When Cynthia Davis’s father had open-heart surgery, his cardiac surgeon asked him what medications he was on, and whether he had any allergies. When he went to the hospital’s outpatient center for pre-admission testing, they asked what medications he was on and whether he had any allergies. The anesthesiologist who visited him right before the surgery asked what medications he was on and whether he had any allergies. At that point, he turned to his daughter in exasperation and said, “Don’t you people ever talk to each other?”
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.
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