The Canadian Institute for Health Information (CIHI) has a simple vision: better data, better decisions, healthier Canadians.
It does appear at times that we are drowning in data, raising the question of how accurate and timely it is, how it is used, and whether we have the smarts to draw the right conclusions from it. Hospitals have at times complained that the breadth of data demanded by the province raises the spectre that too many priorities means there are no priorities.
The choice of what data to collect can create incentives that may not always be the best. The focus on hospital length of stay, for example, has led to charges that patients are being sent home early without adequate care.
However, health data can tell us a lot about how we use the health care system and where to put our resources. One hospital executive noted at a recent Longwood’s conference on Big Data that many of their emergency room readmissions came from patients who lived alone – information that would be useful in planning and justifying enhanced home support.
Despite the existence of CIHI, not every health provider is on equal footing when it comes to utilizing information technology.
The evidence does suggest that the information savvy providers are capable of achieving better health outcomes than the information poor. That’s been the mission of HIMSS – the Healthcare Information and Management System Society — for more than 50 years.
HIMSS certifies health care provider organizations according to their adoption and use of electronic medical records. For many, it is the Holy Grail in achieving quality service delivery.
Dr. Larry Garber, Medical Director for Informatics at the Massachusetts-based Atrius Health spoke recently at the Longwood’s Big Data conference at the Rotman School of Business.
Atrius Health is a large not-for-profit primary care alliance in Massachusetts. They have received the highest HIMSS ranking – stage seven. Atrius also consistently scores among the best in measured health outcomes in the United States. Garber believes that’s no coincidence.
Atrius’ IT systems are tied into claims information from the insurance companies that represent their patients. That means the practice knows when a patient has been admitted to hospital or when they have filled their prescription. The system marks a patient’s 50th birthday by automatically sending them a letter to come in for a colonoscopy or alerts the doctors when a cholesterol test is due. The system supports remote devices that allow patients to monitor themselves at home and provide a data stream directly into their health record. Best of all, at least a third of Atrius’ patients have on-line access to their own health file.
When we consider that in Canada about one in ten patients who show up in hospital emergency rooms are there due to non-compliance with their prescription drugs, knowing if a patient has picked up a prescription is a big deal just by itself.
The ability of an IT system to provide a detailed level of decision-support has huge ramifications for any primary care practice.
Garber says it has taken Atrius two years to go live and another four to five years to “get it right.” The cost: $24 million.
That’s hardly a short-term payoff and may make it a more difficult sell in times of austerity. That doesn’t mean the payoff in quality and efficiency are not large.
The HIMSS rankings are still relatively new – the first stage seven validations did not occur until late in 2008.
John P. Hoyt, Executive VP of HIMSS, told the Longwood’s gathering that 62.6 per cent of Stage 7 hospitals have an “A” safety rating by Leapfrog. In the U.S. Leapfrog is considered the gold standard for comparing hospital performance on safety, quality and efficiency. By comparison only 30.8 per cent of Stage 6 hospitals achieve the same rating, and none at Stage Zero.
Similarly, Stage 7 hospitals rank far ahead of their peers in value-based purchasing and reduction of hospital acquired infections. They also dramatically reduce readmissions to emergency departments by as much as 50 per cent.
There are presently no stage seven hospitals in Canada reported on the HIMSS site, but four of five stage six hospitals are in Ontario – St. Michael’s, Ontario Shores, Markham-Stouffville and North York General.
Moving towards a more advanced IT framework is much more than just the cost of technology. Being able to have the people with the competencies to “optimize” that information will be critical.
To that end, it is possible that the digital divide could quickly delineate the “haves” from the “have nots.” In an ironic twist, just as hospitals get to this level of optimization, the Ontario government appears hell-bent on moving services away from these large institutional providers. That could also mean moving services away from developing information support.
Michael Sherar, President and CEO of Cancer Care Ontario, may have been thinking about this divide when he told the conference that “a lot of the providers will need this support in another way.” He suggested there would need to be a provincial “backbone of analytic support.”
Lydia Lee, Chief Information Officer at Toronto’s University Health Network said “if we expect everyone to be their own analytics shop, we could be in trouble.”
The question is, when hospitals start generating useful analytic data from their patient files, what happens to it?
Some hospitals have suggested that de-identified data could be a commodity that generates revenue for the hospital – not an unimportant point when hospitals are being starved in Ontario of any increase in their base funding.
However, Rick Skinner, Chief Information and Technology Officer at the University of Virginia Health System told the Longwood’s audience that “it serves the public good to put the data out there.” Skinner says any revenue from such data tends to be “miniscule” anyway.
The thinking is the more people who look at the data, the more bright lights will recognize patterns and be able to use it to advance health care optimization for everyone.
Sherar agrees – “it should be freely available. We shouldn’t be the gatekeeper of how it’s used.”