Why Healthcare Reform Hinges on Data
In the United Kingdom and the United States, performance accountability has become a core element of healthcare reform. This includes an increasing focus on measuring and reporting quality, and tying payment to demonstrated performance. Because of this focus, healthcare providers now consider improving performance a strategic imperative.
Simultaneously, providers view a well-implemented digital health record as a critical foundation for better-functioning healthcare. Significant business and regulatory incentives, such as the U.S. Health Information Technology for Economic and Clinical Health (HITECH) program and the UK's National Health Service (NHS) 2018 paperless goal, also are driving that agenda forward.
By coordinating these two initiatives, providers have an opportunity to frame their health IT (HIT) strategies, make quality management and improvement a major objective, and quickly leverage their IT investments.
Today, healthcare providers' performance is measured in a variety of ways, including by regulators, peers and patients. However, as healthcare reform increasingly ties measured performance to accountability and payment, ever-increasing clinical measurements have added to the burden of assembling the information needed for reporting.
Many of these measures rely heavily on information that can only be found in inpatient medical records, most of which is hand-recorded on paper forms. This unwieldy process severely hampers patient management and quality measurement and improvement because it relies on often illegible or incomplete information and delivers the assembled information too late to be put to direct use.
New measures increase expectations
New quality measures expand external hospital performance expectations, further driving their scope and financial implications. Providers that build a capacity to manage against these rising expectations in real time will be well positioned for the future.
Data capture and analysis are at the core of making measurement a real-time reality, but are most powerful when working in parallel with digital health records used by clinicians at the point of care for both seeking and documenting patient medical record information. As more patient-specific documentation is accumulated during a hospital stay, measurement can take a more proactive role than traditional retrospective, often post-discharge, reporting.
Taking a granular look at the data elements for hospital quality measures — by deconstructing measures into data requirements — is a useful first step in planning how to apply the power of the digital health record to quality measurement and management. Achieving the right balance of structured and unstructured information lies at the core of overcoming these challenges, and much work remains to be done.
Keys to the successful journey
The journey to quality measurement and management enabled by the digital health record will be a long one for most hospitals. The following principles can help achieve that goal:
- Make quality management a key driver of the digital health record strategy
- Map a plan for data capture — both measures and interventions — and use
- Have the right person document the information
Suitably recorded patient information is the foundation for HIT-enabled care and quality management. The endgame is better performance rather than measurement. While aiming for an ultimate goal of one electronic source of truth for each patient captured as a by-product of routine care, each increment of the digital health record provides new opportunities.
Hospitals best prepared for the future will have mastered capturing necessary patient information, while also making it easy for physicians, nurses and others to provide quality care. This requires transformed clinical processes and a lot of skill in leveraging digital health records and analytics. Building organizational competency — culture, processes, people — to pull this together is as important as the tools that can make it possible.
Stephen Boyle, RN, is a principal with CSC's Healthcare Group. Jane Metzger is a former research principal with CSC's Global Institute for Emerging Healthcare Practices.