VA Posting Online Clinical Performance Data

Full Article at: VA bares all
By Joseph Conn
Posted: November 22, 2010 - 11:15 am ET
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The Veterans Affairs Department launched a program of clinical performance transparency, exposing its own internal clinical quality dashboard to public view.

The public exposure of the two Web-based dashboards, the Linking Knowledge & Systems, or LinKS, which has been in internal use at the VA for about two years, and the recently developed Aspire system, are part of a pledge made by VA Secretary Eric Shinseki when he took office in 2009 to make the VA “as transparent as possible,” said Robert Petzel, the VA's undersecretary for health.

Petzel heads the Veterans Health Administration, the department's healthcare arm, which operates 153 VA hospitals and more than 700 clinics.

The goal, Petzel said, is to "create an atmosphere of trust" with veterans, members of Congress and others with interest in VA healthcare operations. "Being transparent about your performance data is one of the ways you build trust with those various groups."

Both sites are available to the general public at hospitalcompare.va.gov.

LinKS presents outcome measures in near real time for acute care, ICU, outpatient, safety and annual measures at national, regional and local hospital levels for outcomes and process measures. It gives patients and personnel at each of the medical centers an opportunity to look at their own performance as well as the performance of every other medical center in the VA system, Petzel said.

Aspire uses color schemes, directional arrows and drop boxes for detailed explanatory materials about the measures being collected and reported. It also breaks down the data for comparison at the national level, across the VA's 21 regions, and by 137 healthcare "systems," which in VA parlance are individual hospitals or groups of several hospitals with a shared leadership group.

Each system can be measured against a set of aspirational goals, which in turn are "benchmarked against the absolute best in the country in the private sector," said William Duncan, associate deputy undersecretary for health quality and safety, who oversees the Aspire project.

Data from those community-based outpatient clinics associated with a medical center are rolled up into that medical center in the reports.

The Aspire systems uses colors to provide veterans and other nonclinicians an easy-to-comprehend picture of where each hospital is in relation to the best-in-the-nation benchmarks and uses arrows to indicate whether each metric is trending up or down.

The goals afford the public, clinicians and VA leadership with "a high-level executive look at where we want to be in three to five years," Duncan said. "Our secretary and our undersecretary wanted both of those to be available publicly. So, we're hanging it out there."

"We'll be tracking each organization's progress toward these goals, and when we find people who are stalled, we'll address that," he said. "The secretary will be looking at this and that tends to get a lot of attention."

Duncan said Aspire remains a work in progress. "One of my goals is to have videos, so when you click on the video, it will explain what the metrics mean," Duncan said. "There will be iterations in the future to make this much, much more user-friendly and understandable."

Aspire groups its outcomes and process measures under the six domains of the Institute of Medicine's Crossing the Quality Chasm report—patient safety, clinical effectiveness, efficiency, timeliness, patient centeredness and equitable care.

"We tried to get metrics for each of those domains," Duncan said. "We don't have the data populated for each of those metrics this year. We're expecting in the next quarter to have some of that additional data analyzed."

The VA considered as an alternative to building its own site expanding its participation in HHS' public reporting initiative, Hospital Compare, Duncan said. The VA joined Hospital Compare in March, but the source for it is Medicare data and "we've never billed Medicare," Duncan said."