One century ago, Codman introduced the concept of outcomes analysis. He called this concept “the end-result idea”. The concept was so well liked by his peers that his hospital privileges were revoked. How far have we come since Codman’s time?

The discipline of outcomes science has gained some ground in the last 20 years. However, several attempts to begin regular data collection by surgical societies have failed. In a sense, to quote a famous cartoon, “we have met the enemy and he is us”.

But, to be fair, collecting meaningful data has been impractical for all but a dedicated, well-financed few. This may be about to change. Factors are now in play, which can be viewed as a perfect opportunity or perfect storm. These are: Government, Insurer’s, and Technology.

Medical errors as a source of cost and disability or death have reached the level of lay and now legislative awareness. In June 2003, the state of Minnesota passed a bill mandating reporting of all adverse events beginning in 2005. At this same time, Insurance premiums are sky-rocketing and Insurer’s and employers are searching for ways to identify and reward quality. As a result, many groups are searching for valid results related to care for specific diagnoses. Finally, Moore’s law (the cost of technology halves while speed and capacity doubles every 18 months) has helped to create an Internet that has become a powerful secure means of exchanging, storing, and analyzing data on a real time basis.

During the last three years, mEdisonOnline has worked to create a secure online method of measured data capture that is now being used to document care and create an outcomes comparison across multiple hospital/physician systems. The key principles of this system are: integration with existing information systems, web-browser interface (minimal training), no redundant data entry, utilization of an existing JCAHO requirement to generate revenue (thus no new expense), creation of a new product (comparative outcomes) from existing system dollars and energy (physician and nurse/therapist time).

We have gained success with this method. However, questions remain. During our presentation we will highlight four areas: what is a measurement, how easy does the interface have to be, why open source data, who wins and who loses if this becomes the standard data collection method.