Health Checkup

Health Checkup

Indian Health Service customizes performance management


One federal agency has bucked the trend of buying off-the-shelf software and built its own application instead.

Installing commercial performance evaluation software at Indian Health Service hospitals would have forced the agency to hire more employees'and it still wouldn't have had a system that met the most important health criteria of its community.

Instead, the health agency assembled its own performance evaluation system with programming tools from SAS Institute Inc. of Cary, N.C.

IHS provides health care to about 1.5 million American Indians and native Alaskans from about 550 federally recognized tribes in 35 states, said Michael Gomez, a program manager in the Albuquerque, N.M., office of IHS' Phoenix region.

Michael Gomez customized a performance management system that eventually will help Indian Health Service hospitals comply with federal health care performance standards.

The Indian Health Performance Evaluation System (IHPES) will help IHS hospitals meet performance standards set by the Joint Commission on Accreditation of Health Care Organizations.

The commission's Oryx initiative requires accredited hospitals to compile performance management data for use in future accreditation reviews. Hospitals choose the performance standards they want to monitor, such as percentage of Caesarean births, and software vendors have developed suites for collecting and reporting the Oryx data.

Gomez, however, needed unique performance indicators not captured by such suites. Despite IHS patients' diversity, they share health concerns such as diabetes.

'If it's going to be useful to IHS, it's got to be relevant to the care you're giving,' Gomez said.

For example, IHS hospitals must track whether diabetic patients get annual exams and are screened for dental problems and diabetic retinopathy.

'Now we can verify that people are getting access to the health care they require,' Gomez said.

Data harvest

IHPES passively extracts data from each hospital's installation of the IHS Resource and Patient Management System. IHPES aggregates the data regionally and transfers it to the Albuquerque office, where the national IHS hospital performance statistics are analyzed.
Passive data collection is a big advantage, Gomez said. Most commercial Oryx systems he investigated required a worker to extract data manually from patient management systems and load it into flat files.

IHPES deals only with statistics about procedures and outcomes, not individual patients' records. 'It's not names, it's not diagnoses'it's all summary-level data,' Gomez said.
His team is now developing a data-quality component that will compare the completeness, quality and integrity of local data against national results.

Gomez said he selected SAS products partly because he had a lot of experience with SAS programming, and also because of SAS Public Sector's Pilot Program, which gives short-term assistance on customer projects.

The Web-based IHPES resides on a four-processor IBM RS/6000 server with 28G of internal storage at the Albuquerque office.

Laying the foundation

Gomez and his team used SAS Version 6 to start building the system in mid-1998. They continue to use the base SAS software along with the SAS/IntrNet application framework, the SAS/QC statistical component and the AppDev Studio application development package.

Although some information about IHPES and the Oryx requirements is publicly accessible, passwords are required to reach the data-reporting and verification tools.

The system summarizes every data export process received at the Albuquerque office, so that staff members can verify the data arrived.

Gomez is the only full-time worker associated with IHPES. Three other people in the Albuquerque office, two contractors and one support person assist him. About 15 other clinicians, nurses and technical support workers from various IHS offices gave advice during IHPES' development.

The system will expand to cover the broader performance measures of the Government Performance and Results Act.

'We're reaching the point where we need to move on to a beefier server with a lot more storage,' Gomez said.

Thirty-one of the agency's 49 hospitals, from Yuma, Ariz., to Barrow, Alaska, subscribe to IHPES. Each hospital pays the IHS Phoenix region $4,000 per year to participate.


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