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
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
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
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
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
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
OUR VENDORS
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
9
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
Real-time Clinical Decision Support - Diagnostics
Real-time Clinical Decision Support -
Therapeutics
IT’S ALL ABOUT THE DATA
- Ronald Coase
Tips
»
Be specific in focus
»
Establish a benchmark
»
Define “acceptable”
»
Define “outliers”
13
OPERATIONAL EFFICIENCIES
MEANINGFUL USE
ACUITY MODELS
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
17
STANDARDIZATION
original image courtesy of singingthroughtherain.net
INDUSTRY STANDARDS
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
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
TIE TO OUTCOMES
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
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
