Healthcare Quality Improvement's Big Enemies: Data Capture, Staffing

Health IT Boosts Patient Care, Safety

While many healthcare organizations have teams in place to modernize clinical practice across the enterprise, plenty still struggle to capture the right data and provide optimal staffing to produce ongoing quality improvement, a new survey suggests.

In the first-ever survey on "clinical transformation" from the Healthcare Information and Management Systems Society (HIMSS), 86% of 175 respondents--mostly representing hospitals--said their organizations had established, or were in the process of establishing, a team for clinical transformation. Just 12% cited organizational commitment as a barrier to reporting on quality measures.

HIMSS and survey sponsor McKesson defined clinical transformation as continuous assessment and improvement of care delivery at all levels of a healthcare system. "It occurs when an organization rejects existing practice patterns that deliver inefficient or less effective results and embraces a common goal of patient safety, clinical outcomes, and quality care through process redesign and IT implementation. By effectively blending people, processes, and technology, clinical transformation occurs across facilities, departments, and clinical fields of expertise," the survey report explained.

"Advanced clinical systems exponentially increase the amount of clinical information that is available to drive quality improvement," Deborah Bulger, executive director for product management at McKesson provider technologies, said in a joint HIMSS-McKesson statement. "But while data may be more widely available, this study suggests that many organizations still have a long way to go before it is accessible in a way that facilitates analysis and rapid, sustainable performance improvement."

Bulger said that the $27 billion federal incentive program for "meaningful use" of electronic health records (EHRs) may "bring about the tipping point we need to see real clinical transformation," since providers must report on various clinical quality measures in order to earn Medicare and Medicaid bonus payments.

Indeed, respondents named meaningful use and the related American Recovery and Reinvestment Act (ARRA) as the forces that were having the greatest impact on which quality measures their organizations choose to address, although internal strategic plans also were deemed important. The survey did find, however, that 42% of the organizations revised their policies about quality metrics in response to the "current legislative environment," which includes ARRA.

The survey, conducted online between March 10 and April 15, revealed that nearly half of healthcare organizations were most focused on installing a "fully operational" EHR, while one in eight were concentrating on linking clinical systems with quality measures and patient outcomes. More than nine in 10 indicated they analyzed clinical and financial data to help improve outcomes and hold down costs, while 79% use such data to improve care efficiency.

Still, there remain significant barriers to achieving clinical transformation, per the HIMSS/McKesson definition. Some 60% said that their organizations did not capture data in discrete fields, while 55% indicated that their clinical data were not well defined, 54% had inadequate reporting tools, and 52% said data were not in electronic format.

Nearly two-thirds of respondents said that their organizations used Microsoft Office products for quality reporting--more than any other tool available. About 54% had software specifically for business intelligence.

"In order to analyze data, it needs to be captured and available in a way that promotes analysis," the report stated. "Presently, only 35% of respondents indicated that the data at their organization are imported into a data repository/data warehouse. In addition, nearly half of respondents noted that they rely on interfaces to assist with integration."

Lack of automation also stands in the way of continuous quality improvement: an astonishing 79% of respondents said they still gather outcomes data by hand. "Manual processes for capturing, collating, and analyzing data may be a response to the lack of electronic means to conduct these functions, which is supported by the fact that nearly three-quarters of respondents noted that they needed additional IT resources in order to better report on quality measures," the survey said.

Often, staffing shortages or inefficiency are to blame. Close to two-thirds said staff at their organizations simply did not have enough time to participate in all necessary quality-improvement activities. "This becomes a particular concern when hospital executives don't have direct access to quality reports or specialized IT staff has to intervene to develop reports because the staff running the reports do not have the authority to directly create them," the report said.

About three-quarters of healthcare organizations surveyed had dashboards or scorecards so clinical leaders, executives, or board members could view clinical data, but only about half made such information available to all employees. Financial information was even more in the exclusive purview of executives.

Sometimes, organizations lacked the right types of employees.

"The role of clinical informaticists, including nurse informaticists, continues to be a much valued and necessary position in today's healthcare organization because these experts are essential to the success of quality initiatives, participating in the executive clinical team that analyzes clinical data," HIMSS VP of informatics, Joyce Sensmeier, a nurse, said. "The survey results indicate that these human resources are required to ensure that clinical transformation efforts benefit from appropriate access to clinical data that is derived from the electronic health record."

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