Qualitative
Qualitative analysis of PF contact notes from practices scoring the lowest on both Software Capability and HIT Skill Set (n = 40) revealed three dominant themes: reporting challenges, a mistrust of their data, and a willingness to try to make improvements. (Table 4)
  1. Reporting challenges. Limited staffing resources, access to data, and EHR capabilities presented challenges. Practices described inability to report, lack of HIT expertise or staff with only basic skills, and limited time to run reports. Other barriers included no interface between practice management and clinical data and difficulty mapping diagnostic codes to the problem list. Variations in data entry and data quality were often significant. For some practices a parent health system, network, or hospital controlled and limited access to the data. Limited reporting ability often reduced enthusiasm for engaging in QI.
  2. Mistrust of data : Providers and staff seemed to mistrust or lack confidence in their data accuracy and EHR, which undermined motivation to use data for QI.
  3. Willingness to try : Despite challenges, practices scoring low on the PHITA seemed eager to make improvements using rapid process improvement cycles and alternative data sources for QI. Some purchased registries, upgraded their EHRs, or transitioned to EHRs that promised better capabilities or a registry function.
Examination of PF contact notes for practices scoring highest on both sub-scales (n = 43) revealed three themes: an ongoing need for assistance, a focus on data accuracy, and engagement with QI activities. (Table 5)
  1. On-going need for assistance : High performers had resources and skills to run reports, but faced remaining challenges and needed assistance from their PF, EHR vendor, or parent organization. Challenges were often related to non-familiarity with the complexities of quality reporting, competing priorities, and staff turnover. Specific barriers included limited date range reporting and inability to produce data at the provider or practice level.
  2. Focus on data accuracy : High-scoring practices focused on improving data accuracy through better data capture and report validation. Improved data quality was viewed as a prerequisite to using it for quality improvement. Understanding information flow for reporting encouraged care teams to standardize data capture to improve reporting accuracy. Quality reporting methodology was new to some providers, including data definitions for clinical concepts and understanding population metrics.
  3. Engagement with QI : High-scoring practices were engaged in understanding how reports were created and were willing to use them to guide patient care. They engaged their PF, their EHR vendor, and used other resources. These practices engaged all staff, including providers and leadership in using data for practice improvement.