Whose Data Is It, Anyway?

Cheryl Clark, for HealthLeaders Media , April 18, 2013

Deep down, we knew it would come to this.

If quality of care is ever going to improve, providers must make the big leap from merely tracking process measures, like whether a hospitalized patient got an appropriate drug, to logging whenever complications resulted from their interventions.

Did patients develop surgical infections? Did they require a ventilator for more than 48 hours? Did operations have to be repeated? Were the hospital's rates of renal failure or blood clots higher than average? Did patients require longer lengths of stay? And of course, did any doctor's patients have a higher rate of dying?

This information should be transparent to payers and patients, not closely guarded secrets that only a hospital's insiders get to know. Unfortunately, that's pretty much the way it is today.

Beyond the care team, other hospitals' physicians, payers, employers who buy health plans, and the general public don't get to know that stuff.

But everything, in all likelihood, is about to change in a way that leads to much greater transparency. A few poorly publicized paragraphs in the New Year's Fiscal Cliff law are poised to speed it along this year.

Today, these surgical and procedural complications and their details are gathered by a growing number of physician specialty societies that designed data registries specifically for their members who volunteer their data. The idea as it began, was noble, says Robert Wachter, MD, Chairman of the American Board of Internal Medicine and an expert on adverse medical events.

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2 comments on "Whose Data Is It, Anyway?"

Jason Uppal (4/21/2013 at 9:33 PM)
I am an engineer by training and worked many years in several industries in business transformation. Quality improvement is a fundamental component of business transformation. The mistake the healthcare industry is making the same mistake Detroit automotive industry made 35 years ago. Quality improvement measures such as internal process audits, compliance audits, adverse events are used to ensure the process effectiveness, not to taut your quality score. If you want to measure quality of healthcare at a hospital let them publish patient satisfaction, patient outcome for an episode, length of stay, total cost to achieve that outcome. Those measure matter to the public. When I buy a car, I don't care how many times the assembly line was stopped by a worker because a non compliant product, I care how often I need to take it back to the dealer for fixes that should have never occurred and what I paid for it.

Jane Alop (4/19/2013 at 12:03 AM)
I agree, publicly paid serviced should be transparent to public, but we have to remember it might be also confusing information to public. What is the purpose - to pay less (optimum) or to have a better health care quality? Usually the answer is P4P what means in some cases we pay more for good quality and in some cases we will not pay for poor performance. In both cases we need criteria to identify the quality of provided care and this can be done only by clinicians and patients and its pros and contras are proved in thousands surveys not mentioning the quality of the data from specialty registers this data come from. In Estonia we are very cautious thinking P4P implementation thanks to Alan Maynard report. Estonian Health Insurance Fund, who is a main purchaser, aim is to have better and on equal level quality in whole country. For that purpose we [INVALID] yearly a feedback report to hospitals using the data from invoices the hospitals send to insurance fund to get paid. Based on this data we calculate common quality indicators. Yes, this is a very robust analyze and we all have to remember the data is not specially collected for quality assessment, this data are from a financial document. But this is also the value of it - insurance fund database is most complete database as everyone want to be paid :). Second - the provided services are coded based on insurance fund pricelist all provider have to use. If someone is not happy with results and put the question about data quality it always goes back to hospital as insurance fund don´t change the account information sent by the hospital. The main purpose of this report is to provide feedback to hospitals that they can compare themselves to other hospitals in Estonia and to provoke IN hospital discussion about possibilities of quality inprovement. It is also the way to do benchmarking. And we don´t spend any extra money for collecting this data :) - we are a very small country and can use very limited amount of resources.




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