Performance monitoring using data (pay for performance projects)

Prof. Steven BoyagesMB BS PhD FRACP FAFPHM DDU

Wednesday, 31 July 2013

Clinical Professor The University of Sydney, and The University of Western Sydney

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Summary• HIT allows rapid processing and storing of large amounts of

information

• The term “ Big data” describes the way we deal with the astonishing accumulation of digital information which is often stored in large unstructured data repositories.

• New tools such as business intelligence (BI) have emerged to organise and interpret this vast array of information with benefits in public health, research, patient care and hospital operational systems.

• Performance monitoring of systems, providers and patients will improve quality, experience and value for money

Performance

• System level– Community– Group of hospitals– Hospital– Clinic– Region– State

• Provider level• Patient level

• “Pay”– Incentives

• Gainsharing

– Penalties

• Funding– Case mix– Coding– Diagnostic Related

Groupings

• Linked to targets

The impact of public reporting

• There is strong evidence to support public reporting on the performance of health care organisations. A number of other countries are seeing the benefits that it can bring, particularly when linked to health systems improvement as part of an overall quality framework.

• Public health performance reporting offers significant opportunities to improve the overall performance of Australia’s health system, and achieve better integration between hospitals and primary health care.

Nearly every transaction or interaction leaves a data signature

Someone somewhere is capturing and storing

Sheer scale has far exceeded human sense-making capabilities

At these scales patterns are often too subtle and relationships too complex or multi dimensional to

observe by simply looking at the data.

Data mining is a means of automating the process to detect interpretable patterns

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It helps us see the forest without getting lost in the trees

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Google Flu Trends

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Google Trends Michael Jackson

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Facebook can predict your breakups

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New methods of scientific inquiry

• While it is attractive to contemplate the way everything may become connected to everything else, it presents a number of large challenges.

• The lab research model has been important for over a century in both scientific advancement and product development; soon it may also have to accommodate a search for truth based only on pattern-spotting.

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Your personality can be predicted

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Eating Habits

Clinical Intelligence and Analytics:Keeping Score in Health

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Analogue Scoreboards

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The Next Level: Health Intelligence Systems

• Definition

Responsive Agile Available Flexible Timely

Real timeNear Real time

Capability

Patient Care Safety Decision support Outcomes Research Patient Logistics

Performance Management State Area based Hospital/cluster/network Modality (scheduling) Bedside

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Table 2: Annual benefit paid by Medicare for 25-hydroxyvitamin D testing and percentage increase since 2000

Year     Annual Benefit ($) % Increase

2000 1,021,784 100%2001 1,670,597 163%2002 2,318,770 227%2003 3,216,543 315%2004 5,269,951 516%2005 7,592,467 743%2006 12,149,112 1189%2007 22,621,733 2214%2008 42,358,509 4146%2009 67,643,016 6620%2010 96,746,203 9468%

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b) Frequency of testing in individuals with more than one test Frequency

of testing per individual

Number of individuals

Cumulative Percentage

Frequency of testing per individual

Number of individuals

Cumulative Percentage

2 1026483 49.5

41 12 100 3 496225 73.4

42 11 100

4 251306 85.5

43 11 100 5 132173 91.8

44 10 100

6 71534 95.3

45 8 100 7 39857 97.2

46 6 100

8 22717 98.3

47 5 100 9 13165 98.9

48 5 100

10 7790 99.3

49 5 100 11 4665 99.5

50 4 100

12 2881 99.7

51 3 100 13 1826 99.8

52 3 100

14 1196 99.8

53 3 100 15 809 99.9

54 3 100

16 555 99.9

55 3 100 17 390 99.9

56 3 100

18 288 99.9

57 3 100 19 221 99.9

58 3 100

20 176 99.9

59 2 100 21 145 100

60 2 100

22 126 100

61 2 100 23 106 100

62 2 100

24 93 100

63 2 100 25 79 100

64 2 100

26 65 100

65 2 100 27 55 100

66 2 100

28 47 100

67 2 100 29 43 100

68 2 100

30 37 100

69 2 100

National Health Performance Framework

General Performance Framework

Performance Indicators for Hospitals and Local Hospital Networks

Emergency department performance in Australia

ED performance in Sydney

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Summary• HIT allows rapid processing and storing of large amounts of

information

• The term “ Big data” describes the way we deal with the astonishing accumulation of digital information which is often stored in large unstructured data repositories.

• New tools such as business intelligence (BI) have emerged to organise and interpret this vast array of information with benefits in public health, research, patient care and hospital operational systems.

• Performance monitoring of systems, providers and patients will improve quality, experience and value for money

Needs• Complexity• Chronicity• Severity• Urgency

Benefits• Improved experience• Improved safety• Improved clinical outcomes

Risks• Increased clinical risk• Privacy breach

Trust• Design• Credibility of information• Security• Privacy• Ease of use 

EHRAdoption

Bottom up approach required for the adoption of an effective EHR by patients