Do you remember playing the “telephone game,” that summer camp or party activity that humorously illustrated how information becomes corrupted after it is passed from person to person? Players sat or stood in a circle and the first person whispered a word or phrase into the ear of the person next to her, and on down the line it went.
At the conclusion, the last person in the line repeated the word or phrase, usually to the amusement of the players and anyone watching. The end result rarely, if ever, resembled the first player’s word or phrase.
Did you hear the one about ...
One of the Primaris Quality Data Services managers used the “telephone game” analogy recently to describe what happens when abstraction training and processes are passed down from employee to employee without up-to-date training and, in some cases, no thorough training for the person who first passed down the know-how. She came from a setting where she was responsible for core measures reporting. Her initial training came from a staff member who was retiring. Not surprisingly, that staff member’s introduction and knowledge of core measures reporting was passed down from a previous employee.
“It was a lot like playing telephone,” she said.
Core Measures: No laughing matter.
The result? A lot of double- and triple-checking (and who has time for that?) and, ultimately, a lot of trial and error and a significant risk of reporting inaccurate and incomplete data. And when it comes to something as serious as core measures abstraction, inaccuracies and missing data are no laughing matter. The DIY approach is also risky because core measures are publicly reported. As patients become much more consumer-oriented, they can discover options for quality care by comparing hospitals.
Does your hospital have staff dedicated to the task and the time and organizational commitment to training and staying abreast of manual changes? It’s clear that healthcare professionals already wear a lot of hats in their facilities. That’s why the additional load of core measures data abstraction and reporting can be overwhelming.
Not only is the staff shuffling and multi-tasking an overload at times, data abstraction can be immensely complex. Consider some of these other real-world examples from Primaris abstractors and clients:
- Most in-house abstractors use a limited portion of their electronic health record (EHR) on a limited basis. Primaris abstractors typically use the entire EHR, depending on the measure, and will know their way around the EHR sometimes better than in-house staff.
- Core measures manual changes occur at least annually, often every six months, and sometimes more frequently. Abstractors are expected to keep up with the changes as they become available.
- Not only do manual specs change, but hospitals frequently switch or upgrade EHRs. Learning a new EHR system and maintaining current training is a daunting order for in-house staff.
- Primaris abstractors have achieved a 98 to 99 percent inter-rater reliability accuracy over the past four years. In-house abstraction rarely gets double-checked. There’s simply not time or staff for the task.
Unlocking data's potential.
Data has enormous potential to enhance the quality of healthcare, but unlocking that potential can be challenging. Many medical providers feel like they are swimming in data, clinical teams are expected to chart patient data, and then chart and chart some more.
Charting and entering data, notes, and other treatment or diagnostic information is only part of the workload. To unlock the data, the numbers, codes, and notes must be abstracted – pulled back out of the data reservoir – and then analyzed and reported. That’s certainly the case for core measures data abstraction.
The top IT official at the Office of National Coordinator for Health (ONC) says to get the most value out of all the data we’re collecting – not just for the sake of collecting it – the vast troves of information must lead to direct, achievable results to improve health care for all. It starts with each individual patient, with the first touch-point of care, and requires a new level and commitment to coordination of care among providers.
NEXT IN OUR CORE MEASURES SERIES
- Quality improvement season never ends, meaning core measures abstraction is year-round. How do you handle your ocean of data. Are your drowning in data?
- Summarizing our core measures series, with select tips and reminders to benefit your data abstraction, workflow, and general knowledge of these important measures.
PREVIOUSLY IN OUR SERIES
- Core measures target costliest, common conditions.
- Sepsis is an emergency, plain and simple. The condition claims a life every two minutes and it adds $27 billion to our annual healthcare costs. It’s also a challenging measure for abstractors.