The path to better outcomes: Improving quality performance with population health tools

When Franciscan Healthcare in West Point, Neb., hired CEO Tyler Toline in 2020, he quickly recognized the need for more data. Toline was interested in actionable data that could easily be pulled from an EHR to proactively drive decision-making, quality, and performance.

Toline was surprised that the existing EHR system could not quickly and efficiently extract the necessary data. The reporting process was also cumbersome and time-consuming, with staff manually extracting clinical data, placing it in a spreadsheet, and analyzing it using Excel.

Challenges

Furthermore, Franciscan Healthcare leadership was looking to utilize EHR data to create quality scorecards and proactively manage population health. ACO data submission and reporting required manual entry of data into the existing software, which was a duplicative process for staff. The software was also unable to obtain real-time quality metrics to provide useful and actionable feedback to providers and care teams.

 “One of the first things Tyler requested from me was a list of our diabetic patients, their last A1C result, which physician they saw, and next appointment date,” says Anne Timmerman, Franciscan Healthcare director of quality and safety. “He was surprised that our existing software offered no easy report to extract clinical data. After months of trial and error, Tyler knew we would need to find a different solution to help us achieve the data he was looking to present to the organization.”

The solution

Franciscan Healthcare chose to partner with i2i Population Health after learning of i2i at a conference. As a critical access hospital and rural health clinic, finances and cost-effective solutions are of high importance to Franciscan Healthcare. It was critical for their solution to be able to work with the existing EHR system, be easily implemented by the organization, include training, and remain efficient.

Results

Clinical Director Anastasia Stokely and RN-BC Jen Coufal put i2i to the test by applying for a last-minute hypertension/hyperlipidemia grant to provide funding for at-home blood pressure monitors for remote patient monitoring. Coufal was able to quickly and easily pull the information needed to complete the application by the deadline.

Additionally, i2i has enabled Franciscan Healthcare to pull ACO data at an individual provider level, allowing physicians to improve quality metrics and gaps in documentation. Before i2i, all data shared with providers was aggregated for the organization. After implementing i2i, providers are more actively invested in the quality improvement process.

To support population health efforts, Franciscan Healthcare’s clinics use i2i to perform patient searches based on criteria such as an age group with specific insurance plans, chronic diseases and health issues, specific diagnoses or procedures, or how many new and returning patients each outpatient specialist sees each month. Easily accessible reports have enabled Franciscan Healthcare to build programs around population health management, quality improvement, and patient satisfaction.

Using the data from i2i to identify gaps in workflows and reporting, Franciscan Healthcare has been able to demonstrate significant improvements in their clinical quality measures.

After implementing i2i, Timmerman’s quality reports are more data-driven, and other reports such as patients who have advance directives can be obtained quickly, cross-checked, and easily validated with the patients’ EHR.

Daily huddles have been simplified and more productive with better information to share. Providers can review a list of patients they are scheduled to see and  conditions that require attention, such as overdue vaccines and preventative screenings. Accessing the data in their EHR has empowered Franciscan Healthcare’s care teams to provide proactive, high-quality care.

Lastly, Franciscan Healthcare is utilizing i2i technology’s enhanced metrics to build continuous quality improvement plans, participate in more quality initiatives, and apply for more grants.

NRHA adapted the above piece from i2i Population Health, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.

About Franciscan Healthcare

Franciscan Healthcare is a Catholic health system in northeast Nebraska. The health system consists of a 25-bed critical access hospital with five rural health clinics that offer comprehensive medical care including emergency care, obstetrics, surgical services, and multiple specialty clinics.

About i2i:

i2i is the nation’s largest population health technology company serving the underserved safety net market through critical access and community hospitals, community health centers (FQHCs), primary care associations, and managed care organizations.