I had a meeting a few weeks back with one of the business people at my institution who acts as a liaison with the IT group. It was was rather enlightening. He had a wealth of information regarding the strengths and weaknesses of our institution and a different perspective from my own. I have my own vision regarding how we can use technology to interface with and collect information from patients in a structured way and how this shift could change how we do business.
I am consistently struck by how often I am placed in clinical situations where I am required to address patient's questions where I have little or no real data. How often does this intervention work? How quickly can I expect to see results? What side effects can I expect and when? When I described this observation to my IT/business colleague, he was surprised. In his world, the problem he faces is more often too much data. How can we have too much data at the same time as what appears to be little or no data relevant to the needs of patients and clinicians at the point of service?
The answer is both observations are true. While we may collect mountains of data, little of it is actually collected from patients and the quality of the data collected at the point of service is simply dismal. In particular, the work flows linked to ambulatory patient encounters basically guarantee that the information collected will be at best sketchy and more often than not simply wrong. When patients are referred to me, the notes fall into two basic categories; unreadable hand written notes or computer generated templated notes which may be readable but are devoid of actual useful content. You can mine either of these sources for data and it is likely to be useless.
When patients or referring offices call to set up an appointment , there is little effort to actually identify the reason for the appointment. The idea is to secure an appointment, any appointment with any warm bodied provider with any available time slot. Wrong doc? Not enough time? Insufficient information regarding what has been done before? No matter. As long as the slot is filled, the co-pay collected, and the documentation sufficient to justify the billing, everything is copacetic. I am awash in data showing my scheduled to arrived ratio, my no-show rate, room utilization, and information on waits and delays. I have no idea on who actually calls us and what the nature of their problems are. I know what books of business that we want to expand because they are profitable. I have not idea of what services I need to expand because patients actually want and need them. We do not collect that data. I don't think anyone does.
This situation can only be fixed by changing the work flows associated with ambulatory encounters. However, when I outlined my approach to fixing this, my business/IT colleague had one question for me. "How are you going to monetize this?"Collecting information in a structured format from patients in an ongoing fashion between encounters will take IT resources, equipment, time and money. How can we pay for this. Surely something which brings value to patients can be monetized.
Actually not under the present business model. In many respects, health care entities may be better off not collecting this type of data since we might find something which forces us to respond. There is no CPT code for being more responsive to patient needs or wants. Creating a system to get rapid feedback from your customers is only good for the respective business if they can leverage improved information into a more profitable business model. At this point the there is no way to monetize such an innovative approach. It will not happen until it makes good business sense.
Clayton Christensen talks about the entrance of the mini-mills into the steel industry, focusing on rebar steel. It was the perfect product having no specs and it was buried in concrete so no one could check if it was really substandard. In the ambulatory medical world where there are few if any specs, ambulatory care begins to look like rebar steel. With rebar, the measures of quality are whether the building falls down, a pretty uncommon event. With health care, we focus on high stakes yet infrequent events for any one specific person (like life and death) an ignore whether what we do on a day to day basis may waste people's time and add little or no value to most people we interface with. We simply do not collect the information we need to address such questions.