Measuring Quality in Clinical Informatics – Andrew Boyd, MD

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Andrew Boyd, MD

Summary: Hear how clinical informatics will measure quality with healthcare reform.


If you talk to any clinician, when you look at the quality of metrics as they exist today, if you go to the Agency for Health Research Quality, AHRQ, they have about 1,500 overall quality metrics on everything from patient safety, to physician, to hospitals. That’s a lot of metrics. And they’ve narrowed it down from about 6,000 to about 1,500.

That said, when you actually look at the peer review of why they’re actually measuring those individual values in order to determine quality, many times is because it’s based off of a billion data, or it’s based off a data that’s easily accessible. It may not truly reflect what’s going on with the patient, because medicine is quite complex. The idea of just a single or even 10 diagnoses codes representing the complete complexity of the patient is just silly when you think about it. I mean when you consider all the different patients, all the different presentations, and the possible complications in hospital. Medicine and health care is complex.

So as we get to the Affordable Care and as we look at the reform of health care going forward in the future one of the questions is, where is the value? How do we lower the cost? So right now generally except for a few  aid plans you get paid for procedures, you get paid for doing things, which is fine. But, if we truly want value, if we truly want to reform health care, we’re going to have to pay for outcomes.

So if it has to take three operations in order to get a patient correct, right now the incentive is actually there to do three operations because everyone gets paid three times. If you can come up with another way of doing it once and maybe takes two or three days longer in the hospitalization but overall it’s only a single procedure and single hospitalization, that would save the overall health system more money, but that individual unit might be more expensive. But you’ll save two more hospitalizations in the next month, in the next six months.

So as we’re looking at the data, as we’re looking at health care right, now we’re reimbursed by each individual procedure. But if we start looking at value, we start looking at quality, and not quality measure just by billion codes, but quality like outcomes of patients feeling better, does the patient really feel better? These are the types of questions that understanding the data and actually reflecting back to quality metrics that the patient both a) agrees with and both the clinicians agree with the quality measures.

That is where informaticians can help drive the question. They can understand where the data is, they can understand how do we harness this to get at is that patient really doing better, or are we just prolonging their life for an extra three months but their quality of life is a little bit less?

Again, when we start asking these hard questions as we look at completely restructuring how we pay for the health care system, only if we can agree upon quality, quality measures, meaning they actually reflect reality, not just numbers that are easy to get at, as well as measures that the physicians can buy into with the financial data, can you actually start trying to reinvent the health care system? No one wants to do wrong by the patient. I’ve never meet a doctor or a nurse or a health care provider who really wants to do wrong. But there are pressures.

If you have a single hospitalization and the goal is to get the patient out as soon as possible keeping them an extra day or two is expensive. The way we’re currently reimbursed the hospital may actually lose money. But, if an extra day in the hospital can save two or three down the road, these are the types of trade offs where we really understand how sick patients are, the status of the patient, and what is quality care for the different types of illness, that is when we can really go back and say, “Hey, this might be a little bit more expensive now, but we are going to be saving you money in the long run.”

Right now the way with reimbursement and financial cost and getting to high quality clinical data, that doesn’t exist now. But now that we’re merging this and this is going for state of the art, these are the interesting and exciting questions that the informaticians, the data scientists, the clinicians, we all get to answer that the same time.