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Expanding the Role of Health Information October 2016 Why do we see ads like this? Source: Delta Sky Magazine 2 © 2016 Health Catalyst Proprietary and Confidential THESE PILOTS ARE AMONG Lunar THE BEST But never like this?? Neil Armstrong, NASA PILOTS IN NEW YORK Each pilot has been included in a “Best Pilot” issue of 1243 Fifth Avenue , Suite 134 (212) 343-4356 Puddle Jumpers Orville and Wilbur Wright 5678 Fifth Avenue , Suite 566 (212) 343-4356 Intercontinental Captain Charles A. Lindburgh New York 13 Tenth Avenue , Suite 14 (212) 343-4356 Military All pilots are board certified Capt. von Richtofen 5678 Red Baron Way, Suite 44 (212) 343-4356 Capt. Jimmy Kirk Intergalactic Pilots chosen for New York magazine’s “Best Pilots” were selected by Preferred Pilots Ltd. The nation’s leading provider of information on top pilots Orbital Capt. John Glenn 12 First Avenue , Suite 33 (212) 343-4356 Pilots chosen for New York magazine’s “Best Pilots” were selected by Preferred Pilots Ltd. The nation’s leading provider of information on top pilots Cross Atlantic Amelia Earhart 777 Second Avenue , Suite 567 (212) 343-4356 River Landings Capt. Chesley Sullengerger 3 345 Hudson River Way (212) 343-4356 © 2016 Health Catalyst Proprietary and Confidential Evolution towards a System of Production System of Production Deming & others “Manual” System Frederick Taylor Airline Industry Healthcare Industry “Craftsmanship” Guild System © 2016 Health Catalyst Proprietary and Confidential 4 Outcome Improvement: The AIM of Health Information and Analytics We should be providing the highest quality with an optimal care experience at the lowest appropriate cost for populations Quality Outcomes Experience Outcomes Cost Outcomes The key reason for implementing any healthcare technology should be: How do we systematically improve outcomes? 5 © 2016 Health Catalyst Proprietary and Confidential Core Capabilities for Outcomes Improvement How are we doing? What should we be doing? • • • Clinical Outcomes Cost Outcomes Experience Outcomes How do we change? © 2016 Health Catalyst Proprietary and Confidential 6 Capabilities to SCALE Outcomes Improvement Leadership, Culture and Governance Financial Alignment © 2016 Health Catalyst Proprietary and Confidential 7 Capabilities to SCALE Outcomes Improvement Where do we focus? Leadership, Culture and Governance How are we doing? What should we be doing? • • • Clinical Outcomes Cost Outcomes Experience Outcomes How do we change? Financial Alignment How are we financially compensated? © 2016 Health Catalyst Proprietary and Confidential 8 Types of Best Practice Knowledge Assets Knowledge Asset Type Question to ask Examples Possible Measures Diagnostic algorithms Health Maintenance and Preventive Guidelines Triage Criteria Utilization Who should get the care? Treatment and Monitoring Algorithms Indications for Intervention Indications for Referral Order Sets What care should be included? Substance Selection Clinical Supply Chain Management Admission Order Sets Supplementary Order Sets Pre-Procedure Order Sets Post-acute care order sets IP (SNF, IRF) Home health, Hospice Post-procedure Order Sets Clinical Support Workflow How can care be delivered efficiently ? Transfer Checklist Clinical Ops Procedure Guidelines Discharge Checklist Standardized Follow-up Checklist Risk Assessment Bedside Care Practice Guidelines Patient Injury Prevention Protocol Administrative Support Workflow How can administrative operations be performed efficiently ? AR Escalation Process AR Escalation Process Network Design Process Budgeting Process Recruiting/Onboarding Process Supply Chain Procurement 9 Admits/1000 members IP days/1000 members OP visits/1000 members Procedures/1000 members ED visits/1000 members Readmissions/1000 members Cost/case Cost/procedure OR minutes L&D minutes Other LOS Cost per case Nursing hours by unit OR minutes L&D minutes Cycle times Cost per ancillary test Environmental services AR Days % out of network utilization % Turnover Team member satisfaction/engagement © 2016 Health Catalyst Proprietary and Confidential The Journey to Outcomes Improvement Spreadsheet Silos Centralized Reporting Data-Driven Improvement Culture Common, linkable vocabulary FINANCIAL SOURCES (e.g. EPSi, Peoplesoft, Lawson) DEPARTMENTAL SOURCES (e.g. Apollo) Financial Source Marts Departmental Source Marts Readmissions Administrative Source Marts Diabetes Sepsis ADMINISTRATIVE SOURCES (e.g. API Time Tracking) EMR Source Marts Patient Satisfaction Source Mart Pt. SATISFACTION SOURCES (e.g. NRC Picker, Press Ganey) EMR SOURCEs (e.g. Cerner, Allscripts, NextGen) • • • • • Silos or pockets of analysis Conflicting spreadsheet reports and interpretations of data Battles over data ownership Most time spent on hunting for and gathering data Focus is on is the data “right” • • • • • Centralized single source of truth established in EDW Significant time spent on standardizing definitions Data begins to be trusted Report queue begins to build Focus is on requirements for dashboard applications and reports • • • Improvement teams use analytics to accelerate best practice adoption Data drives decisions and actions Focus is on growing and sustaining outcomes improvement through variation reduction leveraging analytics © 2016 Health Catalyst Proprietary and Confidential 10 Adoption: Diffusion of Innovation Early adopters. Recruit early adopters to chair improvement and to lead implementation at each site. (key individuals who can rally support) N = number of individuals in group N = number needed to influence group (but they must be the right individuals) Innovators. Recruit innovators to re-design care delivery processes late majority early majority Innovators N The Chasm early adopters laggards (never adopters) * Adapted from Rogers, E. Diffusion of Innovations. New York, NY: 1995. 11 © 2016 Health Catalyst Proprietary and Confidential Payment Structure Considerations Knowledge Asset Type Discounted FFS Per Case Bundled Per Case Per Diem CMS Commercial CMS Commercial Condition Capitation Full Capitation Administrative Workflow Workflow Operational Workflow Diagnostic Variation Diagnostic Variation Substance Standing OrdersSelection Medication Selection Standing Orders Triage Triage Criteria Patient Safety Patient Safety TreatmentTreatment and Monitoring Ambulatory and Algorithms Monitoring Indications for Referral Indications for Referral Indications for Intervention = Negative Impact = Positive or Negative = Positive Impact © 2016 Health Catalyst Proprietary and Confidential Where to Start? Get the Right Data Together Example: Adaptive Data Model Metadata (EDW Atlas), Security and Auditing Common, linkable vocabulary FINANCIAL SOURCES (e.g. EPSi, Peoplesoft, Lawson) Financial Source Marts DEPARTMENTAL SOURCES (e.g. Apollo) Departmental Source Marts Asthma ADMINISTRATIVE SOURCES (e.g. API Time Tracking) Administrative Source Marts Diabetes Sepsis EMR Source Marts Patient Satisfaction Source Mart Pt. SATISFACTION SOURCES (e.g. NRC Picker, Press Ganey) EMR SOURCEs (e.g. Cerner, Allscripts, NextGen) More Transformation Less Transformation © 2016 Health Catalyst Proprietary and Confidential Pareto Analysis >> Prioritization Y-Axis = Percent of total resources consumed 100% 90% Top 85 Care Processes account for 80% of the opportunity (+45) 80% 70% Top 40 Care Processes account for 62% of the opportunity (+27) 60% 50% 40% Top 13 Care Processes account for 34% of the opportunity 30% 20% 10% 0% % of Total Cumulative % X-Axis = Care Processes by resources consumed (High to Low) 15 © 2016 Health Catalyst Proprietary and Confidential Internal Variation versus Resource Consumption (Key Process Analysis Dashboard Example shown) © 2016 Health Catalyst Proprietary and Confidential 16 Improvement Methods Major Milestones Prerequisites Recruit team Train team Kickoff • Confirm team mission, charter, roles • Review AIM options • Gather best practices • Profile and visualize preliminary data • Select 2-3 potential AIMs • Guidance team validation AIM • Review visualized drafts of AIM cohort findings • Identify data quality issues • Direct observation • Prioritize and select AIM #1 • Review cohort criteria and visualizations • Guidance team validation Intervention Rollout Finalize cohort Identify intervention(s) Direct observation Solicit front line input on AIM and intervention • Define intervention rollout plan • Guidance team validation • Solicit front line plan input • Finalize analytics dev, testing, and rollout support • Finalize intervention rollout plan • Guidance team validation • • • • Results • Review initial results • Identify, approve any modifications to intervention rollout • Review lessons learned • Create next AIM statement • Repeat process Rollout Date Work Streams 1. Best Practices 2. Define Cohort 3. AIM Statement 4. Design Metrics Select Build and Refine Build and Refine Build and Refine 5. Rollout Plan 6. Rollout 7. Measure Progress © 2016 Health Catalyst Proprietary and Confidential Precise patient registry Move to clinically defined cohorts Problem List (22,955) ICD9 493.XX (29,805) Total Count of Distinct Patients = 106,714 Additional Potential Rules (101,389) Supplemental ICD9 (38,250) Medications (72,581) Standard Registry Precise Patient Registry 18 © 2016 Health Catalyst Proprietary and Confidential Sepsis Example Care Process Improvement Map Evidence-based best practices for each phase of care “Storm Clouds”: key aim focus areas (greatest opportunities for improvement) Key outcome or process metrics for each best practice area Recommended knowledge assets (standardization tools) 78 © 2016 Health Catalyst Proprietary and Confidential Goal, Aim & Intervention Example - Sepsis Outcome Improvement Goal: Decrease the LOS of severe sepsis and septic shock patients by X% by X date. Process Improvement Aim: Increase total compliance of three hour bundle measures (lactate, blood cultures, antibiotic administration and fluid resuscitation) by X% by X date. Intervention #1 Intervention #2 Develop and implement a fluid resuscitation ED quick chart by X date. By X date complete an education program for ED nurses on the importance of rapid antibiotic administration. © 2016 Health Catalyst Proprietary and Confidential Enterprise Data Warehouse - Sepsis Severe Sepsis & Septic Shock Application Data Integration and Common Definitions Clinically defined cohorts, population definitions, comorbidities, patients, labs, encounters, diagnoses, medications, etc. Source Marts Hospital EMR EMR e.g. Epic, Cerner, MEDITECH Benchmarking Patient Satisfaction Benchmarking Patient Sat. e.g. UHC, Truven, Premiere e.g. Press Ganey, NRC Picker Financial Financial e.g. McKesson, MEDITECH © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential Reducing Sepsis Mortality 22% reduction in sepsis mortality $1.3 million in savings © 2016 Health Catalyst Proprietary and Confidential Hip & Knee Example Goal, Aim & Intervention Example – Hip & Knee Outcome Improvement Goal: Increase the % of patients from (current value) to (outcome value) discharged to home by X date Process Improvement Aim: Increase the percentage of patients who have successfully completed the an Enhanced Recovery After Surgery (ERAS) pathway for total joint replacement by X% by X date consisting of: 1) nutrition screening; 2) preemptive antiemetic and analgesia administration; 3) no prolonged fasting; 4) antibiotic prophylaxis VTE prophylaxis; 5) blood utilization Intervention #1 By X date develop & implement a pre-operative order set for TJR that incorporates ERAS items. Intervention #2 - By X date develop an ERAS pathway for total joint replacement surgery 2-4 Process Improvement AIMS should produce a significant outcome improvement © 2016 Health Catalyst Proprietary and Confidential Enterprise Data Warehouse – Hip & Knee Hip & Knee Replacement Application Data Integration and Common Definitions Clinically defined cohorts, population definitions, comorbidities, patients, labs, encounters, diagnoses, medications, etc. Source Marts EMR Patient Satisfaction Surgery EMR Financial Claims EMR Patient Sat. Surgery EMR Financial Claims e.g. Epic, Cerner, MEDITECH e.g. Press Ganey, NRC Picker e.g. Centricity, Epic, Cerner e.g. McKesson e.g. CMS © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential So now you are MACRA experts… Interesting Fact #1: A survey conducted in March, 2016 by Weill Cornell Medical College and the Medical Group Management Association (MGMA) found that physicians spend an average of ??? hours every week processing quality metrics. © 2016 Health Catalyst Proprietary and Confidential Interesting Fact #2: The time physicians spend processing quality metrics translates to an average cost of $40,069 per physician, per year © 2016 Health Catalyst Proprietary and Confidential Measure Metadata Repository/Governance Definitions Metadata Repository • Ability to see what measures are being used and reused • Stewardship over measures • Numerous metadata points for tagging and informing about measures © 2016 Health Catalyst Proprietary and Confidential Build a Data Library MSSP HEDIS PQRS © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential © 2016 Health Catalyst Proprietary and Confidential Questions Contact Information Expanding the Role of Health Information EVP, Chief Clinical Officer Health Catalyst [email protected] October 2016 © 2016 Health Catalyst Proprietary and Confidential
