By Maggie Van Dyke
Like most health systems, Aria Health reports on a growing number of clinical quality metrics, such as infection and patient fall rates. Right now, the Philadelphia health system is tracking more than 70 performance metrics-just in clinical areas alone.
While Aria Health leaders are vested in the conviction that data guides performance improvement, they are also realists and recognize the huge administrative burden associated with quality reporting. "Most of this was primarily a manual, paper-based process, as it is at most healthcare organizations," says CNO Michelle Conley, RN, BSN, MBA, FABC. "We'd collect the data on paper, and then someone would have to sift through all that paper and put the data into a workable product and get the results to the frontline staff. That was incredibly time-consuming."
In early 2011, Aria Health launched a new quality tracking approach, using iPads and a web-based application to collect and analyze the data. The software automatically populates Aria Health's performance scorecard system, which allows leaders and frontline staff to easily track rates on various metrics across the system's three hospitals and units/departments.
"The new approach has really sped up the quality reporting process-from the time data are collected to the time that end users get the results" says Conley, who estimates that the turnaround has decreased from a few weeks to a few days. The new approach has also invigorated the health system's performance improvement efforts by ensuring frontline staff have key data in a more real-time timeframe.
To test the new data collection approach, Aria Health began small. "We started out with five iPads, looking at a select number of quality indicators and worked our way up," says Conley. "Now it's pretty robust. We are using iPads to collect data at the bedside on pretty much anything and everything we can with regard to our quality indicators, including all the core measures, nurse sensitive indicators, and any internal quality issues we're following."
The health system currently has a total of 17 iPads, which are kept on all the nursing units across Aria Health's three hospitals, as well as in the performance improvement and infection control departments. Nursing leaders and staff handle a lot of the data collection around quality metrics, often as they round on patients during a shift. "We put the tablets in centralized locations so staff can access them as needed," says Conley.
All of the iPads carry an app, or web-based software, that provides electronic forms for data collection (see exhibit below). "We build our own custom forms and surveys within the app, which allows us to create our own data collection categories and questions," says Bea Leyden, RN, BSN, MBA, Aria's director of nursing performance improvement. "We are also able to add 'logic' and 'hard stops' into our audit tools that aren't possible on paper. A hard stop reminds the data collector that he or she must input critical information into a field before proceeding. Building logic into the audits makes them more user-friendly. For instance, one question might ask, 'Is the patient on restraints?' If you say 'No,' then you can move onto the next question instead of having to answer five questions related to restraints."
Eventually, Aria Health hopes to provide iPads with the data collection app to all departments, including pharmacy and respiratory, that regularly collect data for performance-based scorecards. The health system also recently issued iPads to its board of directors so they can review hospital performance information electronically.
Aria Health had a web-based performance scorecard system in place before iPads came onto the scene. Health system leaders and staff regularly track rates on various metrics across the system's three hospitals and drill down to the unit level to get a grassroots perspective. "For patient falls, I can look at our health system's overall rate, each of our hospital's rates, and each individual nursing unit's rates," says Conley. "Once I drill down, I may find a unit that isn't really doing so well, and then we can zero in very quickly on where our areas of improvement are."
Thanks to Aria Health's speedier data collection approach, these performance scorecards, which are provided by the same supplier as the iPad data collection app, are now populated in a more real-time fashion. "There is no time delay from the time the data are entered in the iPad to getting the data to our performance improvement staff for proofing," says Conley. "Once approved, the data automatically populate the scorecards."
As a result, frontline staff are more aware of their units' performance data than they were previously, says Conley. "In the past, we would talk about our performance improvement indicators, but I'm not sure these metrics felt relevant to the staff. Before, they would get data that were a month or two old. Now they are getting data that relate back to what happened just a few days ago. It helps them to connect the dots and say, for example, 'Oh yes, our unit's fall rate went up because Mrs. Jones fell two days ago.' Then staff can hold a quick debrief on why Mrs. Jones fell and determine how to intervene and prevent such falls in the future."
A missing link in Aria Health's new quality reporting approach is data transmission-or uploading quality data from the iPads to organizations that collect and track quality data, including the Joint Commission and the Centers for Medicare & Medicaid Services (CMS).
Once again, to address this gap, Aria Health started with a small pilot. Using the same iPad app, the health system recently uploaded pressure ulcer data from one of its hospitals to a national nursing quality database that provides participants with comparative data on nursing-specific metrics.
"This eliminated many hours of manual data entry, and it increased accuracy because we didn't have a human punching all the numbers," says Leyden. "Previously, we were collecting the data on paper, calculating our rates internally, and then hand-populating data through the nursing database's web-based system."
Once she can get enough iPads, Leyden hopes to extend the data transmission pilot to include all Aria Health hospitals, as well as data submission to other entities and regulatory agencies, she says. "But we are young into this process, and there are going to be lots of opportunities for growth and lots of potential."
Aria Health estimates that it is saving approximately 80 hours in data entry time per quarter in each hospital area now using the app, thanks to its new automated quality reporting approach. "Given the state of health care right now, everyone is looking for solutions to time-consuming processes," says Conley. "As health care gets leaner and leaner, we have to be more efficient."
Despite a tight belt on capital spending, Conley had no trouble getting the capital funding needed to launch this initiative. Aria Health's senior leaders quickly grasped that the potential time savings and benefit to high-quality care would more than outweigh the cost of the iPads and the software.
The initiative also fits well with the health system's performance improvement goals. "We can talk about quality and measure it," says Conley. "But if we don't put the data into the hands of people who can change them, then this is really is just an exercise. To me, the most exciting part about this initiative is that frontline nurses and clinicians are looking at this and saying, 'We need to improve our performance on this metric.' Our quality reporting process now puts the data in the hands of the people who can make a difference?and that improves the care experience for our patients."
Maggie Van Dyke is managing editor of HFMA's Leadership publication (firstname.lastname@example.org).
Interviewed for this article:
Michelle Conley, RN, BSN, MBA, CENP, is CNO, Aria Health, Philadelphia (email@example.com).
Bea Leyden, RN, BSN, MBA, is director of nursing performance improvement, Aria Health (firstname.lastname@example.org).
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