The New Data Equation: Quality > Quantity
Guest post from Dr. John Lee, Chief Medical Information Officer at Edward-Elmhurst Healthcare and Allegheny Health Network
Welcome to our first guest-post article!
This week, I’m pleased to introduce John Lee, MD, as our inaugural guest poster. Dr. Lee is a clinical informaticist and practicing emergency physician dedicated to improving healthcare through technology and better information delivery. As Chief Medical Information Officer at Edward-Elmhurst Healthcare and Allegheny Health Network, Dr. Lee has driven high provider satisfaction and efficient, quality care. In 2019, he was named HIMSS-AMDIS Physician Executive of the Year. Through his firm, HIT Peak Advisors, he provides health IT advisory services with a focus on Epic optimization. Dr. Lee is a member of AMIA, AMDIS, HIMSS, and AAEM. His vision centers on data-driven, cost-effective healthcare solutions.
I think you’ll find John’s post on how to define quality and value insightful, succinct, and thought-provoking.
Our health care system is infamously driven by a "fee for service" model, where providers are paid based on the number of services they deliver. If you look at the day-to-day behavior of many healthcare professionals, it’s clear that volume still drives much of what we do. I frequently hear colleagues discuss optimizing their documentation for better billing and coding volume-based metrics. I don’t hear conversations about measurements of quality nearly as much. While there’s been a growing shift toward value-based care — where payment is tied to the quality of care provided — we are still far from that tipping point.
That being said, value-based care is starting to gain ground. As we move to a better payment model, there is a follow up question: What value are we getting from measuring "value"?
We measure many things, like Patient Safety Indicators (PSIs) including hospital-acquired infections (HAIs) and catheter-associated urinary tract infections (CAUTIs). We track 30-day readmission rates, emergency room wait times, length of hospital stays, and medication reconciliation. Of course, we also measure mortality. But what are these metrics really telling us? Are they the right things to measure? While these certainly, heuristically, make sense, are we missing opportunities to measure more meaningfully?
In Peter Attia’s book “Outlive: The Science and Art of Longevity,” he writes of the concept of “healthspan,” which contrasts with the more familiar "lifespan." While lifespan measures how long you live, healthspan focuses on how well you live—your quality of life as you age. It’s a subtle but powerful distinction. Take, for example, an 85-year-old patient with severe dementia who experiences cardiac arrest. A full resuscitation may bring him back, but does it improve his healthspan? After resuscitation, the patient can spend weeks in intensive care, at great emotional and financial cost. Is that more like prolonging suffering than improving life? During such a hospitalization, we are tasked with collecting reams of data and curating huge volumes of quality metrics. For healthcare providers on the front lines, these sorts of efforts maximize the skills we learned in our medical training, but the experience can feel professionally hollow—and contribute to the burnout that so many of us experience.
We’ve developed incredibly detailed systems to measure traditional "quality" metrics, but there are untapped opportunities that could have a more meaningful, long-term impact on patients’ health. Far less than 1 percent of the data that can impact a person’s health is collected at any scale that can impact decisions and insights into best practices. We are focused on many data points that may be distracting us, ignoring other goals that will actually make a difference and improve metrics like healthspan.
There is a growing buzz around social determinants of health—the environmental and lifestyle factors that profoundly influence a person's well-being. While studies and media frequently discuss the importance of exposure to sunlight, sleep quality, diet, and physical activity, the healthcare system barely scratches the surface when it comes to measuring these factors. We track broad data points like food deserts, physical activity, financial strain, and housing stability, but are these metrics too general to provide actionable insights? Shouldn’t we be collecting more specific data? Instead of merely noting that a patient is physically active, why not measure their VO2 Max or lean muscle mass? What about the volume of highly processed food someone ingests? This sort of data could yield more precise insights into managing metabolic disorders, cardiovascular disease, post-surgery recovery … or the ability to take a morning walk every day with your family.
You might point out we don’t yet know which data points are truly important. I contend we actually don’t know if the current metrics make a difference. Additionally, this uncertainty is precisely why we need to start collecting additional data points. Without the data, how can we uncover the insights leading to more effective care? For example, Epic’s Cosmos Platform aggregates massive amounts of patient data. This offers a glimpse of what’s possible when we can access data at scale. If we could collect some of these other data points and make them available in Cosmos and other large data platforms, we could begin to reveal insights about what truly contributes to outcomes like healthspan at scale and speed.
The bottom line is this: if we want to improve healthcare, we need to rethink what we’re measuring. We need to go beyond the legacy data points and start measuring to improve outcomes that represent true quality.
Emergency Physician
Clinical Informaticist
HIT Innovator
At The Surgeon’s Record, we are committed to providing a forum for innovators to share ideas and stimulate discussions (with a special nod to physicians). By surfacing as many opinions as possible from across the spectrum of healthcare, we hope to deepen understanding and build a community of individuals dedicated to a better way forward.
To that end, we are looking for collaborators. If you’re interested in writing an article or being a guest on a webinar, please reach out. Many of you have reached out to me about how you can get involved, build a network, and develop a following. Here’s your chance!
Ben Schwartz, MD, MBA
Editor-in-Chief, The Surgeon’s Record
Commons Clinic Senior Clinical Fellow
