Gao 07 320 Highlights, Hospital Quality Data: Hhs Should Specify ...
April 2007
HOSPITAL QUALITY DATA
Accountability Integrity Reliability
Highlights
HHS Should Specify Steps and Time
Highlights of GAO-07-320, a report to the
Frame for Using Information Technology
Committee on Finance, U.S. Senate
to Collect and Submit Data
Why GAO Did This Study
What GAO Found
Hospitals submit data in electronic
The eight case study hospitals used six steps to collect and submit quality
form on a series of quality
data: (1) identify the patients, (2) locate information in their medical
measures to the Centers for
records, (3) determine appropriate values for the data elements, (4) transmit
Medicare & Medicaid Services
the quality data to CMS, (5) ensure that the quality data have been accepted
(CMS) and receive scores on their
by CMS, and (6) supply copies of selected medical records to CMS to
performance. Increasingly, the
validate the data. Several factors account for the complexity of abstracting
clinical information from which
hospitals derive the quality data for
all relevant information in a patient’s medical record, including the content
CMS is stored in information
and organization of the medical record, the scope of information and the
technology (IT) systems.
clinical judgment required for the data elements, and frequent changes by
CMS in its data specifications. Due in part to these complexities, most of the
GAO was asked to examine
case study hospitals relied on clinical staff to abstract the quality data.
(1) hospital processes to collect
Increases in the number of quality measures required by CMS led to
and submit quality data, (2) the
increased demands on clinical staff resources. Offsetting the demands
extent to which IT facilitates
placed on clinical staff were the benefits that case study hospitals reported
hospitals’ collection and
finding in the quality data, such as providing feedback to clinicians and
submission of quality data, and
reports to hospital administrators.
(3) whether CMS has taken steps to
promote the use of IT systems to
facilitate the collection and
GAO’s case studies showed that existing IT systems can help hospitals
submission of hospital quality data.
gather some quality data but are far from enabling hospitals to automate the
GAO addressed these issues by
abstraction process. IT systems helped hospital staff to abstract information
conducting case studies of eight
from patients’ medical records, in particular by improving accessibility to
hospitals with varying levels of IT
and legibility of the medical record. The limitations reported by officials in
development and interviewing
the case study hospitals included having a mix of paper and electronic
relevant officials at CMS and the
records, which required staff to check multiple places to get the needed
Department of Health and Human
information; the prevalence of data recorded as unstructured narrative or
Services (HHS).
text, which made locating the information time-consuming because it was
not in a prescribed place in the record; and the inability of some IT systems
What GAO Recommends
to access related data stored in another IT system in the same hospital,
GAO recommends that the
which required staff to access each IT system separately to obtain related
Secretary of HHS identify the
pieces of information. Hospital officials expected the scope and functionality
specific steps the department plans
of their IT systems to increase over time, but this process will occur over a
to take to promote the use of
period of years.
health IT for the collection and
submission of data for CMS’s
CMS has sponsored studies and joined HHS initiatives to examine and
hospital quality measures and
promote the current and potential use of hospital IT systems to facilitate the
inform interested parties about
collection and submission of quality data, but HHS lacks detailed plans,
those steps, the expected time
including milestones and a time frame against which to track its progress.
frame, and associated milestones.
In commenting on a draft of this
CMS has joined efforts by HHS to promote the use of IT in health care,
report on behalf of HHS, CMS
including a Quality Workgroup charged with specifying how IT could
concurred with these
capture, aggregate, and report inpatient and outpatient quality data. HHS
recommendations.
plans to expand the use of health IT for quality data collection and
submission through contracts with nongovernmental entities that currently
www.gao.gov/cgi-bin/getrpt?GAO-07-320.
address the use of health IT for a range of other purposes. However, HHS
has identified no detailed plans, milestones, or time frames for either its
To view the full product, including the scope
and methodology, click on the link above.
broad effort to encourage IT in health care nationwide or its specific
For more information, contact Cynthia A.
objective to promote the use of health IT for quality data collection.
Bascetta, (202) 512-7101 or
BascettaC@gao.gov.
United States Government Accountability Office
