Next-gen Quality and Safety: Genetics, Communication, Social Determinants, Data All are at Play

By Bill Siwicki | June 11, 2018

In the future, patients will have more access to their own data and more communication channels with their extended care team.

Quality and safety may very well be the highest goals in healthcare. Healthcare provider organizations clearly aim to deliver the highest quality of care in the safest manners and settings possible.

Technology has a part to play when it comes to quality and safety. And there are changes afoot in quality and safety technology that healthcare executives will need to keep their eyes on.

Electronic clinical quality measures

Next generation quality and safety products will need to support standards-based interoperability and all aspects of electronic clinical quality measures (eCQMs), said Zahid Butt, MD, CEO of quality reporting software vendor Medisolv and vice-chair of the HIMSS Quality, Cost and Patient Safety Committee.

“On the data acquisition side, support will be required for multiple data sources through standards-based interfaces and formats including FHIR and CCDA,” Butt said. “And on the reporting end, robust generation of QRDA I and III outputs should be part of a seamless system where data fluidity within the quality reporting ecosystem is possible.”

Further, as the Centers for Medicare and Medicaid Services and other payers move from process to outcomes measures, the need for more advanced risk adjustment of measure results will lead to the use of clinical variables captured in EHRs for this purpose, Butt contended.

“Pilots of hybrid claims measures already are underway and will increase in the future,” Butt said. “Quality and safety technology products will need to support submission of this type of data and find ways to generate risk-adjusted results using these clinical variables.”

And quality and safety technology systems will need to support the incorporation of patient-reported data either entered directly by patients or generated from their devices as additional data sources for a new generation of patient-reported quality and safety measures, Butt added.

Analytics models with genetics

On another front, genetics could have a part to play. For example, given the massive toll the opioid crisis has taken and the ongoing challenge physicians face when their patients are in pain, there is some hope in the advent of analytics models to predict opioid addiction.

“If physicians knew in advance which of their surgical patients were predisposed to opioid abuse, they could counsel high-risk patients about the risks and prescribe alternatives,” said Heather Lavoie, chief strategy officer at Geneia, a vendor of a variety of health IT, including quality and safety, population health, and analytics. “Experts estimate a person’s genetics account for approximately half of a person’s addiction risk. As genetic testing matures, I am eagerly anticipating the prospect of analytics models that include genetic addiction risk as an input.”

When it comes to information, external data factors beyond clinical and claims information are said to make up 70 percent of a potential patient’s outcomes, Lavoie said. It’s likely even higher for patients recently discharged from the hospital, especially those in need of post-discharge wound care, she added.

“That’s why there is so much emphasis now on social determinants of health,” she said. “Information ranging from access to transportation to primary and specialty care, food insecurity, fall risk, the presence or absence of a caretaker at home, and much more are critical information for the physician and care team.”

From a technology perspective, healthcare is just beginning to integrate and incorporate social determinants of health information in a meaningful way within the clinical workflow. Lavoie anticipates major advances in the next two to five years as healthcare brings in additional data sources and information and normalizes and integrates it in a way that’s actionable.

“Just as important, we are now in a position to calculate and assess social determinants of health risk and incorporate this information into the patient’s record,” she added. “Whereas social determinants of health information provides meaningful context within which to engage and support a patient, social determinants of health risk will allow us to stratify for those most in need of attention and enhanced support.”

Prioritizing social determinants

At a high level, this information allows the physician and care team to readily see who is at highest risk, whether social determinants of health risk is an important factor, and then drill into the risk score to understand the drivers and prioritize which social determinants of health factors to address.

“Social determinants of health risk, like other predictive and current calculated risk models, help physicians and care teams manage large populations and individual patients with more precision, and with less burden,” Lavoie said. “It further helps them to understand their patients more deeply, fostering stronger relationships, which is most meaningful to the patient and the physician, and helping to restore some of the joy to practicing medicine.”

Kanav Hasija, co-founder and chief product officer at Innovaccer, a health IT vendor that offers quality and safety, care management, and analytics systems, believes the key to patient quality and safety is to enable more communication, which he said is broken right now between physicians, patients and the extended care team. When these stakeholders can communicate more among themselves, high patient quality at low cost will not be a dream anymore, he contended.

“Further, a physician will and should get more insights about a patient concisely at the point of care,” Hasija said. “When I say more insights, it’s based on data beyond their own practice EHR. Amazon knows more about us today than we do. Why should physicians be away from insights like gaps in quality of care, what other primary care physicians patients are visiting, whether they are on a lot of meds, do the patients visit the emergency room very regularly, and other important questions like this?”

In the future, patients will have more access to their own data and more communication channels with their extended care team, and technology should motivate them to take cheaper and high-quality delivery alternatives, he said. They should have access to their entire clinical and financial data around their health; they should be able to choose the right primary care physicians, specialists and home health services for themselves based on quality, cost and patient experience metrics readily available for provider organizations in their vicinity, he added.

“And semi-automated central command centers will be formed across provider networks,” he contended. “These command centers will connect data from all types of providers. Additionally, they will enable alerts around gaps in care or patients’ needs for assistance to feed into clerical and nursing task forces’ workflows to get them resolved.”

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