Time and again, we’ve heard CMIOs, CMOs, clinicians, analysts and others express frustrations over their current methods for creating value sets. The struggles can be summed up simply: Institutions don’t always have the dedicated resources required to create and maintain value sets.
In their journey towards value-based care, more and more healthcare organizations need to use value sets to accomplish their institutional goals. However, as the industry moves toward this new model of care, systems struggle to meet the inherent demands of:
- patient cohort identification for population management
- creating automated rules that enhance clinical decision support
- quality measurement for regulatory reporting
A value set is a group of codes used to create a list of patients associated with a specific clinical concept (for example, all patients with Type 2 diabetes in a particular hospital system). However, creating a clinically valid value set with all the right codes is a labor-intensive, manual process. Not only does value set creation require input from clinicians to help accurately define the clinical concept, it also demands creators have the latest knowledge of ever-changing terminologies and requires constant updates to each value set’s rules.
Health care organizations traditionally do not have full time resources dedicated to this effort. Hence overburdened clinicians and analysts need to fit this work into their already busy schedules. Furthermore clinicians, who are trained to provide patient care, typically spend significant time contributing to value set creation by providing clinical input and validation. All this causes a drain on the hospital resources.
It can also lead to errors and inconsistencies. Value sets that are improperly created and maintained will generate inaccurate patient cohorts, which negatively impacts care management and quality measures, ultimately harming both outcomes and revenue.