It would be nice to have an easy, straightforward solution that meshes with existing technology. Technology vendors know this, which is why they’ve convinced providers to connect systems, use analytics, and expand the use of their EMRs. Unfortunately, simple solutions only exist in your dreams.
This may seem odd to hear from a Registry CEO, but health care technology (HIT) is often oversold.
Differences in Technology Defined by Areas of Excellence
Like every other technology, however, from accounting to telecommunications, the One-Stop Solution is a myth. Here’s why:
• Not all technologies are created equal. Like anything else, each technology offers specific functionalities. Most health care technologies arose from specialized knowledge, and these technologies keep abreast of developments within their areas of specialization. In Performance Measurement, for example, you need to know whether the technology you are using is simply capturing “quality codes” or real clinical values.
You want to diversify your mix of technologies both because it’s smart and to avoid shortchanging your initiatives. Here are some unique differences among various health care technologies:
o Electronic Medical Records (EMRs): Gather clinical information, send reminders for prevention and necessary tests, and track patients awaiting results. However, there are weaknesses when more than one EMR is involved in a network or system comparing results across providers, and when the EMR is asked to do true performance measurement and manage complex performance improvement.
o Health Information Exchange (HIE): Create a faster path to connectivity between EMRs. Its weakness—this is not always straightforward, feasible, or cost-effective. Further, the data are not audited for use in analytics or performance measurement, so the HIE’s best use is always checking for tests prior to procedures and at point of care, allowing for validation at that point as well.
o Analytics solutions: Answer many questions about volume, tendencies, and some results. But, unless the performance measurement methodology is sound, you can’t count on Analytics-focused solutions to ensure you meet payer performance benchmarks. In addition, the data are not always actionable in performance improvement.
o Clinical Data Registries: Collect, audit, and measure performance. CDRs are the engine for performance measurement and, depending on the Registry products, for research and specific performance improvement projects. They also audit and validate data coming from EMRs. However, do not expect physicians to use them at point-of-care, because the data is retrospective and providers do not have the capacity to be able to go back and forth between EMRs and Registries to focus on protocols.
• Repeated adjustments must be made to Performance Measurement and Improvement technologies to account for shifting measures and requirements. Performance measurement from any vendor is not the same because core purposes are different. The EMR manages patients’ clinical conditions while Registries are designed for Performance Measurement. Using an EMR for performance measurement makes no sense and ignores the Registry’s scientific focus on validation and measurement, while using a Registry at point-of-care makes no sense as it will never have the same patient management functionality of a good EMR.
• Data are not flawless. Many providers want to buy the idea that data “hooks up” patients and technologies, and that data give you answers. To really make data actionable, however, you need to audit, test, and add experiments (often leading to more data) to reveal the real story.
Technology is Not the Singular Solution
Crossing your fingers and hoping technology will solve all your problems is wishful thinking. Technology, in and of itself, is not the solution. It is just an important tool for a long process of change that often raises more questions than answers.
What providers often forget is changing performance requires changing people—both providers and patients—and the culture of medicine itself. This is a marathon effort, not a sprint. Like any major change, it benefits by a careful approach: assess the problem you are trying to solve; select the right technology and processes to target that problem; implement, evaluate, and repeat. Going for the big “do-it-all” technology presumes technology can do all three parts of that process, which is expensive and unrealistic.
So, How Do You Make the Right Technology Investment?
Technology should be cast in a supportive role, customized to the health care system and its network, and tailored to the solutions needed to improve performance and successfully bear risk. Here are the basic steps, and who performs which:
• Be Selective with the Data You Collect
o Data gathering should be dictated entirely by how the organization will implement its performance program. Data is not necessarily required from all providers across the network. Validating and normalizing the data are required before use for performance measurement and improvement. (Registry, Data Collection vendor, or HIE)
• Examine the problem. Here are a few tasks organizations should undertake, and the technology solutions that apply:
o Work with a consultant to evaluate CMS Quality Resource and Utilization Reports (QRURs) across the organization.
o Contract a Registry to measure performance.
o Utilize Statistical Analysis via consultants or Registries to analyze key areas of leakage that are big payer targets: Inappropriate hospital admissions, readmissions, emergency room use, and outpatient costs. Then export the data to EMR and Registry.
o Engage an analytics vendor to analyze aggregate performance, based on data provided by the Registry, across the system and compare regional or local differences.
• Establish protocols to address the issues, which will involve process and care design, facilitated by technology.
o Ensure providers receive analytics and feedback loops, (Registry, EMR or Communications vendor using Registry data)
o Execute experiments to determine what is effective or not (Clinical Data Registry or Registry research collaborative).
o Establish discrete performance improvement projects by selecting clinical areas for clinical outcomes improvement. Technology must be able to manage the inclusion or exclusion of patient populations and track all provider actions. (Registry or Population Health/Research software)
Improving health care performance is a complex process that requires special functionality to successfully execute distinct steps. An all-encompassing technology that is easy, straightforward, and meshes with existing technology is a seductive dream. Time is too short and resources are too dear to fall for a sales pitch that promises what it can’t deliver. Your investment in a careful assessment of your technology needs and options will pay dividends in the long run—and help you get a better night’s sleep.
Theresa Hush is co-founder and CEO of ICLOPS, LLC., a Qualified Clinical Data Registry founded in 2002 that pairs tailored technology with a supported discovery process to improve patient health.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker’s Hospital Review/Becker’s Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.
