation MD has built in a decision-support tool so that if I've forgotten to complete all quality elements in the report, such as surveillance interval, I'll be reminded to do that," said Dr. Deas. "It's more consistent in data collection and reporting. It's very simple. We do a procedure. We do a report. The vast majority of the fields are collected as part of the report. It's very easy, efficient and reliable."

National Benchmarking

Having ProVation MD in place has also allowed FWEC to respond quickly to the increased pressure being placed on endoscopy centers and other ASCs to participate in national benchmarking initiatives to establish the quality measures. Doing so allows FWEC physicians to objectively compare their performance measures to other gastroenterology professionals across the country.

"We've been tracking quality data for 15 years, but what we're seeing now is a trend toward national benchmarking," said Dr. Deas. "Instead of just tracking internal benchmarks, we can benchmark against others and against national standards."

For example, FWEC is a pilot participant in the GI Quality Improvement Consortium (GIQuIC). Established by the American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE), the goal of GIQuIC is to create a national GI endoscopy data registry of quality measures, including four that are important for improving colon cancer screenings and detection—cecal intubation rate, quality of bowel preparation, adenoma detection rate and appropriate adenoma surveillance interval.

Significant variation with adenoma surveillance interval guidelines currently exists. Benchmarking of colonoscopy performance for colorectal cancer screening provides physicians valuable insight for improving both the quality and cost-effectiveness of their practice. Further, when considering colonoscopy data, evidence clearly indicates that cecal intubation prevents left-side cancers but not right-side. Sharing large amounts of data in a national registry would likely reveal that physicians who are not getting into the right colon and cecum on a regular basis are more apt to
miss an opportunity to diagnose right-side cancer.

ProVation Medical is one of several health IT companies that worked closely with ACG and ASGE to develop reporting tools that automate and streamline the GIQuIC data collection and reporting process. As such, FWEC was able to effortlessly expand its internal tracking and reporting to include participation in GIQuIC. This also sets the stage for the center's participation in other quality initiatives, including those proposed by the Centers for Medicare & Medicaid Services (CMS) that will ultimately impact reimbursements.

The GIQuIC tool streamlines data collection and submission by first guiding physicians through the process of capturing required, conditionally required and optional data elements. The query tool is then used to organize data into a specific format that can be submitted to the GIQuIC registry. For a midsize facility, automating data collection with the query tool can mean a time savings of up to 40–60 hours annually.

"What ProVation MD has done is make it an automated process" said Dr. Deas, who is ASGE President-Elect and served as a member of the Advisory Board for the GIQuIC registry. "The data is moving straight from the report to the GIQuIC database. It's easier, so we can now track measures every quarter or in even closer intervals than we could when we were doing it manually."

By eliminating dictation and transcription, ProVation MD software allows physicians to efficiently document procedures at the point of care. It produces complete, coding-ready and image-enhanced documentation and ultimately results in higher profitability and clinician satisfaction. In a complementary fashion, ProVation® MultiCaregiver software addresses nursing and other caregiver needs in the ASC by eliminating the inefficiencies of paper charting, and allowing for electronic capture of information like vitals, meds and allergies.

Positive Outcomes

So pleased has FWEC been with the outcomes realized from deployment of ProVation MD for GI that, in 2011, it implemented ProVation MultiCaregiver, an electronic health record and patient charting solution designed specifically for ASCs.

The ability to accurately and efficiently monitor and analyze quality data has resulted in several key changes in practice behaviors among FWEC physicians. For example, physicians are spending more time examining the colon during withdrawal, increasing average withdrawal time by several minutes for many physicians. In addition, virtually all physicians have changed to a split preparation, which is more in line with industry best practices. Practitioners who have been measuring adenoma detection rates are also seeing improvements in detection rates.

The decision to deploy an electronic solution that automates the collection and reporting of quality data has laid a solid foundation for physicians at FWEC to measure performance and outcomes against internal and national benchmarks in the most accurate and complete way possible. It also allows physicians to leverage the latest in evidence-based medicine techniques while moving forward with national quality initiatives to raise the bar on patient care and outcomes.

"The best argument you can make for implementing a solution like ProVation is that physicians need to make decisions based on what is right for patients," said Dr. Deas. "The ability to track quality measures should translate into better patient outcomes. We'll have fewer missed cancers and more reliable surveillance intervals, and we'll be complying with evidence-based medicine. In addition, there is a great deal of change mandated in healthcare reform that will make it essential to track performance data. You will have to do it anyway, so you might as well get ahead of the game."