← Becker’s Healthcare Podcast
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- [00:00]
A
Hello and welcome to the Becker's Healthcare Podcast. My name is Chanel Bunger. Today I'm excited to speak with Dr. Malik Purahit, Chief Health Innovation Officer at Dottox Digital Health Labs, who joins us today to discuss the subject of our quality metrics, reducing quality. And Dr. Peroa, could you please get us started out for listeners that don't know you by introducing yourself and telling us a bit about your background?
- [00:22]
B
No, thanks, Chanel, thanks for having me on. It's always a pleasure to be on this podcast. Yeah, a brief background on me. So I'm actually, I straddle the fence between both the health system side and in the non health system side. I have two roles right now. One is serving as medical director and innovation leader for a health system called PAM Health. Post Acute Medical PAM Health. And we take care of patients for rehabilitation needs, whether it be brain injury, neurotrauma, spinal cord injury, stroke, et cetera. And so I serve as medical director there and head up many innovation efforts on that side. And then my other role is on the industry side with digital health research, where we help technologies understand how to conduct research on their product as my other role as Chief Innovation Officer for Datos X. And it's been an interesting journey, having been on both sides and then now simultaneously being on both sides of the health system side as well as industry and understanding both sides and the perspective and how that plays into the healthcare ecosystem that we have today.
- [01:26]
A
Perfect. Thank you so much for the introduction and now getting into the meat of the podcast a bit. What would you say are quality metrics and how. How did they come about?
- [01:35]
B
Yeah, good question. So quality metrics on the surface sounds wonderful, right? Because every industry should have some way of measuring what quality is, meaning what's good, what's not good, and how do we improve it. And as that old famous thing goes, you can only improve things that you measure. And so having quality metrics is an important part of the health system. And so quality metrics will include things like how many infections do you have on the inpatient, how many patients in your outpatient panel who have diabetes are getting annual eye exams or getting a foot exam. And there's a host of a whole list of things that are out there from both private organizations and government organizations to help health systems have something to measure to demonstrate quality. And part of this can also be mortality, meaning of the number of patients that are at your health system, how many have gone home, how many have passed away, etc. Things that on the surface seem like Good measures to have for quality and how health systems are performing. So patients can not only evaluate the name brand or other aspects, but also from a quality metric. Patients can see these online, whether it be CMS star ratings, whether it be other health grades or whatever else, there's multiple systems out there, leapfrog, etc. And so it's good to have these quality metrics and it's good that health systems are held to some sort of standard with these metrics and helping patients have more transparency into how a health system is functioning perfect.
- [03:06]
A
And can you explain how quality metrics are measured?
- [03:09]
B
Sure, great question. And so a lot of times they're measured. And in our world, really the advent of the electronic medical record system into health systems over the past how many years from the ACA to today, has really ramped up the measurement of quality metrics and creation of a quality metric system. Because when it's electronic, you can then go into the data much more easily than when we were fully on paper or you had to have physically go through each chart. And now you can do a much more automated data pool to get into weeds. A little bit though, it's is when you have quality metrics, then those are built into electronic medical records to allow physicians and others that are involved with this to then document things into the medical record that demonstrates the things you've done for a patient and then collate them over whatever period of time that you're looking to do that. And what that means oftentimes is designing a physician note a certain way design, designing a nursing note a certain way, designing other people in the system with certain usages of the electronic medical record so that you can capture that data in a much better way. And traditionally, and things will change as we're getting AI and generative AI and agentic work now. But traditionally what someone had to do was build this into a medical record in what's called a discrete way, meaning you have drop down menus or radio buttons or those kind of things to be able to do a population level data poll on all of your patients at once, rather than manually go chart by chart. If you type it in as free text, it was nearly impossible to capture that data unless somebody went into it. And so what you end up doing is building an entire infrastructure. And I'm pretty well aware of this because I served as chief health information officer for several health systems and we had to set up the entire EMR system for the purpose of data capture. That allowed everyone to get that data and then send it on to various places, whether it be leapfrog, whether it be cms, et cetera. CMS meaning the center for Medicare and Medicaid Services, which is really the largest insurance payer in the country. These are also the places we have to send the data to. What that caused, though, was having to build an entire infrastructure within the EMR itself to do so. Mention your IT teams, which meant your physician that were using the emr, the nurses that were using the emr, et cetera. And so these are all part of that infrastructure and ecosystem that became developed as a result of the need for quality metrics.
- [05:47]
A
Perfect. Thank you so much for walking us through that. Now, can you get into what are some of the pros and cons of quality metrics?
- [05:55]
B
Yeah. Another great question, Chanel, is all this sounds like a great idea with quality metrics, but again, the devil's in the details. Just like anything else with quality metrics, though, as I talked about that infrastructure that has to be built in there, what that actually created was more burden in the EMR for documentation. It takes longer to put a note in for a physician, takes longer to put a note in for a nurse, and that then becomes the focus of what they do because it's a requirement. If you work for a health system, you have to do these things, otherwise you're not allowed to be in the health system. And so now you've got this aspect of creating more burnout and more issues because of a lengthier note. I think by all accounts, when we looked at notes in the US for physicians versus notes in, say, Europe or other places, there's about a 35% increase in note length in the US compared to other comparable countries. And that alone is ripe for a burden on somebody. And again, this is really largely administrative. You know, we don't know if there's no proof that quality metrics truly improves quality beyond a certain level. Does it improve quality by 35% even though you're lengthening the note by 35%? Right. So we don't know if it's there now. If, if it did, then I think by all counts it makes sense. But if your quality improvement is say 2 or 3%, but your note length is 35%, I don't know if that makes a good return on value for what you're doing as an entire infrastructure. Second is, you know, and I say this is not only being on the oversight of it for innovation, but also a practicing physician myself, because that no burden I feel every day when I see patients, but the other part Then is that other visit with patients. It changes the flavor of that appointment and that visit with a patient, because now you have to spend a certain percentage of your time making sure that you check the boxes and click the buttons and all that kind of stuff and go through this sort of semi quote checklist of things that you do with the patient, whether it be inpatient or outpatient, and that then creates a different flavor of that appointment. And oftentimes, because you're spending time on that, you may not be spending time on other things that are important, like checking side effects from medications or the procedure that they had and what they're feeling or what the next steps are, or really, most importantly, having the time to educate the patient on their own health and what the next best steps are for them to improve their own health. And I think that's the biggest thing, is are we really improving quality of care or what a lot of health systems are doing now? And again, this is ubiquitous. It's not one system, not picking any one place. But what has happened with a lot of health systems now is they have large teams of people that are designed to look at quality metrics and find ways to improve that through the EMR build. And as a result, you're creating more and more burden on physicians. And oftentimes all you're really doing is changing documentation, Meaning are you putting down all the comorbidities so that you can account for all the sickness of the patients and so that your documentation gets better, but the actual care of the patient doesn't get better? And it's a little bit complex to go through all the details of it in the podcast, but at the end of the day, the question I have is, are we allowing physicians and nurses and others to practice the care of a patient, or are we doing the care of the EMR and care of quality metrics instead?
- [09:32]
A
Got it, got it. And Dr. Faroha, is there anything else that listeners should know?
- [09:36]
B
Michelle, I think this is a fantastic topic. Thanks for bringing it up. And I think again, I want to advocate that, yes, we should definitely have quality standards. We should definitely do the right thing and make these transparent and care for patients. The question I have though is have you gone too far with the pendulum? And are we, in the name of quality, just creating more metrics instead of true quality? And so the question is a reasonable one. It's not to point fingers, it's not to say that we shouldn't have these, but can we do a better job of creating the right metrics that makes true quality instead of just a quality metric system that people are trying to take advantage of.
- [10:12]
A
That's a great way to wrap it up. Well, Dr. Perett, I want to thank you once again for your time today and for sharing your insights on the Beggars Healthcare podcast. Thank you so much.
- [10:20]
B
Thank you so much for having always an honor and pleasure to be here.