Got Death???

April 10, 2013
Here’s a data-driven kick in the pants for you: two weeks ago, HealthGrades released its twelfth annual “Hospital Quality in America Study,” and

Here’s a data-driven kick in the pants for you: two weeks ago, HealthGrades released its twelfth annual “Hospital Quality in America Study,” and found, based on a review of nearly 40 million Medicare hospitalization records from 2006-2008, that patients have a 52 percent lower chance of dying in the nation’s best hospitals (as determined by HealthGrades) than in the average U.S. hospital. In other words, if you as a patient check into one of those hospitals designated as best in quality, you’ve just lessened your chance of death by half.

That remarkable statistic is indicative of some of the outcomes data coming out of every crevice in the healthcare system these days. From the Colorado-based HealthGrades to the Leapfrog Group to the Pacific Business Group on Health to the Wisconsin Hospital Association to the Medicare program, data is flowing out of every possible source. And what is that data saying? That there are vast, vast gaps in among hospitals and medical groups in quality, clinical outcomes, effectiveness, efficiency, and along just about every dimension one could measure in healthcare.

What’s more, as EMRs, CPOE systems, eMARs advanced pharmacy systems, clinical decision support tools, and other clinical information systems become more and more widely implemented across healthcare, the data waterfall will inevitably become a flood. And that flood is bound to wash way every last vestige of the lame old “our patients are sicker” defense, because of course, all these data initiatives are accounting for age, gender, and every other demographic and other relevant situation that might impinge on the comparability of outcomes data. So more and more, as Hospital A and Hospital B in Your City, USA are compared, the comparers are going to be able to nail your organization for outcomes that are less good than those of your competitors down the street, or even across the region or country.

So what’s the answer? In three words, get better, fast. And here’s where the IT element comes in, and the sword cuts both ways. On the one hand, the pioneering hospital organizations across the U.S. that are using EMR, CPOE, eMAR, advanced pharmacy IS, robust warehouses, and every other possible tool, to help their clinicians practice better medicine, are leveraging their clinical IS tools to drive astonishing changes in outcomes for their patients and communities. I’m just concluding my reporting for our January cover story on evidence-based care, and I can tell you, without “giving away the ending,” as they say in Hollywood, that the overall picture is a clear one. The advanced hospital organizations are moving forward remarkably quickly, leaving their peer organizations in the dust as they propel themselves forward towards a future of high-accountability, high-transparency patient safety, care quality, efficiency, and cost-effectiveness.

Meanwhile, all this data availability cuts the other way, too, because those organizations not making inroads are increasingly going to be held accountable and judged increasingly harshly by the purchasers, payers, and policymakers (and, increasingly, empowered consumers as well) who are forcing change on healthcare. As anyone who hasn’t been living in a cave for the past couple of years knows, reimbursement reform is upon us, regardless of the specific outcomes of the health insurance reform legislation now being debated in Congress.

And again, the basic overall picture is clear: purchasers and payers are determined to drive poor quality and patient safety, and poor overall value for monies spent, out of healthcare, for good. Or, as Rick May, one of the authors of the HealthGrades study put it, in the October 13 press release announcing that study’s results, “The fact is, patients are twice as likely to die at low-rated hospitals than at highly rated hospitals for the same diagnoses and procedures. With Washington focused on rewarding high-quality hospitals and empowering patients to make more informed healthcare choices,” he added, “this information comes at a turning point in the healthcare debate.” And that means value-based purchasing under Medicare, and soon after that, under every private health insurance regime as well. And sticks to join the carrots in every VBP program very, very soon.

The bottom line? “Got death?” is not going to be a very effective marketing slogan for your organization going forward. And for CIOs, it’s time to turbocharge the effectiveness of your clinical information systems and particularly of your data collection, analysis and sharing capabilities. As you’ll see in my January cover story (and I’ve described in other contexts in previous cover stories in HCI, and in my two books on quality in healthcare), the pioneers are moving ahead rapidly. Are you? Or will your organization be left behind?

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