Clinical Data Requires Nimble Navigation

This article appears in the July 2012 issue of HealthLeaders magazine.

"I sense a data theme throughout the results," says Craig E. Samitt, MD, president and CEO of Dean Health System in Madison, Wis., a physician-owned integrated delivery system with 60 healthcare facilities in southern and central Wisconsin.

The 2012 HealthLeaders Media Clinical Quality and Safety Survey shows widespread use of electronic health records, which, for those who work to get it going, can provide a data foundation to be tapped to prevent errors and support clinical decisions. Three quarters of respondents are using EHRs now. One-quarter (28%) of those EHR users have taken the next step and use analytics for such applications as clinician alerts. Within a year, the number of EHR users who are also using analytics will double. Says Samitt, "If we presume that technology provides data and data gives us information to improve quality, it is a critical next step that organizations are moving to analytics, not just technology."

According to Chris Snyder, DO, chief medical informatics officer and chief quality officer at Peninsula Regional Medical Center, a 365-licensed-bed hospital in Salisbury, Md., "The value added from data is going to drive quality."

By and large, metrics associated with the development and testing of new medical procedures are process measures. The value-based purchasing model is designed to reward outcomes, though, so the healthcare industry seeks a different kind of measure.

"We can tick off and achieve some of the quality metrics," Samitt says, "but that doesn't necessarily mean that we are delivering higher-quality care. For example, you can test mammography rates for women for screening, but that is not an outcome measure; it is a process measure." Overall, 86% of respondents "Agree completely" or "Agree somewhat" that the industry needs more measures that address outcomes rather than processes.

A considerable percentage of the respondents—41%—does not know whether value-based purchasing will have a positive effect on clinical quality, and an additional 19% say VBP will not improve clinical quality. Stephen L. Moore, MD, chief medical officer at Englewood, Colo.–based Catholic Health Initiatives, a system with 76 hospitals and other facilities in 19 states, suggests that the PPACA's reliance on process measures is the reason that so many are uncertain.

"There have been a number of studies in the literature for the process measures we are using. Improvements in those numbers have not led to reductions in mortality, complications, or any measureable movement in outcomes-based performance," Moore says. "The survey results suggest that a large number of people are concerned, as I am, that process-measure issues that we have been focusing on to date are not clear enough indicators for outcome improvements."

Observing that 83% of respondents are addressing healthcare-acquired infections, either with a program that has achieved its goals (31%) or a program in which performance improvements are still being made (53%), Samitt once again draws our attention to the importance of the flow of information. "Healthcare organizations absolutely want zero defects, but it is hard to do in the absence of information," he says.  "When information is available, organizations seek to improve." Only 14% of respondents place the prospect of penalties for hospital-acquired infections among their top three VBP challenges, indicating a high degree of confidence in addressing the issue.

Three quarters (74%) of respondents say that their tactic of sharing knowledge about patient-safety practices continues to deliver improvements or is delivering results in a stable and satisfactory fashion. One-half (52%) are seeing safety improvements as a result of continuing efforts to communicate better during handoffs. And just as clinical quality receives a boost from the flow of digital information, so does patient safety: one quarter (25%) say that their IT-based safety checks such as the electronic medication administration record have addressed safety in a satisfactory fashion, and another 40% say that improvements continue to be made.

Four-fifths (82%) of respondents either have a program under way or have a program in place that emphasizes accountability. More than half (53%) reward quality performance. An additional 33% are investigating how to reward quality performance.

Moore describes CHI's review of physician alignment and how that relates to safety initiatives. "In some areas, we have already realigned our structures such that our physicians are coleading service lines with our administrative personnel. We are examining all of our medical director contracts to make sure incentives are aligned with the performance outcomes we are looking for. For employed providers, we are realigning incentives by increasing the percentage of compensation based quality clinical outcomes."

Since healthcare reform challenges us to do more with less, we have to command our processes, procedures, and infrastructure. Some have considerable experience optimizing. Those who are new to the discipline may chafe a bit. Decisions will have to be made and actions will have to be taken with a great deal of precision. Those who are comfortable with data will have an advantage.

And as we shift from a volume-based to a value-based foundation, collaboration will matter more, and sharing data and sharing responsibility for positive outcomes will become more important. As Moore says: "We may have figured out how to care for folks once they get inside our walls, but we are going to be challenged to improve the quality of their care outside of our walls."

This article appears in the July 2012 issue of HealthLeaders magazine.

Reprint HLR0712-3