The Lost City of Gold: Finance and Quality Indicators in Big Data
There are several potential advantages in these new, very large datasets that will have a substantial influence on future research and operational information:
Linking Nurses to Patients – Many EHRs have the ability to link individual nurse to individual patient within and across different healthcare settings. For example, the actual nursing assignment within a hospital shift can provide information about the actual direct care hours and associated nursing care costs. This could also allow for study of the effects of individual nurse characteristics (e.g., experience and academic preparation) for all nurses caring for a particular patient.
Benchmarking Nursing Care Across Settings – With linked databases, we will have the opportunity to share and compare the different amounts of nursing care administered at different hospitals, clinics, home care, hospice, long-term care, etc. These represent “touch points” of both nurses and other healthcare professionals engaged and interacting with the same patient across time and settings.
Developing Performance Metrics and Analytics – The use of real-time clinical and operational data will allow better measurement of nursing and individual nurse performance in patient care. For example, data from electronic medication administration (eMAR) and bar code medication administration (BCMA) systems will allow direct measurement of medication administration delays or omissions for high-risk drugs such as aminoglycoside antibiotics. This measurement can reduce potential safety-risk events or identify patterns of care such as high workload conditions that predispose inpatient units to medication administration delays. Other potential performance metrics include pain assessment and treatment, patient education, discharge planning, and care coordination across multiple settings.
These exemplars represent potential benefits from EHR and other clinical or operational information systems commonly referred to as “big data.” There are a number of key issues and challenges to consider. First, hospitals or other practice sites must dedicate personnel to mining these rich data sources. Second, the complexity of the data collection is problematic and can vary across different settings, necessitating new data-extraction techniques. Finally, there is no broad consensus on how to pose relevant clinical or operational questions in ways that allow coherent, informative sharing and comparing of nursing data. The forum established by the CCNR focuses constant attention on these issues and gives stakeholders consistent opportunities to confer and develop solutions.
A quest this ambitious with consequences this important necessitates a national dialog and vision. Participating healthcare systems have already given the CCNR this broad reach. The holy grail of patient- and nursing-centric data has never been nearer at hand.