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Healthcare Information Management: Means Not Ends

The following guest blog post comes from our newest board member, Dr.Tim Porter-O’Grady.  Given the historical vote in Congress last night, coupled with the rising call for evidence-based medicine, Tim’s perspective from the trenches is very timely.  You can also read Tim’s recent article in Nurse Leader magazine on the case for clinical nurse leaders in the 21st century.

One of the big challenges with leaders and clinicians these days is the overwhelming amount of data that must be collected, codified, generated, and analyzed. A big temptation in this necessary effort is to watch data management convert from means to ends. As I travel around the country working with a wide variety of health care agencies, I see clinicians overwhelmed with trying to balance the collection and management of data with the demands of patient care. While data is important, leaders must remember that clinical and management data should be directed to supporting, improving, and advancing patient care not simply a nonaligned means of the measure of process.

When the demand for measurement becomes overwhelming, it moves from tool to goal. When data becomes a goal it moves from facilitator of practice to an impediment to work. In fact, it begins to undo its very purpose and itself become a “workaround” and just another barrier to effective patient care. For many clinical leaders the demand for information and the urge to collect and provide it becomes more important than the real sustainable achievement of value or outcome. One wonders how many clinicians are now working to instrumentation measures, making those measures their performance goals, losing focus on their patient in the process. While the collection of this data is certainly essential to the methods and techniques essential to measuring the presence of effective process, they are indicators, not results.

It must be remembered, in the midst of all this data collection, that clinicians are providing a service deeply embedded in the context for caring to persons experiencing one of the most significantly vulnerable points in their life’s journey. These patients are expecting that the focus, attention, and center of clinical activity are directed to helping them cope, respond, and accommodate their healing journey. The real value-driven measures are those that well articulate a goodness-of-fit between the needs for caring and the resources necessary to assure that it occurs efficiently and effectively.

The best measure of the utility of data is that which assures that mission, purpose, resources and care interface in a mosaic where the patient expresses exuberance with their experience, the clinician expresses satisfaction with her or his impact and management recognizes value in the efficiencies leading to sustainable outcomes. The achievement of these ends is reflected in the essential dance between the stakeholders and the organization and the music is the information that demonstrates their convergence.

So, finally, it is important for each stakeholder to both recognize and enumerate value in the collection and analysis of data related to the dynamic of caring for patients. Equally important is to acknowledge that data is reflective of value and action, it is not, however, itself value and action. Measurement of the meaningful delivery of service is not the service itself but, rather, is indication of the effectiveness and efficacy of the service. There are three things that must continuously be kept in mind when interfacing data management with clinical care:

  • The ownership for the output of care is always the clinician at the point of service. Transferring that ownership to other points in the organization does not increase personal accountability and does nothing to either facilitate or advance the outcomes and impact of that service. In fact, shifting this locus-of-control from the point of service only impedes the achievement of sustainable value.
  • Data collection and analysis can only serve to inform work and effort; information is not itself the work — it remains forever means not ends. When information becomes the point of work, the real value of that work is lost and its purposes becomes skewed, making it increasingly difficult to recalibrate people and organizations toward who and what they are and do.
  • Clinical leaders must increase both their acceptance and their use of data in the determination of objective and meaningful value in the critical clinical work they do. The meaningful use of information should relate directly back to the point of service and the creation of real value. Through the good use of the means of data collection and analysis, clinicians are empowered to demonstrate genuine value and impact and to make their contribution clear and evident to all.

In the final analysis, sound relationships are the best indicators of both efficacy and meaning. The relationships between health organizations and their clinicians, between clinicians and those they serve, and between health organizations and their communities are the clearest indicators of effectiveness. Data and measurement devices are the lenses through which the value and impact of these relationships can be assessed for both their quality and effectiveness. If all stakeholders in this dynamic keep focused on the ends of advancing the health of those we serve, the data means we use will provide the evidence we need for the validation we seek in fulfilling the central purpose of the caring we provide. Quite frankly, that is why we are here.

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  1. This discussion brings to mind an often forgotten risk in the data rich world we live in and that is the risk of spending our energy “managing the data” instead of “managing guided by the data”. This risk exists in clinical practice where I might easily find myself managing the medical record without ever looking up to see the patient, as well as, in administrative practice where I may focus on managing the financial or operational data instead of managing the practices and processes that resulted in that data.

    As I travel the country working with healthcare organizations focused on improving the management of their largest controllable expense, labor, through the use of analytics, I see how easy it is to lose sight of the purpose of the data. Once the information on the use of overtime, agency, non-productive hours and costs, among many other data points, is revealed through workforce analytic reporting, variances between actual and expected performance are revealed. And this is where the risk of misuse of the data surfaces.

    Once a variance is reported, there are two potential courses of action to correct the variance. The first option, and appropriate use of the data, is to identify the root-cause through proper data analysis and construct an action plan to mitigate the variance. The second option, and risk of misuse of the data, is to look for ways to influence the data itself. Perhaps redefining performance expectations or redefining data elements to be measured in an effort to eliminate the variance.

    In healthcare today, we must be ever vigilant of how we interact with the vast amounts of data available to us. Whether the data is related to clinical care management or the management of the workforce that provides the care, we must make sure the data serves the ultimate purpose of guiding us in the provision of a high quality and safe patient care environment.

    March 25, 2010
  2. Thanks for this perspective. I have recently joined the HIM industry and have been fascinated by the parallels I am discovering between the current state of HIM and EMR to what we experienced not long ago in HRIS and Applicant Tracking.

    It might be interesting to have a dialogue between Dr Porter-O’Grady and other board members/Kronos leaders in HRIS on how the needs and expectations of the industry differ.

    As I follow the federal rule making and drive to certification, I am reminded of OFCCP regulations and HR-XML symposia. ICD-10 reminds me of Unicode and “L10N” efforts of just a few years ago.

    I think that the HRIS field has a lot of mentoring to offer HIM during these transitions. I wonder what the Workforce Institute thinks of that. Thanks.

    April 8, 2010

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