Colorectal cancer, according to the American Cancer Society, is the third leading cause of cancer-related deaths among men and women in the United States, and is expected to cause an estimated 49,380 deaths in 2011. Overall, the lifetime risk of developing colorectal cancer is about 1 in 20, or 5.1 percent.
The good news is that colorectal cancer can be prevented, and it is a priority for the Department of Defense’s Military Health System to prevent as many cases as possible and to manage the population of beneficiaries at risk.
In the effort to prevent colorectal cancer and other diseases, the MHS tracks quality measures that are based on HEDIS® outpatient clinical quality measures developed by the National Committee for Quality Assurance. According to the NCQA, HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 75 measures across 8 domains of care, one of them being the measure for colorectal screenings.
Because so many health systems collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health on a relative scale. Health systems also use HEDIS results themselves to see where they need to focus their improvement efforts, and also for accreditation purposes.
The specific measure relevant to colorectal cancer is simply the percentage of beneficiaries age 50 through 75 years who had appropriate screening for colorectal cancer. In 2009, the MHS colorectal cancer screening rate in the Direct Care System was 67.5 percent, which falls between the 75th and 90th percentiles of NCQA benchmarks. As shown in the figure below, the MHS has continued to improve its rate of colorectal screenings since 2006.
The data that the MHS uses to report on quality measures, including the one for colorectal screenings, is made possible through advances in information technology.
“Information technology is a valuable tool in the delivery of quality health care because it facilitates the sharing of medical information among providers and beneficiaries, increases patients’ access to high quality care, and helps contain excess medical and administrative costs” said Dr. John P. Kugler, Deputy Chief Medical Officer for the Office of the Assistant Secretary of Defense for Health Affairs.
Quality measures help MHS beneficiaries compare the quality of care provided in medical facilities and assist them in making informed decisions about the quality of health services available to them and their families. The standardized and consensus-based measures are also essential for leaders and stakeholders who are focused on evaluating and improving the quality of health care delivered. The MHS makes its quality measures publically available at https://www.mhs-cqm.info, where anyone can go and see how different Military Treatment Facilities stack up against each other.
Reporting quality metrics for the MHS is not an easy task. The MHS has a massive population of beneficiaries and since worldwide implementation in 2006, AHLTA, the military’s electronic health record, has continued to grow. As reported to Congress in 2010, AHLTA had processed and stored over 122 million outpatient encounters, processing encounters at the rate of 152,000 each workday.
With such a large amount of data, the MHS faces the challenge of not only managing that data, but making it actionable.
Using its massive amount of data, the MHS aims to use IT to help providers by giving them the right tools to improve the health of their beneficiaries. “Providers want the data, and they want the data in reports and they want the reports on the Internet,” said Air Force Col. Albert Bonnema, Chief, Clinical Informatics Branch, Air Force Medical Support Agency, Air Force Modernization Directorate. The ability to generate reports is crucial for providers as they track and analyze health trends, considering the depth of clinical records that exists within the MHS.
The MHS uses a number of IT systems that work together so that a provider will be able to run daily, personalized queries on their patients’ health information. By optimizing the way providers interact with these tools, MHS can improve population and individual clinical care, and health business and resource management.
"It is very useful to have an IT system that can feed quality data to us at the clinic level, telling us which patients need certain care. My vision is for each of my Primary Care Medical Home team nurses to have access to the data," said Navy Commander James Ellzy, Chief of Family Medicine Department at DeWitt Army Community Hospital.
Whether it’s colorectal cancer, diabetes, or another critical measure, the MHS is continuing to use its data to maximize clinical intelligence in the effort to deliver top quality health care to all its beneficiaries.
By Matt Allen, OCIO Communications