New JCAHO initiative raises the bar on need for highly refined data skills
ORYX project ties data with accreditation
A new initiative by the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, has raised the stakes in your data collection procedures. Beginning next year, your hospital must begin submitting outcomes data as part of your accreditation a move experts say raises the importance of quality data to a new level.
The commission’s initiative, called ORYX, adds speed to a trend that has been steadily evolving to push health information management out of the file rooms and into the mainstream of medical information.
The commission will require hospitals and long-term care facilities to begin submitting the clinical outcomes data to selected performance measurement companies on a quarterly basis in 1998. That data will be reviewed by the commission in 1999. At first it will only require a trickle of data, but eventually virtually all of your outcomes data and other indicators will be under scrutiny. If the data fail to pass muster with the commission, it could force changes in your clinical operations and possibly interfere with your hospital’s accreditation.
The Joint Commission’s initiative will apply to all hospitals and long-term care facilities, and eventually will include integrated delivery systems such as provider HMOs, physician health organizations, and preferred provider organizations plus home care, ambulatory care, behavioral health care, and laboratories that seek commission accreditation.
Initially, the impact you will feel will be minimal. The only requirement for 1997 is that by the end of the year, each hospital will select an accredited performance measurement system to use for compiling the data. The commission has accredited 60 such systems, and more may be added. (A list of the accredited companies and their systems is available on the Joint Commission’s Internet home page: http://www.jcaho.org.)
Also, by the end of the year hospitals must select at least two clinical performance indicators from their measurement systems that account for at least 20% of their patient care. In 1998, the commission, will collect the outcomes data from those two data sets on a quarterly basis.
After that it gets tougher. In 1999, each hospital must have four data sets accounting for 40% of its patient care. Each year thereafter, the requirement adds two more data sets accounting for an additional 20% of patients until, by the year 2002, hospitals will be reporting all of their outcomes. (To see how the new accreditation process will work, see chart on p. 51.)
Are health information managers ready for the new challenge? Linda L. Kloss, RRA, executive vice president of the American Health Information Management Association (AHIMA) in Chicago, expresses cautious optimism. She points to a commission survey last year that found that 69% of health care institutions already are collecting outcomes data.
But there still will be reverberations from the new initiative. Specifically, health information managers should consider the following:
• Emphasize quality data.
"I think one of the good things that will come from this is a renewed emphasis on quality data and quality control procedures," says Kloss. "If your data are bad, this won’t be just a bad result from your perspective because it now affects your accreditation."
The HIM field has become accomplished at collecting data, specifically for ICD-9 and CPT reimbursement, Kloss points out. But when the stakes are your accreditation and perhaps your reputation if the commission eventually decides to release the data accuracy must become a formalized part of the data collection process, says Kloss.
She urges health information managers to establish an independent review step in the collection process. This "independent eye" should be someone who comes in after the data are gathered to check on accuracy. The sample needed to make the process valid depends on many factors, but it generally can be done in-house, she says.
She also suggests that if you are already working with a performance measurement company that was accredited by the Joint Commission, ask your vendor for help in creating a formalized program.
• Define your terms.
It’s possible to have high quality data that are misleading unless everyone agrees to definitions, says Patrice Spath, ART, a quality consultant based in Forest Grove, OR. "If you’re counting inpatients, for instance, you have to decide what an inpatient is. Are you going to use the definition of someone who’s in the hospital after midnight, or is it the definition used by the billing department?" she asks.
She once worked with an institution that appeared to have a high surgical readmittance rate, but later discovered that while her facility classified these patients as inpatients, other facilities classified them as observation patients.
Some performance measurement companies have a means of using comparative terms, but it’s important to make sure everyone is using the same definitions, Spath says.
She also says that some quality experts have taken over the outcomes measurement arena one goal of health information managers should be to get back in that loop.
• Watch for new career opportunities.
The creation of ORYX may place some extra demands on health information management, but Kloss notes that it also creates career opportunities outlined in AHIMA’s Vision 2006 as follows:
It embraces the importance of the clinical data specialist, someone who develops expertise in collecting and managing clinical databases.
It gives impetus to information managers to expand their sights not only out of the medical records department but systemwide as authorities in collecting and managing data for all management needs.
• Expect an added monetary burden.
The economic burden of the new requirement will vary greatly, depending largely on whether your hospital is already collecting outcomes data with one of the approved companies. The Joint Commission says that starting up ORYX will cost an average of about $10,000, and ongoing maintenance costs should range near $11,000 annually.
But there’s also the cost of using the measurement company. "Some of the approved systems are inexpensive; others are very expensive," says Spath. "They range from Genentech’s, which pays hospitals to collect data for them, to others which can cost up to $100,000. Required systems can not only be costly; they are resource-intensive also. Someone has to collect, format, and submit the data. This could result in a significant economic burden."
• Show them your best.
It’s expected that the first two data sets you choose for analysis will be your best. "We fully expect that the first two indicators hospitals choose will be ones that make a favorable impression," notes Dennis S. O’Leary, MD, president of the Joint Commission. "But the requirement levels will go up over time, so within a few years it won’t be so easy to identify such positive indicators. Our first priority is to get everyone on the train, then to improve the process."
• Expect more data to be released.
The commission has pledged to initially keep private the data you send it. But O’Leary acknowledges that eventually that could change.
Besides the basic version of ORYX, the commission is offering ORYX PLUS, a voluntary option using a common set of performance measures that will lead to the creation of a national database. ORYX PLUS hospitals will only be compared to one another regardless of which performance measuring system their data come through. Hospitals participating in the accelerated option will receive some form of special recognition by the Joint Commission.
Linda L. Kloss, executive vice president, American Health Information Management Association, 919 N. Michigan Avenue, Suite 1400, Chicago, IL 60611. Telephone: (312) 787-2672.
Patrice Spath, consultant in health care quality and resource management, Forest Grove, OR. Telephone: (503) 357-9185.
Joint Commission on the Accreditation of Healthcare Organizations, 1 Renaissance Boulevard, Oakbrook Terrace, IL 60181. Telephone: (630) 792-5000. Internet address: http://www.jcaho.org
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