Introduction
Provision of healthcare services entails a complex process of information exchange among a large network of specialized persons and institutions. From the very basic view, a general medical practitioner may require a patient to consult a specialized doctor such as a dentist for certain reasons. The dentist may on the other hand require the patient to obtain an x-ray before full diagnosis. It may also be necessary to refer back the patient to the general practitioner for further checkups on conditions which according to the dentist, do not relate to the diagnosis given. This entire process clearly requires accurate information exchange among the different parties involved (Abowd & Myatt, 2000, p. 23).
Accurate information sharing starts from the adoption of universally accepted data recording platforms as well as a common channel or media through which the information is to be shared (Health Data Management System, 2010, p. 3). The purpose of this paper is to present a proposal for the audit of information sharing mechanisms within and among medical institutions as per the Clinical Data Interchange Standards Consortium (CDIS) (CDISC Standards, 2010, p. 2). The Consortium has well developed standards with the ability to be adopted globally for efficient information recording and sharing (Eric, 2004, p.45). The writer works in a health institution where the data management in use was developed to specifically fit to the requirements of the institution with little regard to the need for interaction with external institutions.
Importance of Evaluation, Measurement and Research in Healthcare
Healthcare provision is regarded as one of the core issues in any society. This is mainly because the ability of a population to offer optimal productivity for economic growth and development is a direct function of the health status prevalent in the population (Health Data Management System, 2010, p. 2). The availability of a well functioning and responsive healthcare sector remains one of the most important goals for governments in the modern day. Healthcare management thus becomes the epicenter for the development of quality healthcare services (Davida, Paul, & Mark, n.d, p35) Evaluation involves an in-depth assessment of the issue under consideration usually against some set standards (CDISC Standards, 2010, p. 6). In healthcare evaluation is crucial to determining not only the ability of a system to improve the process of providing healthcare services but also its ability to ensure safety of the patients in the process of use (CDISC Technical Road Map, 2010, p. 2). Evaluation avails the all important feedback required to make relevant decisions regarding the need to improve the system.
Performance indicators are very important in healthcare provision. The indicators enhance the efficiency with which the quality of healthcare is monitored. The indicators formulated must be relevant, reliable and valid. A healthcare system should have both internal and external performance indicators. The internal indicators should be relevant to the professional involved. On the other hand, the external performance indicators should be real and fair. Performance indicators for the evaluation of data standardization within and across institutions are seen in the form of the ability of the system in use in within the different medical institutions to conform to the standards developed by ICSDC (Gerrish, Mawson, 2005, p35).
Measurement on the other hand involves the establishment and use of appropriate units or yardstick in scaling the different aspects of healthcare. Focus here is establishing quantifiable measures usable in a bid to establish the level to which the system has had success (Health Data Management System, 2010, p. 2). The measurement element enables effective evaluation. A wrong understanding of the problem means that the solutions developed at the end will be flawed. It is thus important that measurement technique adopted in measuring the qualitative aspects of healthcare are truly representative of the variables they are intended to represent (Davida, Paul, & Mark n.d, p. 3).
Research in healthcare audit entails the process of finding out in great detail the issues which affect the success of the system or process under scrutiny. It is an enquiry process aimed at bringing out the facts which should be put in proper perspective in the quest to develop an even better healthcare system. Due to the sensitivity of healthcare practice it is paramount that it is based on a strong evidence base. A strong evidence base essentially means judicious, current and relevant evidence which is foul proof concerning healthcare. Developing such accurate and trusted evidence requires the application of accurate scientific research methods in research. Testing of new technologies also have to be done accurately so as to ascertain effects on healthcare delivery as well as fully understand the impact on patients, care givers as well as other health professionals (Øvretveit, & Gustafson, 2003, p38)
Research also aides the development of relevant solutions for the problems identified during evaluation and measurement. The feedback got from the process of evaluation is used as the basis of conducting research. This is because it points out the various areas where viable solutions should be focused (Abowd & Myatt, 2000, p. 23).
Indeed, measuring the wrong item in the wrong manner definitely gives a distorted picture on the problem being faced in managing the healthcare system. Research is thus geared towards developing new general knowledge by handling existing and identifiable problems using unique and targeted solutions (Eun-Jung, Hyung-Jik & Jeon-Woo, 2006, p. 41).
The entire process of evaluation, measurement and research represent the ultimate process of improving provision of health care. Evaluation brings out the areas requiring amendment as well as the intensity in application of resources required to adequately deal with the issues identified. Measurement enhances the ability to develop accurate assessment of the element of healthcare and also develop adequate solutions. Research caps it all by providing relevant ways of improvements to the existing systems resulting in better overall provision of healthcare services (Davida & Mark, n.d, p.3).
Rationale for the Audit
Globally there are evident efforts to enhance the ability of different medical practitioners so as to enhance the level of quality as well as efficiency in medical care. The availability of complete and relevant patient records on demand is important to reducing the frequency of medical errors. The sensitivity of accurate data transfer and sharing within and without the medical institutions cannot be overemphasized.
The audit targets the element compliance of data exchange within medical circles to the specifications stipulated by the CDISC. The audits are meant to offer insights to areas of deficiency in application of the standard of data recording. Experts argue that a great deal of inefficiencies in the provision of care services is as a result of lack of proper data standardization across medical institutions. To date, it is clear that a sizeable number of care providers, specialized practitioners and pharmaceuticals are yet to adopt a common platform for communication. This being the case, there is a shortage of accurate accessible data regarding patients within and across medical institutions (Bond, 1996, p.23).
By identifying how well the ICDSC standards have been utilized by various relevant parties, this will help develop a clear picture of the extent to which data standardization has been achieved (Bond, 1996, p.25). In addition, this will give insights to the amount of energies which should be employed in ensuring universal standardization and harmonization of data. The decision to audit the element of healthcare arises from the fact that despite the presence of well developed standards, the rate of compliance to these standards is still low.
Best Practice in Healthcare Data Management
When the patient is on the second floor, the operation room is on fourth floor and the ward is on the sixth floor, there is a clear need to have a common channel where information is exchanged between the different professionals involved. Success in accurately diagnosing and treating the patient in such a situation is hinged not only on the abilities of the chain of professionals involved in the entire procedure but also on their ability to share data concerning the patient effectively (Health Data Management System ,2010. P3). In a case where the patient seeks care from multiple institutions, the presence of a standardized data sharing platform is crucial in ensuring that accurate and reliable data exchange occurs to ensure proper understanding of the patient’s history as a platform for administering further treatment procedures (Eun-Jung, Hyung-Jik, & Jeun-Woo, 2007, p. 23).
Proper data management should be based on several principles. First is relative simplicity. This implies that data recorded should be easy to understand for the people concerned. Simplicity is relative due to the fact that it is only achieved as a compromise for completeness (Bond 1996, p. 25). The implication is that for the required information, the data recording should be as simple as possible. It is however important for all the details required to be availed even if this compromises the principle of simplicity.
The second principle is that of ease of implementation. The data sharing platform should be structured in a way which avails information focused on offering solutions or the best information to guide further processes (How to Navigate the New CDISC Standard 2008, p. 3). An example is where records concerning a patients laboratory tests is accompanied by the diagnosis already offered. This guides the practitioner who later receives the patient on where to start with the treatment. In addition there should be an evidence based criteria (Abowd & Myatt, 2000, p. 28). This means that the data shared should be backed up with some relevant basic evidence. The intention here is to give the receiver confidence on the procedures already undertaken and the results gotten. It also delivers some extra information on the measures especially in a case of laboratory results which give the scale of the health condition at hand (Mead n. d., p. 71).
It is true that there are countries or states where legislation covers issues regarding data sharing. This is meant to ensure that [data sharing is done in a safe and coherent manner. Compliance to the statutory and requirements is also an important principle for consideration in the process of developing the data management program. There should be adequate provisions to ensure that all the statutory requirements are fulfilled. This is not only to ensure the legitimacy of the data sharing system but also capture the concerns being addressed by the authorities enforcing the regulations (Mead n. d., p. 71).
It is however important that the recovery and rehabilitation as well as care plan goals are facilitated by the data being exchanged. This means that the data being shared should be geared towards supporting progress in the recovery process for the patients (CDISC Technical Road Map, 2010, p. 4). It should ensure that the information passed is not only accurate but also geared towards helping the concerned parties improve efficiency in extending care services. This principle supersedes any other (How to Navigate the New CDISC Standard, 2008, p. 3).
Data shared within medical organizations should fulfill several criteria. The most important element is coding. Each patient should have a unique code for proper identification. The code should be referred to and used to identify and record all data concerning the patient represented. The coding system should be complete and accurate (Heather & Edward, 2010, p. 9). Completeness implies that it should carry all the relevant base information which identifies the patient in terms of the categories where they fit and then identify them uniquely within their respective categories. Bar coding is touted as the most water tight method but it should be supported by other measures to ensure effectiveness. This ensures that data exchange is accurate. Secondly, the system should offer clear revenues for revenue management (National Health Service Executive, 1996, p. 56). Apart from the exchange of patient records and other related information, the data management system should track revenues and payments made by the patient throughout the system and ensure that accurate reporting is done to the billing departments within the organization. This ensures adequate and effective management of revenues in the organization (White & Gilliam, 2004, par. 2).
The different departments should be interlinked to ensure minimal movement of people from one department to another. Interconnecting the health facility to the external organization is also crucial in the success of a data management. The system should enable the health facility administrators to track and trace products with suppliers. This enables proper application of recall procedures as well as enabling quicker response time to the needs of the patients (Exploring the Hottest Areas of Healthcare, 2010, par. 3). Here a unique identification number is always required. It helps identify products, locations and patients. The data capture methods save time and reduce costs in addition to reducing errors (Bardsley, Spiegel halter, Blunt, 2009, p. 3).
Overall Purpose & Audit Objectives
The overall objective of the audit is to find out how well healthcare organizations have adopted the data management standards stipulated by the Clinical Data Interchange Standards Consortium (Cook & Campbell, 1979, p. 233). The results of the audit will facilitate policy makers and other concerned parties in their quest to ensure that data interchange within and without the medical facilities is standardized as a measure to improve the level of efficiency in delivery as well as better management (Cimino, 1998, p.32). This will be done by comparing the data management structure applied in different health facilities and comparing them to the standards under the CDISC (Sweeney & Heaton, 2000, p. 26).
The first Audit objective is to establish the suitability of both syntax as well as semantics of the interchange platform. Syntax refers to the structure while semantics is in reference to the meaning (Heather & Edward, 2010, p. 3). These two elements are crucial to the interoperability of systems as well as unambiguous data transfer. An illustration can be obtained through the following two sentences: “The dog eats red meat” and “The dog eats blue trees”. These two sentences follow identical syntax or structure (Cook & Campbell, 1979, p. 236). This is because they start with an article, then a noun followed by a verb, modifying adjective and a direct object noun. However, their semantics are very different (Sweeney & Heaton, 2000, p. 27). The first sentence makes sense while the second one is senseless despite the similarity in structure (Cimino 1998, p. 32). The second example is “The patient was given pain medication” and “The patient was given medication for pain”. These two sentences do not have similar syntax but depending on the level of the reader’s clinical experience, they may have or may not have similar meaning. Thus syntax alone is not a reliable determinant of semantics hence the need to integrate the two elements in the system.
The second audit objective is to find out the compatibility of the data types in use. Data types are the fundamental building blocks around which semantics of a given piece of data are built (Bardsley, Spiegelhalter & Blunt, 2009, p. 5). Healthcare requires several complex data types to support concepts such as physical quantity and time as well as data types describing coded terms within terminology. Close comparability of data types among organizations largely defines the ability of the organizations to share information (Gruber ,1993, p. 24).
The third objective is interoperability. This refers to the ability of two parties to exchange information. Analysts argue that in most cases the problems in interaction among health facilities are not caused by the systems but rather the difficulty of data exchange. Syntactic operability ensures that data structures for the different systems are compatible (Gruber 1993, p. 24). Afterwards human or semantic interoperability guarantees that the meaning is clearly exchanged among the human beings using the two systems (Exploring the Hottest Areas of Healthcare, 2010, p. 4).
Finally, the objective of the audit is assessing the semantic operability among machines used in the different institutions. It does not imply that all the received data has to be processed after reception in a similar manner but that the all the machines are able to make processing decisions based on the same meaning organization (White & Gilliam 2004, par. 2). Notably, the audit entails a comparison of the standards under ICDS which fulfill the requirements discussed above to a very high degree to the actual systems in use among the healthy institutions.
Action Plan
Goal/Purpose
Conclusion
The audit process will not only unearth the compliance of the various health facilities to the standards developed under the ICDSC but also give a clearer picture of the disparities existing among the systems in use in different health facilities. The outcome will offer a better understanding of the enormity of the incompatibility problem in the health facility a situation which can present a great hindrance to the delivery of healthcare services to the patients. By evaluating the syntax and semantics and syntax in use for the different systems available, the possibility of making accurate recommendations towards the adoption of common clinical data interface will be enhanced. Again the data types will guide the technical teams responsible for implementing similar systems on the best data sharing platform available for the adoption of a common data interface. The audits outcome will definitely offer unrivaled evidence to the level of interconnectivity possible among the medical institutions.
In developing the proposal the writer was able to obtain unique insights on the need to engage in proper evaluation measurement and Research. The three elements compliment each other but are also an important integral part to the success of any meaningful enquiry process including performing audits. Evaluation is the expansive and in-depth assessment. It is supported by the measurement element by the fact that a suitable yardstick for measurement has to be developed. Research ensures that outcome from evaluation are utilized in the subsequent development of better systems.
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