Assignment: Medical Data Reporting Needs TIP: Please see the attachment for additional information. Consider the two (2) scenarios below, and then write a 1-2 page paper using proper spelling/grammar

Week 6- Assignment, Rubric, & Lesson Content

Assignment: Medical Data Reporting Needs

Consider the two (2) scenarios below, and then write a 1-2 page paper using proper spelling/grammar in APA format with In-Text citations (with 2 or more references), addressing the items below each scenario.

Based on the information provided in Scenario 1 above, address the items below:

1. What data sources and/or data systems would you suggest that an analyst might consult to generate these reports? Briefly explain your recommendations and be as specific as possible.

2. When Dr. Crunch gets the report, give two (2) examples of ways you think he could use the information to restructure his practice and be sure to consider comparisons with local, regional, and national data for other orthopedists.

Based on the information provided in Scenario 2 above, address the items below:

1. Describe what kinds of data tables or databases would contain the information requested for Dr. Serena. Briefly explain why you chose those particular databases or tables. Be as specific as possible.

2. Explain how the doctor could use this information in her practice in at least two (2) ways and be sure to consider quality of care, patient safety, and dermatology comparison data.

Save your assignment as a Microsoft Word document.

Rubric:

Module 06 Assignment - Medical Data Reporting Needs

Lesson Content:

Data Analysis: Types and Tasks

Why Conduct Data Analysis and Generate Useful Information?

The realm of healthcare is complex, indeed. The groups involved -- providers, payers, governing boards, patients, and healthcare staff -- each have their own unique needs and goals. Just as healthcare is complex, so are the types of studies and analyses that can be desired and pursued.

Consider the following reasons for conducting data analysis and generating useful information for decision makers. Studies may be conducted regarding things such as:

• Patient Safety - how to improve patient safety and individual patient care

• Care Processes - how care is currently being rendered

• Process Improvements - exploring ways to increase efficiency and effectiveness

• Public and Community Health - improving things such as immunization use and rapid response to epidemics

• Healthcare System-wide Efficiency and Coordination Among Organizations - improvements such as more rapid prior authorizations

Each of those study types will be covered in the sections that follow.

Studies on Improvements in Patient Safety and Care

In 1999, the Institute of Medicine published a groundbreaking report called To Err is Human: Building a Safer Health System. That report shook the foundation of many assumptions about medical care and made clear how far the system needed to improve.

Sixteen years later, a follow-up report by the National Patient Safety Foundation (NPSF, 2015) was written by an expert panel convened to evaluate progress toward the goals. The findings are summarized in the report Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human. The (2015) report made the following eight (8) major recommendations:

1. Establish and maintain a safety culture.

2. Provide centralized and coordinated oversight of patient safety.

3. Create a common set of safety metrics to reflect meaningful outcomes.

4. Increase funding for patient safety research.

5. Address patient safety across the entirecare continuum.

6. Support the healthcare workforce.

7. Partner with patients and families.

8. Ensure that technology is safe and optimized for patient safety.

As you can see from those recommendations, there continues to be a call for more oversight of patient care, more measurement via healthcare metrics, and more involvement of the entire care continuum. It is important to recognize that:

• In order to conduct oversight, we need data.

• In order to have measurement using meaningful metrics, we need to use data analysis and the establishment of metrics and goals.

• In order to evaluate safety across the continuum of care, we need more studies, more analysis, and the cooperation of multiple organizations.

We are fortunate that the implementation of improved information systems in healthcare, including the EHR, has been occurring around the same time as that 2015 report. This is convenient for the collection of needed information. Now though, efforts need to be devoted to reviewing the potential of all that data.

Please note that the work of the NPSF is focused mainly on avoiding patient injury and adverse events. Their mission is not "data security," and this is not an information security topic.

A patient safety study topic can be as small as an independent physician's office measuring success with their follow-up care reminders sent to patients with diabetes or as large as an insurance company study aggregating care over many practices and hospitals, evaluating the appropriateness of medications prescribed for conditions such as diabetes.

Studies on Care Processes and Benchmarking

Identifying the current state of our medical practices/healthcare organizations and goals is extremely important. Clinical and business processes affect patients who, ultimately, determine the financial and operational success of our organizations.

The Healthcare Information and Management Systems Society (HIMSS) explained, on their webpage, Define Current State, Needs, and Goals, that for an organization that is focusing on being effective, some studies could be done on:

• data assets

• analyst assets

• healthcare staff assets

Through benchmarking activities, we can also:

• assess current clinical and operational processes and outcomes

• compare baseline clinical, business, and operational performance

Current-state Analysis

Why study current processes if we are not sure they should be continued as is? Well, there is no need to "throw the baby out with the bathwater," if much of what is being done currently meets needs and has evolved out of what is comfortable for our staff. However, benchmarking against other systems, practices, and our own history can help to determine if our performance is comparable to what other organizations are currently doing.

Benchmarking often will look just at the "current state" of a process within our own organizations versus other organizations. We call this a current-state analysis, when the focus is on what a measure or process looks like at present.

To start the current-state analysis, focus on determining what assets are already in place: the data available, the analyst staff, and operational healthcare staff we need to provide input into the benchmarking. This is part of planning out how to do the benchmarking project. Organizations should also evaluate and understand what topics we are already collecting data on, and where this data and information can be found. With the data and analyst assets already in place, we can do these benchmarking activities and perform future studies on improvements and as a force for change, as well.

The simple benchmarking table shown below represents the results from the analysis of the current state "Our Community Hospital" compared with exemplar regional hospitals ("Speedy Hospital" and "Massive Hospital").

The next section focuses on studies aimed at changes and improvements. Current-state analyses are limited in terms of the amount of state-of-the-art improvements that would occur, without further action and plans.

Studies on Process Improvements: Efficiency and Effectiveness

Improving and transforming care processes is an extremely valuable goal for all healthcare organizations and not just for those struggling to survive. Many are realizing that breakdowns in processes and care are occurring, but these organizations need help from other organizations and experts in understanding why and how to fix those breakdowns.

One recent initiative is the Joint Commission's "Center for Transforming Healthcare." As described in their report Facts about the Joint Commission Center for Transforming Healthcare, the Center uses leading hospitals and care centers to analyze their care processes, combining data, initiatives, and insights to determine process "breakdowns" in care. Once targeted solutions are developed, these are shared with all member healthcare organizations accredited by the Joint Commission. A tool for Targeted Solutions is one application made available so that organizations can measure systematically, collect their performance data, and identify their own system's barriers to optimum performance. A Leadership advisory council was formed in 2010 to help guide the work of the Center.

Example: Hand Hygiene Project

One highly effective initiative of the Center for Transforming Healthcare was the Hand Hygiene Project. Within three years after release of that project's findings, average hand washing compliance (in institutions measuring such) improved from 57.9 percent compliance to 83.5 percent. That is an extremely impressive improvement in the practice of hand washing! Without defined measures, focused studies, and much work on education, we would not even be able to measure such changes.

Handwashing is not just an end in itself, though. Improved compliance translates to lower infection rates in patients, as certain infections have historically spread throughout healthcare provider lack of attending to such basic hygiene measures.

Just as that one example has shown, many studies can be done that will require data collection, data analysis, and careful consideration of an organization's processes.

Studies on Improvements in Public and Community Health

One goal of the CMS Meaningful Use program is for community-wide health improvements. As you may recall, the CMS is the federal agency that administers Medicare programs and the federal portion and policy of Medicaid. The Meaningful Use program is the main program that is providing financial incentives and promoting use of Electronic Health Records (EHR) in hospitals and medical practices. The first stage of that program was to provide for increased provider adoption and use of Certified EHR software. Hospitals could begin attesting to Stage 1 requirements starting in 2011, or within a few years afterwards. The second stage of Meaningful Use (Stage 2) features increased reporting on Quality measures in order to receive the incentive payments. Submitting electronic data on immunizations is one example of a Stage 2 function. Reporting cancer cases to a centralized cancer registry is another function that has been added to Stage 2. Stage 3 of Meaningful Use involves greater engagement of patients and community in their care. Features such as patient interactive web-based portals provided by the physician or hospital providers, and written summaries of their care at end of patient visits, are ways to increase the patient engagement and control over their care. Meeting Meaningful Use activities, especially for Stages 2 and 3, involves more sophisticated use of EHR and data use. Ability to meet Meaningful Use criteria is designed to ultimately improve the public's health and engagement in care.

Process improvements within organizations are certainly an important goal within an individual organization. Going beyond the improvements and care in a single organization, though, requires an entire community or regional approach.

The complexity and obstacles of working on region-wide studies are significant. Data are often not comparable from one institution to another. Data definitions and methods used to collect the information entered vary. It takes advanced knowledge of data manipulation, data design, and research methods to be able to design community and regional studies that will have meaningful results.

This process of using patient care for regional studies has begun with greater data sharing on a community and regional basis. The electronic healthcare record (EHR) is making some sharing of patient care information possible via Healthcare Information Exchanges. However, these exchanges involve a great deal of technical and political work in order to achieve desired goals. Also, not all brands of EHR are compatible with each other. The data definitions and formats will vary. As you have seen already in your design work using Microsoft Access, specification of the data names and types is partly at the discretion of the designer. This means that not every EHR system communicates very well with every other system.

In spite of the obstacles, some healthcare insurance entities, national disease registries, and academic research organizations (universities and others) have started to make inroads toward community-wide studies. Also, disease-specific national registries work to provide standardized formats and data collection and perform studies on specific conditions.

Studies to Increase System-wide Efficiency and Coordination

Anyone who has had to coordinate care among several different providers for themselves (or even a relative) to address a complex medical condition knows that there are shortcomings in communications between healthcare entities. Consider these scenarios:

• Insurers demand information for prior authorization but the physician's office has trouble providing the information in the proper format and level of detail. The information goes back and forth, with many faxes and wasted efforts resulting.

• A recent surgery leads to the need for Durable Medical Equipment (DME) like a wheelchair, but the insurer or CMS denies the claim, believing the need to be related to an automobile accident from four years ago instead of the current medical condition. Then, the patient is billed on a private-pay basis for what their insurance is actually supposed to cover. Nothing gets paid for months as the patient, DME provider and insurer argue back and forth over who is responsible.

Also, when a patient is transferred from one healthcare institution to another, communications in the past were often less than optimal. Now, there have been some improvements in the transfer of medications lists and diagnoses efficiently and effectively.

Studies about the medical needs of patients, the efficiency with which information and data are exchanged, and improvements to those processes are all needed. Efforts to make the prior authorization information exchange process more electronic-based, instead of multiple faxed papers, are meeting with some success already.

References

Healthcare Information and Management Systems Society (2017). Define Current State, Needs, and Goals. Retrieved April, 6-2017, from http://www.himss.org/define-current-state-needs-and-goals

National Patient Safety Foundation (2015). Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human. Retrieved April 6, 2017, from http://www.npsf.org/?page=freefromharm

The Joint Commission (2016): Facts about the Joint Commission Center for Transforming Healthcare. Retrieved April 6, 2017, from http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_Fact_Sheet_1-14-16.pdf

Normal Forms

The Importance of Normalizing

"Normal Forms" reflect some of the basic design principles that systems analysts and database designers use. Database designers are well-prepared to organize data into the tables needed. There are a number of principles of design that apply at the systems analysis level.

One of the most common issues with data reporting is that data inconsistencies can occur when redundancies exist within the data. That is, if the same data is entered in more than one place or more than one way, it leads to trouble. For example, we try to not have a patient's address entered into multiple tables since the data entry process (as well as patient address changes) can introduce errors and inconsistencies.

To combat this duplication issue and other design problems, database tables need to be normalized. There are various stages during the process of normalization, called normal forms. Each normal form has certain characteristics. The higher the normal form, the less redundancy exists within the data. The most common normal forms are listed below: