Transcript - University of Alberta

Provincial Perspectives on Data Access,
Management and Linkage
Stafford Dean
Senior Program Officer – Analytics
Research, Innovation, and Analytics
Alberta Health Services
May 14, 2014
1
Outline
• What has been accomplished since the
formation of AHS
• What we have learned so far
• Where are we going from here
2
Accomplishments – Created a Data
Repository
• A Data Repository for Secondary Use – data that is created from
delivering and managing health care is made available to be used
and re-used to support quality management, performance
management and research
• Administrative data (DAD/NACRs) and data from various
transactional source systems are integrated, conformed , and put
into one provincial file.
• Contains the mainstream data sets – DAD, NACRs, Physician
Claims, Registry, ADT, Lab, DI MIS expenditure reporting,
Continuing care, patient experience and many more...
• Analytical data sets – existing pre-mergers of data useful for
analysis
3
The AHS Data Repository – The Value
– Increases efficiency
• Analysts spend more time doing analytics, less time chasing
data
• Data is ready to analyze with formal data set documentation
and (meta data), formal data quality assessments
• Easy to use master reference tables
– Increases the value of information generated by
linking data sets across systems of care
– Enables report automation
4
Analytical Data Sets (Linked Data Marts)
• Data sets that are pre linked and made
available to analysts for various analytic
purposes:
• Prevalence estimate file
• Longitudinal master file
• Population costing data
5
Alberta Health Care Costs by CRG - 2010/11
CRG
1000/1
3017
3018
3019
3078
3079
3080
3099
3100
3101
3141
3142
3195
3196
3244
3273
3274
3317
3357
3358
CRG Description
Population
Total Cost
Healthy
2,654,341 $1,711,112,150
Gait Abnormalities
175
$528,924
Migraine
7,510
$14,835,574
Chronic Neuromuscular and Other Neurological Diagnoses - Minor 22,346
$52,227,155
Glaucoma
13,930
$33,577,361
Cataracts
7,691
$25,075,393
Chronic Eye Diagnoses - Minor
19,209
$48,460,184
Chronic Ear Diagnoses except Hearing Loss
137
$636,492
Chronic Hearing Loss
2,337
$5,234,332
Other Chronic Ear, Nose, and Throat Diagnoses
852
$3,063,103
Chronic Bronchitis
461
$924,669
Other Chronic Pulmonary Diagnoses
1,232
$4,985,431
Ventricular and Atrial Septal Defects
380
$7,083,244
Chronic Cardiovascular Diagnoses - Minor
509
$7,577,368
Chronic Disorders of Arteries and Veins - Minor
7,280
$11,645,285
Chronic Ulcers
3,429
$8,423,173
Chronic Gastrointestinal Diagnoses - Minor
17,720
$56,515,880
Gallbladder Disease
3,034
$16,136,260
Osteoarthritis
17,126
$41,790,546
Chronic Joint and Musculoskeletal Diagnoses - Minor
22,873
$56,691,147
Average Cost
Per Person
$645
$3,022
$1,975
$2,337
$2,410
$3,260
$2,523
$4,646
$2,240
$3,595
$2,006
$4,047
$18,640
$14,887
$1,600
$2,456
$3,189
$5,318
$2,440
$2,479
Alberta Health Care Costs by CRG - 2010/11
CRG
5014
5074
5075
5117
5120
5132
5133
5134
5138
5177
5178
5179
5180
5181
CRG Description
Population
Epilepsy
5,264
Macular Degeneration
2,727
Blindness, Visual Loss, and Chronic Eye Diagnoses - Major / Moderate 2,141
Anomaly Skull and Facial Bones
394
Cleft Lip and Palate
274
Major Respiratory Anomalies
213
Chronic Obstructive Pulmonary Disease and Bronchiectasis
7,185
Other Major Chronic Pulmonary Diagnoses
468
Asthma
37,932
Complex Cyanotic and Major Cardiac Septal Anomalies
215
Other Major Congenital Heart Diagnoses Except Valvular
104
Congestive Heart Failure
3,517
Other Cardiovascular Diagnoses - Major
1,407
Valvular Disorders
1,521
Average Cost
Total Cost
Per Person
$22,580,766
$4,290
$10,630,118
$3,898
$8,998,673
$4,203
$4,502,994
$11,429
$2,761,698
$10,079
$28,269,426
$132,720
$37,679,415
$5,244
$4,334,709
$9,262
$76,652,239
$2,021
$5,157,528
$23,989
$1,545,165
$14,857
$39,380,098
$11,197
$14,949,430
$10,625
$13,078,567
$8,599
Alberta Health Care Costs by CRG - 2010/11
CRG
6100
6110
6111
6112
6113
6114
6115
6116
6117
6120
6121
6122
6123
6124
6125
6130
6131
6132
6133
6140
6141
6142
6143
6144
CRG Description
Population
Total Cost
Chronic Renal Failure and Other Dominant or Moderate Chronic Disease
5,169 $166,538,301
Chronic Obstructive Pulmonary Disease and Congestive Heart Failure 1,318
$43,647,469
Congestive Heart Failure and Diabetes
1,892
$53,589,199
Congestive Heart Failure and Peripheral Vascular Disease
108
$4,412,004
Congestive Heart Failure and Cerebrovascular Disease
266
$16,971,789
Congestive Heart Failure and Other Dominant Chronic Disease
868
$37,898,866
Congestive Heart Failure and Dementing Disease
671
$39,042,465
Congestive Heart Failure and Other Moderate Chronic Disease
1,392
$38,942,533
Congestive Heart Failure and Other Chronic Disease Level 2
318
$9,749,177
Chronic Obstructive Pulmonary Disease and Diabetes
1,494
$29,370,262
Chronic Obstructive Pulmonary Disease and Advanced Coronary Artery Disease
748
$19,101,017
Chronic Obstructive Pulmonary Disease and Other Dominant Chronic Disease
2,451 $109,648,814
Chronic Obstructive Pulmonary Disease and Other Moderate Chronic Disease
3,855
$78,008,685
Chronic Obstructive Pulmonary Disease and Hypertension
1,606
$10,515,291
Chronic Obstructive Pulmonary Disease and Other Chronic Disease Level506
2
$7,850,825
Cerebrovascular Disease and Diabetes
732
$36,590,411
Cerebrovascular Disease and Other Dominant Chronic Disease
898
$55,459,102
Cerebrovascular Disease and Other Moderate Chronic Disease
2,025 $104,556,473
Cerebrovascular Disease and Other Chronic Disease Level 2
108
$4,984,619
Diabetes and Advanced Coronary Artery Disease
2,871
$54,254,062
Diabetes and Other Dominant Chronic Disease
5,152 $157,148,347
Diabetes and Asthma
1,600
$14,113,986
Diabetes and Other Moderate Chronic Disease
12,512 $145,905,668
Diabetes and Hypertension
18,646
$53,219,951
Average Cost
Per Person
$32,219
$33,116
$28,324
$40,852
$63,804
$43,662
$58,185
$27,976
$30,658
$19,659
$25,536
$44,736
$20,236
$6,548
$15,515
$49,987
$61,758
$51,633
$46,154
$18,897
$30,502
$8,821
$11,661
$2,854
Alberta Health Care Costs by CRG - 2010/11
CRG
9010
9020
9030
9040
9050
9060
9070
9080
9090
9100
9110
CRG Description
Dialysis with Diabetes
Dialysis without Diabetes
HIV Disease
Total Parenteral Nutrition
Dependence on a Mechanical Ventilator
History of a Major Organ Transplant
Congenital Quadriplegia, Diplegia or Hemiplegia
Acquired Quadriplegia or Permanent Vegetative State
Spina Bifida
Progressive Muscular Dystrophy or Spinal Muscle Atrophy
Cystic Fibrosis
Ungrouped
Total Albertans
Population
447
436
1,397
235
7
904
444
380
419
493
401
191
3,807,101
Average Cost
Total Cost Per Person
$66,418,668 $148,588
$56,137,027 $128,755
$20,673,284
$14,798
$67,881,142 $288,856
$1,729,379 $247,054
$48,339,275
$53,473
$14,464,148
$32,577
$37,419,493
$98,472
$10,298,742
$24,579
$20,750,000
$42,089
$5,460,307
$13,617
$4,408
$23
$9,424,419,192
$2,475
Accomplishments – Automated Reporting
(Tableau)
• Developed a reporting environment that enables automated
reporting and exploratory analytics /drill downs
• We started with the most common requests – re-admissions,
utilization, LOS,...
• Over 100 dashboards are now automated
• We have over regular 50 tableau dashboard developers and
1,000’s of users.
• We have ‘freed’ analysts time spend on responding to adhoc
requests can now address more strategic analytic needs.
10
11
12
13
Accomplishments – Performance Reporting
• We have developed standard definitions, formal public reporting
process
14
Strategic Layer – Measures
 Satisfaction with hospital care
 Satisfaction with long term care
 Hospital-acquired infections - C-Diff
 Hand hygiene compliance rate
 Hospital mortality rate
 Early detection of cancer
 Mental health readmissions
 Surgery readmissions
 Heart attack mortality
 Stroke mortality
 Emergency department wait to be seen by a physician (median)
 ED length of stay - admitted (median) province's 16 busiest sites
 ED length of stay - discharged (median) province's 17 busiest sites
 Access to radiation therapy (90th percentile)
 Continuing care placement within 30 days
 Actual length of hospital stay compared to expected stay
http://www.albertahealthservices.ca/performance.asp
15
Progress made so far – data sharing
•
•
•
•
•
•
•
Developed a shared data model program that develops relationships and
facilitates data sharing among distributed analytic teams in AHS.
Start with an analytic or reporting need that important to the particular area
The data that is needed to address the need is not currently accessible to
the distributed analytic/data team
Work together in a formal way to develop the analytic product
Develops relationships between DIMR analysts and the distributed
analysts
Distributed teams learn about data holdings in the repository and we learn
about data holdings in the distributed teams
Win - win - win – the potential value by working together is greater than
working in isolation.
16
The shared data model accommodates both enterprise and
departmental data is a key roadmap enabler
Cancer Care
Repository
Perinatal
Population
Health
Operating
Room
Critical Care
Personally
identifiable
data
Cardiac Care
Alberta Data
Repository
/DIMR
Zone
data
Trauma
Seniors
Emergency
Department
Mental
Health
The Open Data Model has…





A centrally managed core
Controlled access to personally identifiable data
Distributed departmental / subject-area databases that can link with the core
Robust master data and identifier keys that link central and departmental / subject-area data
Open Data Model Privacy and Anonymization are foundational issues that must resolved early
17 in the Roadmap
Progress made so far – DI Example
• What is the DI utilization relative to the number
of ED visits what is that utilization relative to
discharge diagnosis across Alberta?
• What is the DI utilization relative to presenting
complaint across Alberta?
18
20
Progress made so far – Access for research
• Developed a process to enable access for
investigator initiated research
• Use a research agreement
• Have a team (3) of dedicated talented analysts
that act as the interface between the research
community and AHS data assets
21
What we have learned so far
• Shared data model is an attractive way to connect
analytic teams
• Adaptive data warehouse – staged levels of data access
and late binding – bring all the data in with limited context
or transformation (raw data materials) then make the
data available in raw form up to very structured data
• Analytics is different than traditional BI
• Fully functioning Data Scientists are rare. We need to
create more folks like these
• Making sure secondary use of data is planned up front
and is a requirement in any info system investments
22
What we have learned so far
• Secondary use of EMR/EHR data is the key to truly be
able to mange clinical service performance
• We have limited experience in using EMR data – pockets
exist, but generally very little.
• EMR/EHR data is very complex
• Trust the analysts. Allow access, let them be creative
and do not use restriction as a means to minimize risk.
Manage what is produced not just what is accessed.
• Produce analytical products and reports with the data
you have. It starts the discussion and makes the
conversations meaningful.
23
What we have learned so far
• Data integration is easier than systems integration
• Not everything needs to be real time
• Getting an actual decision is tough, even when the data
is available and it is obvious what is needed to happen.
We need to build a data driven culture.
24
Where are we going from here
•
•
•
•
•
•
•
Focus on clinical data - need to further develop this capability
Focus on outcome data – PROMs and disease specific clinical
outcomes
Focus on HR and cost data
Bring these together so we can truly analyze relationships between
clinical process, cost and outcomes
Enable measurement from the bottom up – measuring at a meaningful
level for our front line providers by developing balanced measurement
sets across the domains of quality for specific clinical populations.
Enable providers to see how they perform relative to there peers and
relative to best practice.
Accelerate de- identification to improve access to data
• Leverage what AHS has done so far for other bigger initiatives such
as PHAN
25