Analytics and Business Intelligence

Transcription

1 Analytics and Business Intelligence CE-IT Virtual Town Hall series December 12, 2012 JD Whitlock, MPH, MBA, CPHIMS James E. Gaston, FHIMSS

2 HIMSS Clinical & Business Intelligence Overview HIMSS Resources & Opportunities James E. Gaston, FHIMSS Sr. Dir. of Clinical & Business Intelligence HIMSS and HIMSS Analytics

3 HIMSS C&BI Committee Mission Statement The HIMSS C&BI Committee supports the needs of HIMSS members and the healthcare industry. Topics of focus for the C&BI Volunteer Groups include: Knowledge Management to Support Accountable and Quality Care Case Management Analytics Informatics Decision Support Research Data Warehousing/EDW Data Lifecycle Management

4 NEW! HIMSS Clinical & Business Intelligence Providing Thought Leadership Engage with peers and industry leaders through education on technologies and strategies using C&BI to optimize efficiency, effectiveness, and patient outcomes Developing Resources and Tools Gain practical knowledge and implementable guidance to help you effectively turn data into action to support meaningful use, accountable care, & quality reporting To learn more, join HIMSS C&BI Community of Practice today at

5 C&BI Resources To learn more, join HIMSS Clinical & Business Intelligence Community of Practice today at To learn more about clinical and business intelligence and the resources HIMSS provides visit 5

6 Foundations for Clinical and Healthcare Business Intelligence

7 Orienteering Business intelligence (BI) mainly refers to computer-based techniques used in identifying, extracting, and analyzing business data, such as sales revenue by products and/or departments, or by associated costs and incomes. Business Intelligence supports business decision-making.

8 Orienteering Clinical Intelligence (CI) mainly refers to computerbased techniques used in identifying, extracting, and analyzing healthcare data, such as lab results, medical histories, or medical records, to support a healthcare related decision. Clinical Intelligence supports healthcare decisionmaking.

9 Orienteering Mining clinical data with an eye towards patient care Having data across the enterprise available for a consolidated (patient) view Access to key information to make care or business decisions that result in the best outcome for the patients and the business To use currently available and create new data sources to drive all aspects of running an organization Supporting clinical excellence Maximizing the quality of care and minimizing the cost

10 Clinical Intelligence First Steps Patient or Population Associated Information Opportunity for Clinical Intelligence

11 Prepare Clinical Intelligence First Steps Meaningful use Drivers Improve quality, safety, efficiency, and reduce health disparities Engage patients and family Improve care coordination, and population and public health Maintain privacy and security of patient health information Process Measure Data Capture and Sharing Advanced Clinical Processes Improved Outcomes

12 Clinical Intelligence and Business Intelligence A Symbiotic Relationship

13 A Symbiotic Relationship To continue our height example A basic Venn Diagram, composed of two overlapping circles representing 2 groups: All Males Basketball Players NBA Basketball Stars

14 A Symbiotic Relationship Scenarios could be wide and varied Individual deciding on a surgery Hospital administrator managing patient census Clinical Intelligence (CI) overlap with Business Intelligence (BI) BI CI BI CI Optimize lab orders with best treatment practices Pt exhibits disease symptoms order lab to verify MRI Pt volume is beyond capacity MRI is best choice for verifying aneurism Managing legal liability Timeliness of care

15 A Symbiotic Relationship Do ALL healthcare business decisions have a clinical impact? Business Decisions Clinical Decisions Vs. Business Decisions Clinical Decisions

16 A Symbiotic Relationship Clinical Statistical Significance refers to being of a magnitude that conveys practical relevance, or addresses whether an intervention or treatment may or may not fully correct the finding Clinical Intelligence occurs when the use of computer based techniques has a clinically / statistically significant influence on a healthcare decision

17 Practical Use

18 Practical Use CI is about exposing the clinical decision process, turning a gut feeling or intuition into a revealed process that is informed, defensible and consistent In the moment of the care decision Banner Health physicians have access to patient EMR and are prompted upon a visit to provide diagnosis related care Retrospectively examining the circumstances (data) Geisinger uses their patient data warehouse to identify care gaps and push them to clinicians for review

19 Practical Use BIDMC John D. Halamka, MD, MS Chief Information Officer of Beth Israel Deaconess Med. Center Chief Information Officer at Harvard Medical School Chairman of the New England Healthcare Exchange Network Healthcare IT Ten-year-old John Halamka winning the Science Fair in 4th grade with his home-built Van De Graff generator in Healthcare CIOs should implement applications which filter data so that it becomes information, transform information into knowledge, and ultimately provide clinicians with wisdom based on that knowledge at the exact time they need it.

20 Practical Use - BIDMC

21 JD Whitlock, MPH, MBA, CPHIMS C&BI Committee Member Director, Clinical & Business Intelligence Catholic Health Partners Cincinnati, Ohio

22 IOM: The Learning Healthcare System (or) Better Data for Better Care Information technology Operations research Statistical modeling Information Knowledge Insight and action Data A virtuous cycle of discovery

23 From Metrics to Analytics Source: Thomas Davenport, Transforming Health Care with Analytics

24 Largest health system in Ohio Mission focus on meeting needs of the underserved $3.6B revenue 24 acute care facilities ~1,000 employed physicians Payer / PPO with 100K covered lives Vision: CHP will transition to value-based care through a high quality, affordable system of care that improves the health of individuals and the communities we serve.

25 Value Based Care Continuum Value Driven Volume Driven CHP just slightly ahead of the crowd? ACO (1 July 2012 start) Single instance EHR Integrated payer / PPO Critical mass of employed physicians Enlightened leadership willing to take appropriate risks to enter the brave new world of value based care

26 Famous ACO Quotes The shift from volume-driven to value-driven payment is inevitable NEJM 2 June 2011: Spending to Save ACOs and the Medicare Shared Savings Program Getting a second chance on managed care seems to be the only available alternative to drastic rationing of healthcare Wes Rishel (Gartner) Don t be an ostrich or a frog J.D. Whitlock (CHP)

27 CHP ACO Focused Strategy What is it? Why do it? CMS has awarded CHP a Medicare ACO pilot 22,000 Medicare patients have been attributed to the ACO to receive their care It is an attractive partnership option for community physicians It allows CHP to be compensated for managing to appropriate utilization What does it look like? CHP has built Mercy Health Select, a clinically integrated network, to provide care to ACO patients CMS shares savings with Mercy Health Select if we meet both quality and cost goals

28 CHP Population Health Management (PHM) ACCOUNT- ABILITY AND CULTURE INCENTIVES AND FUND FLOWS INFRA- STRUCTURE Population Health Management Capabilities CARE COORDINATION PHYSICIAN BEHAVIOR DEFINITION OF SUCCESS Shift Insurance Model to allow CHP to serve a defined membership Established care protocols for each population (e.g. diabetics) Promote system-wide adherence to care protocols by both members and caregivers Data warehouse to enable complete view of patient and advanced analytics Development of predictive models to provide timely alerts on care process intervention Meeting desired outcomes for each population

29 Tools Required for Value-Based Care ACO-33 Measure the experience, results and active participation of covered pop. Provider Analytics Manage/maintain consistency, effectiveness and openness of care delivery Population Health What are the behaviors, norms and risk profiles of the local population Total Cost of Care Covered individual and total population utilization & spend Improved Outcome, Spend, Utilization & Access

30 Value-Based Care / PHM / ACO Completely Changes the C&BI Game You Need a C&BI Turbo Button

31 Unfortunately there is no such thing as ACO-in-a-box ACO (Despite what some would like you to think)

32 IQ Test: See Any Problems with This Scenario? SaaS PHM Vendor SaaS PHM Vendor SaaS PHM Vendor SaaS PHM Vendor SaaS PHM Vendor SaaS PHM Vendor SaaS PHM Vendor

33 Wes Rishel (Gartner): ACO Requirements vs. Market Availability

34 CHP s Data Warehouse Strategy: PremierConnect Enterprise (PCe) Dashboards CHP Data Sources Stored in Viewable via Claims Quality Clinical Operations Revenue PremierConnect Data Model Powered by: Big Data Data Warehouse Appliance Enterprise Business Intelligence Suite Powered by: Drillable Interactive Reports Self-Service BI Tools Supply Chain Ad-hoc Reports

35 PremierConnect Data Model Roadmap Devote CHP resources to analytics and insight, not data modeling Clinical Care Foundation Measure and track progress against clinical quality, operational utilization and regulatory compliance measures Population Health; Supply Chain; Labor Management Measure and track progress against clinical care plans, population health metrics, labor utilization and materials procurement spend Capacity and Staffing Management; Benchmarking Analyze financial impacts of different reimbursement, resource utilization, service delivery, etc., models; Benchmark performance against internal and external peers Claims, Billing and Financials; Clinical Extensions Measure and track progress against treatment protocols, usage, billed cost of care, reimbursements and financial performance goals Clinical Research and Advanced Care Management Design clinical trials and analyze results; optimize therapeutic strategies and design targeted intervention approaches Release 8.4 Dec 2011 Release 8.5 July 2012 Release 8.6 Nov 2012 Release vnext H Release vnext H Clinical Quality Operational Efficiency Financial Performance Pay for Performance Research Strategic Planning

36 Reality: You can t wait for all the data to be in one place

37 ACO Clinical Measures

38 InforMed: Care Coordination and Total Cost of Care Target patients for Care Coordination Total Cost of Care from available claims data Limited clinical data (lab results, vitals, biometrics) enhances risk stratification and Evidence Based Medicine recommendations

39 Maximize Use of within-ehr Informatics (2012)

40 PHM Within EHR Workflow

41 Efficient Workflow for Care Coordinators

42 Towards Advanced PHM Analytics What is the best way to integrate clinical data into today s claims-based risk stratification and predictive modeling? i.e. who is developing next-gen algorithms that maximize predictive power of adding clinical data to claims data? Extending patient engagement to mhealth and home monitoring devices i.e. metrics for new care models we don t yet have our head around (but we know can move the cost curve) Personalized medicine

43 Print, Digital, itunes all available

44 Event Announcements HIMSS13 NOLA March 3-7, Inaugural C&BI Symposium March 3, px?metadataid=126 Clinical Engineering and IT Leadership Symposium: Executing your Medical Device Integration Roadmap px?metadataid=125

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46 Thank You