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Turning Data into Improved Care

July 23, 2008
by Mark Hagland
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A number of healthcare facilities are working to transform terabytes of raw data into a guide for better clinical care

Few hospital organizations have taken the idea of transforming patient care quality as far as Boston's Brigham and Women's Hospital. In 2000, leaders at the 747-bed academic medical center, which is one component in the vast Partners HealthCare system, created a special Center for Clinical Excellence (CCE), with a full-time staff of clinicians, and a mandate to improve patient safety across the Brigham organization.

Among many elements of the work being spearheaded by the CCE — led by Michael Gustafson, M.D., vice president for clinical excellence and executive director of quality and safety, and Tejal Gandhi, M.D., executive director of quality and safety — has been the initiation of so-called Patient Safety Leadership “WalkRounds.” These involve multidisciplinary executive and clinician leader rounds in various clinical departments; the creation of an integrated patient safety team; and the ongoing development of a consistent, data-intensive process for patient safety event analysis by CCE leaders and analysts.

As part of this ongoing umbrella initiative, every patient safety incident is not only reported, but analyzed; and clinician leaders and executives hear weekly from frontline clinical staff about their patient safety concerns during the WalkRounds process. With constant quality improvement as their charge, CCE clinician leaders are seeing continuous improvement in care quality and patient safety, Gustafson reports. As a result, the hospital has won a slew of national healthcare quality awards, and become a model for other patient care organizations.

Mark kestner, m.d.
At the core of the operational challenge for innovators like Gustafson is the nexus where data meets people, he stresses. “You can't really start having effective relationships with physicians, nurses, and others, if you don't have good integrity of data,” says Gustafson, who practiced as a general surgeon for many years. “You've got to have very clean sources and definitions of data and good integrity of data in order to get basic buy-in from physicians. That integrity is a part of our reputation.” And, he adds, IS departments on their own often produce data and reports that aren't genuinely helpful to clinician leaders like himself. But he credits close collaboration with vice president and CIO Sue Schade and her team as bringing about the IT support he and his team have needed.
Jan mathews, r.n.

Jan Mathews, R.N.

William yarbrough and steve rypkema

William Yarbrough and Steve Rypkema
For her part, Schade says, “It's a challenge, operationally, not yet having clinical documentation (rollout of which is scheduled for the beginning of 2010), because we're still dealing with paper charts in the inpatient sphere, and we're not able to derive the level of detail we'd like” in terms of data. But, she quickly adds, “There is reporting capability through our outpatient EMR, which we call our longitudinal medical record, that allows our quality folks and clinicians to get a fair amount of data directly without going through our balanced scorecard mechanism.” For example, she says, “You can contact all patients who are on a particular medication because of a safety concern raised by the drug manufacturer.”

In 2010, when clinical documentation is rolled out, the hospital will have a constellation of systems to support the organization's ongoing clinical improvement work, Gustafson and Schade agree.

The challenges are many, but so are the opportunities, Schade emphasizes. “I think everybody can and should do this, and they can do it with different degrees of investment.” Very importantly, she says, CIOs need to think about the strategic implications of their clinical IS rollouts, even if their organization is not actively planning for intensive analytics work.

Indeed, Schade speaks from experience. “If you're focusing only on getting some core clinical systems rolled out, but not also planning for what the back-end reporting and analytics need to look like, you're selling yourself short,” she says. “We rolled out the eMAR (Electronic Medication Administration Record) for most of our inpatients, but we didn't account for the back-end reporting tool for that, so now we're trying to juggle the resources for that back-end reporting system.”

For organizations like Brigham and Women's, which have a commitment to improving patient care quality and safety, she says, the right IT setup is critical.

Nationwide, a slew of initiatives

Nationwide, a number of hospitals and health systems are moving to harness information systems in order to provide analytic data that can help clinicians improve patient care quality and safety. Among them: