GIGO is an acronym from the world of information technology that has made its way into common use. “Garbage in, garbage out” – nowhere is that more true than when you're trying to use data from your EMR to improve the quality of your services. The key to having useful data revolves – as most quality improvement (QI) does – around your people.1. Reporting
Most EMRs these days have “canned” reports that you can use for QI purposes. These tend to be on standard topics that align with the federal government's Meaningful Use initiative or general clinical indicators like the average HbA1c of people with diabetes in your practice. Proper documentation is critical to ensure that you can use the data and training is key to proper documentation.
2. Training Matters
You almost can't train too much. No matter how user-friendly your EMR is, you must train your staff properly. It's better if one or two people have the responsibility for training to ensure minimum variability in training practice. Make sure you allow adequate time for training, especially for long-term staff who may be less computer-literate.
3. You Need a Tool
A written training tool should cover the key functions an employee must know to perform the basic functions of documentation in your EMR. If the vendor doesn't have a tool but relies on verbal instructions and hands-on training, you'll need to develop a tool. Oral instruction without a tool increases the odds that over the long term, people will stray from the basics.
4. Confirm Competence
Training is not a guarantee of competence. It's a good idea to confirm that people know what to do, when to do it and how to do it at several points during the training. Have them complete a post-test and return demonstration when the training is finished. Supervise them for a week or two when they are using the EMR in real time.
5. Things Change
Whenever your practice implements a new EMR release/update or changes a work process that involves documentation, you should repeat the training process described above. Regular skills validation is another way to ensure that people continue to use the EMR correctly. It also offers an opportunity to correct poor habits or incorrect practice before they become big problems that affect the quality of your data.
6. Becoming Data Driven
Now you're ready to use data for QI. Run some reports and see what your numbers look like. Your “gut” is key to this process; if the results are poor, double-check that documentation is accurate. Maybe staff are entering colonoscopy screening in text rather than checking the field from which you report.
These steps may seem very basic, but they are vitally important. If you want to avoid GIGO, train your staff well. Confirm their competence and check the quality of your data. Engage them in the process of QI. Otherwise, you'll be practicing GIGO of improving the quality of your practice and patient care.