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Change management for quality improvement
Posted on Mon, Oct 19, 2009 - 01:25 amQuality reporting for performance measurement and provider feedback is the backbone of meaningful use of health IT, David Blumenthal, MD, National Health IT Coordinator, told attendees of a National Quality Forum conference last week.
It's pretty straightforward. The National Quality Forum is converting its existing quality measures for use in EHRs and standardizing them so there is one uniform way of measuring quality among providers across the country. The ultimate goal is to raise the quality of healthcare by changing the way physicians and hospitals operate. Paul Tang, MD, chief medical director of the Palo Alto Medical Foundation and a vice chairman of the Health IT Policy Committee, called it change management. Providing better information to physicians and hospitals will drive them to change the way they practice to improve the quality of care they deliver. Health IT is the enabler or the tool that will provide better information.
There are those who resent being told by the government how to practice. The obvious response is that as a payer, namely the Centers for Medicare and Medicaid Services, the government has the right to determine the rules of engagement.
Another argument is that you can't apply a one-size-fits-all quality metric across the country because there are too many variables and the playing field is not level, especially in poorer regions. The operative word is improvement. No matter where you start, if you improve you win and so do your patients and your community.
Who can argue pushing for quality improvement? So what other opposition is out there? I’m interested in hearing about your thoughts on change management for quality improvement through the use of health IT. What’s the resistance?
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I am convinced that we are entirely capable of spending $20+ Billion and make very little difference in the quality, efficiency, or effectiveness of medicine. In fact, I will go so far as to say that is going to be the natural outcome - lacking a concerted leadership to do more. I believe the key is not the EHR you choose, nor your budget, nor your native intelligence. I believe that there is a single key - why are you doing this and what do you want to get out of it? If you answer this "to get stimulus money", or "to be more efficient", or "because it is inevitable" you will get an electronic version of what you have today on paper. Only if your answer is something along the lines of "we are passionate about improving the health of our patients" will you have the foundation to create something truly compelling. The big discussion should be - what is our intent and how do we lead a change effort to achieve that intent.
I agree with these comments. There is an industry concern that implementations will be done only for the incentives. But you won't get the incentives if you don't prove meaningful use. So, that means before these organizations dive into what they think is easy money, they need to realize (either through the state designated entities, the resource centers, consultants and so on) that installing a system won't cut it. Who knows what percentage of the healthcare systems and provider groups will have that mentality. I will say that there are many healthcare systems and provider groups that have had these big IT initiatives prior to ARRA. Their vision is to improve the quality of care they deliver in a cost-effective manner. They are moving ahead regardless because of their vision. I heard one executive speak at a health IT summit last month and say that his health system is spending more than a million on its health IT initiative. The ARRA incentives, while nice, are pocket change. Those guys need to get their message out more broadly to the industry: We're doing this in the interests of our physicians and our patients. Period.