The Cycle

OA SMR is software designed on a theme: that many software applications are built to measure and remeasure. Many custom business applications (albeit not all) are closely related to at least some of the elements of this theme. There are many reasons for this pattern. One is the increased focus on outcomes in the social service and health care sectors. Outcomes require measurements at the conclusion of service and in many cases at the beginning of service as well.

Second, service organizations are increasingly being ranked on performance measures. One only need to do a simple Google search to see the plethora of rating sites, government ranking services, and insurance company ranking systems. These trends have forced providers to compete on the data, and for payer organizations to use systems that effectively manage these ranking systems. Perhaps most importantly, systems are built in many cases to investigate and judge. This abstract use case lends itself to systems that give the user the ability to measure and integrate measurements into workflow.

This measurement cycle is ideal for technology support. For providers that need to comply with data ranking regimes, they can set up internal projects to compete more effectively by collecting relevant data and injecting that data into a technology assisted workflow process. At the same time payer organizations can increase the sensitivity and efficiency of their tracking and monitoring efforts by using systems that automate the often onerous task of managing the volume and use of tracking data.

Any organization, in any industry, can and does utilize this cycle. The intuition behind this model probably lies in the Plan,Do,Act Cycle we find in the continuous quality control movement. But the SMR TMC cycle is a super set of this model that sits at the intersection of technology and the generic ways businesses can use relatively simple data campaigns to improve quality.

• Measure - Taking measurements in service organizations often involves collecting data for some number of elements - usually more than 5 but less than 100. These data will be particular to the improvement/compliance/standardization campaign under way.
• Advise - When taking action, decision support tools can assist 1) enforcement of a standard approach when applicable, and 2) in bringing an organizational or external best practice to the problem at hand. Modern rule engine software provides a powerful way to provide this decision support.
• Notify - When data is collected in a workflow some data conditions may merit notification of a critical third party. This could be a specialist practitioner or a third party payer requesting notification as part of a contract. Modern software systems enable many different forms of notification channels such as EMail, SMS, and queue based messaging systems. When data is critically out of range, it becomes crucial that all the affected parties; provider, patient, and care manager realize that this case requires special attention.
• Plan - Data collected on an admission, from a first organizational assessment, or from an incident report, can be a critical input to a plan for intervention. This plan could be to improve quality, reduce costs, or simply to effectively match treatment to a measurement in a standard way.
• Implement - Technology enables the efficient measurement of an intervention strategy. An organization can then begin be systematically monitor the relationship between what was measured and what was actually done.
• Remeasure - Following intervention it is critical to monitor improvement or decline. This measurement is often called an outcome measure.
• Analyze - Reporting and analysis is constant through this process. Reporting is critical for ranking activities, targeting difficult populations, matching capacity to need and a host of other possible analytic questions.
• Repeat - Once the process cycle is complete it then becomes time to repeat it with the new information gleaned. In some cases this may be the second phase of an organizational review cycle, in other cases a second phase of treatment, or a second admission and discharge cycle.

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