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Getting Granular

September 29, 2010
by Mark Hagland
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Quality Data Pioneers See A Long Road Ahead for Their Peers-and For Themselves

EXECUTIVE SUMMARY

CIOs and CMIOs whose organizations have been reporting and analyzing various quality outcomes and other clinical data for some time already say they anticipate that hospital organizations just beginning now to establish data reporting systems to comply with meaningful use requirements will face multiple challenges. Meanwhile, those organizations already in the “advanced” category in terms of reporting and analyzing clinical data are branching off into a very broad range of initiatives to improve patient safety and care quality.

David Liebovitz
David Liebovitz

As CIOs, CMIOs, and their colleagues at hospitals around the U.S. rush to begin to comply with the meaningful use requirements under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act, most are just beginning to collect, report, and analyze clinical outcomes data in a serious way. What can they learn from the IT leaders at pioneering organizations that have already blazed trails in this critical area? Some of those pioneers have already made inroads in areas specifically cited in the meaningful use requirements, while others have been focusing on different areas, across a tremendously wide spectrum of potential activity.

YOU CAN'T JUST BE SITTING IN THE BACK CREATING ANALYTICS WITHOUT UNDERSTANDING WHAT'S GOING ON AT THE FRONT END AND CONNECTING THE FRONT WITH THE BACK, IF YOU WILL.-PAUL CONOCENTI

What CIOs and CMIOs at those leader organizations can agree on is that those just starting down the path now face a welter of challenges, none of which will be resolved very quickly.

“The first lesson learned in this area is that this stuff doesn't go in quickly,” says Paul Conocenti, senior vice president, vice dean, and CIO at the NYU Langone Medical Center in New York City. For one thing, he says, “You can't just be sitting in the back creating analytics without understanding what's going on at the front end and connecting the front with the back, if you will. And you come to the point where you have the data, but it's not at the granular level to do the analysis that you need to do. And even more so, you need to understand the data.” Instead, the kind of work that the meaningful use requirements are meant to compel hospitals forward on is going to take numerous waves of implementation and refinement to succeed, he contends.

Conocenti says his organization's experience with collecting and using quality outcomes data offers a particular sense of perspective to the struggles most hospital organizations will be going through as they try to move forward to meet the meaningful use requirements around outcomes data reporting under the federal ARRA-HITECH Act. Having had some form of computerized physician order entry (CPOE) for nearly 30 years, and clinical decision support (CDS) for several years, Conocenti believes that NYU's experience underscores the very long strategic and cultural changes that will have to take place in hospital organizations across the country in order for the management of clinical data to become both routine and truly useful.

THE WORK INVOLVES FINDING WAYS TO FOCUS AND CATEGORIZE, IN A SENSE, THE LEARNINGS FROM THE EXPERIENCE OF [USING] THE COMPUTER SYSTEMS, AND THEN APPLYING THAT LEARNING TO THE FUTURE.-MARTHA RADFORD, M.D.

And, says his colleague Martha Radford, M.D., chief quality officer at NYU and a professor of medicine in the division of cardiology at NYU's medical school, “The work involves finding ways to focus and categorize, in a sense, the learnings from the experience of [using] the computer systems, and then applying that learning to the future.” As a result, numerous compromises have to be made on all sides among different groups of clinicians, as well as IT leaders and others in an organization, she notes.

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