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Making "systems thinking"
standard practice
by Karen Conway, Executive Director, Industry
Relations, GHX
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A s we begin a new
year, I would like to take this opportunity to broaden the content that is
presented each month in Standard Practices. To date, the monthly
column has focused on the adoption of global data standards for product,
location and organization identification. We will continue to cover these
topics, especially with growing adoption of unique device identifiers (UDIs)
and a renewed interest in the value of global location numbers as one of the
tools needed to reduce the complexity of contract administration. At the
same time, I would like to think about standards and standard practices in
the context of the larger healthcare system and efforts to improve the
quality and lower the cost of care. I am a strong believer in applying more
"systems thinking" in healthcare — in fact, it’s a primary reason I am back
in graduate school studying the Science of Healthcare Delivery. As systems
thinkers, it’s important to consider how the adoption of standards — for
both data and processes — influences other aspects of the larger healthcare
system and vice versa. Systems thinking is fundamental to creating a
learning healthcare system that captures and shares accurate data and
insights across boundaries (e.g., functional, professional, organizational,
etc.) to understand what drives better and more cost effective healthcare.
The
Institute of Medicine (IOM) developed the concept of a learning healthcare
system in 2007 in response to earlier studies, including the 1999 To Err is
Human report, which reported that an alarming number of patients were being
harmed, rather than helped, by the U.S. healthcare system as a result of
preventable medical errors. The To Err is Human report was also the
impetus for U.S. Food and Drug Administration (FDA) regulations requiring
standards-based auto identification carriers, e.g., barcodes, on the labels of
pharmaceuticals and medical devices. The ability to capture data on the drugs
and devices used in patient care is an important factor in the effort to
establish a body of evidence on their real world performance, which can then be
shared as part of a learning healthcare system. A 2012 IOM report, entitled
Better Care at Lower Cost, highlighted the fact that there remains very
little evidence for many of the care decisions made today. A learning healthcare
system is designed to correct that.
While medical errors remain a serious problem, a report recently
issued by the Agency for Healthcare Research and Quality found that there were
2.1 million fewer hospital-acquired conditions (HACs) between 2010 and 2014.
That’s a 17 percent decline resulting in nearly $20 billion in savings. Forty
percent of the reductions were in adverse drug events, followed by a 28 percent
reduction in pressure ulcers and 16 percent for catheter-associated urinary
tract infections (CAUTI). Less frequent but often more serious central line
associated blood stream infections (CLABSI) dropped more than 70 percent.
Government officials could not point to the exact causal factors
for the improvements, but they credit payment reforms that no longer reimburse
hospitals for HACs and increased use of electronic health records (EHRs).
Personally, I believe the former is probably the primary catalyst, but if we are
to create a true learning system, we will need to document the specific steps
taken by hospitals to reduce adverse events along with the results. I have high
hopes that EHRs will help us achieve this but not until there is more
interoperability and better clinical supply documentation. I am only surmising,
but could the much larger drop in adverse drug events be related to the longer
standing pharmaceutical barcode rule and meaningful use requirements related to
capture of data on medications in EHRs? If so, then we should watch to see if
increased adoption of UDIs supports improvements in adverse events involving
medical devices. That’s where standardization of data makes a difference.
Standardization of process is also critically important. Ideally, EHRs will be
able to tell us how and when changes in clinical practice contribute to better
results.
On a final note, I would be remiss not to mention the work being documented
by the Association for Healthcare Resource and Materials Management (AHRMM)
through its Cost-Quality-Outcomes (CQO) Movement. On the AHRMM website, you can
find a number of leading practices and case studies around the role of supply
chain in reducing CAUTIs, pressure ulcers and central-line associated
bloodstream infections (CLABSI). In several of these studies, the providers
involved increased expenditures on supply bundles, which helped contribute to
lower infection rates and in turn a better patient experience and lower costs.
If we can document these kinds of detailed studies in sufficient volume, we can
begin to compile the evidence needed to support continual learning and, most
importantly, changes in process, product and practice that will deliver a better
healthcare system. Those are the kinds of topics I look forward to exploring
with you in future editions of Standard Practices. If you have ideas for
topics, I would like to hear from you. |
As the
Executive Director, Industry Relations at
GHX,
Karen Conway works with industry associations, standards bodies, government
agencies, analyst firms, academic institutions and the media to identify
opportunities for hospitals and suppliers to optimize supply chain
operations and improve business and clinical performance. Conway is
chair-elect of the board of directors of AHRMM, the supply chain
organization for the American Hospital Association. Conway is currently
writing a book on the Accountable Healthcare Leader, drawing upon the
concepts developed in her 2013 global leadership book, Leading from the
Edge, which she co-authored with the former chief talent officer of Cisco.
Conway serves on the editorial board of Healthcare Purchasing News.
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