Are you ready for ORYX?

Tips on preparing for data submission

When the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations (JCAHO) introduced its integration of performance measures to the accreditation process last year, the implementation date for ORYX was nothing but a distant spot on the horizon for home care organizations. That’s not the case anymore, though, as the third quarter of 1999 will see the first stream of official ORYX data being collected for JCAHO.

It’s easy to procrastinate for something that won’t be required for some time, but ORYX is something you shouldn’t push off until the last minute. Here’s how to get yourself on track and make the best use of the initiative.

When it comes to where you should be now, there’s no single correct answer, according to Caryn Bing, RPh, MS, FASHP, and president of CB Healthcare Consulting, a home care and long term care consulting firm in Burr Ridge, IL.

"Every provider’s situation is going to be different," says Bing. "By now, organizations should have taken a very careful approach to selecting a system."

JCAHO’s Dec. 31, 1998 deadline required providers to:

• Select one or more JCAHO-approved performance measurement systems, and notify the Joint Commission of the selections.

• Select between two and five approved clinical or perception of care measures that monitor at least 20% of patients.

• Report these selections to JCAHO on the form sent to each accredited home care organization.

Assuming you met the deadline, Bing notes much of what you can do depends on the capabilities and requirements of the vendor you selected.

"Once you have selected the performance measurement vendor and the measures you anticipate collecting, you may be able to start testing data collection, but it all depends on your vendor’s capabilities," she says. "If your vendor is just getting started with the actual data collection process, be sure to work closely with your vendor. If your vendor is saying they will not be able to accept your test data until March or April, but want you to start collecting in February, you better do it."

The first step in making ORYX as painless as possible is finding your vendor and when you can begin testing data collection. With one phone call, your vendor should tell you exactly what you can be doing to make the third quarter data collection process as painless as possible.

Bing adds the vendor should provide a template or a process to follow for data collection and submission. Whether collecting data using a computerized system or Scantron sheets, a template will allow you and your staff to see how easy it can be to collect the necessary information.

If you can collect data and test your system now, Bing advises do so.

"Data collection just to comply with Joint Commission’s ORYX requirement doesn’t have to take place until the third quarter of 1999," says Bing. "But if you have the ability to pull that data from your information management sources, I would suggest that you do a trial run. It would be a good idea to know it is working and you can implement the data collection process into the daily work flow well before the first of July."

Virginia Tritschler, RN, MHA, director of quality improvement and outcomes measures for the Visiting Nurse Association (VNA) of Boston, already knows how difficult it can be to implement a data collection system, thanks to her organization’s participation in the Health Care Financing Administration’s Prospective Payment System demonstration project using the OASIS data collection tool. She agrees with Bing that data collection can present problems.

"You have to consider what the process is going to be for your flow of information," explains Tritschler. "How are you going to get the information into whatever system you select?"

She notes selecting the performance measures was easier due to VNA of Boston’s involvement in OASIS, but warns that collecting the necessary data will be difficult for field staff.

"Education of staff is a major issue because there is a learning curve; you have to count on a reduction in productivity," says Tritschler. "You really have to put the time in up front for education."

That would mean the time is now, not later, to start training staff on the data collection and input.

She adds that the reduced productivity likely won’t be a one-time occurrence.

"We’re worried there is going to be a reduction in productivity even after the learning curve, because you’re talking about adding a lot of documentation," she says.

Depending on the size of your organization, you may need to require your staff to input the data directly into the system rather than passing it to a data input staff.

Look beyond ORYX

A key to the ORYX data collection process is to look beyond the accreditation process and data collection. Bing notes any home infusion provider implementing ORYX should look at the required data collection and reporting more as an improvement initiative than strictly as a Joint Commission requirement.

"Providers should not select all of their measures for areas in which they know they are doing things very well already," says Bing. "Don’t collect data for something that is just fine. Select something that is going to be a meaningful comparison to other organizations so you can identify opportunities for improvement."

Make data meaningful

Keep in mind that one of the purposes of collecting data is to allow for comparisons to other providers and benchmark results. To do this, you must make sure you’re comparing apples to apples.

"Don’t focus exclusively on how you collect data and get it to the vendor, but also consider the content and validity of that data," says Bing. "Is it really the same measure that other providers using the same measurement are reporting? Otherwise the data won’t be meaningful outside that organization."

Along the lines of performance improvement, Bing adds that the last thing JCAHO surveyors want to see when looking at performance measures are numbers that say everything is fine.

"Surveyors know everything isn’t perfect, and perfect numbers are an indication that the organization is not looking for areas they need to improve upon and make better," she says. "I would anticipate that, over time, as the ORYX data becomes more readily integrated into the accreditation process, it will highlight areas that surveyors can address. By sometime in the year 2000, when surveyors go into organizations, they will know a little bit more about where to focus or where to not have to bother focusing."

Looking for more?

Julie Roberts, a JCAHO spokeswoman, notes the Joint Commission addressed dozens of commonly asked questions concerning ORYX. They can be accessed at the Joint Commission Web site by going to www.jcaho.org, or calling the ORYX information line, (630) 792-5085.

Roberts points out the Joint Commission recently changed the data collection start date for accredited home care and hospice organizations from July 1, 1999, to Jan. 1, 2000. Also, the initial receipt of performance data from the performance measurement system to the Joint Commission has been postponed from March 31, 2000, to July 31, 2000.

Also, deadlines for home care and hospice organizations with an annual volume of less than 120 patients have also been delayed. Such organizations will be required to select four measures from a template (available from JCAHO sometime this year) and report their selections to the Joint Commission by Oct. 1, 1999, rather than June 30, 1999. Surveyors will not begin on-site review of the results of data collection and analysis from those measures until after July 31, 2000.