Osheroff: Quality is a business imperative

CHICAGO—The move to value in healthcare creates new imperatives, said Jerome Osheroff, principal of TMIT Consulting, speaking at the Quality Symposium held during the 2015 HIMSS Annual Conference & Exhibition.

“It’s shocking this wasn’t the norm in healthcare delivery all along,” he said. The goal is to improve acute and chronic condition measures, reduce preventable harm and readmissions, improve efficiency and reduce costs. “It’s not just nice to do but these are business imperatives. How can we rise to that challenge?”

The challenge with compliance, said Pauline Byom, MBA, DHSH, regional quality director at the Mayo Clinic Health System, is “the lack of a single source of truth on quality measurement.” There are few case studies and guidelines with evidence of sustainable improved outcomes demonstrating how HER-enabled process workflows can improve adherence to best practices and quality outcomes. “Medical errors still exist. Even though we’re checking all the boxes, we’re still causing harm.”

“There are tools and strategies that can help us do better,” said Osheroff. “It’s like trying to keep the car on the road using just the guardrails—it will work but it’s not the best way.”

But, improving care delivery and outcomes requires “meticulous attention to people, processes and products, he said. Referring to those organizations that have won Davies Awards for their use of health IT, he said they all had “tremendous attention devoted to the people dimension. Projects are usually successful to the degree that people are addressed.”

Successful quality improvement (QI) projects are “win-win-wins” for patients, the QI project team and clinicians.

Osheroff suggested several “warm-up questions” to engage site leads such as: What percentage of our patients are meeting the target? How are we supporting patient and clinician decisions and actions to drive improvement? Are we using our EHRs and other tools to the greatest benefit for workflow and outcomes? How can we work as a group to get more efficient at quality improvement and collaboration? What needs to happen for optimal care?

Organizations also need to know what information flows through which people in what formats and channels at which times that lead to suboptimal performance.

These are all recommendations and guidance included in the Office of the National Coordinator for Health IT’s Practice Transformation Toolkit, he said. The tools have been used in numerous projects on a variety of targets, including asthma control and blood pressure control.

Looking ahead, healthcare faces longer visits and more connections to devices and the industry will have to determine how to make optimal use of the tools at their disposal. “Use of all the apps is going to be exciting,” Osheroff said.

“Healthcare is a system with an output,” he said, but that output is not obvious and it’s changing. It’s up to the industry to understand the nature of the output and figure out how to reengineer the system so “we produce the outcomes we want.”