As Canada’s healthcare system struggles with the myriad structural and technology challenges involved in creating a national system to measure wait times, there may be some lessons to be learned from the U.S. about how IT can benefit this process.
At a recent SAS Canada-sponsored seminar in Toronto on business intelligence and scorecarding best practices for healthcare, two U.S.-based doctors shared their experiences around managing IT change in healthcare and deve- loping performance metrics.
As president and CEO of the Washington-based non-profit National Quality Forum, Dr. Kenneth Kizer has worked to develop a consensus around national standards for the measurement and public reporting of healthcare performance data. It has been a long and difficult process, involving as much bureaucracy as IT, but Kizer said the group now has more than 200 different national performance measures in place, from acute care and nursing home care to ambulatory care.
He added that the level of complexity seen so far is only the beginning. “Ten years from now this is going to make the financial industry shudder at the number and complexity of the metrics.”
Kizer said IT is the critical enabler making solutions happen. The healthcare industry is lagging technically, but he said IT has very strong potential here because healthcare is about getting the right information to the right person, whether it’s X-rays, lab results or patient histories.
“IT is the enabler that allows you to accrue data once, hopefully at the point of service delivery, and use it a hundred times in different ways,” said Kizer.
The Brigham and Women’s Hospital in Boston implemented a SAS balanced scorecard system five years ago. Dr. Michael Gustafson, vice-president of clinical excellence, said managers were inundated with paper reports and wanted a way to easily track trends and changes.
With the new system, Gustafson said staff members track a variety of performance metrics, including patient satisfaction, all the way down to an individual surgeon or nursing unit.
“At a click of a button we can drill into a number of variables,” said Gustafson. “This used to take my department a day of offline reporting and analysis.”
In Canada, provincial health ministers recently agreed on national wait time benchmarks in five priority areas, including cancer care and hip surgery.
However, Dr. Les Vertesi, a director of the Health Council of Canada and an emergency room doctor in B.C., said fundamental changes need to be made to Canada’s healthcare system before wait times can be accurately measured — and technology will play a key role in those changes.
Vertesi said most hospitals don’t currently track wait times because there’s no incentive to do so. Most hospitals book surgeries by dividing operating room time equally among surgeons, who each maintain their own wait lists with patients ranked by priority.
What is needed, said Vertesi, is a province-wide database, updated in real time, that doctors can access easily though a Web portal to enter their patients and priorities.
Hospitals can then use the full patient list when booking surgeries, and wait times can be measured accurately.
However, he said that’s easier said than done, and any system needs to be designed in consultation with doctors to be successful.
There are some pockets of progress, including a successful system along these lines in Kingston, Ont., but Vertesi said another IT challenge is linking different systems across the country.
“It’s slower than we’d like, but there are good pieces to build on,” said Vertesi.