Stand for Quality Group: “Link HIT Investment to Quality Improvement”


On March 24, Stand for Quality — a new group representing 165 diverse health care organizations — called for a new era of quality in health care. Their white paper is titled Building a Foundation for High Quality, Affordable Health Care: Linking Performance Measurement to Health Reform .

The perspectives of Stand for Quality are a remarkable break from the past and have significant implications for future investment in health information technology. The Stand for Quality document unequivocally supports the dog  (disruptive innovator) POV — that providers should be paid for improvements in quality and outcomes. It rejects the cat (incumbent EHR vendors and supporters) POV — that providers should be reimbursed for simply acquiring health IT , with the expectation that quality will naturally follow.  (For a refresher on definitions of the dog/cat POV, see the first post of this series .)

Stand for Quality is a who’s who list that includes substantial representation from the physician, hospital, and health plan communities, as well as many others.  A listing of initial supporters is provided at the bottom of this posting.

The key recommendations of the white paper are:

  • We must improve quality in health care and make it more affordable.
  • Performance measurement is a core building block to provide high quality affordable care
  • Public investments are needed to support the performance measurement, reporting and improvement enterprise.
  • We should build upon the existing public-private performance measurement, reporting and improvement enterprise.
  • Investment in health information technology should be linked to improving care (emphasis added).
  • Performance measurement must be dramatically expanded, but measurement alone is not enough.

From having barely been on the radar screen six months ago, is the dog (disruptive innovator) POV rapidly becoming the majority perspective? Here’s the text from the 5th recommendation:

Investment in health information technology should be linked to improving care:

Health information technology (HIT) represents an important means of advancing quality measurement and improvement which require substantial infrastructure investments. But HIT can only help improve the quality of care if it is designed to more effectively collect performance information. The link between HIT and performance measurement must be planned and strategic.

We should ensure that public and private investments in HIT appropriately support delivery at the point of care, improvement, and quality measurement. For example, support for clinicians’ use of HIT should be tied to demonstrable improvements in care and efficient use of resources. A condition for funding and support for HIT should be that those systems support the collection of performance information as part of the regular process of delivering care, and have adequate protections for patient privacy and data security as core elements of the technologies.

As straightforward as the six recommendations might seem, the Stand for Quality document is a dramatic break from the past.  We’ve never seen such a group of diverse health care constituents put a stake in the ground together declaring: “quality is important, we need to measure it and strive to improve”.  On the other hand, it’s amazing that it took until 2009 for something this simple and obvious to take place.

Dogs (disruptive innovators) are pleased. They are finding themselves in good company, with many new and surprising supporters.


Stand for Quality — Supporting Organizations

National Organizations

Academy of Managed Care Pharmacy
Academy of Medical-Surgical Nurses
Acumentra Health
Alliance for Pediatric Quality
American Academy of Family Physicians
American Academy of Neurology
American Academy of Nurse Practitioners
American Academy of Nursing
American Academy of Otolaryngology
American Association of Birth Centers
American Association of Cardiovascular and Pulmonary Rehabilitation
American Association of Colleges of Nursing
American Benefits Council
American Board of Medical Specialties
American College of Cardiology
American College of Nurse-Midwives
American College of Physicians
American College of Radiology
American College of Surgeons
American Geriatrics Society
American Health Information Management Association
American Health Quality Association
American Heart Association
American Hospice Foundation
American Hospital Association
American Medical Association
American Nurses Association
American Optometric Association
American Osteopathic Association
American Pharmacists Association
American Physical Therapy Association
American Podiatric Medical Association
American Psychological Association
American Society of Health-System Pharmacists
American Urological Association
America’s Health Insurance Plans
Association for Professionals in Infection Control and Epidemiology
Association of American Medical Colleges
Association of PeriOperative Registered Nurses
Association of Women’s Health, Obstetric and Neonatal Nurses
Blue Cross Blue Shield Association
Bridges To Excellence
Calculated Risk, Inc.
CareVariance LLC
Catholic Health Initiatives, Inc.
Center for Health Systems Research & Analysis
Child Health Corporation of America
Childbirth Connection
Coalition for Improving Maternity Services
Comprehensive Pharmacy Services
Consumers’ CHECKBOOK/Center for the Study of Services
Consumers Coalition for Quality Health Care
Consumers Union
Council of Medical Specialty Societies
Discern, LLC
Epstein Becker & Green, P.C.
Federation of American Hospitals
Healthcare Leadership Council
Heart Rhythm Society
Hospice and Palliative Nurses Association
Hospital for Special Surgery
MAXIMUS Federal Services, Inc.
Medco Health Solutions
MetaStar, Inc.
National Association for Healthcare Quality
National Association of Children’s Hospitals and Related Institutions
National Association of Pediatric Nurse Practitioners
National Association of Public Hospitals and Health Systems
National Business Coalition on Health
National Business Group on Health
National Committee for Quality Assurance
National Community Pharmacists Association
National Consortium of Breast Centers
National Consumers League
National Institute for Quality Improvement and Education
National Partnership for Women & Families
National Quality Forum
Network for Regional Healthcare Improvement
Next Wave
Outcomes Pharmaceutical Health Care
Pacific Business Group on Health
Pharmacy Quality Alliance, Inc.
Physician Consortium for Performance Improvement convened by the AMA
Premier Inc.
Qualis Health
Quality Partners of Rhode Island
Quidel Corporation
Service Employees International Union (SEIU)
Shaller Consulting Group
Society for Cardiovascular Angiography and Interventions
Society for the Advancement of Blood Management
Society for Vascular Surgery
Society of Hospital Medicine
Society of Thoracic Surgeons
The Catholic Health Association of the United States
The Joint Commission
Thomson Reuters
U.S. Chamber of Commerce
UnitedHealth Group
Universal American Corp.
WellPoint, Inc

Local/State/Regional Organizations

Alabama Quality Assurance Foundation (AQAF)
Atlantic Health
Baylor Health Care System
Betsy Lehman Center for Patient Safety and Medical Error Reduction
BJC HealthCare
Buyers Health Care Action Group
Colorado Foundation for Medical Care
Employer Health Care Alliance (Ohio — Kentucky — Indiana)
Employers Coalition on Health (Northern Illinois)
Exeter Health Resources (New Hampshire)
FMQAI (Florida)
Greater Detroit Area Health Council, Inc
Hanover Area Health Care Alliance
Health Action Council Ohio
Health Improvement Collaborative of Greater Cincinnati
Health Policy Corporation of Iowa
Health Services Advisory Group (HSAG) of Arizona
Health Services Advisory Group (HSAG) of California
HealthCare 21 Business Coalition (Tennessee)
HealthInsight (Utah and Nevada)
Information & Quality Healthcare (Mississippi)
Integrated Healthcare Association
Iowa Foundation for Medical Care
Iowa Health Buyers Alliance
Kansas Foundation for Medical Care, Inc
Louisiana Health Care Quality Forum
Louisiana Health Care Review
Massachusetts Department of Public Health
Massachusetts Health Quality Partners
Michigan Peer Review Organization
Midwestern University
Minnesota Community Measurement
New Jersey Hospital Association
New York Business Group on Health
Niagara Health Quality Coalition
North Dakota Health Care Review, Inc
North Shore-LIJ Health System
OdeonData, LLC
Oklahoma Foundation for Medical Quality
Pittsburgh Regional Health Initiative
Primaris (Missouri)
Proctor Hospital
Puget Sound Health Alliance
Quality Quest for Health of Illinois
South Carolina Business Coalition on Health
Stoeckle Center for Primary Care Innovation
Sutter Children’s Center
The Carolinas Center for Medical Excellence
The Children’s Hospital (Denver)
The HOPE of Wisconsin
University of Arizona
Virgin Islands Medical Institute, Inc
WellSpan Health
West Virginia Medical Institute & Quality Insights
Wisconsin Collaborative for Healthcare Quality
Wisconsin Medical Society

One thought on “Stand for Quality Group: “Link HIT Investment to Quality Improvement”

  1. Lions, Tigers, and Bears

    I think the gist of your post is that we need to make sure the horse is in front of the cart so to speak; i.e. that health care information technology (HIT) must be informed by measurable and explicitly targeted quality improvement metrics. I totally agree. If we don’t proceed as you argue, I fear the old joke will emerge anew: “The HIT was a success, the patient died.”

    However, I do think it is extremely important to note that is raining more than cats and dogs. There are other animals in the zoo. To see this, we need to state our ultimate goal. I follow the path set by the World Health Organization more than 30 years ago where it was stated we must reach “the highest possible level of health (Alma Alta Declaration, September 12, 1978).

    To do so, we cannot discount other significant consideration that may or may not be part of the Obama stimulus package and HITECH. Let’s call these other significant contributions, Lions, and Tigers, and Bears. Below, I’ve tried to visualize this menagerie in a scientific inspired hypothesis where: C=Cats, D=Dogs, L=Lions, T=Tigers, and B=Bears; the arrows signify causality.


    I could provide some examples, of L’s, T’s, and B’s, but I will leave it to you and your readers to come up examples on your own for now. I end with an expansion of Earnest Hemingway’s immortal words: “The road to hell is paved in unbought stuffed dogs, [cats, lions, tigers, and bears].” (bracketed items are added).

    Thomas Wilson, PhD, DrPH

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