What I Learned Last Week in Cambridge, MA at the World Congress Health Care Quality Conference

The subtitle for last week’s conference was “Moving from Volume to VALUE Based Care”. The theme’s that emerged from the speaker panels, presentations, and one-off conversations I had seemed well aligned:

  1. Healthcare is currently experiencing a paradigm shift from the traditional provider-centric mentality to that of a patient-centric framework
  2. One of the biggest challenges providers face in the pursuit of higher quality is figuring out how to appropriately leverage all of the data they’re currently collecting, manually and electronically
  3. Emerging opportunities for reigning in costs and improving quality including ACO’s, AQC’s, PCMH’s, and others will only be effective if there are standards for implementation and measuring effectiveness consistently across the country
  4. There are a handful of healthcare providers and payers who have taken significant strides in controlling costs while improving quality by implementing technology solutions that integrate data from across the continuum of patient care.

I was encouraged by the level of enthusiasm in the room. Dr. Allan H. Gorroll from Massachusetts General Hospital and Harvard Medical School made it clear that advancing the quality agenda will require significant investments in primary care; Dr. Kate Koplan spoke about Atrius Health’s push to reduce the problems of over testing and unnecessary treatments; Dr. John Butterly from Dartmouth Hitchcock Health discussed the Patient Centered Medical Home (PCMH) and suggested to all providers that they “have a patient on the team responsible for understanding how to establish the PCMH”; and Micky Tripathi the President and CEO of Massachusetts e-Health Collaborative mentioned the challenges of turning data into actionable information with problems like free text data, inconsistent data collection across care settings and the fear many clinicians have of “change” getting in the way.

I too was a co-presenter at the conference and was delighted by the response to our presentation. My counterpart Neil Ravitz, Chief Operating Officer for the Office of the Chief Medical Officer at the University of Pennsylvania Health System, and I discussed a recent solution we designed and implemented. We were able to automate the collection, integration, calculation, presentation and dissemination of 132 inpatient safety and quality measures across 3 hospitals and 7 source application systems. This new tool consolidates measures from across these hospitals and systems into one place for reporting and analysis through the use of dashboards and dynamic, drill down reports. The major benefits of the solution include:

  1. Changed the focus of quality and decision support analysts from data production to data analysis and action;
  2. Automated quality data collection to enable better accuracy and more timely data; and
  3. Enabled a faster quality improvement cycle time by front line leaders

Dr. Atul Gawande recently suggested in an article in the New Yorker that healthcare should be prepared to start implementing standards for nearly all of the care delivered, from total hip replacements to blood transfusions. As we all know, he is a fan of checklists, one logical tool for standardization. He also states, “Scaling good ideas has been one of our deepest problems in medicine”. When I attend healthcare conferences like the one last week in Cambridge, I’m excited by the progress I see organizations making. When I leave the conference though, I’m quickly reminded of the grim reality of healthcare and Dr. Gawande’s point. And then I wonder, at what point will “patient centric”, “accountable care”, “value based purchasing” and all the other catch phrases of the past few years become the industry standard – and not the exception limited to conferences, New Yorker magazines, and headlines that are only ever heard or read, and rarely ever experienced.

Why EMR’s Are Not Panacea’s for Healthcare’s Data Problems

So, you’ve decided to go with Epic or Centricity or Cerner for your organization’s EMR.

Think your EMR is Hamlin’s Wizard Oil?

Good, the first tough decision is out of the way. If you’re a medium to large size healthcare organization, you likely allocated a few million to a few hundred million dollars on your implementation over five to ten years. I will acknowledge that this is a significant investment, probably one of the largest in your organizations history (aside from a new expansion, but these implementations can easily surpass the cost of building a new hospital).  But I will argue: “Does that really mean the other initiatives you’ve been working should suddenly be put on hold, take a back seat, or even cease to exist?”Absolutely not. The significant majority of healthcare organizations (save a few top performers) are already years and almost a decade behind the rest of the world in adapting technology for improving the way the healthcare is delivered. How do I know this? Well, you tell me, “What other industry continues to publicly have 100,000 mistakes a year?” Okay, glad we now agree. So, are you really going to argue with me that being single-threaded, with a narrow focus on a new system implementation, is the only thing your organization can be committed to? If you’re answer is yes, I have some Cher cassette tapes, a transistor radio, a mullet, and some knee highs that should suit you well in your outdated mentality.

An EMR implementation is a game-changer. Every single one of your clinical workflows will be adjusted, electronic documentation will become the standard, and clinicians will be held accountable like never before for their interaction with the new system. Yes, it depends on what modules you buy – Surgery, IP, OP, scheduling, billing, and the list goes on. But for those of us in the data integration world, trying every day to convince healthcare leaders that turning data into information should be top of mind, this boils down to one basic principle – you have added yet another source of data to your already complex, disparate application landscape. Is it a larger data source than most? Yes. But does this mean you treat it any differently when considering its impact on the larger need for real time, accurate integrated enterprise data analysis? No. Very much no. Does it also mean that your people are suddenly ready to embrace this new technology and leverage all of its benefits? Probably not. Why? Because an EMR, contrary to popular belief, is not a panacea for the personal accountability and data problems in healthcare:

  • If you want to analyze any of the data from your EMR you still need to pull it into an enterprise data model with a solid master data foundation and structure to accommodate a lot more data than will just come from the system (how about materials management, imaging, research, quality, risk?)
    • And please don’t tell me your EMR is also your data warehouse because then you’re in much worse shape than I thought…
    • You’re not all of a sudden reporting real time. It will still take you way too long to produce those quality reports, service line dashboards, or <insert report name here>. Yes there is a real time feed available from the EMR back end database, but that doesn’t change the fact that there are still manual processes required for transforming some of this information, so a sound data quality and data governance strategy is critical BEFORE deploying such a huge, new system.

The list goes on. If you want to hear more, I’m armed to the teeth with examples of why an EMR implementation should be just that, a focused implementation. Yes it will require more resources, time and commitment, but don’t lose sight of the fact that there are plenty more things you needed to do with your data before the EMR came, and the same will be the case once your frenzied EMR-centric mentality is gone.