The health care field is drowning in data. But are hospitals really collecting the correct information that they’ll need to transform the work they do? And, in an ideal world, what would measurement science look like for providers?
Those were some of the questions pondered by a panel of experts convened at the H&HN Executive Forum on Wednesday in Chicago. For Nancy Howell Agee, CEO of the eight-hospital Carilion Clinic health system in Virginia and future chairwoman of the American Hospital Association, measurement is a concern that keeps her up at night.
“I do worry about those things that we aren’t measuring, and I think there are some real issues related to delay in diagnosis that we don’t even know about until somebody gets frustrated. How often is it the patient’s responsibility to go from one venue to another to collect their information, from providers who aren’t always using the same [electronic health record],or systems that aren’t talking to each other?”
And even when hospitals do have data, there are questions about the quality. Hospitals have lots of data, but it’s not reliable, timely and relevant, said Cynthia Barnard, vice president of quality for eight-hospital Northwestern Memorial Health Care, based in Chicago. She believes health care needs much more information reported by patients, covering critical pain points along the care path such as diagnostic accuracy, access and transitions of care, and more.
Consumers crave this sort of information to drive their decisions, but the field just isn’t providing it today, Bernard said. Supposed solutions such as Yelp or the Centers for Medicare & Medicaid Services’ hospital star ratings system don't always cut it, she said. “The star ratings are based on a set of assumptions and premises, which are, No. 1, opaque — and I have huge issues with the star ratings’ structure — but secondly, they’re not aligned with what an individual wants out of care,” Bernard said.
Part of the problem is that, too often, incentives are based on what matters to docs and hospitals rather than the patient, said Brent Wallace, M.D., chief medical officer of Intermountain Healthcare, based in Salt Lake City. Quality is often assumed by patients who are undergoing knee surgery — they’re not choosing where to have knee surgery based on readmission health care-associated infection rates — and, really, they’re more interested in issues such as how quickly they might be able take a walk with their grandson.
Wallace said he believes that involving physicians and other clinicians in the development of better measures will be critical. “The metrics, if they’re ones that your caregivers believe in, they can be powerful motivators for improvement,” he said “For our physicians, I think the most powerful motivation for improvement in care delivery is when we have a valid metric that they believe is appropriately attributed in comparison to their peers.”
When asked what health care metrics will look like in 10 years, Barnard said she believes there will be more such data aligned with patient preference (what’s important to you) over longer periods (not measured per doctor visit but for the whole episode of care), and much more nuanced measures. Tracking the statistic of “preventable readmissions,” for instance, doesn’t catch the specific socioeconomic or behavioral reasons a patient ended back in a hospital bed.
“I believe our measures are going to get a lot better and more sophisticated, and they will not rely on ICD codes, God willing, and they will have much better ways of getting the data out of our records, but we as a provider community have to push for this,” she said.
Agee agrees, and she thinks providers throughout the nation should be starting to talk about how they can reach that ideal state.
“I think this is the conversation we need to be having across the country,” she said. “This is very important: What should health care be, and how does that impact what the consumer wants and not just the patient?”