Leadership by Example Coordinating Government Roles in Improving Health Care Quality (2003) / Chapter Skim
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5 Building Stronger Information Capabilities
5 Building Stronger Information Capabilities
Pages 108-128
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From page 108... ...
Congress should consider potential options to facilitate rapid development of a national health information infrastructure, including tax credits, subsidized loans, and grants.
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From page 109... ...
Group purchasers and consumers might use the quality data to assist in the selection of providers and health plans. RECOMMENDATION 6: Starting in FY 2008, each government health care program should make comparative quality reports and data available in the public domain.
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From page 110... ...
Growing evidence supports the conclusion that automated clinical information and decisionsupport systems are critical to addressing the nation's health care quality gap (Institute of Medicine, 2001~. Computerized order entry and electronic medical records have been found to result in measurably improved care and better outcomes for patients (Bates et al., 1999; Birkmeyer et al., 2002; Webster, 2001~.
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From page 111... ...
While it may be too early to determine whether the observed cost savings completely offset or exceed the costs of setting up such systems, evidence on the reduction in harm to patients from computerized order entry is unambiguous and significant (Birkmeyer et al., 2002~. Standardized performance measure datasets containing patient-level information could be mined to learn many things and to support various strategies for quality improvement.
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From page 112... ...
An adequate information technology infrastructure requires an architecture that links and distributes robust clinical information throughout the network while also meeting the information and technology needs of specific users. In addition, health care organizations must meet the growing interest among patients in online access to their health information and the technology applications that can assist them with distance care (Rundle, 2002~.
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From page 113... ...
In general, the four government programs that pay for health care delivered through the private sectorMedicare, Medicaid, SCHIP, and a portion of the DOD TRICARE program have limited ability to obtain computerized clinical data from providers, reflecting the low level of automation in this sector. By contrast, the government health care programs characterized by government ownership and operation of the direct care system the programs of VHA and IHS, and the remainder of DOD TRICARE have implemented more computerized clinical data systems and decision-support applications.
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From page 114... ...
Government Programs That Provide Direct Care The largest programs that provide direct care that of the VHA and that portion of TRICARE provided by DOD through its own facilities and infrastructure (the Military Health Systemic have developed systems for recording and extracting clinical data that stem from their adoption of the computer-based patient record. IHS has developed substantial automated clinical data capacity that complements medical chart abstraction entered electronically, instead of relying on a computer-based patient record.
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From page 115... ...
Participating veterans can obtain electronic copies of key portions of their electronic health records, add medical information in a "self-entered" section, and link to a health education library. The Military Health System The MHS provides information technology support to over 540 military facilities worldwide.
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From page 116... ...
Paper medical charts are routinely abstracted in the medical records department of the facility and added to the electronic records as the Patient Care Component (PCC) , a process that necessarily entails redundant labor and delay in the electronic inclusion of clinical care data.
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From page 117... ...
MOTIVATING CHANGE The committee is recommending that each of the government health care programs implement a core set of standardized performance measures by 2005, and that the number of measures be steadily increased over the next 5 to 8 years (see Chapter 4~. Provider reporting of data necessary to enable performance measurement is required by 2007.
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From page 118... ...
Financial and Administrative Incentives To offset the costs of the capital investment and training required to achieve greater levels of automation, higher payments could be offered to providers that can harvest and submit clinical data electronically according to standardized core sets of clinical performance measures. Alternatively, those that submit performance data electronically could receive more rapid electronic payment.
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From page 119... ...
Grants and Tax Credits The committee envisions a health information infrastructure that enables transfer of the information necessary to measure care across settings, time, and programs to reflect the needs and care experiences of patients, rather than the silo functions of individual providers. Such an infrastructure implies a transformation in the care delivery process that requires national commitment.
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From page 120... ...
Beyond quality improvement, a robust health information infrastructure is essential to other national priorities, such as the medical tracking and followup critical to identifying and combating bioterrorism. Support for development of an adequate clinical information technology infrastructure should be commensurate with its importance to domestic security.
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From page 121... ...
Overview of Reporting Efforts To date, public reporting efforts have focused primarily on health plans, and to a lesser degree, hospitals or particular surgical interventions (Schauffler and Mordavsky, 2001~. Very limited comparative information has been released for medical groups or physicians.
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From page 122... ...
Comparative quality reporting is a rapidly developing trend in both the public and private health care sectors, to a great extent in response to growing demand for information on the quality of care (California HealthCare Foundation, 2002~. In addition to CMS' publication of comparative information on nursing homes, dialysis centers, and health plans, business groups and health plans have begun making public comparative surveys of consumer satisfaction with provider groups.
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From page 123... ...
Reporting efforts with sufficient clinical detail for providers are even fewer in number, but here there are some promising results. Accreditation and certification entities are actively engaged in the collection, and in some cases reporting, of comparative performance data, and the National Committee for Quality Assurance (NCQA)
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From page 124... ...
The steady demand for comparative performance data by accrediting entities, group purchasers, health plans, state governments, and others is indicative of a keen interest in quality information. If the federal government does not share performance measurement data and information with private sector stakeholders, it is very likely that these groups will continue to impose their own reporting requirements on providers, thus contributing to administrative burden.
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From page 125... ...
Use of a Pooled Data Repository Across Programs The government programs should explore mechanisms for pooling the performance data needed to evaluate and compare quality across populations and programs. Pooled data could support quality enhancement at both the micro and macro levels; pooled Diabetes Quality Improvement (DQIP)
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From page 126... ...
2002. Will electronic order entry reduce health care costs?
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From page 127... ...
2001. "Information for Health: A Strategy for Building the National Health Information Infrastructure." Online.
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From page 128... ...
1999. Enhancing performance measurement: NCQA's road map for a health information framework.
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