The project by the Premier alliance is part of wider efforts to get doctors to use EHR data to identify ways to improve medical practice.
By Pamela Lewis Dolan, amednews staff. Posted June 25, 2012.
What is being billed as the largest virtual health care community in the world is being launched online. It is expected to be the first of many efforts to put physicians in control of their performance improvement plans and to rely more on data in their day-to-day decision-making.Physicians always have had an abundance of data available to them either through their hospital systems, insurers, other payers or a combination of sources. But the data have been underutilized, because they are difficult to access, hard to analyze and sometimes impossible to interpret.
PremierConnect databases are aggregates of several data sources, including claims, lab, billing, purchasing and operational data that are updated every 30 days. The data can be queried, based on individual needs or found through pre-generated reports prepared by Premier or other users. The data also include information captured from hospital electronic health record systems.
“All those participating are running reports, so maybe someone does a really great physician scorecard. I don’t need to reinvent that,” said Rebecca Sykes, senior vice president of resource management and chief information officer of Catholic Health Partners, a Premier-member health system with facilities in Ohio and Kentucky.
What data are submitted to the network may vary depending on a hospital’s own objectives as well as state, local or organizational patient privacy rules. In some cases, physicians or other authorized personnel could run reports with identifiable data. Patients would have to sign off on their data being used.
Opportunities for improvementThe goal of the project is to foster both clinical and financial performance improvements, so Premier members explicitly said punitive action against doctors is not the intent of the data system. In the past, insurers and others have created data networks designed to pay physicians or measure their performances based on claims or other data doctors said were flawed. Premier members said they want to empower physicians to identify improvement opportunities on their own while helping one another.
“There’s a lot of need for individual communities to connect with one another,” said Richard Bankowitz, MD, Premier’s chief medical officer. He said individualized networks will be established for specific peer groups, such as physicians within a certain specialty, or for hospital chief information officers. “Clinicians have been desiring better ways to have peer-to-peer interactions for a long time, so this allows a nationwide peer-to-peer network.”
Dwayne McNeil, senior director of information services for Carolinas HealthCare System, a Premier member based in Charlotte, N.C., said the advanced analytics will allow physicians to identify best practices and methods that can address improvement opportunities, such as ways to reduce readmission rates.
“Every physician wants to provide the best care possible and wants to understand if his or her practice varies from their peers and whether those variations are justified or not,” Dr. Bankowitz said.
Data-driven decision-making has been a long-standing desire by quality improvement advocates. It is now becoming a standard of care thanks to several government initiatives such as accountable care organization and meaningful use incentive programs.
Bruce Bagley, MD, medical director for quality improvement for the American Academy of Family Physicians, wrote an article in AAFP’s July/August 2006 issue of Family Practice Management about physicians using data for performance improvement. Dr. Bagley wrote that although measuring care quality is the only way to improve performance, most family medicine offices were not actively engaged in data collection due to the difficulty involved with accessing and understanding the data. They also didn’t have a lot of motivation to go through the hassle.
“Things have changed a lot since 2006,” Dr. Bagley said. Not only are more physicians using more advanced technology such as integrated EHR systems, they also are expected to perform more self-quality assessments, he said.
A system like PremierConnect “makes the data easier to get at, no question,” Dr. Bagley said. But he said physicians don’t need a Premier-sized universe of data to make actionable decisions. Every physician has data available to him or her from other sources, such as payers, but it may take a little work to get the information.
AMA guidebook offers helpThe American Medical Association published a guidebook this year to help physicians use claims data to identify ways to boost performance. The guide says data sent to physicians by payers often are not detailed enough to be useful, and it suggests that physicians request the information they need, such as patient-specific data. The AMA also is developing a prototype standardized data report that will help physicians layer insurer information to drill down to specific improvement opportunities.
Kevin Fickensher, MD, president and CEO of the American Medical Informatics Assn., said he expects that all health care organizations are attempting to deploy some way to support analytics in the way PremierConnect is doing it.
“One of the benefits of the remarkable investment we’ve made in health care information infrastructure over the last decade is the realization that we can now move forward to answer questions on fundamental health care problems,” he said.
But there’s still work to be done. For instance, the data are not real-time, nor are they incorporated into physician work flow by integrating them into an EHR. That integration is something several Premier alliance members are working on, said McNeil, of Carolinas.
“While we’re not quite there,” Dr. Fickensher said, “we are clearly moving in the right direction.”
What physicians can do on the PremierConnect networkUsers of PremierConnect will have the ability to create customized data queries that isolate certain patient populations, disease-specific data or specific demographics. The data can be analyzed to gain a better understanding of their communities and patient populations, as well as look at national trends, outcomes and performance levels. A sample of the reporting, data query and monitoring that can be done include:
- Segmenting patient populations to understand where to focus care.
- Monitoring the effectiveness of a certain treatment or care model.
- Conducting public health surveillance for possible public health outbreaks.
- Monitoring clinical performance to identify practice variations based on diagnoses, procedures and patient visits.
- Comparing readmission rates among physicians or organizations based on specific diseases and treatments.
- Performing predictive modeling to enact corrective action before bad outcomes occur.
- Analyzing which patients are driving up costs and identify patterns that can be changed.
Copyright 2012 American Medical Association. All rights reserved.