Using Real-Time Analytics ANNA DALY, Director of Clinical Data Management (HCA)
VICTORIA WEAVER, Assistant Vice President of Clinical Data Management (HCA)
to Understand Clinical Data 1
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
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Transforming the industry from being reactionary and illness-focused
In this model, the hospital is passive – it is simply the place the physician goes to treat
the patient upon illness.
• 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
photo courtesy of noblehospital.org 4
to being proactive and wellness-focused
In this model, the hospital is
active - managing the post-acute
hospitalization discharge to reduce overall spend and
eliminate readmission.
• Less frequent readmissions • More affordable care • Value of care determined by performance and
outcome • Patients are active in their healthcare plan
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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
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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
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OUR VENDORS
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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 Patient Value
THE VALUE OF QUALITY
Improved Hospital Value
Improved Physician
Value
Improved Patient Value
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QUALITY
Stored in Clinical Database
Outcomes = Lagging Indicators
Consistently deliver correct
outcomes
Basic Science Outcome Analysis
Create clinical
evidence for best practices
Consistently apply best practices
Clinical Trial
Process = Leading Indicators QUALITY IN CONSISTENCY
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Real-time Clinical Decision Support - Diagnostics
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Real-time Clinical Decision Support - Therapeutics
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IT’S ALL ABOUT THE DATA
- Ronald Coase
Tips » Be specific in focus » Establish a benchmark » Define “acceptable” » Define “outliers”
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OPERATIONAL EFFICIENCIES
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MEANINGFUL USE
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ACUITY MODELS
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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
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STANDARDIZATION
original image courtesy of singingthroughtherain.net
INDUSTRY STANDARDS
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1 2 3 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
THE HCA APPROACH
DEFINE AND DISCOVER DISCUSS AND DECIDE DELIVER AND DRIVE
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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
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TIE TO OUTCOMES
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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
DOLLARS DO NOT EQUAL HEALTH
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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
Data
-Driv
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Phys
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Patie
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ocus
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CLI
NIC
AL
BUSI
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S IN
TELL
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CE
HOW TO IMPROVE PERFORMANCE
CLIN
ICAL
BU
SIN
ESS
INTE
LLIG
ENCE
DATA
-DRI
VEN
PHYS
ICIA
N-L
ED
PATI
ENT-
FOCU
SED
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“If we are to achieve things never before accomplished, we must employ methods never before attempted.”
-Francis Bacon
QUESTIONS
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