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July 31, 2018

By: Charlie Harp

In the trenches of healthcare, important decisions are made every day. We make..

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Healthcare Information Quality - What is Quality?

By: Charlie Harp

In the trenches of healthcare, important decisions are made every day. We make decisions about best practices, populations, critical resources and most importantly, patients. These decisions often have serious, even life-and-death, consequences. The quality of these decisions is directly dependent on the quality of the information we use to make them. It stands to reason that it is critical that we do what we can to ensure our information is of the highest quality. Defining health information quality can be challenging, as the concept of quality can take on different meanings.

A word that can have multiple related meanings is called polysemic. Poly the Greek for "many" and sema, the Greek for "sign". In healthcare IT we use polysemic words every day - words like interoperability, normalization, governance, and quality. They can all have different meanings based on what the person who uttered them is thinking at the time. In this post I am going to talk about "quality" and share what I think it means in the context of healthcare information, and to hopefully make it stick in your brains, I am going to use a metaphor.

Healthcare Information Ecosystem

Imagine an ecosystem as a metaphor for healthcare IT. In that ecosystem patient information is ubiquitous, like water.  It rains down and flows throughout the landscape of healthcare information technology. This "natural" resource drives the water wheels of revenue cycle management, erodes channels into the landscape of analytics and splits into tributaries of cohorts. In the end, we need it to fish for food, bathe, wash our belongings, and drink. Without it, we perish.

But things happen to the water as it makes its journey through our landscape. In our ecosystem some clouds rain down salt water (it is a metaphor after all) that can turn our rivers brackish and kill the fish. The water can get polluted in this journey by bad or incorrect data. Some water can freeze in blocks of unstructured text that prevent it from being put to productive use downstream. Without adequate mechanisms, like aqueducts, dams, reservoirs and the occasional treatment plants, we lose control. The water is no longer an asset and could even turn into a threat. A tsunami of information that we do not control is not useful - it is destructive and can result in a disaster.

Defining Health Information Quality

When you assess the quality of water, it is done through the lens of intended use. The water might be fine for bathing, but not suitable to drink. Healthcare information faces the same challenge, the level of quality necessary depends on what is being done with the information. If the intended use of the information is analytics: quality reporting, decision support or business intelligence, then the quality goal must be a high level of accuracy. Accuracy in the patient information that flows through an enterprise is a multifaceted challenge, and there are several factors that drive it. For information to be accurate, it must be current, comprehensible, correct and as complete as possible. These are the four Cs of healthcare information quality and each one of them is necessary for us to trust the data enough to drink it.

Achieving this state of quality is not simple. It is also not a “project” that can be completed. Like water, healthcare information is a force of nature. To establish and maintain quality, the ecosystem must be continuously monitored and managed. To do this, we need the right perspective on the importance of information quality, the right processes to establish what controls we can on the information, and the right tools to automate those processes and optimize efficiency.

In this series, I will be sharing some of the issues that impact the quality of healthcare information and some practices that may help address them.