Transcript Measure Metadata Repository/Governance

Expanding the Role of
Health Information
October 2016
Why do we
see ads
like this?
Source: Delta Sky Magazine
2
© 2016 Health Catalyst
Proprietary and Confidential
THESE PILOTS ARE AMONG
Lunar
THE BEST
But never
like this??
Neil Armstrong, NASA
PILOTS
IN NEW YORK
Each pilot has
been included in a
“Best Pilot” issue of
1243 Fifth Avenue , Suite 134
(212) 343-4356
Puddle Jumpers
Orville and Wilbur Wright
5678 Fifth Avenue , Suite 566
(212) 343-4356
Intercontinental
Captain Charles A.
Lindburgh
New York
13 Tenth Avenue , Suite 14
(212) 343-4356
Military
All pilots are
board certified
Capt. von Richtofen
5678 Red Baron Way, Suite 44
(212) 343-4356
Capt. Jimmy Kirk
Intergalactic
Pilots chosen for New
York magazine’s “Best
Pilots” were selected
by Preferred Pilots
Ltd. The nation’s
leading provider of
information on top
pilots
Orbital
Capt. John Glenn
12 First Avenue , Suite 33
(212) 343-4356
Pilots chosen for
New York
magazine’s “Best
Pilots” were
selected by
Preferred Pilots
Ltd. The nation’s
leading provider of
information on top
pilots
Cross Atlantic
Amelia Earhart
777 Second Avenue , Suite 567
(212) 343-4356
River Landings
Capt. Chesley
Sullengerger
3
345 Hudson River Way
(212) 343-4356
© 2016 Health Catalyst
Proprietary and Confidential
Evolution towards
a System of Production
System of Production
Deming & others
“Manual” System
Frederick Taylor
Airline Industry
Healthcare Industry
“Craftsmanship”
Guild System
© 2016 Health Catalyst
Proprietary and Confidential
4
Outcome Improvement:
The AIM of Health Information and Analytics
We should be providing the highest quality with an optimal care
experience at the lowest appropriate cost for populations
Quality
Outcomes
Experience
Outcomes
Cost
Outcomes
The key reason for implementing any healthcare technology should
be: How do we systematically improve outcomes?
5
© 2016 Health Catalyst
Proprietary and Confidential
Core Capabilities for Outcomes Improvement
How are we doing?
What should
we be doing?
•
•
•
Clinical Outcomes
Cost Outcomes
Experience Outcomes
How do we
change?
© 2016 Health Catalyst
Proprietary
and Confidential
6
Capabilities to SCALE Outcomes Improvement
Leadership, Culture and Governance
Financial Alignment
© 2016 Health Catalyst
Proprietary
and Confidential
7
Capabilities to SCALE Outcomes Improvement
Where do we focus?
Leadership, Culture and Governance
How are we doing?
What should
we be doing?
•
•
•
Clinical Outcomes
Cost Outcomes
Experience Outcomes
How do we
change?
Financial Alignment
How are we financially compensated?
© 2016 Health Catalyst
Proprietary
and Confidential
8
Types of Best Practice Knowledge Assets
Knowledge
Asset Type
Question to ask
Examples
Possible Measures
Diagnostic algorithms
Health Maintenance and
Preventive Guidelines
Triage Criteria
Utilization
Who should get the care?
Treatment and Monitoring
Algorithms
Indications for Intervention
Indications for Referral
Order Sets
What care should be
included?
Substance Selection
Clinical Supply Chain
Management
Admission Order Sets
Supplementary Order Sets
Pre-Procedure Order Sets
Post-acute care order sets
IP (SNF, IRF)
Home health, Hospice
Post-procedure Order Sets
Clinical
Support
Workflow
How can care be delivered
efficiently ?
Transfer Checklist
Clinical Ops Procedure Guidelines
Discharge Checklist
Standardized Follow-up Checklist
Risk Assessment
Bedside Care Practice Guidelines
Patient Injury Prevention Protocol
Administrative
Support
Workflow
How can administrative
operations be performed
efficiently ?
AR Escalation Process
AR Escalation Process
Network Design Process
Budgeting Process
Recruiting/Onboarding Process
Supply Chain Procurement
9
Admits/1000 members
IP days/1000 members
OP visits/1000 members
Procedures/1000 members
ED visits/1000 members
Readmissions/1000 members
Cost/case
Cost/procedure
OR minutes
L&D minutes
Other LOS
Cost per case
Nursing hours by unit
OR minutes
L&D minutes
Cycle times
Cost per ancillary test
Environmental services
AR Days
% out of network utilization
% Turnover
Team member
satisfaction/engagement
© 2016 Health Catalyst
Proprietary and Confidential
The Journey to Outcomes Improvement
Spreadsheet
Silos
Centralized
Reporting
Data-Driven
Improvement Culture
Common, linkable
vocabulary
FINANCIAL SOURCES
(e.g. EPSi, Peoplesoft, Lawson)
DEPARTMENTAL SOURCES
(e.g. Apollo)
Financial
Source Marts
Departmental
Source Marts
Readmissions
Administrative
Source Marts
Diabetes
Sepsis
ADMINISTRATIVE SOURCES
(e.g. API Time Tracking)
EMR
Source Marts
Patient
Satisfaction
Source Mart
Pt. SATISFACTION
SOURCES
(e.g. NRC Picker, Press Ganey)
EMR SOURCEs
(e.g. Cerner, Allscripts, NextGen)
•
•
•
•
•
Silos or pockets of analysis
Conflicting spreadsheet reports and
interpretations of data
Battles over data ownership
Most time spent on hunting for and
gathering data
Focus is on is the data “right”
•
•
•
•
•
Centralized single source of truth
established in EDW
Significant time spent on
standardizing definitions
Data begins to be trusted
Report queue begins to build
Focus is on requirements for
dashboard applications and
reports
•
•
•
Improvement teams use analytics to
accelerate best practice adoption
Data drives decisions and actions
Focus is on growing and sustaining
outcomes improvement through
variation reduction leveraging
analytics
© 2016 Health Catalyst
Proprietary and Confidential
10
Adoption: Diffusion of Innovation
Early adopters. Recruit early adopters
to chair improvement and to lead
implementation at each site.
(key individuals who can rally support)
N = number of individuals in group
N = number needed to influence group
(but they must be the right individuals)
Innovators. Recruit
innovators to re-design
care delivery processes
late
majority
early
majority
Innovators
N
The Chasm
early
adopters
laggards
(never adopters)
* Adapted from Rogers, E. Diffusion of Innovations. New York, NY: 1995.
11
© 2016 Health Catalyst
Proprietary and Confidential
Payment Structure Considerations
Knowledge Asset
Type
Discounted
FFS
Per Case
Bundled Per Case
Per Diem
CMS
Commercial
CMS
Commercial
Condition
Capitation
Full
Capitation
Administrative Workflow
Workflow
Operational Workflow
Diagnostic
Variation
Diagnostic
Variation
Substance
Standing
OrdersSelection
Medication
Selection
Standing
Orders
Triage Triage Criteria
Patient Safety
Patient Safety
TreatmentTreatment
and Monitoring
Ambulatory
and
Algorithms
Monitoring
Indications
for Referral
Indications
for Referral
Indications for Intervention
= Negative Impact
= Positive or Negative
= Positive Impact
© 2016 Health Catalyst
Proprietary and Confidential
Where to Start?
Get the Right Data Together
Example: Adaptive Data Model
Metadata (EDW Atlas), Security and Auditing
Common, linkable
vocabulary
FINANCIAL SOURCES
(e.g. EPSi, Peoplesoft,
Lawson)
Financial
Source Marts
DEPARTMENTAL
SOURCES
(e.g. Apollo)
Departmental
Source Marts
Asthma
ADMINISTRATIVE
SOURCES
(e.g. API Time Tracking)
Administrative
Source Marts
Diabetes
Sepsis
EMR
Source Marts
Patient
Satisfaction
Source Mart
Pt. SATISFACTION
SOURCES
(e.g. NRC Picker, Press
Ganey)
EMR SOURCEs
(e.g. Cerner, Allscripts,
NextGen)
More Transformation
Less Transformation
© 2016 Health Catalyst
Proprietary and Confidential
Pareto Analysis >> Prioritization
Y-Axis = Percent of total resources consumed
100%
90%
Top 85 Care Processes account
for 80% of the opportunity (+45)
80%
70%
Top 40 Care Processes account
for 62% of the opportunity (+27)
60%
50%
40%
Top 13 Care Processes account
for 34% of the opportunity
30%
20%
10%
0%
% of Total
Cumulative %
X-Axis = Care Processes by resources consumed (High to Low)
15
© 2016 Health Catalyst
Proprietary and Confidential
Internal Variation versus Resource Consumption
(Key Process Analysis Dashboard Example shown)
© 2016 Health Catalyst
Proprietary and Confidential
16
Improvement Methods
Major Milestones
Prerequisites


Recruit team
Train team
Kickoff
• Confirm team mission,
charter, roles
• Review AIM options
• Gather best practices
• Profile and visualize
preliminary data
• Select 2-3 potential
AIMs
• Guidance team
validation
AIM
• Review visualized
drafts of AIM cohort
findings
• Identify data quality
issues
• Direct observation
• Prioritize and select
AIM #1
• Review cohort criteria
and visualizations
• Guidance team
validation
Intervention
Rollout
Finalize cohort
Identify intervention(s)
Direct observation
Solicit front line input
on AIM and
intervention
• Define intervention
rollout plan
• Guidance team
validation
• Solicit front line plan
input
• Finalize analytics dev,
testing, and rollout
support
• Finalize intervention
rollout plan
• Guidance team
validation
•
•
•
•
Results
• Review initial results
• Identify, approve any
modifications to
intervention rollout
• Review lessons
learned
• Create next AIM
statement
• Repeat process
Rollout Date
Work Streams
1. Best Practices
2. Define Cohort
3. AIM Statement
4. Design Metrics
Select
Build and Refine
Build and Refine
Build and Refine
5. Rollout Plan
6. Rollout
7. Measure Progress
© 2016 Health Catalyst
Proprietary and Confidential
Precise patient registry
Move to clinically defined cohorts
Problem
List
(22,955)
ICD9
493.XX
(29,805)
Total Count of Distinct
Patients = 106,714
Additional
Potential Rules
(101,389)
Supplemental
ICD9 (38,250)
Medications
(72,581)
Standard Registry
Precise Patient Registry
18
© 2016 Health Catalyst
Proprietary and Confidential
Sepsis Example
Care Process Improvement Map
Evidence-based best
practices for each phase
of care
“Storm Clouds”:
key aim focus areas (greatest
opportunities for improvement)
Key outcome or process metrics
for each best practice area
Recommended knowledge assets
(standardization tools)
78
© 2016 Health Catalyst
Proprietary and Confidential
Goal, Aim & Intervention Example - Sepsis
Outcome Improvement Goal:
Decrease the LOS of severe sepsis and septic shock patients by X%
by X date.
Process Improvement Aim:
Increase total compliance of three hour bundle measures (lactate, blood
cultures, antibiotic administration and fluid resuscitation) by X% by X
date.
Intervention #1
Intervention #2
Develop and implement a fluid
resuscitation ED quick chart by
X date.
By X date complete an education
program for ED nurses on the
importance of rapid antibiotic
administration.
© 2016 Health Catalyst
Proprietary and Confidential
Enterprise Data Warehouse - Sepsis
Severe Sepsis & Septic Shock Application
Data Integration and Common Definitions
Clinically defined cohorts, population definitions, comorbidities,
patients, labs, encounters, diagnoses, medications, etc.
Source Marts
Hospital EMR
EMR
e.g. Epic, Cerner,
MEDITECH
Benchmarking
Patient Satisfaction
Benchmarking
Patient Sat.
e.g. UHC, Truven,
Premiere
e.g. Press Ganey,
NRC Picker
Financial
Financial
e.g. McKesson, MEDITECH
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
Reducing Sepsis Mortality
22% reduction in sepsis mortality
$1.3 million in savings
© 2016 Health Catalyst
Proprietary and Confidential
Hip & Knee
Example
Goal, Aim & Intervention Example – Hip & Knee
Outcome Improvement Goal:
Increase the % of patients from (current value) to (outcome value)
discharged to home by X date
Process Improvement Aim:
Increase the percentage of patients who have successfully completed the
an Enhanced Recovery After Surgery (ERAS) pathway for total joint
replacement by X% by X date consisting of: 1) nutrition screening; 2) preemptive antiemetic and analgesia administration; 3) no prolonged fasting;
4) antibiotic prophylaxis VTE prophylaxis; 5) blood utilization
Intervention #1
By X date develop & implement a
pre-operative order set for TJR
that incorporates ERAS items.
Intervention #2
-
By X date develop an ERAS
pathway for total joint
replacement surgery
2-4 Process Improvement AIMS should produce a significant outcome improvement
© 2016 Health Catalyst
Proprietary and Confidential
Enterprise Data Warehouse – Hip & Knee
Hip & Knee Replacement Application
Data Integration and Common Definitions
Clinically defined cohorts, population definitions, comorbidities,
patients, labs, encounters, diagnoses, medications, etc.
Source Marts
EMR
Patient
Satisfaction
Surgery EMR
Financial
Claims
EMR
Patient Sat.
Surgery EMR
Financial
Claims
e.g. Epic, Cerner,
MEDITECH
e.g. Press Ganey,
NRC Picker
e.g. Centricity,
Epic, Cerner
e.g. McKesson
e.g. CMS
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
So now you are
MACRA experts…
Interesting Fact #1:
A survey conducted in March, 2016 by Weill
Cornell Medical College and the Medical Group
Management Association (MGMA) found that
physicians spend an average of ??? hours
every week processing quality metrics.
© 2016 Health Catalyst
Proprietary and Confidential
Interesting Fact #2:
The time physicians spend processing quality
metrics translates to an average cost of
$40,069 per physician, per year
© 2016 Health Catalyst
Proprietary and Confidential
Measure Metadata Repository/Governance
Definitions
Metadata Repository
• Ability to see what
measures are being used
and reused
• Stewardship over
measures
• Numerous metadata
points for tagging and
informing about
measures
© 2016 Health Catalyst
Proprietary and Confidential
Build a Data Library
MSSP
HEDIS
PQRS
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
© 2016 Health Catalyst
Proprietary and Confidential
Questions
Contact Information
Expanding the Role of
Health Information
EVP, Chief Clinical Officer
Health Catalyst
[email protected]
October 2016
© 2016 Health Catalyst
Proprietary and Confidential