Synergy - March/April 2014 - 17

industry feature

together bits and pieces and create a
hodge-podge OPPE or reappointment
performance report."
The second area that the groups identified
as problematic is the difficulty in collecting
and reporting the data. Most of the present
data collection is manual and decentralized
meaning that it is collected in many different
areas by many different groups. There is no
way to collate all these data sources to allow
for a reasonable report. There is no or little
automation in the process.

Addressing the Performance
Indicator Challenge
When questioned further, many hospital
support staff said that aforementioned
"hodge-podge" report came about because
there was no standardized list of data points
to be collected. Most places would just
gather what they could, a sort of cherry
picking process at best.
The starting point would be to begin with
the end in mind-what would an ideal
OPPE report look like? It should have at
least four major components:
1. Clinical Activity: The descriptive data
on admissions, discharges, procedures,
and consultations.
2. General Clinical Performance Measures:
This category includes performance
measures that apply to practitioners
across the board, such as medical record
keeping, patient satisfaction scores,
incidents of inappropriate behavior,
compliance with blood transfusion
criteria, etc. They tend to be the rules
based measures of performance.
3. Specialty Specific Performance
Measures: These are the specific
measures related to each specialty
practice and involves mostly aggregate
rate outcomes, such as mortality rates,
complication rates, and appropriateness
of medical therapy.
4. Case Review Results: For individual
instances of potentially egregious care or
complex care that still requires the labor
intensive case review by a peer or group
of peers.
Usually, the indicators in Groups 1, 2 and
4 can be created by a multidisciplinary task

force of the medical staff since they generally
apply to large groups of practitioners.
Group 3 is more challenging since there are
so many different specialty areas.
One approach taken by a small hospital
system in Northern California seemed to
work well. They had representatives from
every specialty attend a dinner where there
was a short presentation on developing
indicators. After that, the physicians had
to develop three to five indicators specific
to their particular specialty before they
were allowed to leave the room (excepting
bathroom breaks, naturally). When
they finished, the hospital system had a
large collection of indicators covering all
specialties that they used as a basis for going
forward with their OPPE development.

etc. Often, there are many homegrown
databases on individual computers that are
storing some of this data as well.
The trick will be to first decide what will be
the centralized recipient of the data, which
creates a database of performance that
becomes the source of reports generated for
OPPE and other competency assessments. You
will need to work with your IT department
to effect this process successfully.
Many organizations are now adopting
outside software to help this data collection
along. No matter what decision your
organization may make regarding this IT
support, it is clear that the organizations that
do this well are the ones that can automate
the process to a significant extent. The more

Using an objective process and data, hospitals
need to evaluate the competency of all
practitioners to exercise their granted privileges,
and this must be done every 6 to 9 months.
A quick general point: no one needs to
write indicators completely from scratch.
The AHRQ, the research arm of CMS,
has a national warehouse of performance
indicators that one can access through the
internet at www.qualitymeasures.ahrq.gov/.

Data Collection
The other great challenge is in collecting
accurate and supportable data regarding the
indicators chosen to measure performance.
In addition to the general scattering of the
data repositories, the number of different
people tasked with this data collection within
a given organization can be enormous.
One way to begin to get a handle on this
is to do an inventory of all data sources
of performance measure that exist in your
hospital. The big ones, of course, may be
your basic hospital data system that often
has the coded data as well as modules
that may contain various portions of the
measures, the electronic medical record,
the Operating Room system as well as
any systems supporting specific areas like
the ICU, the Delivery Room, Pharmacy,

the dependence on manual data storage,
the less likely it is that you can get to a
robust OPPE, so get automated today. ■

Mark A. Smith provides
consulting services through
Morrisey Associates as a Chief
Medical Consultant. He is also
an associate with HG Healthcare
Associates, a healthcare
consulting firm. Dr. Smith brings 25 years of
clinical and hospital management experiences to
his work with physicians and hospitals across the
United States. His clinical practice as a surgeon
and multiple roles in senior hospital administration
make him extremely qualified to assist clients in
developing solutions to their complex problems.
Dr. Smith has extensive expertise in peer review,
quality, ongoing and focused professional practice
evaluation, criteria based privileging, low volume
practitioners, ED call and external focused review.
Dr. Smith is a Fellow of the American College of
Surgeons, Southwest Surgical Society, and the
American Board of Quality Assurances and
Utilization Review Physicians. He is a member of
the American College of Physician Executives, the
American College of Healthcare Executives, and
the National Association of Healthcare Quality.
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Synergy - March/April 2014

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