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January 24, 2011 Readers Write 3 Comments

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Connecting Performance Measurement and Clinical Decision Support to Improve Patient Care
By Gregory Steinberg, MD

1-24-2011 6-59-00 PM

In late 2009, the National Quality Forum (NQF) convened a panel of experts from across the health care industry to lay the foundation for promoting clinical decision support (CDS) to enhance performance measurement and help improve patient care. The Health Information Technology for Economic and Clinical Health (HITECH) Act had standardized the information needed for quality measurement.

However, it did not address the lack of standardization when it comes to the information and algorithms for measuring clinical performance, or the importance of linking clinical performance measurement with CDS to help improve it.

Over the past year, a panel of CDS experts, including Dr. Madhavi Vemireddy (our chief medical officer at ActiveHealth), worked to create a “taxonomy,” or classification of the information that connects quality measurement and CDS in clinical information systems. The result – the first step in defining the data sets needed to ultimately drive performance improvement. The panel’s new taxonomy is described in the report Driving Quality and Performance Measurement – A Foundation for Clinical Decision Support, announced this month by the NQF.

This new taxonomy has the potential to significantly improve health care. Today, many health care providers’ and organizations’ systems do not automatically capture the necessary information to drive CDS and performance measurement reporting. Having a common language for CDS and performance measurement is essential to improve quality with every patient.

All too frequently, at the individual practice level, performance measurement data has to be manually collected at the end of each performance year to create static reports that are not linked to CDS. The new CDS taxonomy will not only automate and standardize the data sets within electronic health records (EHRs), but also create the foundation to transform CDS into a dynamic workflow tool that is tightly linked with performance measurement improvement and supports performance measurement reporting as a byproduct of everyday practice. It is this connection that will improve performance and, ultimately, improve patient care and reduce health care costs.

The NQF’s report is only the first step in standardizing CDS datasets and in synergistically linking clinical performance measurement with CDS. Now, it will be up to health care vendors and organizations to begin using the taxonomy, building CDS and performance measurement alignment into their IT infrastructures. The hope is that this alignment will soon become standard practice in hospitals, physician practices, and other provider organizations across the country.

Gregory Steinberg, MD is CEO and president of ActiveHealth Management.


The “One” Thing HIT Vendors Need to Know
By Cynthia Porter

1-24-2011 6-44-18 PM

Reading the Web’s recent prognosis for Meditech strongly reinforced this simple truth: the customer is at the heart of the healthcare IT industry. This can sometimes get lost in the marketing, sales, and product development shuffle, with a company none the wiser until a valued client is no longer a returning client.

Recent blogger opinions beg several questions. What can an HIT company do to make sure it holds onto customers? Why is it so hard at times to better understand clients’ needs? It all comes down to the simple skill of listening. HIT vendors need to listen to what their clients are saying — and they’re saying a lot right now, to be sure.

Market research services fill this listening need. The HIT market is now more than ever in need of an unbiased third party to assist them in listening to their customers. Someone that will derive true opinions from a vendor’s clients — so valuable in continuing to meet clients’ needs when considering future product development.

The third-party solution provides an outlet for HIT customers to compliment or vent to. No selling, no marketing — just an ear that cares.

It is this skill of listening that will enable seasoned (some may say complacent) HIT companies like Meditech to survive. Meditech has been the “one” market leader for years – in the 200-bed market. What HIT vendors like Meditech need to realize is that the market is moving beyond the four walls of the hospital. HITECH, HIE, and ACOs are changing the game and expanding the walls.

Vendors need to listen to their customers and better understand the impetus behind their growing need for new HIT solutions. EHR integration, as mentioned in connection with Meditech’s issues, is just one part of this.

As Curly says in the movie City Slickers, there is just “one” thing and that is all there is to know. But the “one” has gotten bigger. One hospital is now one community. One state is now multiple states or regions. One patient is now the e-patient who demands access to his or her data any time, anywhere.

Meditech will need to adapt to this new way of thinking to remain the “one” vendor its customers have traditionally turned to. Luckily, it has one of the best and most active user groups on hand to help navigate this new course.

Cynthia Porter is president of Porter Research.

Steps to Take Against Medical Snooping
By Pete Niner

Medical snooping is in the news again, with the firing of four workers for looking at Congresswoman Giffords’ hospital records after the Jan. 8 shooting. While this instance was swiftly detected and punished, most instances of snooping will not make headlines, and are thus more difficult to detect. 

Few care providers will ever have a patient whose treatment will be front page news (thankfully). But lower-profile patients are victims of snooping as well.  For every case that makes the tabloids, there are doubtless many more cases involving less-newsworthy victims. A concerned father looking at his daughter’s suitor’s records, an irritated neighbor looking for malicious gossip, or a bitter ex-spouse seeking ammunition in a custody battle are much more difficult to catch.

Technology, alas, isn’t too much help here. Information security products have historically been focused on stopping unauthorized access, not the misuse of authorized access. Though there are a few products on the market that purport to detect and stop medical snooping, they are both expensive and cumbersome, beyond the financial and technical resources of many organizations. Those who can’t afford to spend six figures on a sleek, high tech product need to use other means to detect medical snooping.

Assuming your security fundamentals are in place, below are some additional ideas we’ve seen work.

Implement thorough segregation of duties. Many organizations default to an "all access" or an "all clinical access" policy for information. While this aids in staff flexibility, it is worth asking whether all staff need access to all information and judiciously trimming unneeded access.

Periodic review of access entitlements. Most organizations have solid processes to grant access; far fewer have good procedures to modify or remove access once it’s no longer necessary. An annual or bi-annual review of entitlements can clean up obsolete permissions and prevent surprises from lurking in dusty corners.

Spot checks of access, This can be done two ways: patient-centered or personnel-centered. Either review all access used to a particular patient’s records or review all access used by a particular employee. These can be done either randomly or for cause — an employee who steals medication is probably more likely to have misused his access as well.

VIP monitoring. Should a VIP enter your doors, closely monitor who accesses his or her information and why. We know of one organization that, when a VIP checked in, created half-a-dozen null records of non-existent persons with identical demographic and treatment information to that of the real VIP (security types call this a honeypot — stage actors recall 1 Henry IV, Act 5, Scene 3: "The king hath many marching in his coats".) All those who viewed the record of the dummy VIP were terminated.

Once the misuse is detected, of course, there should be clear, HR-approved procedures in place to very publicly discipline the offender.

Medical snooping can be tough to detect, but you’re not helpless. There are steps to take that will increase your ability to detect and deter such misuse.

Pete is a director at Techumen.

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Currently there are "3 comments" on this Article:

  1. $$$$$This new taxonomy has the potential to significantly improve health care.$$$$$

    Dr. Steinberg, please cite a reference in a peer reviewed journal to support your statement. Thank you. From one of the five trolls known to me.

  2. When I read passages like this in the Health IT Expert Panel I Final Draft Report, I have to ask myself a question:

    Do I want my medical care determined (even in part) by from-the-seat-of-the-pants “guesstimations” such as the one below, “Quality Score for Common Data Types”, with results utilized by bureaucrats and those looking to maximize profits, or would I prefer the unfettered judgment of the doctor-patient relationship with a doctor I’ve selected to represent my interests?

    The latter for me, please.

    This is not a personal question; it affects everyone.

    C. Quality Score for Common Data Types
    These data types vary in their quality and availability in the EHR. The Panel proposed a framework to assess the quality of each data type as it currently exists in EHRs. This framework is an important new dimension through which to examine the electronic data required for quality measurement. Specifically, the data quality framework provided an initial assessment of the availability and quality of a given data type, as well as the validity and reliability of data stored and retrievable from EHR systems. The Panel proposed these quality criteria be measured using a 5-point scale, weighted to account for qualitative differences in their perceived importance to data quality (Table 3).

    — SS

  3. MIMD, I have a hard time understanding your dissatisfaction with the passage you critiqued. It has very little to do with healthcare being delivered by “seat of the pants guesstimations [sic]”, as you put it. The passage you selected to defend your thesis here does not discuss clinical decision support whatsoever. It is an analysis of how well EHR’s capture, retain and transfer clinical data. This passage indicates that the panel looked at the reliability of several different types of data elements that are stored in most EHR systems (Home medications, lab results, vital signs, etc), and then they scored the systems on how well they did at ensuring that when this clinical data was captured, it came from an authoritative data source (that the reception clerk is not entering the visit diagnosis), that it is captured in a manner within the clinicians current workflow, and that it can be audited and exported in a universal language. This passage is about the reliability of data in an EMR, not about influencing the medical decisions or the Doctor Patient relationship in any way.  Do you actually understand what you are reading when you look to these reports, or do you just see EHR and jump strait to angry.







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