Susan LeFrancois Ph.D. Assistant Professor of Science and Logistics Florida Polytechnic University
Despite a Serious Investment in Information Technology, Patient Safety and Productivity Have Not Improved
Behind heart disease and cancer, preventable medical errors are the number three killer in the United States, claiming the lives of some 400,000 people each year. These errors are costing the United States approximately one trillion dollars annually. In an attempt to fix this epidemic, the Federal Government has required the healthcare industry to move toward electronic health records (EHRs) and to use these records to improve processes and outcomes for patients (i.e., meaningful use). The Federal Government is providing incentive payments to healthcare organizations through the HITECH Act totaling $27 billion dollars over 10 years to promote the use of EHRs (McCain, 2014).
There are three levels of meaningful use outlined by this Act that must be obtained in a federally designated time period in order for healthcare organizations to avoid paying penalties for noncompliance. Meaningful use Stage 1 requires that by 2012, healthcare institutions capture data electronically in a standardized format and are able to share this data for care coordination and for patient engagement. Stage 2 meaningful use must be complete by 2014 and can be summarized as advancing the clinical processes by increasing requirements for e-prescribing and incorporating lab results among other objectives. Finally, the main objective of Stage 3 meaningful use is to improve outcomes, with a completion date of 2018 (Twachtman, 2015). The Stage 3 proposed rule aims at eight objectives which include: data security, e-prescribing, clinical decision support, CPOE (Computerized Physician Order Entry), patient access, care coordination, HIE (Health Information Exchange) and public health reporting (Miliard, 2015).
Peter Pronovost, M.D.,Ph.D, FCCM, senior vice president for patient safety and quality and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins, is one of the world’s leading authorities on patient safety and has been quoted as stating, “Medicine today invests heavily in information technology, yet the promised improvement in patient safety and productivity frankly have not been realized” (McCain, 2014). Healthcare organizations require information management talent and resources to properly use the data collected. Many healthcare institutions have the understanding that they are collecting “Big Data” to perform analytics to improve patient outcomes, but they do not know how best to incorporate analytics into their operations. Healthcare organizations need help to determine how best to utilize all of the data they are collecting and how to measure success when a solution is created by their team.
However, this push to improve the healthcare systems by professionals with big data analytics degrees will not be fully realized until the issues of data governance and data stewardship are more specifically outlined by stakeholders in the healthcare industry. A data steward is a person who collects, maintains, aggregates, analyzes, and uses health data. The data steward must have respect for the data and be knowledgeable about regulations and laws that govern the data.
Data governance, or managing the collection and utilization of data, has not been around very long in healthcare and therefore there is a tendency to operate in extremes, either too much or too little governance (Sanders, 2013). Due to recent trends in healthcare, including increased use of technology to collect personal health information, there is a wide array and larger amount of health data that could be used to improve performance outcomes and quality while lowering overall healthcare costs.
Unfortunately, public policy is not keeping up with the demand for data sharing creating an obstruction for innovation. Industry needs to know how to set up a system to share personal health information while properly protecting patient privacy. Health informatics industry experts at the AMIA’s (American Medical Informatics Association) 2012 Health Policy meeting recommended that stakeholders, which include patients due to their increased involvement in decision making, need to work together to create a strategy for data sharing that mitigates risk. The topic of best practices for data stewardship needs to be addressed, how to improve security to prevent re-identification of data that has been de-identified and how to improve current patient consent and privacy practices. Finally, there is an open dialogue on how to adequately educate the public on the importance of health data “reuse” for quality improvement and how to incentivize the donation of data by patients for research purposes (Hripcsak, 2014). In closing, for progress to be made in the healthcare industry, there needs to be a balance between proper data security and acceptance of external stakeholder data access.
McCann, Erin. Deaths by Medical Mistakes Hit Records. The way IT is designed remains part of the problem. Healthcare IT News. July 18, 2014.
Twachtman, Gregory. CMS delays Stage 3 meaningful use until 2018, simplifies program. Practice Economics. October 7th, 2015.
Miliard, Mike. Meaningful use rules in OMB for review. A 90-day 2015 reporting period confirmed. Healthcare IT News. September 4, 2015.
Sanders, Dale. 7 Essential Practices for Data Governance in Healthcare. Health Catalyst. September, 2013.
Hripcsak G, Bloomrosen M, FlatelyBrennan P, et al. J Am Med Inform Assoc 2014;21:204–211.