Creativity Required

During the 14 September, 2010 HIT Policy Committee meeting, members raised the issue of quality reporting for different purposes. Much of this focused on the difference between quality measures that are reported to health agencies for purposes of meaningful use or public health, vs. the kind of measures that might be used to analyze the individual organization. While the Committee recognizes that the two can be very different, its work will likely remain tailored, at least in the shorter term, to making recommendations that directly address “meaningful use” of EHR systems as specified in the legislation that created the Committee. » Continue reading “Creativity Required”

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Pay Yourself First

Financial advisors will often tell you to “pay yourself first.” That is, if all of your paycheck goes to pay the bills, you’ll never have any savings or build any long term equity. Set something aside for yourself right off the top; then pay everyone else. The same concept works with data. In the US, the new rules for ‘meaningful use’ of EHRs require physicians and hospitals to report quality data in order to qualify for incentives through Medicare and Medicaid. In a paper-based environment, pulling quality metrics for reporting purposes can be time consuming. In an electronic environment, there will be all kinds of data collected during the course of providing care, and some of it will be used for quality reporting. The bottom line is that in theory at least, technology will make it much easier to collect the kind of data that agencies currently require. If you look at the meaningful requirements as nothing more than a checklist, you may miss a great opportunity to learn something about your organization and the community you serve.

Remember that it is first and foremost, your data. Certain elements must be reported of course, but here is the chance to “pay yourself” by thoughtfully planning how to analyze the data you will be collecting by asking:

  • What are the missing pieces of information about your practice or hospital that would really help improve efficiency, safety, patient satisfaction, etc.? (This is not a question you ask the IT department.)
  • Does the information exist?
  • If it does, who has it? If not, can it be captured?
  • Can the EHR capture the data? Is reprogramming required? (Now you’re talking to the IT department.)
  • How can the data be accessed?
  • How will the data be validated and analyzed?
  • Who should do this?
  • What will be done with what is learned?
  • How have you prepared everyone in the organization to accept the analysis as 1) valid and 2) contributing to the overall success of the mission?
  • What else can be discovered?

Welcome the flood of data; use it to your advantage. While the requirements for meaningful use will be met through federal reporting requirements, your organization will see the immediate benefits of this “self reflection” because you had the foresight to pay yourself first.

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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String of Questions

I’ll admit I don’t have an answer to this question: We talk about “data ownership” related to data that has been collected and stored. Some argue it is the patient’s data, while others claim it belongs to the institution that collected it. But as we get more and more information flow among various organizations, and as data in aggregate becomes more available to researchers, will there be such a thing as ownership of “discovered knowledge?”

I suppose the answer to that depends upon whether or not the analysis of collected (anonymous) medical data remains an academic exercise. Cynically, I would say that it really depends on who paid for the research to be done. So the question here is, if a private enterprise analyzes data in such a way as to learn something completely new about how the body works, or what causes a disease, is the enterprise obligated to share its knowledge as a contribution to the greater good? Or can that knowledge be withheld while a unique drug or treatment is developed for profit? I’ve just been thinking about this one, as our ability to collect more and more data will have been provided as the result of a huge public investment in EHRs through HITECH and other health reform legislation.

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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Embedded Knowledge: Scanner Opportunity

It seems several patients who have received CT brain perfusion scans at some US hospitals have been exposed to an apparent overdose of radiation. The New York Times followed up on the story, which revealed a couple of interesting points. While the scanners have built-in features that allow lower doses of radiation, in some circumstances the scanners actually increase the dose. Oddly, the machines in question do not warn clinicians when the amount of radiation exceeds a safe threshold. Here, technology is used as a valued clinical tool, but it remains isolated from some important facts we know about its use. This lack of “self-awareness” on the part of the technology reinforces the role of people, culture and process in the data life cycle. For example:

  • With information technology, scanners (and other pieces of equipment) could record or make available to the electronic health record, the machine identity and the dose administered, so that the event can be linked to the patient for later analysis. This is as much a patient safety issue as it is one of quality reporting. It should be a simple matter to generate a list of all patients that have been treated using a particular piece of equipment. Part of the problem here is in the creation of medical device identifiers and standardized protocols for communicating among them. This work is underway, but still not completely implemented;
  • Scanners could be made to have an awareness of current guidelines for radiation dosages, and they should not operate at those levels unless deliberately overridden by the clinician. We already use information technology to check for drug interactions, and this is the same thing;
  • Guidelines should be standardized in structure and application, to ensure that there is no variance from vendor to vendor;
  • Physicians must actively participate in developing the data life cycle (from data to knowledge). If they are responsible for entering data, they have every right to expect that it is contributing to the development of better knowledge systems, which should continue to improve with each vendor update;

Technology performs as it is programmed to do. We cannot blame it for shortcomings that are the result of muddy processes. Figuring out how to do this properly involves cooperation among vendors, clinicians, the government, and many others. This is an example of knowing better (we know what constitutes a radiation overdose) but not yet having the processes in place to embed that knowledge into our clinical tools and the information systems that we will increasingly use to connect them. We must create processes that allow us to more fully trust the technology now, so that we can come to rely upon it, and build upon its role in the future.

The full NYT story is here.

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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