the power of data: igniting, scalable and sustainable change

© 2014 Health Catalystwww.healthcatalyst.comFollow Us on Twitter #TimeforAnalytics

© 2014 Health Catalystwww.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics

John L. Haughom, MD

May 2014

The Power of Data:Igniting, Scalable and Sustainable Change

© 2014 Health Catalystwww.healthcatalyst.comFollow Us on Twitter #TimeforAnalytics 2

Healthcare: The Way It Should Be

Part One – Forces Driving Transformation

• Chapter One – Forces Defining and Shaping the Current State of U.S. Healthcare

• Chapter Two – Present and Future Challenges Facing U.S. Healthcare

Part Two – Laying the Foundation for Improvement and Sustainable Change

• What will it take to successfully ride the transformational wave?

Part Three – Looking into the Future

• What will it take to successfully ride the transformational wave?

http://www.healthcatalyst.com/ebooks/healthcare-transformation-healthcare-a-better-way/


Poll Question

1. On a Scale of 1-5, how would you rate your organization’s ability to manage complexity?

a. 5 – 8%

b. 4 – 26%

c. 3 – 45%

d. 2 – 17%

e. 1 – 4%


Implementing an Effective System of Production in Healthcare

Analyticsystem

Contentsystem

Deploymentsystem

Scalableand

sustainableoutcomes


Analytic System Components


Using Data Appropriately

Micromanage Kill the Messenger(denial, shift blame)

Fear

Filter the data(game the system)

Scherkenbach’s Cycle of Fear


Using Data: Learning vs. Acountability

7

Accountability

• Knowledge used by consumers, regulators, other physicians, etc.

• May encourage gaming the system• Reward centric

Learning

• Knowledge used by care delivery organizations and improvement teams

• Nourishes intrinsic motivation

• Result centric

Measure, manage & improve the system

Suboptimize Game the number

Berwick DM, James B, Coye MJ. The connections between quality measurement and improvement. Medical Care. 2003; 41(1Supplement): 30-38.


less transformation

Provider

Patient

Bad Debt

Diagnosis Procedure

Facility

EncounterCost

Charge

Employee

Survey

House Keeping

Catha Lab

Provider

Census

Time Keeping

more transformation enforced referential integrity

Enterprise data model

FINANCIAL SOURCES (e.g. EPSi, Lawson,

PeopleSoft)

ADMINISTRATIVE SOURCES

(e.g. API Time Tracking)

EMR SOURCES

DEPARTMENTAL SOURCES(e.g. Apollo)

PATIENT SATISFACTION(e.g. NRC Picker)

EDW


EMR SOURCE

Oncology

DiabetesHeart

Failure

Regulatory

Pregnancy Asthma

Labor Productivity

Revenue Cycle

CensusPATIENT SATISFACTION

SOURCES(e.g. NRC Picker)

DEPARTMENTAL SOURCES (e.g. Apollo)

FINANCIAL SOURCES (e.g. EPSi, Lawson,

PeopleSoft)



less transformationmore transformation

Dimensional data model

Redundant data

extracts


Metadata: EDW Atlas security and auditing

Common, linkable Vocabulary

FinancialSource Marts

AdministrativeSource Marts

DepartmentalSource Marts

PatientSource Marts

EMR Source Marts

HRSource Mart

Diabetes

Sepsis

Readmissions

Less transformationMore transformation

FINANCIAL SOURCES (e.g. EPSi, Peoplesoft,

Lawson)



EMR SOURCE

DEPARTMENTAL SOURCES (e.g. Apollo)

PATIENT SATISFACTIONSOURCES

(e.g. NRC Picker, Press Ganey)

Human Resources(e.g. PeopleSoft)

Late-Binding™ Data Warehouse


ACADEMIC

STATE

Early versus late binding of Data

SOURCEDATA CONTENT

SOURCE MARTS CUSTOMIZED DATA MARTS

DATAANALYSIS

OTHERS

HR

FINANCIAL

CLINICAL

SUPPLIES

INT

ER

NA

LE

XT

ER

NA

L

ACADEMIC

STATE

OTHERS

HR

FINANCIAL

CLINICAL

SUPPLIES

RESEASRCH REGISTRIES

QlikView

Microsoft Access/ODBC

Web applications

Excel

SAS, SPSS

Et. al

OPERATIONAL EVENTS

CLINICAL EVENTS

COMPLIANCE AND PAYER MEASURES

DISEASE REGISTRIES

MATERIALS MANAGEMENT

1

Data rules and vocabulary binding pointsearly binding

low volatility vocabulary or business rules?

late binding

high volatility vocabulary or business rules?

2 3 4 5 6


DATA CAPTURE

• Acquire key data elements electronically• Assure data quality• Integrate data capture into workflow

DATA ANALYSIS

• Interpret data• Discover new information in the data

(data mining)• Evaluate data quality

DATA PROVISIONING

• Move data from transactional systems into the data warehouse

• Build visualizations for use by clinicians• Generate external reports (e.g., CMS)

Automating data gathering


Population Health ManagementParadigm shift

Acutecare-centric management

Inpatient Outpatient

Home

Clinic care

Hospice Cemetery

Skilled nursing facility

Inpatient

Home healthcare

Population-centric management


Home(patient portal)

* To Invasive Care Processes

Clinic Carenon-recurrent

Clinic Carechronic

Acute MedicalIP Med-Surg

Acute Medical IP ICU

Invasive Medical

Invasive Surgical

Diagnostic work-up

Bedside care

Triage to treatment venue

Substance preparation

Invasive* subspecialist

Chronic disease

subspecialist

Screening & preventive Symptoms

Population Health ManagementAnatomy of Healthcare Delivery

Diagnostic algorithms

Indications for referral

Indications for intervention

Triage criteria

Diagnostic Algorithms, Triage Criteria, Referral & Intervention Indications

Utilization management

knowledge assets

Substance selection

Substance selection

Clinical supply chain management

ProcedureTreatment and

monitoring algorithms

Admission order setsAdmission order sets

Supplementary order sets

Pre-procedure order sets

Post-procedure order sets

Discharge

Bedside care practice guidelines, risk assessment and patient injury prevention protocols, bedside care procedures, transfer and discharge protocols

Treatment and monitoring algorithms

Health maintenance and preventive guidelines

Standardized follow-up

Post-acute care order setsIP (SNF, IRF)Home healthHospice

Management of Preventive, Ambulatory, Acute Medical, Invasive & PAC Modules

Prevention and treatment

knowledge assets

Clinical ops procedure guidelines and patient injury prevention

Post-procedure care


Population Health ManagementClinical Integration hierarchy - care process families

Hyperlipidemia

Acute Myocardial Infarction

(AMI)

Percutaneous Intervention

(PCI)

Coronary Artery Bypass Graft (CABG)

Cardiac Rehab

Ischemic Heart Diseasecare process family

Home OutpatientClinic Care Inpatient SNF Home Health Hospice

CoronaryAtherosclerosis


Population Health ManagementClinical Integration hierarchy - clinical programs

Vascular Disorders care process family

Heart Rhythm Disorders care process family

Heart Failurecare process family

Ischemic Heart Diseasecare process family

Cardiovascular clinical program

Home OutpatientClinic Care Inpatient SNF Home Health Hospice


Clinical Integration hierarchyClinical programs – ordering of care

Primary Care

careprocessfamilies

e.g.,Diabetes

CV

careprocessfamilies

e.g.,Heart

Failure

W&C

careprocessfamilies

e.g., Pregnancy

GI

careprocessfamilies

e.g., Lower GIDisorders

Resp-iratory

careprocessfamilies

e.g., Obstructive Lung

Disorders

Neuro Sciences

careprocessfamilies

e.g.,Spine

Disorders

Musculo-skeletal

careprocessfamilies

e.g., Joint

Replace-ment

Surgery

careprocessfamilies

e.g.,Urologic

Disorders

GeneralMed

careprocessfamilies

e.g.,Infectious Disease

Oncology

careprocessfamilies

e.g., BreastCancer

Peds Spec

careprocessfamilies

e.g.,Peds

CV Surg

Mental Health

careprocessfamilies

e.g., Depressio

n


Primary Care

CareProcessFamilies

e.g.,Diabetes

CV

CareProcessFamilies

e.g.,Heart

Failure

W&C

CareProcessFamilies

e.g., Pregnancy

GI

CareProcessFamilies

e.g., Lower GIDisorders

Resp-iratory

CareProcessFamilies

e.g., Obstructive Lung

Disorders

Neuro Sciences

CareProcessFamilies

e.g.,Spine

Disorders

Musculo-skeletal

CareProcessFamilies

e.g., Joint

Replace-ment

Surgery

CareProcessFamilies

e.g.,Urologic

Disorders

GeneralMed

CareProcessFamilies

e.g.,Infectious Disease

Oncology

CareProcessFamilies

e.g., BreastCancer

Peds Spec

CareProcessFamilies

e.g.,Peds

CV Surg

Mental Health

CareProcessFamilies

e.g., Depressio

n

Diagnostic Clinical Support Services (workflow models)(e.g., pathology and laboratory medicine, diagnostic radiology)

Ambulatory Clinic Clinical Support Services (workflow models)(e.g., primary care clinics, chronic disease specialty clinics, subspecialty clinics)

Acute Medical Clinical Support Services (workflow models)(e.g., Emergency Care, ICU/CCU/NICU/PICU, General Med-Surg)

Invasive Clinical Support Services (workflow models)(Interventional Medical [e.g., cath lab, interventional radiology, GI lab, L&D, rad onc] and Surgical [e.g., amb, IP])

Therapeutic Clinical Support Services (workflow models)(e.g., pharmacy, transfusion medicine, respiratory therapy, physical, occupational, speech therapy)

Clinical Integration constructClinical support services – delivery of care


Value Stream Protocols to Help Prevent Patient Harm

Clin Path Anat Path Radiology Peds Adult ECU ICU/CCU Med-Surg IP Surg ASC Interv MedSubstances

Pharmacy x x x x x x x xMedications x x x x x x x x xFluids x x x x x xElectrolytes x x x x x x x xParenteral nutrition (TPN) x x x x

Transfusion Medicine x x x xGlycemic Control (Glucose Mgmt) x x x xHealthcare Associated Infections

Ventilator Associated Pneumonia xUrinary Catheter Infections x x x x x xSurgical Site Infections x x xCentral Line Assoc Bldstream Inf x x x x

Venous Thromboembolism x x x xPressure Injury (Decubitus Ulcers) x xFalls (Strength, Agility, Cognition) x x xPatient/Procedure Control x x

Value Stream MapDiagnostic CSS Ambulatory CSS Acute Medical CSS Invasive CSS


Mapping – admin codes to clinical


Population Health ManagementMedicare FFS payments by venue – 2008-2012

OutpatientClinic Care Inpatient SNF Home Health Hospice

$ 152 Billion11.8%

372 Billion28.7%

447 Billion34.5%

$ 133 Billion10.3%

$ 90 Billion6.9%

$ 48 Billion3.7%

LTCH/IRF

$ 53 Billion4.1%

Clinic Care Outpatient Inpatient SNF LTCH/IRF Home Health Hospice

$ $


Top 10 care process families account for

over 40% of the opportunity

Top 32 care process families account for

80% of the opportunity

Care process families by resources consumed (high to low)

Per

cen

t o

f to

tal r

eso

urc

es c

on

sum

ed

Inpatient per case KPA


In Summary… • Organizations need a comprehensive framework to help them implement

a solid strategy and foundation for the future

• The Three Systems (Analytic, Deployment, Content) is an example of a comprehensive framework that can lead to future success

• Use data primarily for learning rather than judgment

• The late binding data model is the quickest to set up, cheapest to maintain, and most importantly, offers the flexibility required to support continuous improvement

• Automating data distribution allows frontline workers to become self-service gatherers and analyzers of data

• The Anatomy of Healthcare Delivery and Clinical Integration Hierarchy can help organizations focus their improvement efforts and maximize value for the investment


Coming Attractions (next webinar)

The Analytic System: Bringing it all together

• Understanding variation and the role of SPC charts in quality improvement

• A thoughtful approach to improvement

• Finding meaningful patterns in the data

• Demonstration of the power of modern analytical tools• We have come along way, and yes, clinicians can use

these tools!


Poll Question

2. On a Scale of 1-5, how effective is your organization’s analytical strategy and capability (as described today)?

a. 5 – 4%

b. 4 – 16%

c. 3 – 31%

d. 2 – 35%

e. 1 – 14%


Poll Questions

3. Does your organization have a robust strategy to identify high value improvement opportunities?

a. 5 – 14%

b. 4 – 13%

c. 3 – 37%

d. 2 – 30%

e. 1 – 6%


Thank YouUpcoming Educational Opportunities

Data Driven Care: The Key to Accountable Care Delivery from a Physician Group PerspectiveDate: May 29th Presenter: Dr. Gary Spencer, CMO, Crystal Run Healthcare, Luke Skelly, Health CatalystRegister at http://healthcatalyst.com/

Accountable Care Transformation: The Four Building Blocks of Population Health ManagementDate: June 4th, 2014Presenter: Dr. David Burton, MD, Chairman, Health CatalystTime: 1:00 - 2:00 PM ETRegister at http://healthcatalyst.com/

Healthcare Analytics SummitJoin top healthcare professionals for a high-powered analytics summit using analytics to drive an engaging experience with renowned leaders who are on the cutting edge of healthcare using data-driven methods to improve care and reduce costs.Date: September 24th-25th Location: Salt Lake City, UtahSave the Date: http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014

For the New World of Healthcare, A Declaration of Independence Is Only the BeginningOn April 28, 2014, Dr. Daniel Craviotto, Jr. published an editorial in the Wall Street Journal, “A Doctor’s Declaration of Independence,” in which he argued that it is time to “defy healthcare mandates issued by bureaucrats not in the healing profession.” Read Dr. Haughom’s response on how the medical profession needs to move beyond frustration and cynicism to create a vision for a better, more effective healthcare system. http://healthcatalyst.com/For Information Contact: [email protected]

http://healthcatalyst.com/



http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014

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Obtain unbiased, practical, educational advice on proven analytics solutions that really work in healthcare.

The future of healthcare requires transformative thinking by committed leadership willing to forge and adopt new data-driven processes. If you count yourself among this group, then HAS ’14 is for you.

OBJECTIVE

MOBILE APPAccess to a mobile app that can be used for audience response and participation in real time. Group-wide and individual analytic insights will be shared throughout the summit, resulting in a more substantive, engaging experience while demonstrating the power of analytics.

the power of data: igniting, scalable and sustainable change

Documents

health catalystwww

power of data

apollofinancial sources

healthcare chapter

nrc pickerdepartmental

sustainable change

transformational wave

care delivery organizations