Down in Washington DC for the next couple of days attending the Agency for Healthcare Research and Quality (AHRQ) conference. This is their first major conference bringing together a multitude of researchers, all having received funding from AHRQ. Conference, which was free, was completely booked about a month prior to the event. Estimate about 500 attendees. An interesting event, but puzzling as well.
First some of the interesting tidbits I picked up on the first day:
- Large healthcare groups/providers are really struggling with defining Quality metrics. Such metrics are being put forth by state and federal agencies (CMS, et. al.), insurers, employers, academics, etc., leading to a plethora of various metrics, some working at cross purposes to one another. Apparently, there is no central organization that is stepping up to the plate and saying these are the quality/performance metrics that must be tracked to satisfy all of these stakeholders thereby streamlining the reporting process. Without such a national set of standards, it is difficult for providers and their chosen software vendors to build the reporting tools into the software.
- Think through how one can optimize workflow before a major HIT project. Expected efficiency gains will not materialize if you hardwire existing workflow into a new HIT system.
- One large provider organization, Trinity, saw CPOE adoption vary from less than 25% at one facility to more than 85% at another. Poor implementation of the CPOE led to physician rejection of the system at the facility with low adoption, something this large provider has still not been able to recover from.
- Trinity found CPOE adoption highest in Emergency Depts.
- Providing a computer kiosk to allow parents to enter detailed information about child’s medical condition and history is as accurate as that taken by an admitting nurse and statistically more accurate than that of a physician.
- Physicians rarely trust a tethered PHR as they are often not up to date.
And some of the more puzzling aspects of this event:
- Where are all the major stakeholders? Little representation from payers, patient advocacy groups, HIT consultants, HIT vendors. Without their active participation, this event seems detached from reality.
- Some AHRQ funded research projects and their methodologies just do not make any sense. One provider tried showing whether or not quality increased after HIT go-live, but most metrics tracked were ones that already had high adherence/quality rankings, so viola, little improvement shown.
- One researcher will be conducting a study on Medication Therapy Management (MTM) and whether or not a PHR can contribute to better MTM in older populations. Problem here is that this researcher knows next to nothing about PHRs and was actually thinking of having someone on her staff create a PHR for this study. (I talked with her later and strongly encouraged her to adopt an existing PHR for her research. Could be a good opportunity for a PHR vendor who may be targeting older population.)
- Most presentations on quality and HIT were inconclusive, i.e., the use of HIT in a care setting rarely showed any statistically significant improvements in quality of care provided. Is this a problem with the metrics being measured, the lack of change in workflow, poor research methodology, poor implementation and use of HIT I don’t know, but I do find it disturbing.
- Many of the sessions and their presentations did not have any cohesiveness meandering aimlessly across the research on quality landscape.
But hey, this conference is free, so who am I to complain.
I do commend AHRQ in pulling this conference together as it does provide a great opportunity to see over the course of a couple of days the wide variety of research on quality that is being funded by this Agency. But moving ahead, this Agency could provide a far greater service to this sector if it focused more on some of the underlying business issues that drive decision making in a healthcare setting, take a leadership role in creating a set of national quality metrics, and look at how HIT and the data contained therein can be better leveraged across the healthcare continuum, rather than focusing its precious resources on what are largely academic, applied research projects that oft-times have little relation to reality.