March 2006

Data Standardization Provides Opportunities


The coordinated implementation of Catholic Health Initiatives’ new Information Management Plan will achieve several goals, including leveraging economies of scale for information technology systems to reduce costs and improve support. Just as important, however, is the goal of standardizing data across the system.

The coordinated implementation of Catholic Health Initiatives’ new Information Management Plan will achieve several goals, including leveraging economies of scale for information technology systems to reduce costs and improve support. Just as important, however, is the goal of standardizing data across the system. “Standardizing or normalizing data across Catholic Health Initiatives will better enable us to conduct benchmarking activities, share knowledge with each other, track quality performance and address regulatory requirements,” said Rick Turner, MD, vice president of clinical information management for Catholic Health Initiatives. “We’re asking Catholic Health Initiatives and market-based organization employees to help in this process by participating in affinity groups — groups of people with a common area of expertise — to evaluate, define and develop data standards in their areas.” Areas in which Catholic Health Initiatives is actively conducting data standardization include emergency services, pharmacy and clinical documentation. Emergency Departments Employees from Mercy Medical Center in Nampa, Idaho, and Saint Elizabeth Health Systems in Lincoln, Neb., the two market-based organizations that currently use Meditech’s emergency department management module, are working together to standardize the collection of patient information in their emergency departments. To create the standards, the employees formed an affinity group in July 2005. “The group has created tools to standardize triage, department orders and discharge instructions,” said Turner. “These tools are the result of a collaborative effort. While the group agreed on specific pieces of data that must be captured, there is the opportunity for individual facilities to add elements that meet their specific needs.” Turner said the group focused on data standardization for specific pieces of the overall emergency department process. “They knew that trying to standardize everything at once would amount to too much change in too short a time,” he said. “That approach creates a need for implementation to proceed perfectly, which is not realistic. The group has achieved good results by dividing the work into smaller pieces.” Pharmacy Turner said the members of the Emergency Department Affinity Group were inspired by the success of a group that previously created a pharmacy formulary. During 200 hours of meetings and phone conferences over six months, representatives of five market-based organizations that use Catholic Health Initiatives’ Advanced Clinical Information System (ACIS) established the formulary, which is a standard list of preferred pharmaceuticals, including specific instructions for nursing administration. “When this type of collaboration and cooperation is successful, others are encouraged to do the same,” said Turner. At first, the members of the pharmacy group were not sure it would be possible to create the formulary. “But, they found there was already a great deal of consistency among the market-based organizations: more than 70 percent of their individual formularies were already consistent, which put the goal of 90 percent within reach,” said Turner. The discovery of unexpected consistency in processes and practices among geographically diverse facilities repeated itself in the emergency department effort. “There is always variability in the practice of medicine, but when we bring people from across Catholic Health Initiatives together we find remarkable consensus,” said Turner. “That makes the process of standardization much more productive and rewarding.” Clinical Documentation While Catholic Health Initiatives’ facilities are widespread and diverse in size, they all perform clinical documentation. “All of our health care facilities ask questions of patients in order to register them and assess them,” said Ann Shepard, RN, director of clinical information management for Catholic Health Initiatives. “Standardizing that function, where it makes sense to do so, will benefit everyone involved.” For example, there are many different ways to record data on a patient chart. “A caregiver might document that a patient’s heart rate is exactly 72 beats per minute, or that the heart rate is within normal limits,” said Shepard. “A caregiver can document patient discomfort using a scale of one to ten, or by recording facial expression. If those or other pieces of clinical information can be documented more consistently, it would produce valuable information about patient care across our system.” Catholic Health Initiatives’ clinical information management team will work with nursing leadership to bring together temporary action groups (TAGs) that will work on standardization of specific pieces of clinical data. “For example, a TAG of patient caregivers could decide on a standard method of charting patient discomfort that would be adopted across Catholic Health Initiatives,” said Shepard. “These decisions will be made by advance practice and clinical specialty nurses, managers and ancillary colleagues who actually gather the data in their daily work. Because they will be so focused, we expect that TAGs can accomplish their work in just a few meetings, usually via conference call. With the work of many TAGs, we hope to eventually standardize appropriate elements of data collection from patient intake through discharge.” Exciting Benefits In addition to improved patient care, data standardization can deliver the important benefits of easing compliance, reducing costs and setting benchmarks. “The greatest benefit of this work is that it drives people to share information and to collaborate in creating tools that make all of us work better,” said Turner. “When people know that a standard is being created, they bring their best ideas to the table. And, the ultimate result of sharing best practices is better patient care.”