Data: IT problems hinder state infection compliance
Technical limitations have created headaches for providers trying to comply with new state laws designed to reduce infections at hospitals.
States such as Colorado, Missouri, Pennsylvania and Vermont have signed laws in the past two years ordering hospitals to submit hospital-acquired infection data that would be turned into public reports.
There are 22 states with infection-reporting requirements in place or in the works, according to the Kaiser Family Foundation Web site State HealthFacts.org and Consumers Union. That includes Massachusetts, which announced its plans on Feb. 14, and California, which required that reporting start Jan. 1.
But getting all healthcare facilities onboard and reporting the same information into the same system is taking more time and effort than many thought. The hiccups also have slowed the reporting process in some of the states.
Hospitals in Pennsylvania are required to submit data through a federal database, but the data-mining systems that the state has approved for use under the law aren't ready to upload into the network yet, said Cheryl Herbert, director of infection prevention at 445-bed Allegheny General Hospital, Pittsburgh. Until the first system is ready, which is expected to be this summer, hospitals are entering all that data into the federal network by hand, she said. We're sort of in an in-between time as electronic systems are phased in, she added.
The different laws all require the same basic function: Healthcare facilities report data about prevalent hospital-acquired infectionssuch as catheter-associated urinary tract infections, central-line associated bloodstream infections and surgical site infectionsand the states are required to analyze the data submitted and publish reports on an ongoing basis.
Like in Pennsylvania, most of the laws require providers to enter data through the federal Centers for Disease Control and Prevention's National Healthcare Safety Network, an infection-reporting database. It's a process that carried a few glitches for some. The biggest challenge was ensuring all the healthcare facilities were using the same standard definitions for infection reporting into the CDC system, said Amber Miller, infection control manager for 543-bed Exempla Lutheran Medical Center, Wheat Ridge, Colo. Miller said the hospital has one person dedicating eight hours a week to managing infection data.
Similarly, the Colorado Department of Public Health and Environment was supposed to produce its first infection report in January, following legislation signed in the summer of 2007, but it missed that deadline because of limited resources and technical problems, said Gail Finley-Rarey, section chief at the department. The division only has one person to act as coordinator for the 76 facilities in Colorado required to report into the CDC's network, which itself has limitations about what type of health facility can report into it, Finley-Rarey said.
In addition, the time between the law's introduction and the first report was too short for the state to collect more than one month of infection data, which was not sufficient for generating meaningful statistics at healthcare facilities, Finley-Rarey said. The health department expects to have an initial report ready by July, with a full report published in January 2009.
It was the same thing Missouri first went through when it began its program two years ago, said Eddie Hedrick, emerging infections coordinator and senior epidemiologist at the state Department of Health and Senior Services. Staff turnover set back the department's efforts six months, and the last report was late because the department had to stop to train a new employee while there wasn't money available for the whole information technology office to work on the project, he said. The department did receive $600,000 from Missouri to help implement the program, he added.
Missouri's law went into effect in 2006, and the first report was due January 2007. Since then the health department has released reports of central-line and surgical-site infections, and reports on another measure, bed elevation, will be included this year in the spring, Hedrick said.
Missouri is not currently using the CDC network under its law but plans to transition to it. Hospitals are used to using CDC criteria to define infections, so using the system to report infection data keeps everyone on the same page, said Patti Reynolds, infection prevention supervisor at 603-bed St. John's Hospital, Springfield, Mo. St. John's has additional personnel dedicated to collecting data and training nursing staff about how to report infections, said William Sistrunk, a physician and infection prevention medical director for the hospital.
In Vermont, not all the state's 14 hospitals were ordered to report infection data because they didn't all do the types of procedures that led to potential infections. When reports were initially set to be published, in June 2007, not all the hospitals could use the CDC's infection reporting database, but now all hospitals are enrolled in the CDC system. They are not all required to report into it because of their procedure rates, said Jill Olson, vice president of policy and operations for quality with the Vermont Association of Hospitals and Health Systems.
Pennsylvania's law went into effect in July 2007. At first, no one was giddy with excitement to begin the massive effort needed, but everyone was allowed to air their concerns, said Calvin Johnson, a physician who is secretary of health for the state.
The facilities have filed infection-control plans with the health department and began reporting data through the CDC network on Feb. 14. About half the hospitals were already reporting through the CDC, Johnson said. Of the 248 facilities required to file plans by the end of 2007, almost all nursing homes and hospitals did so, but ambulatory surgery centers required an extension through the end of January to file. Those centers were slower to get up to speed because infection reporting is new to them, he said. The ambulatory centers will not be required to submit data through the CDC network because the database is not set up to accept information from that type of facility.