QA, RM and UM Functions Require Coordinated Information Management


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Abstract

The public demand for access to health care data in general has created a flurry of activity at the health care provider level. Specifically, data on quality plays a pivotal role in this competitive, litigious and cost-conscious environment.Currently, data (manual or computerized) on clinical and organizational performance is sparse, although health care institutions have traditionally had QA and related utilization review, risk management and peer review activities in place to fulfill requirements for licensing and accreditation. Where data exists in isolated pockets, little coordination or integration has occurred, thereby diminishing the potential value of the data as part of a comprehensive information system.Today, institutions are responding to the demands for QA, RM, UR data in many ways. Much progress has been made in establishing comprehensive QA programs utilizing centralized, coordinated data from multiple sources to demonstrate both clinical and organizational performance. These comprehensive programs have clearly defined the need for computerization with the ability to re-use existing information.Applying this technology, however, requires assessment and planning. Allowing department-oriented, microcomputer-based application prevents sharing of resources and in many cases results in redundant and perhaps uncoordinated data capture. Decentralizing of the decision-making process leaves the ultimate selection of computerized QA and related applications to the individual user, whose focus is generally centered on his/her own priority. These systems are frequently incompatible with other existing systems. This approach will not support the institution's need to provide timely, accurate, complete information about the quality of service rendered nor information critical for internal management and planning.Health care institutions moving toward the concept of information management through computerization should consider a definitive plan of action for determining data required to demonstrate comprehensive clinical and organizational performance; what currently exists to support performance assessment; and how the existing systems (data) can be modified or augmented to support the creation of a coordinated, usable data base.

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