Davis, a registered nurse and a principal for consulting firm CIC Advisory, will address that very issue in a HIMSS session that she’s presenting with Philip Smith, M.D., who’s written a book on implementing CPOE and is a former CMIO for Adventist Health System.
"Health care typically functions in siloes, though it’s getting better,” Davis says. “But if we don’t have a common set of definitions for what is an allergy and what is a medication, we can’t use the data to connect care.”
Davis and Smith will look at defining data needs, understanding baseline data and its limitations, establishing priorities, and setting requirements for data gathering and validation. They’ll also look at analytical tools and infrastructure considerations.
One key step is establishing the “source of truth” for each data point, regardless of how many different systems generate it. “In some organizations, we run our reports and each system gives us a different answer,” Davis says. For example, the finance department may say that a “day” starts at midnight for determining length of stay, while the quality department needs to start the day at the time the patient is actually admitted. If data is to be used across departments, all the users must come to the table and agree on definitions. Top executives may need to be firm about the need for agreement in order to persuade individual departments to change their ways.
The need for common definitions will become even greater as organizations feed information into health information exchanges, and Davis and Smith will look at how that issue is handled in working HIEs. She looks forward to the day when healthcare has definitions that are as consistent as the routing numbers used by the banking industry, which are interpreted the same way by every bank. “If we had standards like a bank routing number, we’d be in better shape,” she says.
Although his surgeon, the pre-anesthesia clinic and his anesthesiologist all asked the repetitive allergy questions, the cardiologist who met him only briefly prior to surgery so that she would be recognized when she picked up his care after the case, dd not.
His estate's attorney asked the cardiologist why she had not asked about his allergies. She replied that the data was available to her in the EHR and that she was aware of it, so she didn't find it necessary. But the attorney proceeded to paint her as an uncaring, negligent physician who was so interested in making fast money that she was unwilling to take the time to confirm the data, and that she was so driven by greed as to ignore the proper care of her patients. Displaying large, high quality images of the decedent's swollen, black, purple and bloody arms and legs resulting from the HIPA, as the decedant's daughter sobbed nearby, the attorney succeeded in gaining the sympathy of the jury and the cardiologist was found guilty of negligence. The $20 million judgement far exceeded her malpractice coverage of $3 million dollars, she lost her practice privileges at the hospital, and the state medical board stripped her of her license to practice medicine a year later. 18 months later, the evening after she was forcibly removed from her home due to a sheriff's sale following asset seizures to enforce the judgement, she committed suicide.
It doesn't really matter whether those people talk to each other or not, and medical care has absolutely nothing to do with it. In our current malpractice environment, it's simply every man or woman for himself.