Most senior healthcare executives have been prodded by market forces and beseeched by their bosses to muster a winning strategy for information management.
If those forces haven't been enough to spur a plan of action, the potential to run afoul of the Joint Commission on Accreditation of Healthcare Organizations could provide even more incentive.
Starting in 1997, a host of information management standards in the areas of planning and the use of comparative data will be elevated to a prominence that could cloud an accreditation report.
The JCAHO classified information management as a discipline of its own just three years ago. The first time around, hospitals got a break on much of the scoring while the agency assessed the challenge of complying with an added dimension of accreditation, said Paul VanOstenberg, director of the department of standards.
But after the first of the year, all hospitals will have gone through the information management scrutiny under the three-year accreditation cycle. The second time around, more will be expected of them.
Accreditation is scored on a 5-point scale, with 5 the worst score. But a number of information management standards were made exceptions to that rule: No matter what surveyors found, they couldn't officially reach a judgment of worse than a 2.
But those scoring breaks, or caps, will be dropped to a 3 for nine standards (See chart). That's a significant development for accreditation, said Jay Coburn, managing director of Greeley Co., a Marblehead, Mass.-based accreditation consulting firm.
"Anything going to a 3 for the first time is something that can give a hospital a Type I recommendation, when before it couldn't," Coburn said. That's the most serious adverse judgment imposed by the JCAHO, and it calls for formal remedial plans to clear up the problem before a hospital can be accredited free and clear.
Accumulating enough of those can lead to worse consequences-probation or threats to accreditation. But it takes a score of 3, 4 or 5 to get slapped with a Type I, Coburn said. With information management standards moving into that range, "you now have a list of new ways to generate a problem for the hospital," he said.
Most of those standards have to do with planning and executing information management, from standardizing data formats to devising appropriate plans for a hospital's size and complexity.
Surveyors scored hospitals based on the actual compliance they saw, so their evaluations provide a look at what the scores would have been had they not been capped, VanOstenberg said. In executive briefings conducted in August and September, a report on those actual results showed that 9% of hospitals accredited between January and June 1996 would have received scores in the Type I range.
Developing a management plan is not equivalent to developing an information-technology plan, VanOstenberg said. The JCAHO is interested in smooth and comprehensive handling of all types of data, both computerized and in written or other hard-copy form, he said.
Part of that challenge is getting three diverse departments to cooperate, Coburn said. The information management category brings together information systems, medical records and medical library functions, which historically have different viewpoints.
As healthcare organizations continue to get more complex, information technology may become a bigger part of the accreditation demands. Besides the specific challenges of making an information management plan work, other operations such as performance improvement and quality control will depend increasingly on timely and accurate information. Hospital technology planning "will need to be focused on resources to support the information management plan," VanOstenberg said.