Dignity Health’s data repository defines big—every night it grows by some 500 GB. Encompassing 39 hospitals across four western states, Dignity (the former Catholic Healthcare West) is using that data warehouse to create an analytics infrastructure to drive quality improvement efforts among an initial group of 600 physicians, themselves scattered across disparate locations.

Spanning 3 million patients, the database has information feeds from a number of feeds, including ambulatory EHRs, claims systems, and surgical systems in place at Dignity’s inpatient hospitals, says Dennis Sweeney, program director. “We are building a multi-tiered, relational database that includes patient demographics, patient encounters, labs, test results, vital signs, and radiology reports,” he says. (Sweeney will describe the data warehouse and analytics projects and their many challenges at Health Data Management’s forthcoming Healthcare Analytics Symposium & Expo, July 15-17 in Chicago. For more information about the event, click on www.healthdatamanagement.com/conferences/hcs/).

The surgical systems add data from on procedures and any surgical site infections documented. The database is used to comply with a state law mandating the reporting of surgical site infections to a federal database, National Healthcare Safety Network, maintained by the Centers for Disease Control, he adds.

Dignity also reports data to other federal programs from the database, including Meaningful Use and Medicare’s Physician Quality Reporting System. Its physicians asked for more comprehensive quality reporting about their own practices, an effort which Sweeney describes as “extraordinarily difficult.”

Even though the physicians use EHRs in their practices (and mostly use the same software, from Allscripts), they lack standardized ways of documenting conditions and work done, Sweeney notes. “Trying to determine if a patient had a colonoscopy is not easy,’ he says. “It might be recorded as a procedure, as part of a history, as a problem, as an order, or it just might come back on a claim. We can use the claim to denote the procedure was performed, but not the result."

In his conference talk, Sweeney will discuss Dignity’s efforts to tackle these documentation challenges and how clinical informatics leaders are creating standardized workflows at the group practices.

Despite the documentation challenges, Dignity has made headway in generating reports on a number of common quality metrics, such as treating diabetic patients. Using the database, physicians can chart their own quality efforts with their assigned patient panels and run comparisons against their peers in the same medical group. If a physician is falling short in one area, such as ordering foot exams for diabetics, he can use the warehouse to drill down to individual patients in need of the test who are holding down the quality score. “We create ‘pursuit lists,’ ” Sweeney says, describing how the set-up can generate lists of tasks for physicians to complete where quality is lagging.

Sweeney says other, even more perplexing challenges lie ahead. The health system has been designated as an accountable care organization for some of its Arizona hospitals, and ACO will include physicians outside Dignity’s corporate structure. “In one market, we have over 60 different practices in the Medicare project with different EHRs and different kinds of data being captured,” he says.

Sweeney’s talk, “Successes and Challenges Developing an Enterprise Clinical Analytics Solution - Ambulatory Information Management,” is scheduled for Tuesday, July 16, from 4:15 to 5 p.m.

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