The Whole World Is Watching: The Increasing Importance of Structured Data

April 20, 2010 at 4:54 pm Leave a comment

One aspect of surgical reporting that is receiving increasing attention is the capturing of quality indicators.  Quality Indicators are usually defined as those elements of caring for patients that can be tracked and used to determine best practices in future patient care.  (A listing of some can be found at this site.)  Capturing how physicians approach each procedure – in terms of medication administered, instructions upon discharge, or methods adopted in treatment – creates a large pool of data for future students/physicians to examine in determining best practices for particular procedures and what effect each part of the patient’s care is having on his/her outcome.

But beyond the improvement of patient care – which is clearly the highest of importance – why else should physicians be aware of quality indicators?  Perhaps physicians should be interested in quality indicators because they are now being used to determine the effectiveness and reputation of the medical facilities where surgeons are working.

As referenced in this DOTmed article, the Illinois Department of Public Health (IDPH) – working in conjunction with the Center for Disease Control and Center for Medicare/Medicaid Servics – has created a new website that grades Illinois hospitals, clinics and ambulatory surgery centers.  These grades come from multiple sources of data and are weighed accordingly (for more on the IDPH’s methodology, please visit this page).  No, quality indicators alone aren’t determining the scores for these hospitals and surgicenters – but they are contributing to their reputations and standing within the community.

How are these points of data captured? And how important are they?

As we’ve given demos of OpNote to various physicians and hospitals over the past few months, we’ve been hearing more questions regarding capturing quality indicators in surgery.  For some, it’s not a concern – they merely want to quickly and comprehensively capture their operative report with as little intrusion into their workflow as possible.  Others, usually those who work at teaching hospitals, are interested in capturing such informatics as when antibiotics were administered and what DVT prophylaxis was used in the procedure.

Documenting this information is not just for the sake of academic curiosity.  For some hospitals, quality indicators are integrated into Pay For Performance (P4P) initiatives and in other facilities they can help increase the reimbursement the physicians receive.  It’s probably more likely that institutions (hospitals, ASCs, etc.) are interested in capturing quality indicators since they are bits of data that can be traced and studied in order to better understand the gestalt of the treatment a patient receives while exposing any variables or deviations that either promoted or hindered a patient’s recovery.  Institutions are better suited (and set up) to be able to monitor all of the various aspects of a patient’s treatment – much more so than the average physician.

However, as the IDPH Hospital Report Card site shows, the data is no longer just viewable to a select few physicians or administrative personnel.  Everyone is able to see the extrapolation of these data points.  For those living in Illinois, it may determine what hospital a person chooses to attend or what sort of treatment a patient elects to have at a particular facility.  These points of deidentified data are now out in the ether and informing all manners of decisions – decisions which can have repercussions in future health policies, treatment, employment, budgetary concerns and a whole host of other areas.

But how is this information collected?  For some aspects, surveys are used, or financial data is extracted from various tax returns and other budget forms.  But for the rest – how do people know which doctors are utilizing which quality indicators?  The answer is structured data derived from synoptic reporting.

At mTuitive, we’ve been big proponents for structured data because, well, that’s what we do.  That aside, we prefer structured data because it is so much easier and flexible for future users.  In order to capture those small points of data, and turn mostly unstructured data into something people can graph and easily study – people have two choices:

  1. Extract Structured Data from Unstructured Text
    Currently, when a physician dictates his report (postoperative, pathological, what have you) – this is just free standing text.  Much later, after all the revisions have been made to the reports, someone has to go through each of these reports looking for the exact phrasing for the information s/he needs for whatever study they are conducting.  And since there’s no set structure for any of this data, it could be anywhere in the report.  Or it could not be included in the report at all.  There’s a lot of time and effort that is needed in order to pull out synoptic data from a sea of information.
  2. Enter Data in a Structured Way
    If the data is originally entered in a structured manner, like a form or an electronic report, then there is no extraction or abstraction process.  Instead, those looking for information merely have to generate a report based on those discrete pieces of data as they are already entered.  Tallies, averages, commonality of occurrences – these can now be easily formulated and figured out.

Structured data is becoming more integrated into our daily routines.  As discrete data becomes more commonplace, it’s also becoming more accessible for others – and therefore continues to gain in importance.  These informatics are determining so many factors in our careers, our medical treatment, our lives.  It’s important that the data that is used to generate policies and best practices is accurate and captured correctly.  The best way, it would seem, to ensure that is to utilize synoptic reporting programs that facilitate these needs.  Because now that the whole world is watching, can you really afford to be seen playing catch up?

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