Using Real-Time Analytics

Transcription

1 Using Real-Time Analytics to Understand Clinical Data ANNA DALY, Director of Clinical Data Management (HCA) VICTORIA WEAVER, Assistant Vice President of Clinical Data Management (HCA) 1

2 Founded in 1968, Nashville-based HCA was one of the nation's first hospital companies. Today, we are the nation's leading provider of healthcare services. Making 18 million patient contacts a year with: 164 hospitals in 20 states and England 125 free-standing surgical centers 550+ physician practices Approximately 200,000 employed physicians Approximately 35,000 affiliated physicians 3

3 Transforming the industry from being reactionary and illness-focused Patients are readmitted frequently Hospital stays are expensive Physicians are the primary decision makers Physicians largely determine value of care given Patients are passive in their health In this model, the hospital is passive it is simply the place the physician goes to treat the patient upon illness. photo courtesy of noblehospital.org 4

4 to being proactive and wellness-focused Less frequent readmissions More affordable care Value of care determined by performance and outcome Patients are active in their healthcare plan In this model, the hospital is active - managing the post-acute hospitalization discharge to reduce overall spend and eliminate readmission. 5

5 OUR APPROACH Build a vendor-agnostic Clinical Data Warehouse with analytics for harvesting data Lay the foundation for Health Information Exchange Integrate financial, supply chain and clinical data Better manage operations across the continuum of care Persist data in a standardized manner Provide near real-time discrete data reporting Define an interoperability roadmap to further expand CDM s functionality 6

6 OUR CHALLENGES Scalability its difficult scaling to our needs in terms of support and timing Standardization implementing an enterprise-wide standard is a huge undertaking The Unknown we ve never implemented a clinical design of this kind - limited lessons learned 7

7 OUR VENDORS 8

8 THE VALUE OF QUALITY Improving quality using real-time data to reduce variation geographically, between facilities and between practioners. Resulting in: increased efficiency due to performance feedback more affordable care due to reduced waste and risk consistent outcomes Improved Hospital Value Improved Physician Value Improved Improved Patient Patient Value Value 9

9 QUALITY IN CONSISTENCY Outcomes = Lagging Indicators Process = Leading Indicators Stored in Clinical Database Basic Science Clinical Trial Outcome Analysis Create clinical evidence for best practices Consistently apply best practices QUALITY Consistently deliver correct outcomes 10

10 Real-time Clinical Decision Support - Diagnostics 11

11 Real-time Clinical Decision Support - Therapeutics 12

12 IT S ALL ABOUT THE DATA - Ronald Coase Tips» Be specific in focus» Establish a benchmark» Define acceptable» Define outliers 13

13 OPERATIONAL EFFICIENCIES 14

14 MEANINGFUL USE 15

15 ACUITY MODELS 16

16 DATA HURDLES Message Volumes Over 8 million transactions per day On average 450 clinical data elements per encounter Data Latency Initial goal of 4 hour data latency Assessing the specific data is needed in < 4 hours Longer than expected processing times Alerting and Monitoring Establish a monitoring and control framework Focus on various factors: Completeness Consistency Timeliness Accuracy Validity 17

17 STANDARDIZATION INDUSTRY STANDARDS 18 original image courtesy of singingthroughtherain.net

18 THE HCA APPROACH DEFINE AND DISCOVER DISCUSS AND DECIDE DELIVER AND DRIVE Identify clinical variation Gather clinical evidence Conduct Assessments Review organizational structure Define strategic goals Clarify project structure Initiate and train teams Observe/validate processes Review order sets Review clinical pathways Review data and EBM Generate portfolio Design solutions Write implementation plans Continued solution design Engage implementation plans Monitor clinical indicators Track quantifiables Define escalation protocol Develop sustainability plan Clarify ongoing structure 19

19 IDENTIFY OPPORTUNITIES Goals Identify keys to effective physician/facility engagement and partnership Demonstrate improved clinical performance and reduced clinical variation Assess impact on physician satisfaction Findings Data, analytics and clinical evidence along with administrative support throughout the change process Aligned practices with best evidence improved utilization and LOS and costs decreased Physicians and Operators who took active roles in the pilot phase felt engaged and assured that the hospital cared about quality 20

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21 TIE TO OUTCOMES 22

22 DOLLARS DO NOT EQUAL HEALTH Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States had the highest or near-highest prevalence of: Infant Mortality Heart and Lung Disease Sexually Transmitted Infection Adolescent pregnancies Injuries Homicide Disability 23

23 HOW TO IMPROVE PERFORMANCE Be Transparent with Data Communicate performance and cost standings to physicians Identify opportunities, quantify value and prioritize efforts Track Performance Track intiatives and report metrics back to facility and division Routinely provide data-driven feedback to encourage dialog Transfer Clinical Knowledge Establish a single source for clinical knowledge Provide a guide for implementing initiatives CLINICAL BUSINESS INTELLIGENCE CLINICAL BUSINESS INTELLIGENCE Data-Driven DATA-DRIVEN Physician-Led PHYSICIAN-LED Patient-Focused PATIENT-FOCUSED 24

24 QUESTIONS If we are to achieve things never before accomplished, we must employ methods never before attempted. -Francis Bacon 25