It is impossible for a hospital to collect data to measure everything it wants due to its limited resources.  Thus, while a hospital may desire to choose which ever clinical processes and outcomes are most important, but I think it is a prerequisite that any hospital must collect data to measure the managerial processes and outcomes which relates to patient demographics and clinical diagnoses based on its mission, patient needs, and services.

The process, procedure, or outcome to be measured for the managerial area which relates to patient demographics and clinical diagnoses is one of the nine managerial measures recommended by the Joint Commission International (JCI) as outlined under the JCI Standard QPS.3.2 which states that “The organization’s leaders identify key measures for each of the organization’s managerial structures, processes, and outcomes.”

The subject of process, procedure and outcome reminds me of the Three Core Process Model, which groups the many processes that take place in any hospital into three core categories: (1) clinical processes, (2) operational or patient flow processes, and (3) administrative processes.

I shall focus on operational or patient flow processes, and administrative processes which concern the managerial processes and outcomes which relates to patient demographics and clinical diagnoses.

Health Information Management (HIM) / Medical Records (MR) practitioners will be familiar with the standardised operational or patient flow processes which includes processes that typically start with registering and admitting of patients during their visit to the hospital or in the course of their stay in the hospital that enable them to access the clinical processes related to diagnosis, treatment, prevention, and palliative care to address their clinical needs. An operational/patient flow process is an example of a managerial process which utilises and collects patient demographics data during the processes available and familiar to HIM / MR  practitioners when:

1. admitting inpatients for care
2. for registering outpatients for services
3. admission directly from the emergency service to an inpatient unit
4. the process for holding patients for observation in the Emergency department (ED)
5. how patients are managed when inpatient facilities (beds and/or services) are limited
6. how patients are managed when no space is available due to ED crowding and high hospital occupancy rates, thereby creating temporary inpatient holding areas (boarding patients) before admitting patients or to admit patients to the appropriate unit

The administrative decision-making core processes occupy two positions in The Three Core Process Model, one above clinical processes and the other below operational or patient flow processes. Decision making, communication, resource allocation, and performance evaluation processes make up the administrative decision-making core processes. These processes are definitely not under the domain of HIM / MR  practitioners, but HIM / MR  practitioners do contribute to administrative decision-making core processes by the hospital’s leaders by providing data, e.g bed statistics for resource allocation, participating in performance evaluation processes from e.g. Medical Records Review data analysis, uniform use of diagnosis and in the procedure codes based on patient record documentation which supports data aggregation and analysis as well implementation of diagnosis-related groups (DRGs) for decision making processes, and when they communicate with care providers about documentation and compliance issues related to the appropriate assignment of diagnosis and procedure codes.

HIM / MR  practitioners will be aware of prevailing mandatory local, national and international guidelines, standards and norms to measure processes related to patient demographics and clinical diagnoses. Nonetheless a hospital’s leaders are finally responsible for making the final selection of targeted measurement activities. The hospital’s leaders will decide and determine the following:

1. identify the process, procedure, or outcome to be measured
2. the availability of “science” or “evidence” supporting the measure to reduce unwanted variation in outcomes
3. how the measurement will be accomplished by deciding the frequency of measurement
4. how to organise the measurement activities so as to incorporate data collection into daily work processes

Hospital leaders are busy attending to both operating and strategic-level issues that concern quality, but they usually and always put patients first, and they will use data and information to examine and respond to problems, and rely on the participation of the entire workforce including HIM / MR  practitioners as members of the team who must possess a thorough understanding of the processes and the knowledge of specific tools to assess and to improve processes including those related to patient demographics and clinical diagnoses.  HIM / MR  practitioners must work with the hospital’s leaders to constantly seek changes that will co-produce improvement in a continuous cycle while outside regulators for example, the JCI checks on the quality of care of patient care systems and the outcomes they produce.

The measures selected and the analysis of the measurement data must ultimately fit into the hospital’s overall plan for quality measurement and patient safety, when they prove helpful in better understanding or more intensively assessing the areas related to patient demographics and clinical diagnoses that is under study. They also help to formulate strategies for improvement in the area being measured, and subsequent follow-up measures becomes helpful in understanding the effectiveness of the improvement strategy.

References:

1. Diane, LK 2007, Applying quality management in healthcare : a systems approach, 2nd edn, Health Administration Press, Chicago, Illinois, USA
2. Joint Commission International, 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA
3. Prathibha, V (ed.) 2010, Medical quality management : theory and practice, 2nd edn,  Jones and Bartlett Publishers, Sudbury, MA, USA