California QIO Redesigns Practices’ Workflow to Improve Tobacco Screening Documentation

In its work assisting physician practices to leverage electronic health records (EHRs) for quality measures reporting, Health Services Advisory Group of California, Inc. (HSAG of California), the Medicare Quality Improvement Organization for the state, observed that reported tobacco screening rates for Medicare beneficiaries among some practices were far lower than other similar practices.

Specifically, some 88 physician providers using a particular certified EHR reported an average 6 percent of Medicare beneficiaries were being screened for tobacco use, but  given the providers’ attention to smoking cessation best practices  in Q1 2013, the QIO knew right away that something was amiss.

HSAG of California determined that physician practices that initiated screening activities at or near the front office reported higher screening and counseling activity than did practices that initiated such activities in exam rooms. As a result, the QIO designed a workflow model to empower mid-level providers at doctors’ offices—specifically, health care professionals with some supervisory responsibilities—to conduct screening activities at the front office. A screenshot of this workflow can be accessed here. The QIO also prescribed which front desk staff could initiate tobacco screening among visiting Medicare patients and conducted comprehensive onsite training on screening and EHR documentation for physicians and staff.

After implementing the new workflow, 80 percent of patients were reported as having been screened for tobacco use by Q2 2013. That is, the providers’ prior screening efforts, which had previously been undocumented, were captured, fully reflecting their dedicated efforts to help beneficiaries quit smoking. This rate of successful documentation has held through early 2014, proving that the efforts of the practice staff have made the workflow changes sustainable over the long term.