The fact that many clinical performance measures are now being designed with EHRs as their data source may lead to systemic improvements in patient safety. Healthcare Informatics looks at four healthcare providers whose IT infrastructures already underpin their performance improvement strategies.
Most healthcare organizations focusing on performance improvement have traditionally faced some trouble getting buy-in from clinicians. In many cases this was because reports were based on 6-month-old data from chart abstractions, which were partial, random, and sometimes inaccurate.
As more healthcare data becomes electronic, clinical informatics teams have begun extracting data from transactional electronic health records (EHRs) into data warehouses, where it can be normalized and reported on much more rapidly. “In a lot of settings, quality improvement has been embedded for 20 years, but by pulling information from EHRs, you can get a much broader population view and more timely data,” says Carole B. Black, M.D., who oversees clinical development for Chicago-based Valence Health, a solutions and consulting firm that helps healthcare organizations measure quality care and outcomes.
EHRs tend not to do a good job of this reporting, says Elizabeth Simpkin, Valence Health's vice president of consulting services. “EHR vendors are working on improving in that area, so I would argue that the time you might need help with a data warehouse is now. Even if hospitals have ways to get data from their own systems, they now need to extract it from multiple sources.”
Where organizations are gaining the most benefit is using EHRs for population-level reporting, Simkin adds, by extracting data from a variety of EHRs in use and then synthesizing it to provide a comprehensive view of a patient across service providers. “The larger integrated delivery networks and multispecialty groups have spent more time thinking about the population level,” Black says, “but so far other providers have spent more thinking about the patient right in front of them. It is a different mindset.”
Healthcare Informatics recently spoke with leaders of four healthcare system initiatives about how their IT infrastructure and strategy underpin their performance improvement strategies and about some of the improvement gains they are already seeing.
EHRs DESIGNED FOR MEASUREMENT
Typically, quality measure reporting tools have been bolted on to existing EHR systems, most of which haven't had strong reporting tools baked in. But one organization, the Alliance of Chicago, had a vision early on that among key uses of its system by more than 25 safety net health centers were quality, safety, and research, says Erin Kaleba, director of research initiatives. “The Alliance selected a system before rollout that it could customize with structured fields to make it easy to pull data out of the back end,” she adds.
WE DECIDED TO LET THE CLINICIANS THEMSELVES ASK QUESTIONS ABOUT PATIENT SAFETY MORE TARGETED TO THEIR SPECIALTY, AND THEY ARE LEARNING TO ASK INNOVATIVE QUESTIONS.-JEFFREY FERRANTI, M.D.
The Alliance's centrally hosted GE Centricity system was chosen because of its flexibility to allow for the creation of evidence-based dashboards, adds Tim Long, M.D., chief clinical officer. “We are getting accurate, population-level data in front of providers for the first time, and the power of that is amazing,” Long says. “We are able to show them 100 percent of their population. They can see it is tied into national measures and American Diabetes Association guidelines. That is powerful. A lot of people think they are adhering to guidelines when they are not.”
The Alliance provides its member health centers monthly dashboard reports of performance on diabetes, coronary artery disease, preventive care and screening, HIV/AIDS, and hypertension.
Kaleba says the Alliance is making some modifications to meet the 44 meaningful use clinical measures, but by and large those are things it is already doing. “Where we will have to do more is in patient engagement with a portal and having visit summaries ready for patients,” she adds.
Another next step is getting clinicians more comfortable with using clinical decision support tools at the point of care and sharing data with patients, Long says. “Physicians are missing the boat if they see this whole new tool only as a way to do what they used to do on paper but do it electronically.”
BOTTOM-UP REPORTING AT DUKE
Enterprise data warehouse efforts at the three-hospital Duke University Health System in North Carolina have evolved to take a bottom-up approach to performance improvement. Duke clinical informatics leaders have layered business intelligence tools on top of the data warehouse and then opened them up to its own clinicians on the Intranet.