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The Politics of Health Care

Putting Information at the Center of Smarter Health Care

Published February 19, 2009 1:49 PM by Frank Irving

Guest commentary by Wayne Janzen, Executive Information Agenda Consultant for Global Government and Health Care, IBM

 

Health care organizations have made significant investments in IT over the years to improve both patient care and business processes. For genomic research, predictive medicine, and even basic preventative care, more information is available now than ever before. However, the need for more intelligent health care remains at a tipping point. The push toward higher standards in health care will only continue given The American Recovery and Reinvestment Act, which includes a $19 billion allocation toward health information technology, was passed by Congress and signed into law by President Obama this week. In an age when we cannot afford not to have health care reform, intelligent information lays the foundation for a new approach to transforming the delivery of health care and contributes to a new infrastructure for the health economy.

 

Despite large investments in areas such as electronic medical records, diagnostic imaging, practice management and scheduling systems, many health care organizations remain data-rich and information-poor due to the volume and complexity of data they have to deal with. Medical mistakes kill nearly 100,000 people every year, according to the Institute of Medicine. "That is equivalent to a 747 crashing every other day," according to Denis Cortese, MD, president and CEO of the Mayo Clinic. These errors, more than half of them preventable, cost the United States as much as $29 billion each year.

While most health information systems are designed to provide data quickly -- one patient at a time -- most are not designed for the cross-patient analysis required to answer complex questions. Meanwhile, critical opportunities for collaboration and interoperable information-sharing are often missed. In health care, on-demand access to pertinent and complete information about patients is mission critical.

Are you getting the most out of your data ?

One of the greatest challenges to our health care system today is that valuable data remains in disparate systems built for speed and performance, not aggregation and analysis. Reporting, analyzing and trending quality and cost data can provide valuable information to improve medical outcomes, but the reality is this is labor-intensive. Frequently, too much time is spent gathering and accessing data instead of analyzing information. Many providers spend millions of dollars acquiring and implementing advanced information systems that collect incredible amounts of data. According to the 2008 Healthcare Information and Management Systems Society (HIMSS) Leadership Survey, 44 percent of organizations have a fully operational electronic medical records system in place at one or more of their facilities. More complex functionality, such as computerized physician order entry, physician notes or clinical documentation, is slowly being implemented and adopted. However, health care organizations often find themselves stymied when asked to prove how these new systems have affected outcomes and improved overall care and efficiency.

Implementing new systems and collecting more data is just one piece of the puzzle in the effort to achieve the new administration's goals for dramatically improving health care delivery for every American. Vast amounts of data and content must be tapped so health care organizations can better focus on their primary mission -- delivering top-quality patient care in spite of intense pressure to cover rapidly rising costs, and maintain profitability through improvements in operational efficiency.

In light of significant reforms in health care policy and new investments in health information technology, the challenge becomes to create a comprehensive, holistic view of data spread among multiple applications from myriad vendors. Data from those applications must be synchronized through careful planning and organization around a well-defined architecture supported by a robust information infrastructure. To accomplish this, health care organizations need to achieve information agility, where they are able to leverage trusted information as a strategic asset. Those with a strategy for effectively using information have an opportunity to outperform their competitors and innovate quickly while maintaining high levels of patient care. Some of the most successful health care organizations are developing an Information Agenda to do just that.

An Information Agenda is an approach for transforming information into a trusted source that can be leveraged across applications, processes and decisions. It allows organizations to achieve information agility by accelerating the pace at which information can be managed independent of applications or business processes.

An effective Information Agenda can help health care organizations:

● improve quality of care;

● create a safer patient environment;

● increase revenue and gain entry into new markets;

● reduce costs and enhance operational efficiency;

● introduce new services quickly;

● improve clinician productivity and efficiency;

● meet regulatory requirements and reduce risk exposure;

● increase compliance visibility; and

● protect patient and financial data and mitigate fraud risks.

Four key components of an Information Agenda are imperative for addressing the information needs of health care business processes.

Information strategy - In creating an information strategy, you must take into account the primary information-centric clinical and business imperatives that drive virtually every decision. These include areas such as cost reduction and improved efficiency; profitable growth; quality; safety; governance and risk. A vision for managing each of these areas can help guide decisions and determine how best to support business goals.

Information infrastructure - A unified information infrastructure enables the effective creation, capture, management and use of information associated with patients, services, products and market. By deploying an information infrastructure that meets both immediate and future needs, health care organizations can begin the journey of using information in new ways to enable smarter health care.

Information governance - Information governance establishes standards for data quality, management processes and accountability. These standards help improve business performance through the creation of standard definitions and processes that establish a more disciplined approach to managing data and information across the enterprise.

Roadmap - An Information Agenda roadmap provides the direction to help unlock the value of information for not only improved care, but the delivery of trusted, accurate information to optimize clinical and financial performance. The first step in creating a step-by-step plan is to identify and prioritize IT projects that have the greatest impact in helping health care organizations achieve their strategic imperatives

Consistently delivering trusted information, securely, to the right people at the right time, provides the ability to use information in entirely new ways to improve care delivery and operational performance. New technology allows data capture from a host of medical devices, images and laboratory diagnostics almost anywhere. In recent years, the cost of storing and managing that data has come down dramatically, and the ability to apply sophisticated analytical tools has improved clinical outcomes along with the ability to ensure patient privacy. As high-bandwidth communications and high-performance computing continues to evolve, trusted and secure information for smarter health care will become more critical.

The volume, variety and velocity of data in health care is a very good example of where our world needs "new intelligence." With information at the center, it will be easier to manage and process medical records to lower the cost and increase the quality of health care, put more research and genetic data to work, and shift from a system that treats disease to one that better prevents and manages it.  

3 comments

I have worked in the VA Medical Center in Tomah Wisconsin now for 25 years.  I work presently as an MDS Coordinator.  The documentation system that we presently have is worthless.  Yes we have VISTA and CPRS GUI but the charting process is nothing but messy and redundant.  There is a template for everything except facts.  Nurses are writing endless notes that are repetitive in nature over and over again.  We are writing notes for the sake of writing notes.  The notes no longer have meaning and are frequently cut and pasted over and over again.  Long term nursing used to only require monthly charting but now administration requires weekly charting.  There is no reason why the federal government in order to be reimbursed properly for care delivered to our veterans is to purchase software meant to meet the needs of our long term care population.  Administration complains when the end of fiscal year arrives, why again is the budget is short? The focus needs to prioritize the proof of documentation that indeed such care was delivered. Nurses and nursing assistants need to have the tools/software in order to provide a clear and concise record to indicate the care delivered.  It would seem to me that administration would put their money where their mouth is since "we the people" are paying for such care.  CMS and other Long Term Care surveyors expect the proper documentation of care delivered.  The RAI/MDS is a reflection of that care.  Improper coding without the appropriate documentation is considered fraud.  There are many vendors with excellent documentation programs that work with the requirements of the MDS.  There are also many VA Medical Centers who have made that choice to have user friendly documentation tools for nursing staff.  However there are not enough VA Medical Centers making this a priority. An updated article written by the American Health Information Management Association (AHIMA) (updated 6/2009) clearly outlines the requirements and the need for documentation that provides a functional picture of the resident.  The AHIMA states that "medical records in long term care should be complete, accurately documented, readily assessable and systematically organized” The AHIMA notes that a problem that exists in many documentation systems is the collection of duplicate or redundant information in the medical record.  This whole process needs to change especially with the anticipated release of the new MDS 3.0 2009/10.

Jeanette, RAI/MDS Coordinator - Registered Nurse, VAMC October 27, 2009 11:13 PM
Tomah WI

Lee's comments are exactly correct.

Ed February 23, 2009 12:40 PM

One other thing that needs to be in the mix is the fact that all IT systems are ultimately there to support people making decisions, and decision making, like it or not, is not a purely analytical process. Culture and behaviors often get in the way of optimal solutions. How you deploy new systems is every bit as important as what you deploy.

Lee White February 19, 2009 2:41 PM

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