“I came at a good point,” says Sarah K. Meadows, MS, CCMEP, manager, accreditation and programs, with Denver-based National Jewish Health’s Office of Professional Education. She adds that she was able to learn from what did—and did not—work with some of the other performance improvement programs that were under way when she joined National Jewish Health. She credits the success to date of this program to her colleagues who “have been doing the difficult work of saying, ‘We said we want to do all this stuff but some of it has been a real challenge. What do we need to change to make it work?’ The MOC component is completely new for us, but so much of the modifications and groundwork for this program were lessons learned from our other projects.”

But there always will be new barriers. For example, while using electronic health record data is “working out great for this initiative because these clinics were very engaged and able to incorporate new prompts at the onset of the initiative,” there have been challenges with EHR systems with other programs. She says, “We didn’t realize how many barriers there were to things like getting spirometers hooked up to an EHR system, for example. If it doesn’t happen when we expect right at the beginning of a program, everything gets delayed because we can’t get to the data.” To get around the problem, they have to find another way to look at the data in addition to the EHR, “because the EHR doesn’t always tell the full story.”