The analytics race: how fast are you going?

Transcription

1 Optimizing Data and Analytics in an Accountable Care Environment Western Clinicians Network April 29, 2014 Janice Nicholson, CEO 2i Systems The analytics race: how fast are you going? 1

2 Applying Technology (to Dr. Moore s talk) On getting clean data Tools for evidence-based decision-making Giving decision-makers near real-time performance data Establishing one undisputed source of performance data Q & A Get clean data entered in the first place. 2

3 Thank goodness for technology, but Yesterday - Illegible handwriting - Sampled chart data with large margin of error Today - Inaccurate data entry - Population data poorly codified and mapped Ethnicity field had Hispanic misspelled 22 different ways 3

4 EHR Medication Library Issues A Health Center with over 250 different medications listed for aspirin or entries like: I m on 7 medications for my CHF I think I m on a mood stabilizer, they hide it in my food Allergy Library Data Issues 4

5 What about the data you DON T have? Patients with missing recorded demographic data elements Patients with no primary care physician documented Patients with a medical visit in last seven days with missing vitals Patients with a medical visit in last six months with no No Known Allergies indicator or who have not had allergies reviewed/updated Missing tobacco use assessment on adult patients with a medical visit in the last week Hypertensive patients with a recorded BP > 140/90 but no recorded BP in last three months Diabetic patients with no HbA1c within the last 91 days Patients with medical visit in last two years but no PCMH agreement Good analytics tools expose EHR data Data validation searches 5

6 New World New Roles Data Stewards Someone responsible for knowing how and where data is being entered into the EHR They advocate for clean data They are responsible to manage the data quality Data customers work with data creators to understand the needs of data Use the right tools 6

7 Evidence-based Decision-making Evidence-based decision making Or, Data-driven decision making Four key ways to achieve this: 1. Give decision-makers near real-time performance data at their fingertips. 2. Establish one, undisputed source of performance data 3. Consciously articulate business rules and update them. 4. High quality coaching to decision-makers on a regular basis (change the culture). 7

8 Closing the Gaps in Care % of Adults Screened for Tobacco Use: By Facility Leading facility shares best practices Lower facilities getting better Facility 1 Facility 2 Facility 3 Facility 4 Facility 5 8

9 Comparative Analytics HbA1c s > 9 High Performer HbA1c screening rate Give decision-makers near realtime performance data at their fingertips. 9

10 Day of Care Planning Morning Huddle 10

11 Instant Feedback How many patients did you see yesterday where something got missed? Establish one, undisputed source of performance data. 11

12 Everyone wants CQMs UDS 12 quality of care measures (process and outcome) Health Center Controlled Networks Achieve HP2020 goals for UDS measures, PCMH recognition Meaningful Use Program 64 clinical quality measures by Stage II Health Plan Incentives 50%+ of incentives based on quality measures Accountable Care Organizations 32 quality measures by year 3 Careful CQM definitions vary UDS Definition MU/NQF Definition Measures Table Sect. Notes MU Notes Adult Weight Screening & Follow up (NQF 0421 PQRI 128) Hypertension: Blood Pressure < 140/90 (NQF 0018) 6B F Core 7 B Core Note slightly different denominators Cervical Cancer Screening (NQF 0032) 6B D Num=3 year Alternate lookback, Den = 1 year lookback for medical visit Num=3 year lookback, Den = 2 year lookback for medical visit 12

13 CQM source fields (num, denom) must be normalized Data fields must be matched across EHRs for apples-to-apples How many sources of CQM data truth do you have? One is best! 13

14 Questions Analytics in an accountable care environment Just a bird of a different feather. 14

15 What are your business rules? Business rules should align actions of the operational decision makers with the strategic objectives of the company. For the care team these are: Evidence-based practices/protocols, guidelines for care that result in improved strategic measure performance. Care Team Initiative Once a month generate a list of diabetic patients who have not been seen in the previous 4 months and outreach for re-care 15

16 Business Rule DM case manager runs the report, by provider and sends it electronically to the lead MA of each pod The lead MA assigns the lists to the individual MA "buddy" for each provider and recommends which shifts are most available for additional appointments. (i.e. schedule for Wednesday, if the patient has no preference). Workflow for each MA: double check insurance eligibility up to date for the month ensure the patient hasn't moved or already has an appointment scheduled in the system. (or other reasons for which there should be no phone call) Look to see if the patient is also due for major Health maintenance items: retinal exam, foot filament check, labs. Call patient's primary phone number contact. If message machine or another person picks up the phone, ask patient to call back and ask for "Jane" their doctor's MA. If the MA talks to the patient use standing orders to order health maintenance requirements (i.e. schedule retinal exam, mail lab requisitions to patient to be done prior to the appointment). If other issues come up with phone call, record them in telephone encounter and send to the appropriate person. Offer to make an appointment with the provider, preferentially at the times recommended by the lead MA. Technology Support Automated reminder to actually do the task and track the completion of it Easy reports with phone numbers and outreach information That report includes any outstanding health maintenance care indicators or referrals Automate the measurement of success for the initiative 16