Thursday, August 20, 2009

Health Care Quality

Back when I worked in manufacturing, there was a saying that went:

What gets measured gets done. What gets rewarded gets done well.

Healthcare escaped the "quality revolution" that swept through many other industries in the 80s and 90s. That is about to change. When manufacturing changed from a culture and reward structure that focused on quantity (build to the numbers) and incorporated quality metrics into the evaluation and compensation packages of leadership, we saw a dramatic improvement in quality. As I heard it stated once, "It's amazing what you can accomplish when management is paying attention." Management pays attention when their performance reviews, bonuses and promotional opportunities are influenced by achieving quality metrics.

ARRA requires HCOs to report 27 Quality Measures to CMS to qualify for "meaningful use" financial incentives.

Some of the ARRA Quality Measures seem to be pretty straightforward. For example, there is a requirement to report "The percent of orders entered directly by physicians through CPOE." We all know that the error rate is greater when physicians write out orders and someone else enters the data for them than it is with CPOE. CPOE has significant advantages over the manual order writing system. As a local radio commercial says "even McDonalds doesn't use paper orders in 2009." So, one measure of how effectively an organization is using its EHR will be the CPOE Percentage.

Another measure is to report the percent of smokers offered smoking cessation counseling. This is the sort of measure that I have an issue with. So, you offer them counseling. Big Deal. Since we are concerned with outcomes, a better measure would be "the percent of smokers that quit smoking." Just measuring whether you offered smokers counseling reminds me of those kids camps where every kid gets a ribbon for showing up, so that we don't hurt their feelings.

We know that once CMS has this data, it will be made public. And then organizations will be able to compare their scores against their competitors (yes, virginia, hospitals do compete with each other). Also, consumers will be able to look at the scores for hospitals and doctors and use this as a determining factor in deciding where to take their health care business.

An important component of any Quality Management System is specifying what is to be measured. If there is any ambiguity in the description of what is to be measured, we will end up with inconsistent results and will be "comparing apples to oranges."

HL7 is balloting a Healthcare Quality Measures Format (HQMF). I did some work helping to put the document together.

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