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Making the Case for Health Care Data to Get Clinical

McCombs TODAY is highlighting research that will be discussed at the Innovation in Health Care Delivery Systems Symposium, including Kristie Loescher's work on characteristics of an information-driven organization.

Is there a more challenging industry for data management than health care? After more than 20 years experience analyzing medical care management and outcomes, Lecturer Kristie Loescher of McCombs's management department thinks not.

"To start with, there aren't industry clinical (non-financial) data standards that are apples-to-apples across hospitals," Loescher explains. "For example, the Holiday Inns and Disneyworlds can electronically track and analyze their customers across locations and countries. We cannot do that in health care."

And it turns out that is only a tip of the iceberg. Just a few of the other complexities that arise in this space include:

  • Data integration. Though there are some standards that are used widely across hospitals, like medical coding, they don't currently tie in to important demographics and situational data. For example, did the person who had complications at the ER do so because they were given inadequate care, or because they refused care? Further, how do four separate pharmacists across town figure out if someone is mixing prescriptions (from different doctors) that they shouldn't be?
  • Community standards of care. Each region, hospital, doctor and nurse has differing standards and reporting methods and measures they employ. Demographics of a region (i.e. a very busy hospital system vs. a more relaxed one) may also play into standards.
  • Difficulty of tracking outcomes. Once a person leaves the hospital or doctor's office, how do we track outcomes in the longer-term? Why did the patient not return to the hospital--can we assume they are healthy? Or might they simply have moved to another town?
  • Medicine viewed as an art (versus something more quantifiable) by some health care providers. Cultural norms are always some of the hardest things to change in any organization, particularly given the typical hospital structure where physicians are their own bosses.

Ironically, the complexities are exactly what make the ability to reap benefits so high.

"In health care, more is not better." Loescher says, continuing, "However, customers do not experience the marginal utility concept in health care services that they do with other goods and services. The consumer is always willing to buy 'more health' and typically see more care as being equal to more health--but in reality, this is not the case."

Why? Because paying for, and getting, treatments or tests that won't benefit you wastes time and money and also may even increase your risk--if it's an unnecessary medical procedure, for example. Further, benefits of data integration (like built-in heuristics) can help minimize medical error, particularly for drug interactions or other complex, but quantifiable, procedures.

"Health care is one of last frontiers for us in terms of major turnarounds. We have not even scratched the surface of the quality improvements that can happen," Loescher asserts.

Loescher's research focuses on ways to reengineer the organizational and cultural infrastructure of health care so that tools like clinical data warehouses (CDWs) and electronic medical records (EMRs) can flourish, creating better health for us all and minimizing costly medical mistakes. She believes that in this effort government must be a patron to cultivate major success.

"For any given hospital to make this change requires a huge investment and many of the benefits that would occur would be for patients, not the hospital itself." There are also network effects to consider; the more health care uses integrated data systems, the more valuable the data and systems become over time for everyone who uses them. "Health care is one of last frontiers for us in terms of major turnarounds. We have not even scratched the surface of the quality improvements that can happen," Loescher asserts.

However, she is also points out that, in spite of the lack of much medical integration, that we enjoy excellent health care in the United States.

"We have great health care here in the U.S., despite these data issues. Generally, with concerned care givers putting in extra effort, along with patients acting as their own advocates, patient needs are met. So, imagine what is possible if the system was driven by more coordinated, seamless information!"

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