Good or perfect: Cutting the fastest path forward

Guest post by Patrick GordonDirector, Colorado Beacon Consortium

Early pioneers to Colorado did not have the luxury of waiting for railway or infrastructure to be in place before taming a new frontier. Their vision and determination laid the foundation for the settlers who followed. They used the tools and talents they had to develop an infrastructure and ultimately build viable, productive communities. Had they waited for the perfect conditions, they’d still be back east.

It’s a lesson we’ve applied to health care transformation. At the Colorado Beacon Consortium (CBC), we resisted the temptation to delay good learning opportunities and wait for perfect solutions. We embraced the ONC/HHS’ challenge to demonstrate how costs can be reduced and patient health improved by integrating health information technology (HIT) into a transformed clinical workflow. This pioneering effort requires new competencies with patient and population data, more sophisticated technology, and a supporting workforce. So far, we’ve offered technical assistance to more than 50 primary care practices in western Colorado. We are laying a foundation.

Through hard work and persistence, the validated, longitudinal improvements that CBC participants have achieved in the past two years have been significant. CBC staff within Rocky Mountain Health Plans (the local, not-for-profit payer) and Quality Health Network (the community-based health information exchange, or HIE) have worked intensively within the Learning Collaborative to deploy quality improvement advisors that support practices, develop skills, and use data for continuous quality improvement, patient activation and population management functions.

Participating practices joined CBC based on their readiness. The first two learning groups of practices achieved remarkable results during the past 12 months:

  • The percentage of CBC ischemic vascular disease patients with LDL levels below 100 increased from 39 to 53 percent.
  • Tobacco counseling increased from 25 to 52 percent.
  • Outside the realm of Stage 1 Meaningful Use, depression-screening rates (PHQ 9) for patients with diabetes increased from 58 to 93 percent.

These gains may not directly correlate with health cost reductions in the short run, but they position us to adopt more sophisticated measures of value and achieve significant savings in the coming years.

How did we do this? Since we understand that electronic interoperability and data coding standards for exchange of health information are embryonic at best, we decided to create a culture that supports a continually learning workforce. This approach fits the evolutionary nature of data exchange solutions across multiple platforms and applications. Further, deploying a skilled workforce through a shared community resource (QHN) – rather than trying to coordinate separate IT departments – enabled development of deep insight into clinical operations in multiple settings, as well as maintenance and transfer of knowledge at the lowest possible cost. Physician practices, we discovered, are also more likely to adapt (if not create) community standards as they evolve, using the experience and intellectual capital accumulated along the way.

Many health systems attempt to bypass interoperability problems by adopting costly, big-platform arrangements. Big platforms standardize functions and data, but they extend only as far as the walls of the adopting organization — while perhaps adding others that are near-enough in orbit to be pulled in. Despite the initial and ongoing cost, the big-platform approach may be attractive from the standpoint of corporate control. But over the long haul, big platforms are at odds with innovation and best-of-breed evolution. This is particularly evident when an organization finds that the platform vendor’s business model entails retailing data back to the owner through incremental, “value-added” services. In our community, we opted to remain nimble for our journey.

Like any good pioneer, our providers appreciate signposts: They derived tremendous value from the measures published for Stage 1 Meaningful Use. We use these measures as the basis for development of data use and quality improvement measures to nurture the culture and competencies necessary to transform traditional clinical operations. While most of the measures are process-oriented and more disease-centric than person-centric, the availability of credible, clinically pertinent and programmatically aligned measures provided an important basis for progress in our community.

Like those before us, and others around us today who are blazing their own   trails, if we had delayed our quest waiting for ideal conditions, we would have never advanced. Had we waited perfect electronic health records, interoperability standards or outcome measures, we wouldn’t have created provider engagement and momentum along a path toward community-wide transformation. We also would have missed a golden learning opportunity. Incremental improvements provide insight into where we can go next, using technology as a tool, to create community. We may not have turned our settlement into a city, but because we have the people, the will, the tools and the vision, we are well on the way.

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