In order for healthcare organizations to achieve their vision of timely, effective, equitable and excellent care, Clinical Analytics in Healthcare must become a pervasive and widely practiced activity. There has been a widely spread global adoption of the Electronic Health Record (EHR) which has increased the volume of data available for performance measurement and healthcare organizational capacity for continuous quality improvement. However, EHR adoption does not automatically result in optimal use of clinical data for performance improvement. In order to understand organizational factors related to use of data for clinical analytics, a survey was conducted of hospitals and hospital-based clinics. The survey revealed the sub-optimal use of data captured as a byproduct of care delivery, the need for tools and methodologies to assist with data analytics, and the need for disciplined organizational structure and strategies. Informatics nurse professionals are well-positioned to lead analytical efforts and serve as a catalyst in their facility’s transformations into a data-driven organization.
Clinical Analytics in healthcare is important because it could significantly improve the cost and quality of care. There are many healthcare initiatives that could benefit significantly from clinical analytics. For example:
The shift from fee-for-service reimbursements to value-based purchasing: Up until 2010, when the Affordable Care Act established the Hospital Value-Based Purchasing Program, hospitals received payment based on the volume of care they provided. This fee-for-service reimbursement program in some cases encouraged the overuse of healthcare services without necessarily improving care outcomes. Now, health systems are facing the greatest financial challenge in their history as they transition to value-based purchasing — a model that rewards decreased costs and improved quality. It’s a challenge health systems can overcome. But to be successful, they need clinical analytics to access to their data to understand how they compare to the many clinical quality measures and the costs related to delivering care. With payments now hinging upon quality, focusing solely on old metrics won’t bring financial success, particularly not in a world of accountable care organizations (ACOs), bundled payments, quality measures, and shared savings. Instead, health systems must concentrate on lowering the costs of healthcare while also providing higher value and quality.
The challenges of shifting to value-based purchasing may seem overwhelming. But by using clinical analytics to pull from the wealth of data an enterprise data warehouse (EDW) collects, it will be possible for health systems to meet these challenges. In specific, clinical analytics make it possible for health systems to do the following: Reduce waste, Improve margins, Improve Performance, Streamline operations, Automatically track quality measures, Succeed in shared savings arrangements and
Understand the complete picture of the cost structure.
Another initiative is the widely recognized
Accountable care organizations (ACOs): Accountable care organizations (ACOs) are another healthcare initiative that encourages groups of providers to voluntarily give high-quality, coordinated care to populations of patients. The concept of an ACO is still evolving, but typically the groups of providers include doctors, hospitals, health plans, and others. The coordinated care an ACO offers is designed to give patients the right kind of care without adding extra expenses. ACOs are able to avoid the extra expenses by only ordering care with a proven benefit and by not ordering duplicating services — a significant shift from fee-for-service. In addition, ACOs are particularly concerned about making sure the chronically ill receive proper care. To unlock the data in their ACO EMR investment, health systems need an EDW. The EDW provides the clinical analytics abilities so desperately needed because the EDW makes it possible for analysts to dig into the data in a single repository that pulls in all of the data from the various source systems. Yet, less than 25 percent of healthcare organizations have any type of EDW.