MONAHRQ gains momentum

Research Activities, October 2010, No. 362

What happened in Las Vegas with sharing health care data shouldn't stay in Las Vegas.

The State of Nevada has been collecting health care data and generating health statistics since the mid-1980s. Some information was available to the public, but interest was minimal until summer 2010 when "Do No Harm: Hospital Care in Las Vegas" ran in the Las Vegas Sun newspaper.

The five-part series opened with the prologue:

"There's a running joke about hospitals around here: 'Where do you go for great health care in Las Vegas?'

'The airport.'

The implication is everyone knows hospital care in southern Nevada is substandard.

The reality, however, is that almost no one has had access to meaningful information about the quality of Las Vegas hospitals. Until now."

Two Sun reporters analyzed hospital billing records to report on preventable injuries, infections, and surgical mistakes in Las Vegas hospitals in 2008 and 2009. "Do No Harm" not only won accolades for the authors when they were named Pulitzer Prize finalists, it helped spur a package of health care reform and transparency laws in Nevada.

Joseph A. Greenway, M.P.H., director of the Center for Health Information Analysis in Nevada, knows how tough it can to be to provide transparency. He explains, "First we were met with resistance, then an initial backlash after the Las Vegas Sun articles, but now we have cooperation, collaboration, and even encouragement."

Even with more support and a larger budget for his Center, Greenway still had a small staff and a lot to do to comply with the new State laws that require health care data reporting on a quarterly basis. Greenway got help. He says, "MONAHRQ® saved the day."

"With this Web development product, we multiplied the information on our transparency Web site twentyfold," Greenway told Research Activities. "With MONAHRQ, we produced in days what could have taken years."

MONAHRQ®, an acronym for "My Own Network powered by AHRQ," is free downloadable software the Agency for Healthcare Research and Quality developed for organizations to create their own reporting Web sites.

"We'd been asking ourselves for a long time, 'Why should it be so expensive to generate and put out basic information on quality of care, utilization, rates of conditions, and procedures?' and 'Why should this information be so difficult for the public to get?'" says Anne Elixhauser, Ph.D., of AHRQ. She also grappled with "Why should an organization that wants to share this information have to reinvent the wheel every time they want to do this?"

Elixhauser answered her questions with action.

MONAHRQ® uses hospital administrative data to analyze, summarize, and present information in a format ready for use by consumers and other decisionmakers to compare quality in four key areas: hospital ratings, hospital utilization, preventable hospitalizations, and rates of conditions and procedures.

Through MONAHRQ®, State and local data organizations, hospitals, and health plans load their own data or measure results and create their own look with the colors and images they want. MONAHRQ® can be used internally or for public reporting. As organizations and States search for ways to share quality data inexpensively, quickly, and efficiently, MONAHRQ® is taking flight throughout the United States.

MONAHRQ® in Maine

The State of Maine is legally required to report on comparative health care quality on a publicly accessible Web site. Carrying out this State mandate is the Maine Health Data Organization, a small independent State agency. Their new Web site, powered by MONAHRQ®, replaced their "older and woefully outdated Web site," says Susan Schow, epidemiologist at the Maine Health Data Organization. At the new site, people in Maine can get answers to basic questions such as "What is health care quality?" They can also find out which hospitals see the most patients with head and neck cancer or compare the average stay for mental health conditions at hospitals.

The least ethnically diverse State in the country also has the oldest population and a high percentage of people living in rural areas who may need to travel long distances for hospital care. "The fact that folks can query the data themselves is tremendously valuable," says Schow.

A racially diverse State

Hawaii is about as far as you can get from Maine in many ways. In addition to being one of the most racially diverse states in the country, the Aloha state is also different because there is no public reporting requirement for health data. "We can't report hospital-level data publicly, and our primary business obligation is to our paying members," says Jill Miyamura, Ph.D., vice president of the Hawaii Health Information Corporation.

But Miyamura also uses MONAHRQ®—for two sites. One site provides data by the county level, which is public. The second, password-protected site for hospitals provides more detailed information.

"MONAHRQ® gives us a giant step forward toward being compliant with reporting guidelines we do have in Hawaii," she says. "MONAHRQ® also helps us fulfill the commitment to the public that is implicit within our mission to improve the quality and cost-efficiency of health care services to the people of Hawaii."

"In the past year or two, we've seen a heightened interest in data," she says. "Even though Hawaii is known as the 'healthy State,' we have opportunities to identify where we need to get better."

Another healthy State

Like Hawaii, Utah gets high marks for the health of its citizens. Keely Cofrin Allen, Ph.D., attributes this to the fact that Utah has the youngest average age of any State and a large portion of the population are members of the Church of Jesus Christ of Latter Day Saints, which prohibits smoking and drinking alcohol. "This ripples out to other areas of the State," says Cofrin Allen, director of the Office of Health Care Statistics at the Utah Department of Health.

The Office of Health Care Statistics has been collecting health care data in Utah since 1990, but the requirement to publish hospital comparison data using nationally recognized measures didn't became law until 2005.

For Cofrin Allen, MONAHRQ® means her data will be useful. When MONAHRQ® debuts in December on her State's Web site, "My Health Care in Utah," consumers will be able to look at everything from the last hospital satisfaction report to columns by AHRQ Director Carolyn M. Clancy, M.D., on how to navigate the health care system.

"You can collect a pile of data and analyze it all day long, but until it's communicated, it's not useful," says Cofrin Allen. "People will be more engaged with the data. They will be able to do more research to find out what's going on where they live."

A State in the stroke belt

By most measures, Arkansas has many health challenges. "We are considered to be part of the stroke belt. We have a high rate of stroke and related diseases such as hypertension, diabetes, and other chronic conditions," says Lynda Lehing, hospital discharge data section chief for the Arkansas Department of Health.

Arkansas also has another challenge. "We're pretty unique," says Connie Marie Ardwin, research policy analyst with the Department, "because we have a law that prevents disclosing any information that could identify an individual hospital." Yet, Lehing and Ardwin share a commitment to being as open as possible. They're in the process of using MONAHRQ® to put out information that will allow people to compare health data by county. For example, the State can use data on hospital admissions for certain chronic conditions to target certain areas for disease-prevention programs. Also, consumers can see which counties have hospitals that perform the most of certain procedures, since procedure volume is often connected to care quality.

"We hope that when people start seeing this information, we can work toward being more transparent," says Ardwin. "We want to stir up interest."

An innovation leader

The U.S. Department of Health and Human Services (HHS) honored MONAHRQ® as one of six winners in the HHSinnovates program, which received 90 nominations for the competition to recognize innovation. At an awards ceremony, HHS Secretary Kathleen Sebelius told the audience, "HHS is all about innovations. 'We've always done it this way' is one of my least favorite phrases."

MONAHRQ® is a stellar example of innovation at its best. As transparency gains more momentum, MONAHRQ® will continue to help make useful health care data widely available.

Editor's Note: Visit http://www.monahrq.ahrq.gov for more information.

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