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Automated systems that provide whatever regulatory information is necessary when it is needed; sharing of data to improve quality; data mined for specific groups of patients: Those are just a few of the trends predicted by health care experts asked to comment on the future of benchmarking and data strategies. Certainly, such innovations are needed. For example, many hospitals continually run into problems when it comes to finding the right data sets for the targeted patient groups.
Sharon Lau, a consultant with Medical Manage-ment Planning (MMP) in Los Angeles and a member of Healthcare Benchmarks’ editorial advisory board, notes particularly the data needs of children’s hospitals. Children aren’t simply little adults, so looking at the same data from a children’s hospital vs. a general hospital might not be the best path forward. MMP is gearing up to work with the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Health Care Organizations and children’s hospital associations to create pediatric core measures.
"This is pretty historic," says Lau. "We’re looking to find funding to develop the best set of measures for pediatrics, rather than trying to shoehorn pediatric hospitals into the adult measure set," she says.
The senior vice president of the Joint Commission, Paul Schyve, MD, agrees that finding the right data sets for the right patient groups is a wave of the future. "If an organization is doing well in four core areas you are measuring, you might feel good going there," he says. "But when you are pregnant, do you really care how a facility does in cardiac surgery? Our assumption is patients and purchasers will become increasingly interested in how organizations do in specific areas. We can’t measure everything, but we will have to measure those things that are most common, most serious, and most costly in specific areas that are of interest to specific groups."
Carol Diephuis, vice president of the Ann Arbor, MI-based consulting firm The MEDSTAT Group, agrees that consumer interest in data is a trend for the future. "Baby boomers are used to getting information throughout their lives to make decisions," says Diephuis. "Health care should have that available, too." The public also is aware of medical errors, both from personal experience and the media. And cost pressures from employers are leading patients to use health care information to make better-reasoned decisions about their care.
The access that purchasers and patients have to data is driven largely by the technological revolution. Lau says that in light of new technology, facilities will move in the direction of using Internet-based data that are closer to real-time conditions than current data are. And because of the increased demand for data to be available to patients and purchasers, there will be more sharing of data, too, Lau adds.
"More of the benchmarks will be out there for people to share, rather than being proprietary," she says. "I think people are figuring out that just knowing the data isn’t going to make them any better. It’s what they do with it that matters."
Schyve predicts there will continue to be proprietary benchmarks, particularly regarding processes. "I don’t think if you are extremely efficient at the way you turn over your operating rooms you will necessarily tell a competitor how you do it. That is part of a competitive advantage," he says. But for outcomes measures and measures related to patient safety, there already is a willingness to share. "It’s almost an ethical obligation."
Diephuis sees two other trends for the future:
1. There will be growth in evidence-based medicine. "We are now able to convert evidence into clinical performance measures," she explains. "That lets us look at things beyond cost-and-use data." In the future, information on the gold standard of treatment may also include data on patient preferences, she adds. For example, it is one thing to tell a patient she needs kidney dialysis three times a week, four hours a day to increase her chance at a long life. "But if [she doesn’t] want to spend half [her] life on dialysis, [the patient] may choose to have a greater mortality risk," Diephuis says. "I think we will augment clinical benchmarks in the future with that kind of patient preference information."
Diephuis already is hearing from physicians who want that type of information. "A lot of the docs we work with tell us that this is the missing piece," she says. "They resent the fact that they are scored against a gold standard when they are not in control of what the patient chooses. They don’t want to be penalized for that."
2. Regulatory pressure will continue to increase, which means data collection will too. "That makes it more important to standardize the data, eliminate redundant data collection, and also allow more comparable data comparisons," Diephuis says. That’s already starting in some instances, such as the Joint Commission using information from the Health Care Financing Administration to drive its initial core measures sets.
Another trend Lau sees is more emphasis on a balanced scorecard approach that looks beyond cost issues. "You’ll see limited numbers of indicators, graphically displayed, that you can see at a glance to get a sense of where you are," she says. "A year ago, most hospitals weren’t using it. But it’s getting more common now."
The impact of the changes in benchmarking will be positive for all stakeholders, says Schyve. "Professionals, providers, purchasers, and patients all have a shared interest in high-quality safe care," he notes. "Even efficiency is important to me as a patient, at least when I’m not deathly ill. Most people won’t argue about using resources wisely." Because of those shared interests, there will be an increasing demand for meaningful measures to show how well an organization is providing that quality care. "This is going to help drive improvement," Schyve explains.
Diephuis says that passive patients are a thing of the past, and there will be more active engagement between physicians and patients as a result of the increased access patients have to health care data.
Meanwhile, health care organizations will assume more accountability and will actively work to measure and report on clinical excellence. "They will want to achieve it to differentiate against their competitors."
Because of the increase in data required by regulatory agencies, Diephuis thinks there will be a real drive to standardize information and use it for multiple purposes. But she also thinks there will be sampling. "There will be less of a push to count every patient," Diephuis explains. "There is a lot more effort involved to collect information like patient preference data."
Although there are benefits to having more data that are more widely available, there is also a concern, says Schyve. "What if the data are bad?" he asks. "Any one of the stakeholders can be hurt if that happens." Data need to be risk-adjusted; for instance, if you measure outcomes for cardiac surgery, you know diabetic patients will have poorer outcomes than others. Older patients also don’t fare as well, he says. "Those kinds of factors have to be taken into account. But for every additional piece of data you collect, there is an additional cost," Schyve points out.
There are always more data to collect, Schyve continues. The problem is that for most hospitals, that involves someone going through records by hand, trying to find a specific piece of information somewhere in the file. If all hospitals had electronic medical records, it might be easier. "But that takes investment. You have to do the equation: What is the risk if the data aren’t quite accurate, and what is the cost of making them accurate?"
[For more information, contact:
• Sharon Lau, Consultant, Medical Management Planning Inc., 2049 Balmer Drive, Los Angeles, CA 90039. Telephone: (323) 644-0056.
• Carol Diephuis, Vice President, The MEDSTAT Group, 777 E. Eisenhower Parkway, Ann Arbor, MI 48108. Telephone: (734) 913-3000.
• Paul Schyve, MD, Senior Vice President, Joint Commission on Accreditation of Health Care Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5950.]