The Landscape: CIOs are realizing that everything they and their fellow executive and clinician leaders want to accomplish in hospital-based organizations - improving patient safety and care quality; enhancing efficiency and clinician workflow; delivering evidence-based patient care; creating outcomes transparency for purchasers, payers, and consumers; and participating in value-based purchasing initiatives, not to mention snagging federal funding under the ARRA-HITECH legislation passed last year - will require robust data infrastructures. And as pioneers are learning, creating those infrastructures is challenging and complex, but immensely critical.
The Future: Experts say the need for robust data infrastructures to support performance improvement and transparency will only intensify. The time is now to put the needed technologies into place.
No one needs to explain to Marianne James, senior vice president and CIO at Cincinnati Children's Hospital Medical Center, or Uma Kotagal, M.D., senior vice president for quality and transformation, the importance of a robust data infrastructure to the pursuit of performance improvement. Cincinnati Children's, a leader in the development of evidence-based guidelines for inpatient pediatric care, has been zooming ahead with patient safety and quality improvement progress for the past few years.
Some of the many positives, says Kotagal, have included increased compliance with guidelines for the administration of antibiotics to avert surgical-site infection, from 56 percent a few years ago to 98 percent; and a greater than 70 percent reduction in opiate over-sedation of patients. “We've been using a rapid-cycle process involving daily and weekly failure reports to clinicians to examine care delivery practices and improve them,” she reports. “Physicians very much respond to data, but the data has to be timely, actionable, and reliable.”
The secret to such rapid advances? A robust, enterprise-wide data infrastructure that can produce such reports day in and day out. And that has been job number one for James and her colleagues in IT. “In the past,” she says, “the success we had had with evidence-based care and quality improvement had required us to go through some heroic efforts in IT to make sure things have happened, as we've had to pull together all the disparate data. Now that the data sits together in one place, with common data definitions, it should further empower our clinical informaticists to work even more fully with our clinicians.”
Like their colleagues nationwide, James and Kotagal recognize that the ability to pursue the new, evidence-driven healthcare depends strongly on the strength of the organization's core data backbone. And that means having EMR, CPOE, eMAR, and advanced pharmacy applications implemented, along with an advanced data warehouse, and sophisticated reporting capabilities. Chief Technology Officer Tony Johnston and the rest of the Cincinnati Children's team are working to upgrade and implement the systems needed to support such clinical transformation.
A confluence of factors
What the IT team at Cincinnati Children's is doing mirrors efforts nationwide to upgrade the core computing infrastructures as organizations push ahead into the emerging operating environment. Industry experts see tremendous challenges and opportunities alike in the current landscape.
“For years, we've been talking about the need for robust data warehouses as a fundamental element in hospital IT plans, but there always seemed to have been more urgent things to take care of,” says Jane Metzger, principal researcher in the Waltham, Mass.-based Emerging Practices group at CSC (Falls Church, Va.). “But several things have happened,” she says, “and the performance management challenges for hospitals and their business and operating environment have radically changed.” In addition to the push from organizations like the Joint Commission that have been demanding documentation of quality improvement, Metzger says pay-for-performance programs, the potential for broader value-based purchasing, and the push for greater safety have all awakened CIOs to the need for stronger data structures. On top of all that, the drive to fulfill the meaningful-use requirements under ARRA-HITECH in order to obtain federal stimulus funds has really jump-started the discussion around data infrastructure.
Indeed, a strong awareness of the need for robust infrastructure has been top of mind among the CIOs of those hospital organizations that are pioneering the most dramatic innovations in patient safety, care quality, evidence-based care, and clinical transformation. At 20-hospital University of Pittsburgh Medical Center, Senior Vice President and CIO Daniel Drawbaugh says, “As you move in the direction of an integrated electronic health record, what occurs on the reporting side is that the requirement and demand for reporting for clinical analytics and financial analytics just skyrocket.” As a result, he notes that 91 data marts - subcomponents of the health system's broader data warehouse - have burst forth, up from 55 just a few years ago. And, as UPMC's clinicians pursue more and more patient safety and care quality improvements, the demand for data and reports will only continue to intensify, he says. Presently, there are already 25,000 clinical reports of all types available for the appropriate clinicians and managers to use.