As the nation buzzes with the latest twists and turns of healthcare reform, one thing is increasingly clear: investments in health information technology must be linked to improving care. In the midst of the unprecedented industry discussion about the definition of “meaningful use,” one area of consensus is that this opportunity must drive the use of information to improve patient health status and outcomes — not simply mandate the existence of the technology or specific functionalities.
Performance measurement core to healthcare reform
The ripple effect of meaningful use will be a new focus in how the data captured in EHRs can be used more effectively. Information grounded in good evidence will support quality improvement, payment reform, and enable better clinical and consumer decision-making. This information can indicate what care is leading to better outcomes; which treatment options are more cost effective; and which health plans, hospitals and clinicians are delivering safe, high quality, affordable care.
Health IT is the recognized delivery vehicle for this information, thus the incentives for HIT implementations through ARRA HITECH. However, technology can only help improve the quality of care if it is designed to more effectively collect performance information. The healthcare industry does not currently communicate health information well, nor does it aggregate it effectively enough to see patterns across time and find trends. An EHR should provide a means of aggregating information to better understand processes and treatments that are effective for a given disease. The industry is now seeing an emerging priority and demand for information: healthcare organizations must become more information-sensitive and aware.
Intelligence optimized for clinical quality improvement
Effectively addressing ARRA requirements – as well as increasing requirements from JCAHO, CMS and other quality initiatives – will require the integration of analytics into the clinical workflow, allowing organizations to effectively track and measure clinical performance and identify how clinician actions affect patient outcomes and clinical costs. Organizations will need to monitor and improve performance related to The Joint Commission, core measures, hospital acquired complications and other quality initiatives, while facilitating:
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Proactive management of patient populations through just-in-time surveillance reports and automated data abstractions
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Visibility into usage patterns and effectiveness of order sets and clinical decision support on outcomes
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Insight through retrospective trending and root-cause analysis with drill-down and drill-through capabilities
Maximizing codified data capture.
As the industry moves toward codified data for analytics efforts as well as interoperability, organizations may realize that the data they have already captured may not be effectively shared or used for reporting and performance improvement efforts. How data is captured and how easily it can be extracted will become increasingly important, potentially requiring a second look at the clinical data repository. For example, documentation full of free text instead of hard-coded fields will pose challenges for interoperability and analytics.
A key requirement for reporting and interoperability is the ability to capture structured data so it can be used outside the bounds of the system initially capturing it, trended and analyzed. Codified and structured data also play a critical role in data quality issues that can confront many organizations. The industry challenge has long been that the more structure required for the data going into the system, the more resistance to clinician adoption because it can change workflow and add time to what many clinicians consider an administrative function. This situation presents a conundrum — codified data is essential for performance improvement and data sharing, yet it creates adoption obstacles.
Questions to ponder
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How does your organization currently gather data for reporting?
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Does your current solution capture the data required for your performance improvement or reporting needs?
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What constituents currently have access to reports and analytics data? Frontline clinicians? Managers? Quality analysts? Executives?
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What is the timeliness of the data?
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Are you currently effectively using data for performance management or quality improvement efforts?
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Do you currently have the ability for ad hoc reporting? Dashboards? Predictive analytics?
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Do your clinicians have the ability to leverage quality data within their workflow?
The primary focus of Melissa Honour’s career is measuring and understanding the impact of information technology on healthcare cost, operations quality and patient safety. Melissa is currently Outcomes Director at Eclipsys Corporation, previously she worked at Brigham and Women Hospital, Boston, as a senior healthcare analyst and The Agency for Health Care Research and Quality (AHCRQ) as a senior healthcare analyst.
