Banner Health Friday, February 20, 2015
Leveraging the Power of Clinical and Business Intelligence: A Primer Presented by: Dr. Maxine Rand, DNP, RN-BC, CPHIMS, Director, Clinical Education, Practice and Informatics, Kaiser Permanente
Learning Objectives Define the strategic advantage of understanding and implementing C&BI Review the ways that healthcare organizations have benefited from C&BI Identify the core competencies needed to move both your organization and your career forward with the power of C&BI
National Healthcare Challenges for Leaders Reducing healthcare costs while improving patient care outcomes. Improving the health of complex populations. Increasing patient satisfaction, patient engagement, and retaining customers. Multiple co-morbidities & complex reimbursement policies. Budget cuts, increased system demands, creating efficiencies with fewer resources. Competitive marketplace with increasing consumer options. Mergers, acquisitions and the elimination of valuable price and quality competition.
The C&BI Road Map
Nationally Recognized Healthcare Metrics NQF CMS Quality Measures Center for Medicare and Medicaid Services The US federal agency administering Medicare, Medicaid, and the State Children's Health Insurance Program. Reporting programs include: The Hospital Inpatient Quality Reporting (IQR) Program, The Hospital Outpatient Quality Reporting (OQR) Program, The Physician Quality Reporting System (PQRS), and Clinical Quality Measures (CQMs). Hospital Consumer Assessment of Healthcare Providers and Systems - The patient experience measure designed to produce comparable data on the patient's perspective of care allowing objective and meaningful comparisons between hospitals on domains important to consumers. Public reporting of survey results is designed to create incentives for hospitals to improve their quality of care. The Healthcare Effectiveness Data and Information Set is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. National Quality Forum-endorsed measures are tools that show whether the standards for prevention, screening, and managing health conditions are being met.
Measures, Metrics, Data Warehouses & Data Marts Performance Measure - A way to calculate whether and how often the healthcare system does what it should. Measures are based on scientific evidence about processes, outcomes, perceptions, or systems that relate to high-quality care. Numerator: The number of patients who meet the definition of the measure. Denominator: The number of patients who are considered eligible.. Structural measures - Assess healthcare infrastructure such as an organization s staff, facilities, or health IT systems. Process measures - Assess steps that should be followed to provide good care. Outcome measures -Assess the results of healthcare that are experienced by patients. They include endpoints like wellbeing, patient safety, ability to perform daily activities, or even death. e-prescribing: % of prescriptions transmitted electronically. Nurse to patient ratio. Cervical Cancer Screening: % of women who had a cervical cancer screening with a Pap test. Diabetes - Average hemoglobin A1c level for population of patients with diabetes. Hospital-acquired infections, adverse drug events, and patient falls.
Example of a Process Measure: Controlling Gestational Diabetes Numerator: Patients who were screened for gestational diabetes during the sixth or seventh prenatal visit (assuming Diabetes screening at 24-28 weeks). = Base Population All women who gave birth during a 12-month period, seen for continuing prenatal care. Denominator: Exclusions: Documentation of medical reason(s) for not screening for diabetes during the sixth or seventh visit (e.g., patient has known diabetes).
Measures, Metrics, Data Warehouses & Data Marts Quality metrics are those measures that have been developed to support self assessment and quality improvement at the provider, hospital, and/or health care system level. These metrics represent valuable tools to aid clinicians and hospitals in improving quality of care and enhancing patient outcomes Mental health: The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family members or caregivers. Pediatrics: Percentage of children 3 months-18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode.
A data warehouse is a central repository for all or significant parts of data utilized by an enterprise s business systems. The top dpwn data warehousing approach spins off data marts for specific groups of users after the complete data warehouse has been created. The bottom up approach builds the data marts first and then combines them into a single, allencompassing data warehouse. Mayo Clinic ICU Data Mart
More Leadership Healthcare Challenges To control spiraling costs in managing chronic conditions, 70 percent of healthcare organizations will invest in consumer-facing mobile applications, wearables, remote health monitoring and virtual care by 2018, creating demand for big data and analytics. Leaders must increase their understanding of how clinical and business intelligence can lead to improved performance in cost and quality of health care. From: Health Data Management (2015). Big HIT changes predicted.
Strategy and Benefits from C&BI Clinical and Business Intelligence and analytics has a major impact on clinical decision making and improving the value of patient care a process that is known as big data. In a research study published in Health Affairs on July 8, 2014, researchers highlight opportunities to reduce costs through the use of big data. Adopting an evidence-based strategy will result in a strategic advantage, organizational benefits, and better patient care management. Opportunity #1 A large chunk of healthcare budgets are depleted by 5% of high cost patients. Management of these patients relies on predictive analytics using past data. This helps to anticipate future business expenditures and facilitates accurate budget planning.
Strategy and Benefits from C&BI Opportunity #2 As many as one-third of readmissions may be preventable, providing a significant opportunity for improvement in care and reduction in cost using algorithms. This includes: Patient specific interventions during hospitalization, patient monitoring after discharge and evidence-based medical interventions based on data analysis. Opportunity #3 Correct selection of staff and bed resources, unit for care, patient management, and clinical practice guidelines. Opportunity #4 Effective use of physiologic data, monitoring devices, and analysis using multiple data streams to detect patient decompensation.
Strategy and Benefits from C&BI Opportunity #5 Reduce adverse events. Researchers call out three areas, patients with renal failure, adverse drug events, and infection as specific opportunities to utilize big data to reduce costs. Opportunity #6 Effective management of multi-organ or systemic chronic conditions including autoimmune disorders such as rheumatoid arthritis and lupus to predict disease trajectory. Identify measurements taken as part of routine care to predict progression of patient disease, and personalize treatments and therapies appropriately. Grandma uses big data to predict new sources of food.
C & BI and analytics tools enhance clinical quality metrics, performance benchmarking, and clinical decision support The Medicare Innovation Center Pioneer ACO Model Pioneer ACOs generated estimated total model savings of over $96 million and savings to Medicare Trust Funds of approximately $41 million. Pioneer ACOs outperformed published quality benchmarks in year one and improved in almost all quality and patient experience measures in year two. The Banner Health Network (BHN) recently announced that it has been selected to participate in the Pioneer Accountable Care Organization (ACO) model.
Kaiser Permanente, an accountable care organization (ACO), and health maintenance organization, is a fully integrated delivery system where the insurer, physician groups, and hospitals are part of one organization. For many decades it has delivered strong care coordination and integration of clinical services, care management, and clinical integration systems. There are 424 organizations identified as Medicare ACOs, serving over 7.8 million Medicare beneficiaries. As existing ACOs add providers, and more organizations join the Shared Savings Program, participation in ACOs is expected to grow. Medicare ACOs participating in the Shared Savings Program and the Pioneer ACO Model combined generated over $417 million in savings for Medicare since 2012..
TOOL: Assisting Leaders in Use of Metrics As a leader in the organization, you will need to understand how to measure or access data. Here are some questions you can work through to focus your efforts. What is Your Overall Goal? Before jumping into the question of metrics, be clear on staff performance goals. If the goal is closely aligned with patient outcomes, there may be an existing metric to measure current or prospective progress toward that goal. Are We Currently Measuring That Goal? Can We Measure Things that Drive the Outcome? Is it a single Measure or Multiple Measures? Will the Target Induce Performance Improvement? How Do We Communicate to Teams About Metrics? When you have a clear idea of the goal, investigate whether any reports or existing performance measures are a good fit for that goal. If not, it may make sense to adjust the goal to take advantage of existing reporting systems. In some cases, it may be more appropriate to measure certain drivers that affect the outcome rather than the outcome itself. For example, month-to-month data for strokes and heart attacks will often be too variable to be a reliable measure of the team s performance. Instead, encourage them to focus on key drivers of the outcome (e.g., effectively controlling hypertension) and track this using a report. Just because a measure does not provide exactly what you are looking for doesn t mean it can t be helpful. You may need to evaluate results utilizing multiple measures or reports over time to effectively evaluate a process outcome and assess trends. Prior to presenting data to a team or department, be sure that it encourages performance improvement complex reporting and interpretation can become a source of discouragement. Look at the three best-performing departments in your medical center and aim for their level of performance. Everyone on your team should understand how the metric works and how they can improve it. You may need help from analytic staff within your medical center who can explain the metric and how to interpret it.
In 2011, Kaiser Permanente introduced Empowering Hospital Operations as a means of evaluating management teams ability to utilize the EHR to assess the quality of staff documentation, evaluate their ability to interpret operational reports (Workbench reports, service line reports) and analytic reports (Clarity) and generate these reports as needed. The comprehensive assessment required two hours of time with an informatics specialist to assess their ability to navigate flowsheets, synopsis reports, medication administration records, patient education, plans of care, laboratory results, progress notes, admission data, and a variety of other features associated with transitions of care and patient safety.
Patient Reports in the EHR Incredible amounts of information
Workbench Reports The Find All System
Clarity Reports Delivered as Desired
Inpatient Home Page
Ambulatory Home Page P to P classroom training and Subject Matter Experts (SMEs) available in every specialty clinic
Trainers support Hospital staff with EHR questions
Technosavvy Resources
References Accountable Care Facts. (2015). What is an Accountable Care Organization (ACO)? Retrieved from http://www.accountablecarefacts.org/topten/what-is-an-accountable-care-organization-aco-1 Banner Gateway Medical Center. (n.d.). Banner Health Network to participate as Medicare Pioneer Accountable Care Organization. Retrieved from http://www.bannerhealth.com/locations/arizona/banner+gateway+medical+center/for+physicians/news+for+physicia ns/_banner+health+network+to+participate+as+medicare+pioneer+accountable+care+organization.htm Carmen, et al. (2013). Patient and family engagement: A framework for understanding the elements and developing interventions and policies. Health Affairs, 32(2), 223-231. Centers for Medicare & Medicaid Services. (2015). Fact sheets: Better Care, Smarter Spending, Healthier People: Improving Our Health Care Delivery System. Retrieved from http://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2015-fact-sheets-items/2015-01-26.html Federal Trade Commission.(2015). Competition in the health care marketplace. Retrieved from http://www.ftc.gov/tips- advice/competition-guidance/industry-guidance/health-care Institute for Healthcare Improvement. (2015). IHI Triple Aim Initiative. Retrieved from http://www.ihi.org/engage/initiatives/tripleaim/pages/measuresresults.aspx Health Care Insights. (2014, July 15).Six cases where big data can reduce healthcare costs. Retrieved from http://healthcareinsightsblog.iirusa.com/2014/07/six-cases-where-big-data-can-reduce.html Herasevich,V.,Kor, D.J., Li, M. & Pickering, B.W. (2011, Oct 24). ICU Data Mart: A Non-IT Approach. Healthcare Informatics. Retrieved from http://www.healthcare-informatics.com/article/icu-data-mart-non-it-approach National Quality Forum. (2015). Glossary of terms. Retrieved from http://www.qualityforum.org/show_content.aspx?id=119 National Quality Measures Clearinghouse. (2014). Retrieved from http://www.qualitymeasures.ahrq.gov/content.aspx?id=47976