Healthcare Data’s Baby Steps: Meaningful Use, Pay for Performance, Quality Improvement (Part 1)

By Carol Newcomb, Senior Consultant

When I think about all the time and energy that has been spent and dollars invested in collecting and analyzing healthcare data over the past 30 years, it makes me crazy!!  From fee-for-service to HMOs to PPOs to HDHPs, billions of patient records exist that could inform policy on quality, safety, outcomes, effectiveness and efficiency, but as with our little Christmas-day Bomber incident, “We had the data, we just couldn’t put it all together.”  In the time that it has taken banks, retailers, even government to retool their operations to provide real-time, web-enabled, customer-focused applications, healthcare has gone nowhere.  The government is literally bribing healthcare organizations to convert from paper-based systems (or from stand-alone off the shelf-applications) to integrated electronic systems.  “Meaningful Use” is being touted as the newest data reporting incentive to show that your EHR system is up and at least partially running.  The first phase of evidence will include attestations that providers are using certain features of the system.  Not data, attestations!! 

And this isn’t the first attempt to get healthcare organizations to willingly embrace their data.  For the past two decades, outfits like the Joint Commission, AHRQ, NCQA, NQF and many others, have developed reporting metrics, hoping to drive down not just the cost of care, but the inefficient, wasteful and sometimes harmful practices that exist in our provider organizations.  Tying these measures to accreditation, CMS reimbursements, Pay for Performance and other carrot-or-stick mechanisms hasn’t been enough for hospital CIOs to seriously undertake more than just one-off fixes to their data infrastructure.  What they need is a back-to-basics roadmap for enterprise data management to integrate and govern data as it is gathered and aggregated over time.  Data governance is virtually non-existent in healthcare as a formal program.  Without governance, an organization cannot stand on its own data.

Healthcare is swimming in data.  Some would argue that what healthcare needs is better business intelligence.  Sure enough, it’s pretty hard to analyze a lot of loosely-coupled data that resides under any one healthcare organization’s roof, much less tie it to any one patient or doctor.  What good are analytics if the data haven’t been through rigorous quality controls?  What if the data aren’t stable or even accurate?   How many people contribute diagnosis and procedure and billing codes and modifiers to any single patient record?  How many people change it before a claim is submitted to a payer?  How many different sets of rules are there and who enforces them?  A few months ago, I went for an elective outpatient surgical procedure, but due to complications they were unable to operate.  Two days later, Blue Cross notified me of a claim for the full procedure.  When I called to contest it, they told me they couldn’t second-guess the doctor’s office.  Huh??  They paid for the un-performed procedure in full.  Wither our scarce healthcare dollars? 

(To be continued……)

photo by marisag via Flickr (Creative Common License)

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Carol Newcomb is a Senior Consultant with Baseline Consulting. She specializes in developing BI and data governance programs to drive competitive advantage and fact-based decision making. Carol has consulted for a variety of health care organizations, including Rush Health Associates, Kaiser Permanente, OSF Healthcare, the Blue Cross Blue Shield Association and more. While working at the Joint Commission and Northwestern Memorial Hospital, she designed and conducted scientific research projects and contributed to statistical analyses.

Comments

[John Burich]

Good article. You are spot on, the marginal investments the government and industry are making in deployment of EMR's and connectivity will produce marginal gains in meaningful use. The real value will come from aggregating all the data, enriching the data, adding data and running analytics to produce meaningful information to all stakeholders. Few if any involved with HIE or HITECH are thinking this broadly. Hopefully the BI industry can come forward with examples to demonstrate the critical need for BI in Healthcare.

[Carol Newcomb]

John- How do we get all these hardworking healthcare people to think more broadly??