As it turns out, all six trends are relevant not just for healthcare generally but for patient safety in particular as well — the subject of this blog.
Indeed, these trends are accelerating progress in patient safety directly as a result of COVID-19. Fundamentally, there is a seismic shift occurring across health systems as they move from the “See something, Say something” approach of traditional voluntary event reporting to cost-effectively using clinically validated adverse event outcomes using real-time EHR data (“AE Outcomes”). These AE Outcomes are driving patient safety, quality improvement, and many other programs across health provider enterprises with more accuracy, timeliness, and actionability.
Let’s unpack each one of these trends one by one.
1. Reform. For many years the healthcare industry has relied upon claims-based measures (i.e. using administrative and billing data) instead of clinical data to measure patient safety. CMS has announced new EHR-based hospital harm measures, in which it is publicly known that the Health IT Research Lab of Pascal Metrics along with leading health systems in our national Community Collaborative were involved. The National Quality Forum approved for promulgation by CMS the first few of these in 2019, such as for hypoglycemia.2 As the machinery of the regulatory regime gathers momentum, it will only be a matter of time before EHR-based adverse event measures are being used not only for provider reimbursement by CMS but also to improve regulated patient safety throughout the FDA-regulated regime.
2. Health for All. While the unreliability of voluntary event reporting data for identifying patient harm in healthcare organizations is increasingly acknowledged, lesser known is the human bias that recent peer-reviewed published research has found in event reporting data. Indeed, the “See something, Say something” method that even the highest performing hospitals and clinics have been relying on for decades finds only approximately 5% of safety problems. Evidence-based EHR-based harm identification (per #1 above) is applied to all patients all of the time and, therefore, eliminates the social and racial bias that can arise through what Pascal has termed the “Social Determinants of Safety” (“SDOS”).3
3. Era of Exponential Improvement. The advent of virtual patient safety (“VPS”) is enabling exponential improvement, which we define as identifying and reducing adverse events at an increasing rate. Health system adoption of solutions taking a 24/7 approach to identifying and reducing safety vulnerabilities and quality variation began in 2020. The world of 24/7 VPS is replacing the “See something, Say something” approach of voluntary event reporting. The problem is not only that “See something, Say something” identifies only 5% of events but also that traditional quality improvement relies on this event data to identify patterns of patient harm in the population. Based on the evidence, using only 5% of harm events misses the patterns of harm in the other 95% of the patient safety events that are missed due to not being surveilled. Value is low, which has not been a problem until the recent emergence of an alternative. It’s now a problem for health systems that can be solved. The good news is that, as we use this new method relying on AE Outcomes to identify the incidence, severity, and prevalence of harm in a health system’s own patient population, we also can identifying new patterns of harm that heretofore have proven invisible to traditional methods — and achieve exponential improvement in health IT-enabled quality improvement.
4. The Big Squeeze. If there is going to be a big squeeze, there will be higher appetite for cost reduction across each and every function. In safety, CMOs and CFOs will question the value they are receiving from current vendor offerings. Large health systems spend millions of dollars annually on software systems based on the event reporting method supporting functions across the enterprise such as patient safety, quality improvement, peer review, risk management, revenue cycle, and more. Pascal predicts that CXOs will focus their safety spend where they can demonstrate the most value and refactor budgets that have traditionally supported safety spend that no longer is justifiable in a healthcare organization whose performance can be measured and managed with AE Outcomes.
5. Fragmented, Integrated, Consolidated Care Delivery. Health systems with which Pascal engages for the first time invariably are interested in applying VPS to the outpatient setting. While Pascal as a matter of strategy approached hospitals where we found the preponderance of evidence, budget, and EHR data, the world has changed since we first brought the vision of real-time patient safety to the healthcare industry almost a decade ago. Today we find existing clients interested in extending the success of outcomes-driven patient safety to the outpatient setting. Further,new prospects tell us that, if they adopt VPS, they will apply this new method beyond the walls of hospitals. Practice is affirming that we are on course to see patient safety using AE Outcomes for performance improvement across the continuum of care.
6. Next Generation Managed Care. One of the most significant and yet unrealized opportunities for cost reduction in healthcare today lies in patient safety. The business case historically in patient safety has been, to be polite, poor. There has been a lack of rationale to demonstrate, a lack of rigor in analysis, and a lack of positive result in execution. A big driver has been that traditional payment models do not reward outcomes; they reward activity. Significant internally validated studies at leading health systems (by both clinical and financial CXOs) have shown hundreds of millions of dollars of annual cost reduction opportunity.4 For example, each adverse event in a hospital results in excessive length of stay, higher hospitalization costs, higher readmission, higher likelihood of additional complications, and higher utilization in other settings such as outpatient even 6-12 months after discharge — for which even advanced analytics without AE Outcomes provide little, if any, lens. Value-based care, although incremental, is a tailwind. As we move more and more towards value, both health providers and health plans will benefit by reducing harm, which is simply “waste” from the perspective of the payor.
Without question, COVID-19 has elevated the priority of patient safety in global healthcare. Traditional patient safety has suffered from reliance on unreliable data, goal-setting based on proclamations from national organizations, high level cultural interventions bereft of data-driven learning common in other fields, and the perception — often times not without merit — that quality improvement fails to make a meaningful impact in improving outcomes.
The trends Pascal is seeing in 2020 — including those above pointed out by McKinsey & Company — suggest that, when our beleaguered colleagues in healthcare delivery make it past the pandemic, there will be a new world of clinical outcomes and financial opportunity awaiting in patient safety.
Stockwell, D. C., Landrigan, C. P., Toomey, S. L., Westfall, M. Y., Liu, S., Parry, G., Coopersmith, A. S., Schuster, M. A., for the GAPPS Study Group (2019). Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children. Hospital Pediatrics, 9(1). Thurtle, D.P., Daffron, S. B., & Halvorson, E.E., (2019) Patient Characteristics Associated with Voluntary Safety Event Reporting in the Acute Care Setting. Hospital Pediatrics.;9(2):134‐138.
Real world evidence generated by Pascal’s national Community Collaborative membership.