Variation - noun
a: the act or process of varying; the state or fact of being varied
b: an instance varying
c: the extent to which, or the range in which, a thing variesFact: Technology and innovation when applied "thoughtfully" solve the challenges inflicted by what has become a massive technology disparity between healthcare platforms. Every day new and exciting vendors emerge, each presenting unique solutions to mediate and solve these problems. And while the implementations of quality measure programs have driven updates to current EHR solutions to streamline and normalize data capture, many challenges still persist. As Director of Client Services for Healthjump, I regularly face the challenge of working with the aforementioned exciting vendors.
Narrative: A patient walks into his doctor’s office and the front desk staff checks that patient into the system. 15 to 20 minutes later, that patient checks out. For the patient and people who live outside of the HIT space, this seems trivial, almost routine. In reality, the processes between checkin and checkout, specifically the variation of processes between individuals, employees and health systems is propagating a swamp of inconsistent data.
As of today, 4000+ ONC certified vendors are providing EHR products and services. With different architectures and capabilities, the disparity of technologies and data collection has never been greater. Even as the EHR space is consolidating, the same challenges persist.
- Clinicians and administrators modify their software to minimize "clicks".
- Test results are manually entered into EHR systems breaking the order loop.
- Health systems make acquisitions and decide not to migrate their legacy EHR systems.
- Specialty practices focus on only documenting information specific to their practice and fail to codify and maintain comprehensive patient information.
The broad variances in technology platforms, process shortcomings, and user disinterest stretches the data gaps stunting the ability to aggregate and report to government agencies and ultimately improve patient care.
At Healthjump, we apply a “common sense” application of our technology to assist our practices and partners to fill in those data gaps. Our larger partners, often acting as the Qualified Reporting Entity or Qualified Clinical Data Registry (QCDR), will invest in working one on one, sometimes even onsite, with their practices educating on better application of their EHRs and data collection. Smaller partners tend to act as a conduit between their practices and the reporting entities. Their resource limitations will prevent them from encouraging and reengineering the type of responsible cultural changes needed to encourage proper data capture. While Healthjump provides the type of customized data mapping and quality control tools to overcome the data gaps, it’s time for a "human engineering" movement in the HIT space. The attention to quality data capture should be asserted from the onset of the education pathway, for administrators and providers alike. While the incentive is to capture comprehensive data is often to avoid monetary penalties, a case can be made that the true incentive resides in an increase in quality care, workflow efficiency, and overall patient satisfaction.
Case in point, a recent practice of a Healthjump partner was receiving mammogram results via fax. The EHR showed an order for the mammo, but never any results. At first glance, it could be assumed that the Healthjump queries were at fault. The Healthjump client success manager researched the issue, as they do for all data conflicts. The CSM discovered that the mammo results were being manually entered into a mammogram quality data record, not to the order itself. It seems that the decision to fulfill a quality data measure trumped the decision to comprehensively codify and record the result to its order. What the Healthjump partner was left with fragmented data, requiring post capture alterations. And while the flexibility of Healthjump platform allowed the partner to custom map these non-codified data points, the underlying issue remains at the practice.
At an administration level, the penance for poor quality reporting equates to loss of revenue. For clinicians, workflows optimized to improve quality data reporting imply improved patient care. For EHR vendors, the challenge is to infuse the two narratives. For healthcare platforms like Healthjump, the challenge is to stay nimble and adapt to these challenges. While we could say that the flexibility of the Healthjump platform is a result of forward thinking innovation, the reality is the innovation is bred from the data gaps our partners present consistently, meriting the development of nimble solutions.
“If you torture the data long enough, it will confess to anything “ - Ronald Coase
Never has a statement rang more true than today.