Benchmarks: Changes are afoot for clinical and business intelligence
A study earlier this year from the University of Missouri showed that most patients took a dim view of doctors who make use of clinical decision support technology.
Researchers found that patients saw physicians who use CDS as somehow less capable than those who don't. They saw the IT tools as impersonal, and thought the systems were a barrier between them and their caregivers.
That's the wrong way to think about it, says John Hoyt, executive vice president, HIMSS Analytics.
"They just need to understand it's not taking the place of their physician," he says. "It's an aid and reminder of the latest peer-reviewed advice and best practice alerts, etc."
It can "touchy," says Hoyt, because it may suggest, "subconsciously, that your physician is flawed, that he has a human brain – that may be a shock to some people."
But far from being a cheat, or a crutch to be leaned upon, decision support is an essential tool in the clinician's arsenal. Especially nowadays.
"Things get complex," he says. "A good physician will go out and search the literature. In days of old, they used to spend time in the medical library. But now we can bring it to their faces, at the moment."
But there's a fine line between that and "in your face," as it were.
Designing CDS to supply relevant information – at the right time and place – without risking physician alert fatigue, "is an art," said Hoyt. "We don't want to remind the physician, 'Hey, we've got a patient with high cholesterol, order a lipid test.' For God's sake, they know that."
It's even worse in the pharmacy: "Every minute, today, in these hospitals, the pharmacists are getting alerts that are far more detailed and hypnotic than the physicians get."
But clinical and business intelligence technology is changing, evolving – and getting smarter.
"Now that we've had electronic medical records for years, we have data," says Hoyt. "And we now can do some real analysis of our practice patterns and our outcomes. This is now mega data analytics. But eventually you can bring it to the bedside as well: 'From our experience, here at Acme Hospital, we have learned that . . . ’ And you can now deliver that content to the physicians at the bedside."
For the most part, most decision support content is still purchased from sources like Zynx Health and Milliman, he says. But lately, bit by bit, "organizations that are doing their data analytics are seeing their practice patterns" – seeing what works and what doesn't – "and they're able to deliver that data to the bedside."
Recently, HIMSS Analytics has been publishing a series of white papers examining how different hospitals and health networks have been designing and deploying their own clinical and business intelligence programs in the pursuit of value-based care.
And this past month it was announced at the 2013 HIMSS Annual Conference & Exhibition that HIMSS Analytics is partnering with The International Institute for Analytics to develop a model that's meant to help more providers do the same.
Billed as the first benchmarking survey designed to measure and score clinical and business intelligence and analytics maturity in healthcare organizations, the project – to be launched in May – will offer health organizations an unbiased assessment of their program’s maturity compared to their peers.
"The model helps organizations transition from the acquisition of clinical and business intelligence tools to the implementation and use of those tools in an effective way," says James Gaston, senior director of clinical & business intelligence at HIMSS Analytics, who's spearheading the project.
"Is the physician staff able to use it effectively in their practice? And does it make a difference and an impact? Is it pervasive within a healthcare organization, or is there one particular practice area that's using it, say, urology and orthopedics? Is it integrated with the business side of the hospital and healthcare organization?"
No question, facilities' C&BI maturity varies widely. There are plenty of barriers preventing more efficient use of those tools.
First, says Hoyt, "Do you have the data?" Many hospitals, of course, are still in the health IT infancy. For those who do have clinical information to drill into, then, the question becomes, do they have the skills and technology to do smart and worthwhile analysis? "Or is it just a bunch of monthly reports you send to department heads who are not really mining their own data?"
"Of course, the people who are not mining their own data are not improving as much as they could," he says. "They're not spending the money and the effort, they don't have the leadership. That's all the kind of stuff we're trying to measure."
Adds Gaston: "You've got to bring new resources and new talents to bear to begin to effectively leverage the information that meaningful use brings into play."
If it's a challenge for providers to properly deploy this technology, it's just as challenging for vendors to develop it. Ideally, this new-breed C&BI should be able to pull data from across a particular solution, from all facets of the organization where it's deployed. It should also be able to integrate information from external sources – a health information exchange connecting with a physician practice, say, or a doc's office with the lab.
It should then be able to "pull all that information together and present it in a way so that the physician doesn't feel threatened," says Gaston, offering them appropriate advice at the point of care. "That's a real challenge. That's hard to do."
Still, "It's starting to happen," he says. "We're going to get to a point where we have iPads and very sophisticated technology that just talks to you and gives you back medical advice, where you can weigh your risks and costs dynamically."
Gaston cautions, though, that providers have a role to play in all this. These tools will only become widespread if there's a market for them, a willingness to use them.
"I wouldn't say it's all on the vendors' plate to make these things appear," he says. "The vendors can only be as progressive as they can be where the marketplace will accept them. If no one's going to buy their product, if it's too invasive or difficult to use or doesn't fit in enough practice scenarios, then they lose market share."
And HIMSS Analytics Vice President of Market Research Lorren Pettit makes one more point: Deploying technology to distill data and drive better clinical and financial outcomes is great, of course. But let's not forget that there are people behind that data.
"There's an element of the psychosocial that patients want addressed with their physician," says Pettit. "All this intelligence that we're harnessing, it still is not addressing the psychosocial, that 'human touch' part."
Adds Pettit, "It's wonderful. This is the future. But ultimately there has to be a human interface that is taking this information and communicating it in a fashion that is appropriate for the patient. That is going to be the challenge, going forward."
[See also: 'Alarm fatigue' endangers patients]