Clinical system generates performance reports

The Indian Health Service (IHS) received an “effective” rating for the performance of its medical programs, according to fine print buried in President Bush’s fiscal 2007 budget.

The more remarkable part is that the service’s Clinical Reporting System (CRS) automatically generated the data. The system gathers data from the service’s 182 clinics and other programs in 12 regions. Then the system compares the agency’s quantitative goals with program results, as required by the Government Performance and Results Act.

For example, the agency has a goal of ensuring that by 2010, 70 percent of women between 52 and 64 whom the service treats get mammograms to check for breast cancer. In 2005 41 percent had undergone the procedure, up 1 percent from 2004. But in two regions, fewer than 30 percent of the women got mammograms, and four regions’ performance was worse last year than in 2004. That shows managers where they need to devote more attention.

“What we’re seeing as an agency is that our ability to track performance and monitor it is leading to a change in what’s discussed on a regular basis,” said Theresa Cullen, a senior medical informatics specialist at the agency. She calls the system and its use by IHS managers “a success story for performance-based budgeting.”

“We took a federal mandate that most people thought was pretty ugly and used it to improve clinical quality,” she said.

For 2005, IHS reported data on 20 clinical measures reported through the CRS system. For only one of the measures, body-mass index assessment, the service did not meet its goal of 65 percent. However, there was a 4 percent increase compared with 2004.

Cullen said IHS is the only one of three major federal agencies that provide medical services in which an automated system does performance reporting linked to an electronic medical records system. In one of the others, the Department of Veterans Affairs, charts are reviewed manually, while the Defense Department uses billing data, she said.

“We don’t do chart pulls anymore,” Cullen said, adding, “When we didn’t have a tool that made it easy, [performance reporting] didn’t happen.”

The agency is continually improving CRS, adding to the items measured and fine-tuning what is measured. For example, a November 2005 release added osteoporosis screening for women.

A national health IT organization, the Healthcare Information and Management Systems Society, will present a major award to IHS for CRS at the society’s conference this month.

The clinical information system IHS uses in caring for 1.3 million people is called the Resource and Patient Management System. It is based on the VistA system developed by the VA.