Health IT Summit: Good quality begins with data integrity

BOSTON--When it comes to quality improvements, you’ve got to start with data integrity, Dirk Stanley, MD, MPH, CMIO at Cooley Dickinson Hospital in Northampton, Mass., said at the iHT2 Health IT Summit on May 13.

“Data integrity is absolutely central and must be happening at the point of care,” Stanley said. “This requires more work than people appreciate. If you are not doing that, your data may be statistically significant but meaningless.”

Part of understanding data integrity is recognizing potential sampling bias; for example, if data are only collected during the day and not at night, analytics reports will be inaccurate. Thus providers should make sure workflow and the data collection process are part of the analytics strategy “not to just collect data—but meaningful data,” he said.

Within University of Florida Health Shands Hospital’s quality department, data on mortality, infections and readmissions, among others, are regularly analyzed to improve care delivery. While quality and integrity of data are an issue, “the piece that keeps me up at night are the issues of safety,” said Randy Harmtaz, who is senior vice president and chief quality officer.

To prevent safety risks, “you need to think of the workflow.” Nurses would document the same information in multiple places, thus the hospital had to redirect everyone to what and where to document items from a real direct care perspective, he said.

“Sometimes if the data don’t look right, you have to look at the workflow and see if something is broken there,” Harmtaz said.

Support is plentiful during the rollout of new technology, but when IT and other staff move to the next project clinicians often revert to old workflows or invent new workarounds. “Twenty-seven-year-old residents will work around safety and do things in ways you couldn’t even realize,” he said. That requires a tool to manage the workflow so even with a rotating workforce, it remains solid and measurable at key points.

“This is definitely one place we’ve fallen on our face,” added Gerald Greeley, CIO at Winchester Hospital in Massachusetts, on failing to look back after the implementation of a health IT project.

“People get the terminology and everyone gets on board, but then they don’t do it,” he said, citing the example of missing equipment, which a clinician could fail to document. “Workarounds can be seen as cherished.”

Winchester Hospital spends a lot of time analyzing normalized EHR data on dashboards to pinpoint employee and patient harm, so if something doesn’t look right, they go back to the source, he said.

“Workflow plays second fiddle to a lot of other conversations we have in health IT,” said Stanley, noting that accountability required of EHRs breaks a lot of old workflows, like physicians pre-signing prescription pads for nurses.

“Things we used to do in old medicine don’t work anymore. This is an unwritten cost of EHR implementation. And vendors don’t know workflows, and no one talks about that,” he added.