Clinical Business Intelligence Ferdinand Velasco February 25, 2012
Introduction Strategic Operational Tactical Summary Agenda
Introduction Strategic Operational Tactical Summary Agenda
The enemy is fragmentation. -Dr. Don Berwick Former CMS Director Source: http://www.kaiserhealthnews.org/checking-in-with/checking-in-with-berwick.aspx
Texas Health Resources 25 hospitals in North Texas 14 wholly owned hospitals 133,903 Inpatient Visits 1,238,392 Outpatient Encounters 469,309 ED Visits 89,452 Surgeries 27,200 Deliveries 5,500 Active Physicians 7,500 RN s 22,000 Employees
Texas Health Resources Mission: To improve the health of the people in the communities we serve One of the things we must do to improve health is transition from a fee-for-services model to a value-based accountable care model directed by physicians. We will make that transition, and we will bend the cost curve of healthcare away from its upward trend. - Doug Hawthorne, CEO
Strategic Transformation
Information Technology Fully deployed Electronic Health Record Meaningful Use ($52 million) HIMSS EMRAM Stages 6-7
Resources
http://tinyurl.com/cbi-glaser
Introduction Strategic Operational Tactical Summary Agenda
Population Health Care Delivery & Reimbursement Wellbeing Blue Zones
Accountable Care
Health Reform Trajectory
CBI Charter from individual hindsight to enterprise foresight Instinct & Intuition Fact-driven Reactionary Limited & slow Human Insight Inefficient Directive Real-time Validated Insights Optimized
Transactional Transparency Better Outcomes Smarter Decisions Actionable Insights Usable Information Relevant Data
Varying Levels of Analytics
Analytics Across the Care Continuum Acute Care Initial Diagnosis Pre Acute A D T C V E A D T Post Acute Health Maintenance 30 Day Readmit Improve outcomes Reduce variation Reduce cost Avoid 30 day re-admission penalties
Timescale OLTP OLAP
Introduction Strategic Operational Tactical Summary Agenda
Leadership
ACO Dashboard Case Study Analytical tool developed to support THR s accountable care programs Data management Data governance Implementation considerations
Data Management The steps an organization takes to ensure that its data have a wellunderstood meaning, are of good quality, are appropriately used, are protected and have potent analyses tools. Data management is very difficult. - John Glaser, Siemens
The CBI Green Team!
Content Statistics 2.7+ Billion rows of data 1000+ Data Elements 100+ Tables 3 TB data Historical data back to 2009* Extract data from 3 source systems
Content Subject Areas Phase Subject Area # Tables Population Heath Analytics Phase 1 # Data Elements Record Count Clinical Findings 10 100 2,500,888,722 Clinical Orders 17 170 212,449,007 Pharmacy Orders 21 147 85,000,000 Medications 8 40 41,000,000 Diagnosis 1 20 27,531,506 Procedures 6 60 2,660,909 Groupers 4 32 475 Encounter 18 180 11,792,653 Foundations Patient 15 150 5,683,494 Practitioner 13 130 168,000
ACO 33 Initial set of performance measures for ACOs Pay for reporting (Y1), for performance (Y2+) Overlaps with Care Maps, HEDIS, PQRS, Meaningful Use 4 Domains At risk populations (12) Preventive health (8) Care coordination safety (6) Patient experience (7) Data needs Care coordination: Healthways PMT Reporting to CMS: TBD Analytics: Texas Health CBI
Data source ACO Analytics Clinical data in EHR Quality Measures CMS specifications Provider attribution Claims-based vs. assigned PCP
Patient experience CG-CAHPS Care coordination Future Work Overlap with Meaningful Use Stage 2 Total Cost of Care Network Analytics
Prioritization
CBI Roadmap Population Health Analytics ACO Dashboard Service Line Analytics Heart & Vascular Dashboard Diabetes Service Line Improve Market Share Referral Analytics Performance Measurement Transition executive dashboard to CBI
Data Governance
Data Governance Case Study Normalizing Race documentation in CareConnect and AllScripts according to the federal standards. OMB Categories CareConnect AllScripts Race Count Race Count White WHITE 1,719,932 White 345,622 WHITE-HISPANIC 63,039 CAUCASIAN 55,368 Black or African American BLACK 309,151 Black or African American 63,853 American Indian or Alaska Native BLACK-HISPANIC 3,381 AFRICAN AMERICAN 5,599 NATIVE AMER-HISPANIC 1,940 American Indian or Alaska Native NATIVE AMERICAN 10,374 Asian ASIAN 62,263 Asian 9,303 CHINESE 36 FILIPINO 64 JAPANESE 7 ASIAN-HISPANIC 1,045 Native Hawaiian or Other NATIVE HAWAIIAN-PI 2,655 Native Hawaiian or Other 20 Pacific Islander Pacific Islander Not supported UNKNOWN 825,877 Undefined 773,360 1,186 OTHER 1,242 Refused to 132,763 report/unreported UNKNOWN-HISPANIC 76,015 More than one race 3,987 TWO OR MORE RACES 9,583 HISPANIC 6,180
Initial Access Security Grid Level of detail ACO leaders ACO physicians THR leaders THR/Zone X X X Clinic X X X Physician X X X Patient X (all patients) X (their patients only) None ACO Leaders THR Leaders Dr. Stoltz, Dr. Terry, Tom Z., Catherine H. and team, Karim K., Barbara A., Dr. Heighten, Dr. Meyers Dyad, 6 Pack, Aaron B. and team, SVP of Pop Health, Linda G.
Introduction Strategic Operational Tactical Summary Agenda
Introduction Strategic Operational Tactical Summary Agenda
Summary Health reform Population health data management Transactional: EHR, HIE (Meaningful Use) Analytical (CBI) CBI strategy and deployment Executive leadership, project team, partners, collaborators Data governance, marketing, deployment, training, support Value delivery
Discussion FerdinandVelasco@texashealth.org @ftvelasco