All healthcare systems are experimenting with new ways to gather, share and analyze their own data. Small, rural hospitals also need to study their patient data but often lack the resources to invest in systems and informatics personnel. But safety net hospitals are starting to pool their resources to do analytics. During a recent webinar put on by the Health Resources and Services Administration (HRSA), Sue Deitz, director of the Critical Access Hospital Network (CAHN) in Eastern Washington, described how the members of her organization are aggregating data and learning from each other as they work on cost containment and quality improvement initiatives.
CAHN, established with a HRSA grant in 2002, includes seven rural hospitals and a dozen rural health clinics, most within a two-hour drive of Spokane. Those providers are dealing with rural disparities around economics, education and age, she said. “When you take those together, they impact overall health status. There are higher rates of diabetes, congestive heart failure and obesity,” she explained. “You can see a disparity between those in a rural setting and those in their urban counterparts in Spokane or the state as a whole. We said, let’s target these needs and work in unison toward impacting care. And we do that around care transitions, patient-centered medical home recognition, telehealth services, and behavioral health integration.”
In 2011 CAHN received a HRSA Rural Health Information Technology Network Development grant to work on chronic disease management and performance reporting tools. In addition, CAHN built a secure virtual private network health information exchange in preparation for working with a functional statewide exchange. The population health tools provide analytics for diabetes, cardiovascular disease, congestive heart failure and prevention screening.
The goal, Deitz said, was to start studying data on chronic disease management to impact outcomes and learn from each other. “If one county is doing well on managing diabetes, what lesson can other counties learn about best practices?” she asked. Each region has access to a disease registry mapped to their EHR, so there is no duplicate data entry. “From the registry we have de-identified the data and put it into a central data repository, so all the members can look at it from a regional perspective as it relates to chronic disease management.”
CAHN needed a disease registry that could connect to a variety of EHRs with ease. “We found we needed to work with the vendor, Praedx, to create our own solution,” Deitz said. “We created a live, real-time disease registry that is quite intuitive to use.” Providers can now look at specific dashboards, with measures around chronic disease that support patient-centered medical homes. The next step, she added, is to address the “so-what” questions. “We often input a lot of data, but sometimes we have trouble closing that feedback loop on how to apply that information to daily practice, so we are working with Group Health in Seattle to learn what to do with all this data in the repository and start identifying its impact on admissions and readmission rates and provider satisfaction.”
Although they are in the early stages of using data to drive performance improvement, the rural hospitals of Eastern Washington now have the infrastructure in place to become a vital part of the learning health system.