Together with all of the healthcare reform efforts being considered, the massive adoption of electronic health records (EHRs) nationwide is expanding the focus on reducing costs and improving quality. Many healthcare organizations are embracing the concept of clinical transformation to achieve these goals, but they still require the tools and capabilities to make data available in real time and reduce the burden on scarce resources. These are among the key findings from the HIMSS 2011 Clinical Transformation Survey.1 This is the HIMSS organization's first industry survey to measure clinical transformation. To ensure respondents had a level foundation for their responses, the following definition was developed:
Clinical Transformation: This involves assessing and continually improving the way patient care is delivered at all levels in a care delivery organization. It occurs when an organization rejects existing practice patterns that deliver inefficient or less effective results and embraces a common goal of patient safety, clinical outcomes and quality care through process redesign and IT implementation. By effectively blending people, processes and technology, clinical transformation occurs across facilities, departments and clinical fields of expertise.
Approximately 175 respondents assessed the degree of clinical transformation within their organizations in terms of measurement, governance and leadership, organizational behavior and data access. Among the key findings:
- Clinical priorities: Nearly half of respondents indicated that their organization was presently focused on ensuring that a fully operational EHR is in place.
- Key drivers for addressing quality metrics: While meaningful use/ARRA is the influencer driving which quality metrics to address, the choices made by healthcare organizations are also driven by other federal efforts, The Joint Commission, and other quality initiatives.
- Improved outcomes: Organizations aren't only using the analysis of clinical and financial data to improve quality and efficiency of care, but to control costs and improve revenue, as well.
- Barriers: Respondents identified the fact that data aren't captured in discrete fields or defined consistently as key barriers to the capture and use of clinical data for quality metrics.
- Clinical transformation teams: While nurses and physicians are well represented on clinical transformation teams, one-third of respondents noted that these teams were lead by a member of the executive office.
- Organizational changes: As organizations are evaluating how to use IT to effectively implement clinical and quality improvement efforts, more than 80% are evaluating clinical workflow and process.
- Addressing change management: Three-quarters of respondents rely on education and training to address change management issues.
According to the survey findings, there are numerous improvements that organizations can make to enhance their ability to use clinical and financial data to improve patient outcomes. For instance, data isn't always available in a way that facilitates easy access and reporting. Only 35% of respondents presently import data into a data warehouse, and nearly half of respondents noted that they rely on interfaces to assist with integration. Since not all data is available in an electronic fashion with discrete data elements, reviewing charts by hand is still a key means for measuring clinical quality. Having the correct resources in place to improve reporting capability is also an issue. Nearly two-thirds of respondents noted that their organization needs additional resources in order to report appropriately on quality measures.
Although there's organizational support for clinical transformation, there are gaps and barriers to being able to accomplish goals and objectives in this area. Specifically, nearly three-quarters of respondents noted that they needed additional IT resources to report on quality measures. This was closely followed by additional staff (61%) and more money (58%). Only 4% of respondents indicated that they don't need additional resources. In addition, two-thirds of respondents directly noted that while they had staff qualified to report on quality measures, the staff simply didn't have the time needed to create reports. Other respondents (43%) noted that their organization's priorities were focused elsewhere.
The role of clinical informaticists, including nurse informaticists, continues to be a much valued and necessary position in today's healthcare organization because these experts are essential to the success of quality initiatives, participating in the executive clinical team that analyzes clinical data. Survey results indicate that these human resources are necessary to ensure that clinical transformation efforts benefit from appropriate access to clinical data that is derived from the EHR.
The recently published IOM report on The Future of Nursing asserts the U.S. healthcare system has the opportunity to transform itself, and envisions nurses as active leaders in this transformation.2 Nurses have already taken a leadership role in embracing technology as a necessary tool to innovate the delivery of healthcare. The report recommends that nurses take on leadership roles to improve safety and efficiency, bring evidence for decision making to the point of care, and empower patients to be involved partners.
Also recognizing the vital leadership role of nurses in providing quality patient care, the HIMSS Board of Directors approved a position statement this summer describing how to transform nursing practice through technology and informatics.3 Leaders from the HIMSS Nursing Informatics Community, representing over 2,900 members who not only serve the nursing profession, but also, the broader healthcare industry and HIMSS membership at large, developed the following position statement.
Position Statement: Nurses are key leaders in developing the infrastructure for effective and efficient health information technology that transforms the delivery of care. Nurse informaticists play a crucial role in advocating both for patients and fellow nurses who are often the key stakeholders and recipients of these evolving solutions. Nursing informatics professionals are the liaisons to successful interactions with technology in healthcare. As clinicians who focus on transforming information into knowledge, nurse informaticists cultivate a new time and place of care through their facilitation efforts to integrate technology with patient care. Technology will continue to be a fundamental enabler of future care delivery models and nursing informatics leaders will be essential to transforming nursing practice through technology.
In addition to the need for knowledgeable and available leaders, nearly all survey respondents (87%) indicated that their organization leverages technology to standardize and automate practices, such as the format of a discharge summary, to enable additional focus on new quality initiatives. Survey respondents were also asked if they were leveraging data from diverse information sources to measure quality. Approximately half of respondents (53%) noted that they've created interfaces to support integration. A third (35%) noted that their organization imports all data into a repository-warehouse. Only 12% reported that the tools they use are fully integrated into their EHR. 55% reported that these tools are partially integrated, and 13% reported that these tools aren't automated with organizational EHRs.
One organizational leader in this area, Catholic Health East (CHE), has launched a massive, multi-year initiative to move forward with the development and implementation of a system-wide evidence-based care/clinical transformation initiative.4 This new delivery model, the ACT (Advancing Clinical Transformation) initiative, was developed in 2008 and introduced throughout CHE in early 2009. The initiative is focused on ensuring excellence in quality and patient safety outcomes—every person, every place, every time. Evidence-based care has been established throughout CHE using core measures, technology assessments, standardized documentation, order sets and computerized provider order entry. CHE will also leverage existing information systems and introduce new system capabilities and industry standard clinical terminology to provide patients with their personal health information and exchange key clinical information with authorized entities and public health agencies.
The HIMSS Clinical Transformation Survey respondents were also asked to identify the tools used to facilitate quality reporting. Two-thirds reported using Microsoft Office products while 60% reported that they use tools provided by their vendors. (See table for a full list of the used spectrum of tools.)
Patient data, when used in conjunction with a patient's complete medical history or compared against a broader patient population, has the ability to be a very powerful tool in improving the quality of care delivered. Clinical transformation involves assessing and continually improving the way patient care is delivered at all levels in an organization. This study suggests that healthcare organizations are beginning to implement the tools needed to create an environment that fosters clinical transformation.
1. HIMSS (2011). HIMSS Clinical Transformation Survey, sponsored by McKesson.
2. IOM (Institute of Medicine) 2010. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press.
3. HIMSS (2011). HIMSS Position Statement on Transforming Nursing Practice through Technology..
4. Catholic Health East Horizons (2010). In Pursuit of Clinical Transformation.