It’s one of the most common complaints among healthcare quality professionals: There are so many metrics and so much data to compile. How can we ever keep up?
A group in Oregon is hearing the pleas and trying to find a solution. The Portland-based Collaborative for Health Information Technology in Oregon (CHITO), a nonprofit which includes healthcare organizations and related groups addressing data needs, recently investigated the problem of data overload in the state and found strategies that could help nationwide.
The group recently issued a report, “Aligning Health Measurement in Oregon,” which is a result of months of collaborative research to study and develop recommendations around a proliferation of hundreds of overlapping — and sometimes competing — state, federal, and commercial healthcare quality reporting initiatives and mandates.
(The report is available online at http://bit.ly/29Ut2QH.)
The following are some highlights from the report:
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There are more than 420 reporting measures in Oregon from various state, federal, and commercial healthcare programs and initiatives.
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Many quality incentive programs have mixed results as they are not tied to best practices, are siloed among dozens of sponsors, and the results are not always available to the public.
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“Previous efforts to align measures were well‐intentioned but had little success, in part because those involved did not have the authority and resources to implement changes,” according to the report authors.
“The quantity of reporting requirements is just overwhelming,” says Andy Davidson, president & CEO of the Oregon Association of Hospitals and Health Systems, a member of CHITO. “There is not only the state and federal payers, but even within those there can be subsets. The variability is huge just with the government plans, and then there are the commercial payers.”
A key finding of the study was that metrics are siloed far more than the CHITO group expected, Davidson says. The lack of access to many of the measurement results also was a concern.
“We think there needs to be a public/private effort that develops Oregon-specific goals. We think there needs to be a limited set of measures that align with those goals,” Davidson says. “That may mean we replace some existing measure sets.”
Part of the problem, Davidson says, is that so many measures are developed for narrow healthcare groups and localities. In its 2015 assessment of its own measurement efforts, CMS analyzed more than 700 measures across 25 programs and found that only half of the measures were shared across programs, and that nearly half of the measures were developed locally.
“What the healthcare community can clearly see now is that though each effort may cite the Triple Aim or the National Quality Strategy — or both — as a guidepost in their work, that has not prevented measure sets from proliferating to a nearly unsustainable degree,” the CHITO report says.
The good news is that there are existing frameworks that might help address the problem. Recent national-scale initiatives, such as the dashboard proposed by the Center for Healthcare Transparency, or the framework for a Culture of Health developed by the Robert Wood Johnson Foundation, are two examples to consider, the report says.
Their recommendations reflect an attempt to balance the immediately feasible with aspirational measurement; to include measures that are broadly applicable and measures which target specific populations and challenges.
The Oregon experience is not unique, Davidson says, but it illustrates the challenges posed by the overload of metrics and hints at what can happen if the healthcare industry does not find a solution.
He notes that some healthcare organizations have to hold office space open for the constant flow of chart reviewers sent by the payers.
Other healthcare providers have reported that document overload adds five minutes of administrative work for every patient, Davidson says.
“We’re really concerned about burnout and organizational focus on improvement and patient safety,” Davidson says. “People are spread thin, and ultimately we are concerned if that if we layer more and more metrics on people we can take the system backward. I don’t say that lightly.”
