Just 2 days after we reported that EHRs fared well in a head-to-head comparison with other quality improvement strategies, a Washington Post expose lambasted client-server EHRs as expensive, clunky, imperfect tools.
Although the Post’s hack job doesn’t apply to low cost, user-friendly SaaS-based EHRs, we thought it would be a good time to highlight a reasonably inexpensive, effective QI tool that was somehow overlooked in the above study.
The technique is simple: publish data showing how providers stack-up against each other on a menu of quality metrics, and then let nature take its course.
One of the oldest and most impressive examples of simple feedback systems like this is PHC4, the Pennsylvania Health Care Cost Containment Council which began publishing medical outcomes data 20 years ago to help consumers decide where to receive non-urgent hospital care.
PHC4 reports rely on medical records (both paper and electronic) to calculate risk-adjusted mortality and complication rates associated with about 50 medical conditions. They’re released annually and cover all 172 acute care facilities in the state.
Over the years, they have prompted dozens of hospitals to undertake QI efforts. For example, when a report surfaced that Erie’s Hamot Medical Center had unusually high infection rates complicating IV catheter placement, the hospital began cleaning IV catheters more frequently and replacing them earlier. In less than a year, its infection rates dropped 20%.
Similarly, the very first PHC4 report revealed that Philadelphia’s Hahnemann University Hospital performed "worse than expected" on 8 out of 55 tracked procedures, but next time around, ratings had improved on all but one of them.
The impact of PHC4 has been so profound that a study in the August, 2008 issue of the American Journal of Medical Quality reported that the odds of dying from common medical diagnoses in a Pennsylvania hospital were 21-41% lower than in other states.
Equally gratifying have been scattered reports that high quality care is associated with lower overall medical costs, a point not lost on many self-insured employers in the state. For example, when Hershey Co. encouraged employees to join a coverage plan based on PHC4 results, the iconic chocolateer found that its employee’s health costs dropped by 50%.
In coming up with its benefits plan, Hershey ranked 23 local hospitals using a formula that was based 70% on PHC4 outcomes data and 30% on hospital prices, which it obtained from separate sources.
"The correlation between cost and quality was zero," Hershey’s benefits manager Richard Dreyfuss told the Wall Street Journal. "You go in thinking that all hospitals are pretty much equal, but this was eye-opening. Generally, higher-cost hospitals had poorer outcomes."
Hershey ended up selecting 10 hospitals for its plan, and discounted the plan heavily to funnel employees towards it.
For its part, the Philadelphia police union's benefits-management company devised a similar scheme and claims to save about $5 million per year versus comparable plans.
Of course, not everyone loves PHC4. Academic medical centers are convinced to this day that its risk adjustment methodology doesn’t do enough to account for the complex cases they care for routinely.
"These reports are very important for transparency, but I don't think you can look at a PHC4 report and conclude you should not go to that hospital," said P.J. Brennan, the CMO at the University of Pennsylvania Health System.
For their part, cash-strapped community hospitals cringe at what has become a state-wide requirement to collect data on behalf of PHC4, an endeavor the state hospital association claims can set back a facility more than $10 million per year.
That’s the price for success, we say, and the same calculus should apply when evaluating EHRs as QI tools. It’s not just whether the tools are effective, it’s how much they cost and how well they are accepted by providers. This is the kind of math that works well for SaaS-based EHRs.
Glenn Laffel, MD, PhD
Sr. VP, Clinical Affairs, Practice Fusion
Although the Post’s hack job doesn’t apply to low cost, user-friendly SaaS-based EHRs, we thought it would be a good time to highlight a reasonably inexpensive, effective QI tool that was somehow overlooked in the above study.
The technique is simple: publish data showing how providers stack-up against each other on a menu of quality metrics, and then let nature take its course.
One of the oldest and most impressive examples of simple feedback systems like this is PHC4, the Pennsylvania Health Care Cost Containment Council which began publishing medical outcomes data 20 years ago to help consumers decide where to receive non-urgent hospital care.PHC4 reports rely on medical records (both paper and electronic) to calculate risk-adjusted mortality and complication rates associated with about 50 medical conditions. They’re released annually and cover all 172 acute care facilities in the state.
Over the years, they have prompted dozens of hospitals to undertake QI efforts. For example, when a report surfaced that Erie’s Hamot Medical Center had unusually high infection rates complicating IV catheter placement, the hospital began cleaning IV catheters more frequently and replacing them earlier. In less than a year, its infection rates dropped 20%.
Similarly, the very first PHC4 report revealed that Philadelphia’s Hahnemann University Hospital performed "worse than expected" on 8 out of 55 tracked procedures, but next time around, ratings had improved on all but one of them.
The impact of PHC4 has been so profound that a study in the August, 2008 issue of the American Journal of Medical Quality reported that the odds of dying from common medical diagnoses in a Pennsylvania hospital were 21-41% lower than in other states.
Equally gratifying have been scattered reports that high quality care is associated with lower overall medical costs, a point not lost on many self-insured employers in the state. For example, when Hershey Co. encouraged employees to join a coverage plan based on PHC4 results, the iconic chocolateer found that its employee’s health costs dropped by 50%.In coming up with its benefits plan, Hershey ranked 23 local hospitals using a formula that was based 70% on PHC4 outcomes data and 30% on hospital prices, which it obtained from separate sources.
"The correlation between cost and quality was zero," Hershey’s benefits manager Richard Dreyfuss told the Wall Street Journal. "You go in thinking that all hospitals are pretty much equal, but this was eye-opening. Generally, higher-cost hospitals had poorer outcomes."
Hershey ended up selecting 10 hospitals for its plan, and discounted the plan heavily to funnel employees towards it.
For its part, the Philadelphia police union's benefits-management company devised a similar scheme and claims to save about $5 million per year versus comparable plans.
Of course, not everyone loves PHC4. Academic medical centers are convinced to this day that its risk adjustment methodology doesn’t do enough to account for the complex cases they care for routinely.
"These reports are very important for transparency, but I don't think you can look at a PHC4 report and conclude you should not go to that hospital," said P.J. Brennan, the CMO at the University of Pennsylvania Health System.
For their part, cash-strapped community hospitals cringe at what has become a state-wide requirement to collect data on behalf of PHC4, an endeavor the state hospital association claims can set back a facility more than $10 million per year.
That’s the price for success, we say, and the same calculus should apply when evaluating EHRs as QI tools. It’s not just whether the tools are effective, it’s how much they cost and how well they are accepted by providers. This is the kind of math that works well for SaaS-based EHRs.
Glenn Laffel, MD, PhD
Sr. VP, Clinical Affairs, Practice Fusion
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