The Never-Ending Burden of Reporting Patient Safety & Quality Metrics

Quick: how long does it take you to collect, aggregate, and report your SCIP, PN, AMI, and HF Core Measures? How about infection control metrics like rates of CLABSI, VAP, UTI, and MRSA? Or for that matter, any patient safety and quality metric that is mandated by JCAHO, CMS, your Department of Health, or anyone else? If you answered anything less than 2 months, and if I was a betting man, I’d bet you were lying.

There is a never-ending burden strapped to the backs of hospitals to collect, aggregate, analyze, validate, re-analyze, re-validate, report, re-validate, report again….quality measures. Reporting of these quality metrics is meant to benchmark institutions across the industry on their level of care, and inform patients of their treatment options. Fortunately for the majority of institutions, it is not difficult to achieve a high rate of compliance (>80-90%) because clinicians genuinely want to provide the best standards of care. Unfortunately though, the standards for achieving the highest designation according to CMS guidelines (achieving top percentile >99%) requires hospitals to allocate a disproportionate amount of time, money, and people to increase very small increments of compliance. I sat with a SCIP Nurse Abstractor last week and we spent 90 minutes drawing out, on 2 consecutive white boards, the entire process from start to finish of reporting SCIP core measures. There are over 50 steps, 5 spreadsheets/files, 4 hand-offs, 3 committees, and a partridge in a pear tree. It takes 2.5 months. I wonder how much money that is if you were to translate that time and effort into hard money spent? I also wonder what the return on investment is for that time, effort, and money. If we’re going to start running healthcare like a business, which I argue we should, this seems like a great place to start.

STEP 1: Reduce the amount of time spent on this process by ensuring the data is trustworthy There are way too many “validation” steps. Most people do not trust the data they’re given, and therefore end up re-validating according to their own unique way of massaging the data.

STEP 2: Integrate data from multiple sources so your Quality Abstractors and Analysts aren’t searching in 10 different places for the information they need. I’m currently helping a client implement interfaces for surgery, general lab, microbiology, blood bank, and pharmacy into their quality reporting system so their analysts can find all the information they need to report infection rates, core measures, and patient safety metrics. In addition, we built a Business Objects universe on top of the quality data store and they can do dynamic reporting in near real time. The amount of time saved is amazing and we have been successful in dramatically shifting the type of work these people are responsible for. The BI Capability Maturity Model below depicts our success helping them move from left to right.

STEP 3: Empower your analysts. With much more time to actually analyze the information, these people are the best candidates to help find errors in the data, delays in the process, and opportunities for improvement.

STEP 4: Create a mechanism for feedback based on the information you uncover. Both overachievers and underperformers alike need to be recognized for the appropriate reasons. Standardize on the best of what you find, and be sure to localize your intervention where the data is inaccurate or the process breaks down. This will also demonstrate greater transparency on your part.

Extend the Value of Picis ED PulseCheck in the Emergency Department

How long does it take to report your AMI, HF, and Pneumonia Core Measures in the ED? If your answer is weeks or months, you’re like the majority of hospitals in this country. Why? Because you’re overburdened with chart abstraction, free-text/unstructured documentation analysis, and what I like to call, “manual process fatigue”. That’s ok though, because some hospitals have started making progress automating their ED processes with applications like Picis’ ED PulseCheck. Deciding to evolve from a paper-based to electronic system in your ED is the easy part; implementing an ED Information System can be much more difficult (I know I know…”thanks Captain Obvious”). There are steps, though, that can make your journey much smoother.

There are ways to extend the value of an application like ED PulseCheck from the very beginning. It is a great application for integrating charge capture and the clinical documentation necessary for full reimbursement; it’s interoperable with other hospital systems; it’s ARRA compliant; the list goes on. Aside from the out of the box functionality, there are ways to morph this type of application into a larger asset than most Picis clients even consider. One example relates to Core Measure compliance. As I mentioned in my opening, the average hospital will report August 2010 Core Measure compliance sometime in October or November (when will you?). This is because it takes teams of people countless hours to sift through any number of paper or scanned documents and free-text narrative clinical documentation to identify the words and phrases necessary to satisfy the stringent CMS requirements. If you want to drastically reduce the timeframe to report Core Measures start by considering these and other reporting requirements when you first implement, upgrade, or extend your EDIS. One more advantage to an application like Picis ED PulseCheck is the fact that it is malleable and can be easily customized to the user’s needs. I’ve helped customize the tool to embed the exact language CMS expects for Core Measure compliance right at the point of data entry so your clinical staff is not responsible for memorizing the CMS rules, especially because they change twice a year. Removing this burden improves your compliance and in addition, wins over the staff by reducing the time spent documenting their care. Instead of continuing to allow unstructured data entry in that Picis memo field, create a drop down menu of available options for what the clinician should be documenting aligned with CMS standards. One example we delivered to an IDN in the southwest was a drop down list of antibiotics included in their pharmacy that met the requirements of the PN-5 measure for antibiotic timing. In this way, the clinicians could discretely document the drug given, no manual written or typed entry was necessary, and the nurse abstractors could simply run a query that monitored the field for the right antibiotic administered, along with the date/time field of administration and the date/time field of when the patient arrived, to ensure compliance with the 6 hour mandate.

How are you extending the value of ED PulseCheck in your hospital? I’ll collect the stories and feedback I get and post a response to this blog at a later date.

Ryan Hayden
Principal Consultant
Email: rhayden@edgewater.com

So You Think an Accountable Care Organization (ACO) is a Good Idea – First Things First, What’s your Data Look Like?

I will not pretend to know more about Accountable Care Organizations (ACOs) than Dr. Elliot Fisher of Dartmouth Medical School who is the unofficial founder of the ideas behind this new model for healthcare reform. But if I may, I’d like to leverage some of his ideas to outline the necessary first step for creating a new ACO or being included in one of the many that already exist.

First and foremost, I understand that there are very smart people out there who insist ACOs are a bad idea (click here and here to read strong arguments against ACOs). Having said that, there are fundamental aspects of ACOs that are prerequisites for success; one of these is the ability to calculate mandated performance metrics and share this data electronically with other members of the ACO. How else are they going to know if it’s working (and by working I mean lowering costs while improving the quality of care)?

Healthcare providers are used to having to calculate quality metrics, like Core Measures amongst others, for the purposes of demonstrating high quality care, being compliant with regulator mandates, and satisfying their patient populations. What they’re not used to is having to report in a timely fashion. Hospitals routinely, for instance, report CMS core measures months after the patient encounters actually occurred. The previous 3 clients I worked with reported March/April/May measures in August. The Senate Bill that allows for CMS to contract with ACOs specifies the need to share performance metrics among participating entities but leaves the how and how often to each ACO to decide. This could be extremely problematic considering the huge discrepancy across our provider networks of the necessary healthcare IT infrastructure to gather, calculate, and report these metrics across care settings in a timely manner.

The first thing to consider when contemplating participation in an ACO is, “How robust is your data infrastructure and can you meet the reporting requirements mandated for any ACO participation?” Dr. Fisher points out, “We have been collaborating withCMS, private health plans, and medical systems to identify and support the technical infrastructure needed to deliver timely, consistent performance information to ACOs and other providers.” If you think your paper-chasing and manual chart abstraction that gets you by today for most reporting requirements will fly, think again. An ACO will only be as strong as its weakest link. A successful ACO is able to monitor its progress against the benchmarks established for total cost for delivering healthcare services per enrollee. The overall goal is to lower the cost to provide services while maintaining a high level of quality, and subsequently share the cost savings. There are other similar models such as the Alternative Quality Contracts (AQCs) currently rolled out by BCBSMA, with similar criteria and financial incentives. In both cases, though, the fundamental data infrastructure is required to meet the stringent reporting requirements. In addition, as ACOs gain traction and identify new ways to lower the cost of providing care, the need for a robust reporting infrastructure to eliminate the tremendous amount of time and money spent on collecting, calculating, reporting and distributing information including quality, operational, clinical, and financial metrics becomes even more instrumental.  The best case scenario also includes an evolution to healthcare analytics when analysis of data spans care settings, siloed applications, and even facilities (Chet Speed, the American Medical Group Associations VP, Public Policy agreed with me on this point in his recent interview with Healthcare Informatics). But first things first.

You can do a lot to improve your chances of success within an ACO; start with understanding the requirements for sharing discrete, accurate, consistent data, it’s a great first step. Good luck!

So You’ve Signed an Alternative Quality Contract (AQC), Now What?

There have been headlines recently announcing the partnerships BCBSMA has struck with MA-based providers called Alternative Quality Contracts that seek to flip the traditional fee-for-service model on its head. Instead, these contracts advocate payments for the highest quality of care, not necessarily the most expensive. BCBSMA boasts, “The AQC now includes 23% of physicians in their network, providing care to 31% of their MA-based HMO members”. There are some recognizable names on the list of organizations already signed up including Mount Auburn, Tufts, Atrius and Caritas Christi among others totaling 9 hospitals and physician groups. I would argue, though, that signing the contract is the easiest part to this partnership (even though the lawyers for both sides may disagree). The foundation of the contracts is the quality measures that both parties agree represent the best way to monitor the quality of the care being delivered. The hard part is finding the most efficient ways to calculate and report the measures to save money and improve revenue from this new model for reimbursement. BCBSMA explicitly states, “Providers can retain margins derived from reduction of inefficiencies.” Well where are the biggest opportunities for “reducing inefficiencies”? The biggest inefficiencies lie in the collection, aggregation, and reporting of the data required to calculate these quality measures!

Almost every hospital I’ve worked, volunteered, or consulted for has the same problem – it takes too long to calculate and report quality metrics. Paper-chasing and manual chart abstraction burden overqualified nurses and delay decision makers from improving their processes. By the time the information is collected, it’s too late to make an actionable decision to either improve or standardize the best practice. Hospitals will clamor, “Our core measures are above 90%”. My response is always, “ok but you just reported June’s numbers and it’s August! And how much did it cost you to report those numbers that you now can’t do much with because you’re two months behind the information?”

In Massachusetts, the public reporting of physician and hospital performance is currently being developed. This trend will undoubtedly spread to the rest of the country, eventually. The demand for transparency of true healthcare costs and quality of care, I’d argue, has never been higher. The AQCs are a great first step in the right direction. But until hospitals and physician groups tackle the bigger problem, the huge amount of time, money and effort currently being wasted on paper-chasing and manual chart abstraction required to collect, calculate, and report their quality metrics, these contracts will only be yet another piece of paper to keep track of. Good intentions don’t equate to good business.

Healthcare Analytics – A Proven Return on Investment: So What’s Taking So Long?

So what do you get when you keep all your billing data in one place, your OR management data in another, materials management in another, outcomes and quality in another, and time and labor in yet another? The answer is…………..over 90% of the operating rooms in America!

That’s right; the significant majority of operating rooms DO NOT have an integrated data infrastructure. In the simplest terms, that means that the average OR Director/Administrator CAN’T give answers to questions like, “of all orthopedic surgeons performing surgery within your organization (single or multi-facility), what surgeon performs total knee replacements with the lowest case duration, least number of staff, lowest rate of complication, infection, and re-admission rate at the lowest material and implant cost with the highest rate of reimbursement?” In other words, they can’t tell you who their highest quality, most profitable, least risky, least costly, best performing surgeon is in their highest revenue surgical specialty. Yes, I’m telling you that they can’t distinguish the good from the bad, the ugly from the, well, uglier, and the 2.5 star from the 5 star. Are you still wondering why there is such a strong push for transparency of healthcare data to the average consumer?

You’re sitting there asking yourself, “Why can’t they answer questions like whose the least costly, most profitable and highest quality surgeon?” and the answer is simple, “application-oriented analysis”. Hospitals have yet to realize the benefits of healthcare analytics. That is, the ability to analyze information that comes from multiple sources in one location, instead of trying to coordinate each individual system analyst and have them hand their spreadsheet off to the other analyst that then adds in her data and massages it just right to hand it off to the next guy, and then….ugh you get the point. If vendors like McKesson, Cerner, and Epic could make revenue off of sharing data and “playing well with others” they would, but right now they don’t. They make their money off of deploying their own individual solutions that may or may not integrate well with other applications like imaging, labs, pharmacy, electronic documentation, etc. They will all tell you that their systems integrate, but only once you’ve signed their contract and read that most of the time, it requires their own expertise to build interfaces, so you’ll need to pay for one of their consultants to come do that for you – just ask anyone who has McKesson Nursing Documentation how long it takes to upgrade the system or how easy it is to integrate with their OR Management system so floor nurses can have the data they need on their computer screen when the patient arrives directly from surgery. Out of the box integrated functionality/capability? Easy-to-read, well documented interface specifications that a DBA or programmer could script to? Apple plug-n-play convenience? Not now, not in healthcare.

Don’t get too upset though, there are plenty of opportunities to fix this broken system. First, understand that organizations such as Edgewater Technology have built ways to integrate data from multiple systems and guess what – we integrated 5 OR systems in a 7 hospital system and they saved $5M within the first 12 months of using the solution, realizing a ROI 4 times their original cost.  Can it be done? We proved it can. So what is taking so long for others to realize the same level of cost savings, quality improvement and operational efficiency? I don’t know, you tell me? But don’t give me the “it’s not on our list of top priorities this year” or the “patient satisfaction and quality mandates are consuming all our resources” or don’t forget the “we’re too busy with meaningful use” excuses. Why? Because all of these would be achievable objectives if you could first understand and make sense of the data you’re collecting outside the myopic lens you’ve been looking through for the past 30 years. Wake up! This isn’t rocket science, we’re trying to do now what Gordon Gekko and Wall Street bankers were doing in the 80’s – data warehousing, business intelligence, and whatever other flashy words you want to call it – plain and simple, it’s integrating data to make better sense of your business operations. And until we start running healthcare like it’s a business, we’re going to continue to sacrifice quality for volume. Are you still wondering why Medicare is broke?

Picis Exchange Global Customer Conference – “It’s All About the Data”

The Picis Exchange Global Customer Conference went off without a hitch last week in Miami. The main information sessions were categorized by the four areas of a hospital Picis specializes in: Anesthesia and Critical Care, Emergency Department, Perioperative Services, and Revenue Management Solutions (via its acquisition of LYNX Medical Systems). I was able to attend a number of sessions, network with both the company and its customers, and hear what the top priorities for this diverse group are over the next few years. As I reviewed my notes this weekend, thinking back to all the conversations I had with OR Directors, Quality Compliance Managers, Clinical Analysts, Billing and Coding Auditors, Anesthesiologists, and IS/IT Directors, one theme emerged – it’s all about the data!

The most frequent discussions centered around a few major challenges the healthcare industry, not just Picis clients, must deal with in the coming months and years. These challenges vary in complexity and impact on the 5 P’s [Patients, Providers, Physicians, Payers, and Pharmaceutical Manufacturers]. Picis customers and users, who collect, analyze, present and distribute data most efficiently and effectively related to the following challenges, position themselves as stable players in an increasingly turbulent industry:

  • Meaningful Use – “What data must I show to demonstrate I’m a meaningful user of Healthcare IT to realize the greatest number of financial incentives available? How can I get away from free-text narrative documentation and start collecting discrete data in anticipation of the newly announced HIMSS Analytics expanded criteria?
  • Quality & Regulatory Compliance – “How can I improve my quality metrics such as Core Measures and keep them consistently high over time? How can I reduce the amount of time it takes for me to report my data? How can I improve my data collection, analysis, and presentation to enable decision makers with actionable data?”
  • ICD-9 to ICD-10 Conversion – “What data and processes must I have in place to demonstrate use of ICD-10 before the looming deadline? Is my technical landscape integrated and robust enough to handle the dramatic increase in ICD-10 codes? Does my user community understand the implications of the changes associated with this conversion?”
  • Resource Productivity – “How can I reduce the amount of time my staff spends chasing paper, manually abstracting charts, and analyzing free-text narrative documentation? What percentage of these processes can I automate so my staff is focused on value-added tasks?”
  • Revenue Cycle Improvement & Cost Transparency – “How can I integrate my clinical, operational, and financial data sets to understand where my opportunities are for enhanced revenue? How can I standardize these as best practices? Can I cut costs by reducing inventory on hand and redundant vendor/supply contracts or by improving resource utilization and provider productivity? How will this impact patient volume? Am I prepared for healthcare reforms’ “call for transparency?”

All of these challenges, although unique, have fundamental components in common that must be established before any progress is made. Each instance requires that processes are established to standardize the collection of data to ensure accuracy and consistency so users can “trust the data”. A “single version of the truth” is essential; without this your hospital will continue to be pockets of siloed expertise lying in Excel spreadsheets and Access databases (best case), or paper charts and scanned documents (worst case) that are laboriously re-validated at every step in the information lifecycle.

Picis did a wonderful job of reinforcing its commitment to its customer base. It promised improved product features, more intuitive user interfaces, an enhanced user community for collaboration and idea sharing, and more opportunities for training. Fundamentally, Picis is a strong player in a market that seems ripe for consolidation and its potential for growth is very high. Yet, Picis will always be just that, a product company. The healthcare industry no doubt needs strong products such as Picis to drive critical operations, and collect the data necessary for improved decision making and transition from paper to automation. But Picis acknowledged, through its evolving collaboration with partners such as Edgewater Technology that understand both the technical landscape and clinical domain, that the true spark for change will come when the people and processes align with these products more effectively. This combination will be the foundation for a heightened level of care from an integrated data strategy that propagates a formula of superior patient outcomes from every dollar spent.

Analyzing Clinical Documentation Requires Discrete Data

How many of your patients’ paper medical charts look something like this?  How many similar piles are on the front desk of the OR? The PACU managers office? The scheduling department? Your office?

I know it’s not pretty, it’s legible…barely, it’s written free hand, it’s clunky, it’s outdated, it’s like hearing your favorite song on an 8-track or cassette tape, it’s simply a thing of the past. Oh, and it takes a lot of time which means it costs a lot of money.

Doctors spend a lot of time and money going to school to become experts on the human body – that’s who I want taking care of me. Unfortunately, they are burdened by a system that requires they write specific phrases, terms, and codes just to get paid essentially becoming experts in understanding a set of reimbursement business rules – that’s not who I want taking care of me. Healthcare is an industry that’s core infrastructure, its backbone of information centered on diagnosis, procedure, and other treatment and care delivery codes, is broken. Why? Because all of that information is currently written down – not electronic!

I’m prepared to help fix a broken system. I have personally seen over 100 different ways for a physician to write down their observation after a routine visit with a patient. This includes the phrasing of the words, penmanship/legibility, abbreviations (only officially “accepted” abbreviations though), and interpretation.  The same thing goes for an appendectomy, blood work, an MRI, and an annual physical. This is unacceptable. The important information that a physician records must be entered as discrete data elements directly into a computer. This means that each piece of data has its own field – sorry circulating nurses who love free-text “case notes” sections at the end of surgery – and the time of free text and narrative documentation is over. Do you know how much time and money can be saved by avoiding the endless paper chasing and manual chart abstraction? Me either, but I know it’s a lot!

How do you fix it? I’m not going to lie and tell you it’s easy. Governance helps. You can guarantee that surgeons, anesthesiologists, hospitalists, specialists and the rest will all have their needs and comforts…and opinions. “If you want to perform surgery at this facility you need to document your information discretely, electronically, consistently and in a timely fashion.” Physicians are used to writing stuff down, its familiar, its comfortable, it’s home cooking. In order to change that comfortable behavior you must emphasize the benefits:  they will spend less time documenting, they will have faster clinical decision support, they will have automated and timely reporting capabilities, they will have near real time feedback on their performance, benchmarks against best standards, and opportunities for improvement. Doctors can appreciate an investment in an evidence-based approach. In order to automate the collection, reporting, and analysis of the mountain of information collected every day, on every patient, in every part of the hospital, it must be entered discretely. That or you waste more time and money than your competitor who just went all electronic. Do you really want to control costs and get paid faster?  Stop using paper and join the 21st century!

How to heighten core measure compliance

How do you go from SCIP compliance that looks like this?

To SCIP Core Measure compliance that looks like this?

It all starts with the documentation in your OR! How are the nurses, surgeons, and anesthesiologists documenting the data and information they collect throughout the patient visit as he/she moves from Holding to Pre-Op to the OR to PACU? The most critical aspect of high core measure compliance, whether its SCIP in the OR or Pneumonia, AMI, and HF in the ED, is electronic, discrete data capture.

One of the biggest problems in healthcare is the free-text field available in most healthcare applications, also known in the data and IT worlds as the “catch-all bucket”. Whenever users can’t find the right location within an application to put the information they’re documenting, they by default chose a “memo” field, or “case note” or just free text area for any and everything that could be typed from a computer keyboard. The problem is, this information can’t be mined and reported automatically. So what happens, nurses and other medical record professionals are paid to simply do chart abstraction which is a more professional way of saying “paper chasing”. The last 3 hospitals I consulted with paid nurses with 25+ years experience and a deep domain knowledge of core measure compliance over $70k / year to chase paper and make sense of free-text documentation. What a waste of expertise, skills and money. Wouldn’t these same resources be infinitely more valuable finding ways to improve the dips in core measure compliance instead of spending the significant majority of their time just chasing down the 10-12 different places SCIP data can end up (case notes, discharge summary, case record, op notes,  paper chart, order sets, etc.)?

First Steps Towards Higher Core Measure Compliance

So now we know the main problem, what steps can you take to change the nature of clinical documentation to naturally improve your ability to report SCIP compliance and heighten your performance?

  1. Make sure your end users know, “the [OR] applications are as good as they help make them”. No one should be locked into user interfaces, drop down fields, and data points that can’t be changed to accommodate clinical workflows. If you can’t change now, wait until the next upgrade or version release, collect the nursing feedback and address changes later on. And if your vendor rep says there’s nothing he/she can do, slap them! These are CMS mandated measures and the systems need to help in raising compliance in every way they can.
  2. Build values that CMS mandates directly into the documentation – make being compliant a default behavior. If CMS says that for SCIP-3 the only acceptable reasons for continuing an antibiotic past 24 hours are: “Infection”, “Possible Infection”, or “Documented spillage of fecal contents during abdominal surgery” then make those values options in your drop down menu. Don’t make it easy for users to be non-compliant.
  3. Create communication standards for feedback and accountability: OR Directors and Nursing Managers must have a consistent way for communicating breakdowns in compliance. This makes a strong case for Data Governance; there must be a way for you to have conversations with your clinicians that may not be easy or popular, but must be done nonetheless. No surgeon wants to be told he/she has done something wrong, it hurts their ego’s…but as my mother once told me, “you don’t always get what you want”.
  4. Equate high core measure compliance with benefits that relate directly to clinicians top priorities – Patient Care, Patient Satisfaction, Reputation, and Financial Incentives (in that order). The diagram below depicts the tremendous benefits realized when an institution can achieve high compliance consistently over time.

Unfortunately for you, these first steps are the easiest in any organizations quest towards higher core measure compliance or a move towards electronic documentation in general. I promise, there will be frustration before there is elation. Lucky for you, Edgewater has done this plenty of times with a high degree of success with healthcare providers of all shapes and sizes because we know the proper way in which to achieve these goals. So, when you’re ready, give us a call and we can help get you started or move you on to the next step because I promise, it’s much easier than it looks.

Organizational Transparency: Introduce Your IT Team to the Business Users

If you thought siloed data was a problem in healthcare, well you’re right. There are tremendous opportunities to improve this fundamental problem in OR’s, ER’s, and units in hospitals of all shapes and sizes. A majority of healthcare CIO’s agreed as well, identifying it as the Top Tech trend on their radar for 2010. But more and more large healthcare organizations are realizing it’s not just the disparate data scattered across the technical landscape that’s causing headaches, its’ siloed departments as well. “Dr. Smith, meet Ryan the head of clinical decision support.”

I have personally been a part of those awkward conversations, which as a consultant, are never fun. That is, when you are engaged with a client and you become the person that introduces a clinician (physician or surgeon or charge nurse) from the business side, to their counterpart [within the same organization] on the IT side (Manager of Data Warehouse, Director of Clinical Decision Support). The first thing that enters my mind (and I hope theirs) is, “how have you two not met before today?” Unfortunately, these continue to happen and with higher frequency than anyone would like to admit.

The role of Healthcare CIO has changed, the qualifications for a successful CIO now demand a strong understanding of the business in which they operate. Ben Williams, CIO of Catholic Healthcare West and its 42-hospital enterprise, said it best, “there is a greater demand on CIOs to be business leaders and innovators and know the business and know the challenges and parameters.” One way for organizations to improve this cross functional understanding and ensure coordination between business and technical leaders is to have their integration embedded in the guiding principles of enterprise data governance.  The demand for clinical analysts that can bridge this gap has never been higher; aside from these types of resources, the people on the front lines who have proprietary knowledge of clinical workflows, applications, and technical infrastructure must be challenged to expand their expertise outside of their direct responsibilities, regardless of the side of the organization they currently sit [comfortably]. 

The Many Costs Associated with Lack of Transparency

“So what if Bill from IT doesn’t know David, the Director of the OR! I run a huge organization, not everyone knows everyone else.” Wrong attitude; let me quantify the costs associated with this lack of resource coordination:

  • Lack of both clinical and technical requirements creates project re-work that misses deadlines, lengthens implementations and extends “Go-Lives”.
  • User dissatisfaction with applications, user interfaces, and system capabilities from inconsistent education – pockets of expertise littered amongst a sea of novice users underutilizing the apps
  • Distrust of technical/clinical counterparts and the data/information within the systems
    • Dr: “Why can’t it just work? I want IT to be like the lights; if I turn it on it should work.”
    • IT: “Why can’t the users just learn how to use the system correctly?”
    • Failed projects leaves long-term impact on users/staff involved
    • Diminished Return on Investment

How will you ensure your clinical decision support staff understands the clinical requirements for near-real time reporting of data related to quality, performance, and compliance? How can you ensure your clinical staff are proficient in the use of your most recent system implementation in the OR, floor unit, or ED? What argument must you articulate to the naysayers and critics amongst your anesthesiologists, surgeons and nurses when they ask, “Why do we have to move from paper to automation?” If the answer is not consistent from both sides of the house, business and IT, the message is lost and the battle to win over your end users becomes harder and harder to win as each new initiative is rolled out.

And we know one thing, paper in healthcare is like pleather, shoulder pads and mullets in fashion…if it makes a comeback we’re all in serious trouble. 

Healthcare IT Gets Snubbed in “State of the Union”……So What!

I would not want to be the President right now. No matter what he said on Wednesday night, he undoubtedly would leave someone out; some initiative, some special interest, some high priority agenda item. Then how, with tackling the exorbitantly high cost of healthcare as the single highest profile item on his desk, did he forget to mention Healthcare IT (HIT)? Seriously, how?

There was no mention of the ARRA and HITECH money allocated to demonstrating “meaningful use” of healthcare IT that hospitals, doctors offices, healthcare clinics and every other possible recipient has been scrambling like chickens with their heads cut off to understand for the past 6 months. There have literally been new businesses created to analyze and make sense of this information; new government committees established to oversee the process; experts and pundits claiming this and that on national stages, radio shows, conferences; with all the press HIT has gotten from the day the President was sworn in, you’d think he would’ve give us a progress report, at least from his point view.

There was no mention of the EMRs, CPOE, Clinical Data Repositories, PACS, and Electronic Documentation that are all suitable candidates for the initial projects providers can tackle because of the availability of research and best practices available for these initiatives. No mention of the increased regulations from JCAHO, HIPAA, and CMS. No mention of the accessibility issue so closely related to the President’s broadband initiative that will determine patient accessibility beyond the hospital walls.

There was no mention of the strategies that CIOs, CMIOs, CEOs, and CFOs are utilizing such as data warehousing, clinical data marts, electronic capture of patient information through kiosks (just like when you check in at the airport); clinical alerting to increase compliance with Core Measures and other regulations; and using evidence-based decision making from strong data quality, discrete, standard, timely data collection, and last but not least, enterprise-wide data governance strategies.

Ok, so we were all left out, but as Tom Hanks would say “there’s no crying in baseball”.  Good thing for us, we don’t have time to sit and sulk.  First things first, get your act together.  You will never understand where your weaknesses lie and your opportunities for improvement sit without understanding the information you’re collecting, on a day-to-day basis, across the entire spectrum of your healthcare organization.  The average hospital has 120 different software applications, mostly transactional, that all have their own subset of data. Understanding this vast landscape, and integrating the data and transforming it, in a timely manner, into actionable information, is critical for any executive; the providers able to balance government demanding reform, patients begging for lower costs of care, researchers advancing the standards for higher quality, and the constant advancements in technology will be the ones who not only survive, but emerge from this recession stronger than when they entered. You will be looking for a roadmap!