Assessing the Value of Digital Health

Leveraging the HIMSS Value STEPS™ Framework

Kendall Cortelyou-Ward, Margaret Schulte, Lorren Pettit

• Publisher: Productivity Press
• Year: 2018
• Print ISBN:
  9780815376422
• eBook ISBN:
  9781351237598
• Topic: Medicine
• Subtopic: Operations

HIMSS set out to develop a dynamic framework by which to easily catalogue the varied beneficial evidences of digital health. From this effort, HIMSS introduced to the market the HIMSS Value STEPS™ framework.

This book will leverage the HIMSS Value STEPS™ model to identify and define the expressions of value the use of health IT systems can yield per the following domains: Satisfaction, Treatment/Clinical, Electronic Secure Data, Patient Engagement and Population Health, and Savings. Using this framework, HIMSS has developed a collection of over 2,000 cases reflecting the value that hospitals, health systems and other providers have experienced following implementation of their electronic health record and/or other IT-related applications. The more than 17,000 value statements that have been extracted from the 2,000+ case articles have been classified within 85 Standard Value Standard (SVS) within the five STEPS domains. The book will describe the STEPS model to demonstrate the impact of health IT in healthcare organizations, and the quality of care and overall financial and operational performance improvements that have been achieved.

Chapter 1

Background: Why Focus on Digital Health Information Technology Value?

Margaret Schulte

Learning Objectives

■ Define healthcare value from the perspective of patient, provider and payer.

■ Describe the importance of “value” in the expansion of HIT adoption in the United States

■ Frame the evolution and the purpose of public policy in support of HIT.

■ Identify and explain incentive programs that spurred the development and implementation of HIT.

Definitions

■ Triple Aim: A framework developed by the Institute for Healthcare Improvement (IHI) that describes an approach to optimizing health system performance. It is IHI’s contention that new designs must be developed to simultaneously pursue three outcomes, which together are called the Triple Aim: (1) Improving the patient experience of care (including quality and satisfaction), (2) improving the health of populations; and (3) reducing the per capita cost of health care (IHI, 2012).

■ Value-based payment system: Also known as “performance-based reimbursement.” Value-based payment systems provide financial incentives to healthcare providers for meeting performance improvement measures. Those measures are designed to achieve improved quality of care.

Introduction

U.S. healthcare delivery organizations today face a new challenge as well as a new opportunity: to improve the patient experience of care and the health of populations while reducing the per capita cost of healthcare. This chapter focuses on how the provider market’s demand for data and information to achieve new measures of value has accelerated the adoption of electronic health records (EHR) and other digital technologies (e.g. mobile, telehealth). Driven by multiple forces including the Triple Aim, changing reimbursement structures and the Agency for Healthcare Research and Quality (AHRQ), the federal government’s leading agency charged with improving the quality, safety, efficiency and effectiveness of health care for all Americans, efforts to realize these concurrent goals have pushed U.S. healthcare organizations to re-focus healthcare delivery on “value” rather than “volume.”

In the transition from volume to value, provider success is based on the assumption of risk and the expectation that the delivery system can accurately assess its performance and the health of its population. Value-based payment methods have been designed to incentivize the achievement of improvements in quality and to drive cost reduction. Core to the development of value-based payment design is the availability of information systems and the analytics that support users in clinical and management decisions. Indeed, delivering value as prescribed by the Triple Aim is too complex without the aid of supportive technologies. The AHRQ defines quality health care “as doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results” (AHRQ, 2003).

The digital record for example, supports the identification and adoption of measurable quality goals. Performance can therefore be evaluated against the goals on each of these measures. Consequently, access to data and the insight its analysis provides are critical to the success of transitioning to value-based care.

In this chapter, we focus on the factors driving U.S. healthcare providers to embrace this new definition of value in healthcare, as well as the concurrent demand for data and information to achieve new measures of value. We also spend some time exploring the forces driving the ubiquitous adoption of EHRs and other digital technologies in order to gain improved outcomes in the health of the population. Financial incentives and delivery structures, supported by information technology, have been put in place to derive value in improved quality of care and efficiency that otherwise would not be possible. Case #1.1, Nicklaus Children’s Hospital, provides an example of improved quality that was made possible because of the availability of an EHR. Discussion of these incentives and structures and their relationship to performance improvement for increased value follows.

Case #1.1: The Nicklaus Children’s Hospital—Reducing blood transfusion error

Errors in blood transfusion practices can lead to serious consequences. The majority of errors occur due to the incorrect sampling of blood from a patient, obtaining the wrong unit of blood for a patient, or transfusing blood inappropriately. The Nicklaus Children’s Hospital was able to drop blood transfusion error rates to zero using barcoding technology.

Source: HIMSS, 2017b: Miami Children’s Health System.

Background

Michael Porter, the renowned American economist, says that:

[A]chieving high value for patients must become the overarching goal of health care delivery, with value defined as the health outcomes achieved per dollar spent. This goal is what matters for patients and unites the interests of all actors in the system. If value improves, then patients, payers, providers, and suppliers can all benefit while the economic sustainability of the health care system increases.

Porter, 2010

In the complex world of healthcare, value is too often defined subjectively based on individual roles or perspectives, i.e. those of the patient, provider, payer, regulator, etc. In a system that is already very complex, these perspectives can be in conflict. The individual or group perception of value may focus on one or a number of values such as access, satisfaction, efficiency, profitability, quality of care, cost savings, personal work ethic, etc.

Even with the best of intentions, achieving the highest health outcomes per dollar spent (i.e. high-level quality and improved efficiency) has been too often thwarted due to lack of data to support goals of measurable improved outcomes. For decades, healthcare providers cast “value” as something other than specific patient outcomes. Rather, it was expressed in vague statements such as “we provide high-quality care” and “the patient is our first concern.” These “truisms” were accepted when analytical data was not available to confirm or demonstrate otherwise. Even though we are in the infancy of healthcare information technology implementation and data analytics, the data that has already been generated is being used by organizations to achieve measurable performance improvement. For example, Case #1.2; describes how Parkland Health and Hospital System achieved a reduction in sepsis because they had the tools to identify early indications of possible sepsis. Given the organization’s access to the detailed data that digital technology provided on each patient, clinicians at Parkland were able to improve compliance with significant quality improvement measures from 14% to 29%.

Case #1.2: Parkland Health and Hospital System

Parkland Health and Hospital System used innovative mobile solutions for sepsis alerts by aggregating multiple patient-specific measures in real-time to estimate the risk of a patient being classified as septic. Parkland’s sepsis bundle compliance improved from 14% to 29%. The average and median length-of-stay reductions for Sepsis POA (present-on-admission) patients were 21.5% and 12.6%, respectively.

Source: HIMSS, 2017c: Parkland Health and Hospital System.

With the publication of the 1999 Institute of Medicine (IOM) report “To err is human: Building a safer health system,” healthcare leaders came face-to-face with credible data related to the numbers of preventable patient deaths and injuries that were happening within the care delivery system—almost 100,000 deaths each year. Preventable errors occur due in large part to unintentional human error and lack of information to recognize, measure and correct. As Don Berwick, MD, President Emeritus and Senior Fellow, IHI, put it: “We must accept human error as inevitable—and design around that fact” (IHI, 2018).

Prior to the publication of the IOM report, healthcare providers were at a major disadvantage to gauge their performance in that they did not have the information to see themselves in the “data mirror.” Once they saw and accepted the data, they recognized that they had to take steps to change performance outcomes. They had to determine where to focus, to design and to implement the necessary clinical measures and processes for change. More detailed data was needed, and it was only going to be accessed through information technology. According to HIMSS:

IT provides organizations with the means to assess their value-based care optimization efforts, create their HIT optimization strategies, achieve their goals, gain recognition for their efforts, and finally, share their success stories with others like them—all by leveraging the power of people, processes and technology to transform health and healthcare through IT.

HIMSS, 2016

Finding Value in HIT: A Brief History

For decades, going back to the 1960s and 1970s, there was a small but growing number of professionals in healthcare actively viewing the EHR as an essential tool to collect meaningful data and, with it, improve healthcare delivery and outcomes. This was an elite group of very early adopters of what were rudimentary information systems when the EHR was introduced. However, it was only after decades of gradual progress in developing the technology, of dramatically rising healthcare costs, and the publication of the 1999 IOM report that the number of voices advocating for the EHR became strong enough to effectively press for a national initiative to significantly boost the path to the adoption of EHRs throughout the healthcare system. Policy makers, payers and providers generally agreed that something had to be done to address rising costs and to stop the many fatal and/or harmful, but preventable, outcomes that occur in varied healthcare settings. In its report, the IOM directly addressed the need for IT in healthcare. They concluded, among other things, that healthcare would be safer with such systems as computerized physician order entry (CPOE) in place to reduce medical errors that result from causes such as indecipherable handwriting. More and better information was believed to be the answer that would drive better decision-making, more efficient processes, and better outcomes (i.e. better value).

Within 5 years of the release of the IOM report, President George W. Bush allocated $50 million in the FY 2004 federal budget to provide grants to local and regional organizations to develop systems for information sharing. A year later, in the FY 2005 budget, he took this a substantial step further when he increased the funding to $100 million calling for “widespread adoption of electronic health records in 10 years,” (Healthcare IT News, 2004) and created, by Executive Order, the sub-Cabinet Office of National Health Information Coordinator. The $100 million funding was designated for EHR demonstration projects throughout the country to pave the way for widespread adoption.

According to White House documentation on this initiative, the President belie...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Contents
• Preface
• Acknowledgements
• Authors
• 1 Background: Why Focus on Digital Health Information Technology Value?
• 2 HIMSS Value STEPSTM Framework
• 3 Satisfaction
• 4 Treatment/Clinical
• 5 Electronic Secure Data/Information
• 6 Patient Engagement and Population Management
• 7 Savings
• 8 Inter-Relationships of the Domains in the STEPSTM Value Framework
• Appendix A
• Appendix B
• Appendix C: HIMSS Value STEPSTM  Framework Domains
• Index