In partnership with CHIME, healthsystemCIO.com has developed a blogger series featuring insights from hospital and health system CIOs and other key IT leaders representing organizations from around the country. The blogs focus on the major issues affecting CIOs, including the health IT workforce shortage, mobile device management, and federal regulations.
The Criticality of Clinical Measures For a Collaborative Care Community (Say That Five Times Fast)
Why the big push to get all this data?
As I look forward to the impact of healthcare reform, whether it is a partisan or bipartisan initiative, I can only predict one thing: we will need access to accurate and comprehensive clinical, operational, and financial data in order to meet whatever new requirements may come. Most communities are still struggling with process measures and have not even begun to tackle the elusive outcome measures. Those fortunate enough to be on a single system have a definite head start, but communities that have separate facilities, providers, and ancillary care systems are facing many challenges.
A little about our community and our journey
Our community (Fort Drum Regional Health Planning Organization) consists of seven hospitals, nearly 100 practices, and 280 providers. Through a grant, we recently connected many of the practices and six of the seven hospitals to the health information exchange (HIE). So now that all the entities are connected, we should have access to data to guide our initiatives, correct? Unfortunately, no. The HIE had a data warehouse, but had not developed the algorithms, reports, or measures to create useful information from all of this data. However, this was not even the core problem, since many of the EHRs were not sending the data elements needed in their interfaces. It was apparent to us that we were hitting a dead end. On to plan B.
A regional disease registry. This market specializes in getting all the data out of the hospital and ambulatory systems, some with real-time interfaces, and some with “flat files” (reports that generate a delimited data set) for manual upload. They also are good at presenting useful, actionable information to all decision levels, from the provider all the way up to the CEO or public health. The unfortunate part is we have to create a parallel process of interfacing all practices and hospitals to the registry, which was something we thought the HIEs were going to reduce or prevent; the proliferation of all these expensive interfaces. Again relying on grant funding, we had no other choice but to implement the registry in order to be able to gather the required regional measures.
Why all three?
We started to learn some of the strengths and weaknesses the three players conveyed and why we needed to incorporate all three to create a complete solution:
One of the most difficult issues for the communities that are already struggling to provide care in today’s healthcare market is to convince them they should invest in a system that will actually reduce their revenue in the short-term (assuming a fee-for-service market) in order to prepare for the inevitable risk-based contracting, bundled payments, ACOs, etc. What are they supposed to do during the transition period when they are losing revenue?
Another major issue is alignment between the providers and the hospitals. The hospitals are the first to feel the change in reimbursement for readmissions in 2013 or 2014 for sole community hospitals. The providers have a huge impact on this, but have no financial incentive or looming penalty to invest time, money or participate in programs that may actually reduce their own revenue. Add on to this that EHRs, HIEs and disease registries all are very expensive to buy and to support, and you have a very challenging model to sustain past the initial grant support (assuming your community was one of the lucky ones to receive this initial financial support).
The vision and next steps
What we need to build is a system that can support all levels of the care continuum, from the patient to the community. Engaging all members of the care teams, from the patient to the health system, to share accurate information, support decisions and eventually improve outcomes and reduce costs. Getting our community to this end goal before we are mandated by regulations or financially required in order to survive is essential, as this is a long, expensive journey full of hard decisions and changes; not something we can accomplish overnight. So, we are taking a leap of faith that our community will be ready for the future, leveraging accurate and comprehensive financial, clinical and operational information to care for our patients, prioritize resources, sustain our healthcare system, and meet future requirements.