The weeklong Premier Breakthroughs conference that wrapped up June 11 in Washington, D.C., put a spotlight on the efforts of hospital clinical data analysts to drive quality improvements through measurement and collaboration with physician-led process improvement teams. Owned by more than 200 hospitals and health systems, the Charlotte, N.C.-based Premier alliance offers programs to help with group contracting and clinical quality improvement, many of which are driven by informatics. One issue many attendees are just starting to grasp is that meaningful use will require them to collect data on some new measures and glean them from within electronic health records. Few organizations do that today, either because the systems aren’t designed for that type of data extraction or as some attendees told me, their community hospitals aren’t even using EHRs yet. Almost all data gathering for quality reporting is currently done through manual chart abstraction. Thursday, June 10, saw impressive presentations from Ashley Patterson and Joyce Mundy, quality management coordinators at 225-bed Bon Secours Memorial Medical Center in Mechanicsville, Va., who described how they use reports generated from Premier’s web-based ClinicalAdvisor tool for a surgical care improvement project. After reviewing and scrubbing data collected by chart abstractors, Patterson said, she works with quality improvement teams in the surgery division to understand trend data over time as well as comparative benchmarks with other hospitals. The reports help them identify target areas for improvement. “We have physician champions lead these collaborations,” Mundy said, because they can drive process improvements with other physicians. In a separate presentation, Stephen Grossbart, Ph.D., chief quality officer of 34-hospital Catholic Healthcare Partners (CHP), described his Cincinnati-based organization’s race to eliminate preventable mortality. Grossbart’s 22-person process improvement team has developed an internal measurement system that offers up external benchmarks and uses internal administrative data to provide feedback every two weeks on measures of mortality and harm. As CHP gradually rolls out the Epic EHR across its hospitals in the next few years, more of the data will come from clinical systems, he added. The preventable mortality effort, launched in 2008, has put CHP on the path of decreasing inpatient mortality. In 2009, the mortality rate fell 7 percent. As much as data gathering is central to his team’s efforts, Grossbart said hospitals have to overcome cultural reluctance to admit that preventable harm exists. “If you can’t see preventable death, you can’t start to make the changes to prevent it,” he said. “You have to be willing to admit that patients die in hospitals needlessly.” A Premier educational session called “Putting the Meaning in Meaningful Use” led off with the presenter asking how many people present had read any of the meaningful use interim final rule. Hardly anyone in the room of approximately 50 people raised their hand. As the presenter went through a description of what the Centers for Medicare & Medicaid Services (CMS) expects from them, many expressed confusion or disbelief that here was a new slew of quality measures, some of which do not overlap with the ones they already produce for CMS’ Annual Payment Update (APU) program and the Joint Commission. They also couldn’t believe that many clinical information systems will have to be upgraded to allow clinical measures to be derived from them. “What if we have separate systems for clinical and financial?” one attendee asked. “We might get the numerator from Cerner and the denominator from 3M? We will have to create interfaces to automate that process.” The fact that a group of people who work full time on clinical quality measurement seemed surprised by the scope and potential impact of the Office of the National Coordinator’s work suggests the feds still have a lot of public relations and educational work ahead of them.
