Dashboard Overview Webinar

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Regional Information for Shared Excellence

(RISE) Initiative

Dashboard Overview Webinar

Jerry Lassa, MS Statistics

May 15 & May 17, 2012

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Do You Ever…

• Spend a lot of time reviewing data trying to make sense out of it?

• Wonder how you did last month, last quarter or last year as a reference

point?

• Wonder how well you’re doing compared to your colleagues,

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competitors, the state or the country?

• See a change in data from one month to the next and wonder whether

you should take action or not?

• Make a decision based on gut instinct or prior experience because you

don’t have data to support the decision?

• See a relationship between clinical care and operational functioning of

your clinic but can’t quantify it?

• Feel knowledgeable about performance data in your organization but

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others don’t?

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Agenda

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RISE Background

1

Baldrige Performance Excellence Framework

2

Dashboard Reporting & Use: Best Practices

3

Data Validation Basics

Beginner Dashboard Design

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5

Beginner Dashboard Design

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Big Changes in the Industry

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Vendor selection

- Vendor selection

- Workflow redesign

- Hardware/software

N t

k

- Network

- Training

- Implementation

- Data-driven culture

- Performance measures

- Link to EHR fields

EHR

C

hange

- Optimization

_{- System use, data integrity}

- Reports, dashboards

- Training

EHR

Implement

Data

Management

C

Training

- Optimization

Management

& Analytics

Ti

Time

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Then and Now

Then:

Physician DOS Patient ID Avg A1c BP LDL Foot Exam

Smith 4/12/2011 2949983 6 YES YES YES Smith 4/12/2011 9851498 4 YES YES NO Smith 4/10/2011 3134878 10 YES YES YES

Now:

Smith 4/10/2011 3134878 10 YES YES YES Smith 4/12/2011 8866369 6 NO NO YES Smith 4/12/2011 2007528 7 YES YES NO Smith 4/13/2011 9070925 6 YES YES NO Smith 4/13/2011 1438507 8 YES YES NO Smith 4/13/2011 4871361 8 YES YES YES Smith 4/10/2011 8549370 7 YES NO NO Smith 4/10/2011 2458352 4 YES YES YES Jackson 4/13/2011 6187972 4 YES YES YES Jackson 4/13/2011 305191 6 YES YES YES Jackson 4/13/2011 554553 7 YES YES NO Jackson 4/13/2011 554553 7 YES YES NO Jackson 4/12/2011 4968186 5 YES YES YES Jackson 4/12/2011 7947836 10 YES NO YES Jackson 4/12/2011 8331051 10 YES YES NO Jackson 4/13/2011 1320313 6 YES YES YES Jackson 4/13/2011 7647899 6 YES YES NO Jackson 4/10/2011 7724504 8 YES NO NO Jackson 4/10/2011 5041785 7 YES YES YES

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Is Your Organization Ready

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RISE Initiative

Background

Over the past decade, clinics have worked to enhance quality

improvement efforts, transform culture, information systems, and care

delivery

Significant work in tracking and reporting key performance measures to

assess the quality of patient care

Several statewide projects have supported this work

AQICC Tools for Quality other regional efforts

AQICC, Tools for Quality, other regional efforts

Results: definition of standardized clinical and operational measures,

enhancement of quality improvement processes and implementation of HIT, including registries, to collect and report on quality data

including registries, to collect and report on quality data

RISE Initiative:

Runs October 2011 to December 2012

Continued data collection reporting and use work with a focus on Data

Continued data collection, reporting and use work with a focus on Data Sharing Communities and accelerating improvement of clinical and operational performance by supporting data-driven management

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RISE Initiative

Project Description

Data Sharing Communities (DSCs):

Super Region Data Sharing Communities

North North Coast Clinic Network (Super Region Lead) Alliance for Rural Community Health Health Alliance of Northern California Bay Areay Redwood Community Health Coalition (Super Region Lead)y ( p g ) Community Health Center Network Community Health Partnership San Francisco Community Clinic Consortium Central Valley Central Valley Health Network (Super Region Lead) DSCs organized by measure South Community Clinics Health Network (Super Region Lead) Coalition of Orange County Community Clinics Community Clinic Association of Los Angeles County

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RISE Initiative

Project Description cont.

1. Regional Learning Communities

Data analytics, including data validation, analysis, reporting and sharing data with providers through the use of dashboards

Enhancing the patient experienceg p p

Team approaches to care delivery

Patient panel management

Staff engagement/culture changeStaff engagement/culture change

Patient self-management support

Health coaching

Operational changes to increase accessOperational changes to increase access

2. Data Analytics

The collection, review, and reporting of key metrics across project

participants Quarterly sharing of data and using it to improve patient care participants. Quarterly sharing of data and using it to improve patient care with reporting to CHCF every six months

Measures sets contain three to six measures with at least one measure in each of the clinical, operational and patient experience measure domainsp p p

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RISE Initiative

Project Description cont.

3. Dashboard Use

Each DSC will use a standardized dashboard in various forums to display data, and facilitate discussions

A standardized dashboard template is available but each DSC and Super p p Region has the flexibility to customize the dashboard to suit their needs (e.g., different measure sets, display of blinded and unblinded data, variety of audiences)

Need to ensure the dashboard is populated appropriately and accurately, and disseminated to various audiences in an effective and meaningful way

4. Plan for Improved Outcomes

Each community or region has committed to improvement on at least one measure in the first year, and at least two measures in the second year of the grant

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RISE Measures

Clinical Measure Meaningful

use

UDS North Super Region Bay Area Super Region Central

Valley SR South SR ARCH HANC NCCN CHCN CHP RCHC SFCCC ARCH HANC NCCN CHCN CHP RCHC SFCCC Hypertension: BP Measurement CORE T7 (control of HTN) ✔

Tobacco Use Assess &

Tobacco Cessation Interv.

CORE Table 6B _✔ _✔

Adult Weight Screening &

Follow‐Up CORE Table 6B _✔ Childhood Immunization Status Alternate CORE Table 6B _✔

Diabetes: Hemoglobin A1c Additional Table 7 Diabetes: Hemoglobin A1c

Poor Control

Additional

Set

Table 7 _✔ _✔ _✔ _✔ _✔ _✔

Diabetes: Low Density

Lipoprotein (LDL)

Management and Control

Additional

Set

Table 7

✔ ✔ ✔

Controlling High Blood

Pressure

Additional

Set

Health Out/

Disparity ✔ ✔ ✔ ✔

Cervical Cancer Screening Additional

Set

Table 6B _✔ _✔

Percent of patients without a _✔ Percent of patients without a

PCP visit in last 12 months ✔

+ Operational: Third Next Available Appointment (TNAA), % No-Show Rate + Patient Experience: TBD (RISE year two focus)

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RISE Linked with BSCF CCAP Initiative

(Blue Shield California Foundation

California Comparative Analytics Project)

• Purpose:

Purpose:

• Support adaptation of i2i's PoplQ software to serve the data

collection and analytic needs of community clinics and other safety

net providers who use BSCF’s self-assessment tool

net providers who use BSCF s self-assessment tool

• The adapted software will help community clinics and other safety

net providers collect, compare, and share data related to

clinical

quality financial operational and patient experience

quality, financial, operational, and patient experience

performance indicators generated by the tool.

• Finance measure focus:

• Operating margin or net margin, Days cash on hand, Current ratio,

Revenue mix, Average cost of clinic visit, Average cost of clinic visit

by payer, Net revenue or loss by payer or Net operating margin by

payer, Collections ratio, by payer, Benefits as % of total salary or

wages, Claims quality

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Importance of Smart Data Display

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44% (Medicaid National Best)

51% (Commercial National Best)

35% (Medicaid National Average)

What’s the measure?

Time period?

Which direction is good?

Benchmark?

Goal?

Is performance level a priority? If so, what do we do? Who’s responsible? What

resources are allocated? Who and how to hold accountable for improvement?

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Importance of Balanced Measures

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Measures from multiple “domains” (e.g., clinical, operational, financial)

tell a much richer story than a single measure and better inform decisions.

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So many more measures to manage…

need to have efficient reporting

1. HTN blood pressure 2. Tobacco use, cessation

24. Oncology breast cancer: hormone therapy 25. Oncology colon cancer: chemo for stage III

All Clinical Measures:

3. Weight screening 4. Flu vax for older adult

5. Diabetes: HbA1c poor control 6. Diabetes: LDL mgmt and control 7 Diabetes: BP mgmt

26. Prostate cancer: avoidance of overuse of bone scan 27. Smoking and tobacco cessation, medical assistance 28. Diabetes: eye exam

29. Diabetes: urine screening 30 Diabetes: foot exam 7. Diabetes: BP mgmt

8. HF: ACE/ARB for LVSD 9. CAD: beta-blocker for prior MI 10. Pneumo vax for older adult 11. Breast cancer screening

30. Diabetes: foot exam

31. CAD: drug therapy for lowering LDL 32. HF: warfarin therapy for atrial fib 33. IVD: BP mgmt

34. IVD: use of aspirin or other antithrombotic 12. Colorectal cancer screening

13. CAD: oral antiplatelet therapy 14. HF: beta-blocker for LVSD 15. Anti-depressant med mgmt 16 POAG: optic nerve eval

35. Initiation and engagement of alcohol and other drug dependence tx

36. Prenatal care: screening for HIV 37. Prenatal care: anti-D immune globulin 38. Controlling high BP

16. POAG: optic nerve eval

17. Diabetic Retinopathy: docum of macular edema 18. Diabetic Retinopathy: communication with physician

managing diabetic care

19. Asthma pharmacologic therapy 20 A h

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39. Cervical cancer screening 40. Chlamydia screening for women 41. Use of appropriate meds for asthma 42. Low back pain: use of imaging studies 43 IVD l li id l d LDL l 20. Asthma assessment

21. Appropriate testing for children with pharyngitis

43. IVD: complete lipid panel and LDL control 44. Diabetes: HbA1c control (<8.0%)

+ Operational Measures + Finance Measures

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Baldrige National Quality Program

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President Reagan called for a national

study on productivity in October 1982 in

response to declining US productivity

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This resulted in a National Quality

Award signed into law in 1987

Baldrige Program promotes excellence

in organizational performance,

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Malcolm

recognizes the quality and performance

achievements and publicizes

successful performance strategies

Malcolm

Baldrige

1922-1987

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Baldrige National Quality Framework

H f t How your key strategic objectives address your strategic

challenges. How you ensure strategic and operational plans are achievable and adequately scoped. How you develop and deploy action plans throughout the organization to

H i How you foster an

employee culture conducive to high performance. How d p y p g g achieve objectives. How your senior

leaders

communicate with and engage

th ti you manage and

develop your staff to utilize their full

potential. the entire workforce and encourage frank, two-way i ti communication throughout the organization Measurable results you achieved achieved. H How you “Listen

and Learn” from your key

stakeholders _{How you manage}

and improve your organizations’ key processes. stakeholders including Customers, Community, Partners and Partners, and

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How It All Fits Together

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Example Plan

Strategy

Objective

_Measurable

Strategy

“Pillars”

Objective

Statements

Measurable

Indicators

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Create a strategy that fits your organization—

Don’t piece one together

Don t piece one together

Accountable

Care

Accountable

Care

Organization

Meaningful Use

_{Patient Centered}

Medical Home

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Baldrige as a Guide for Dashboard Design

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• Provides balanced model for organization

performance

• Used heavily in health sector

• Since 2005, > 50% of Baldrige award applicants are health

care

• Provides context for data management

• Measures should “align” with the industry

• Measures should align with the industry

• e.g., NQF or P4P at local, state, national

• Dashboard measures should “align” with organization

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strategy

• Dashboard measures should be “balanced”

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Dashboard Reporting

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Best Practices

Dashboard Formats

Trend/time charts with internal goals and external benchmarks or

norms

Stoplights (red, yellow, green coloring to indicate measure status)

Dashboard Deployment

Use to track strategy and annual plan execution

Use same dashboard format

Horizontal

Across sites, divisions, departments/specialties

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Use similar measures as relevant (e.g., TNAA applies to

all clinical departments)

Vertical

BOD, senior leadership, management, staff

Measures should “roll up” with selected “core” strategic

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Review of Dashboards in Meetings

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Best Practices

Review dashboard results

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Recognize improvements

Scan trends across all measures, look for potential issues

Discuss and prioritize opportunities

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Develop a plan to address; establish goals for improvement

Assign responsibility

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Accountability for Results

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• A measurable Strategic and Operating Plan is the main

reference point for accountability in outcomes achievement

• Need alignment of goals between governance leadership

Need alignment of goals between governance, leadership,

management, and staff

• Assign responsibility for specific strategy objectives and goals

to appropriate governance and management committees (e.g.,

clinical quality, finance, IT)

• Incorporate performance goals and incentives into board

• Incorporate performance goals and incentives into board,

leadership, and staff performance management plans and

reviews; incorporate goals into provider contracts

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Public Accountability and Transparency

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“The good will earned by accountable and transparent nonprofits is

one of, if not the most important, of its assets.”

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--National Council of Non-Profits

Health reform through

Health reform, through

Accountable Care

Organizations,

will make accountability and

transparency a business

imperative for community

health centers

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Data Validation Basics

Understand the measures (you and everyone else)

Numerator, denominator, exclusion criteria

Historical data requirements for selected measures

Sample (paper charts) vs. Population data (EHR)

Sample data requirements

Ensure representative and random sampling

Ensure appropriate sample size for achieving desired margin of error

UDS requirements: n=70

Population data requirements

Appropriate use of EHR queries and report writers when selecting data

follow inclusion/exclusion criteria in measure definitions

Ensure data are accurate and reliable

Run frequency tables to cross validate patient totals and system use

Identify clinical content, screen flow issues to inform EHR optimization roadmap

Ensure reliability of interfaces (e.g., lab, pharmacy)

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Examples of System Use Measures

These types of

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measures help you

monitor data

validation issues

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Beginner Dashboard Design

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Excel basics

Worksheet tabs and optimal use of the “real estate”

Appropriate use of columns and rows with data for charts

Common commands: formulas, cell formatting

Excel graphs

Rationale: Visual presentation of data improves user ability to interpret

Approach: Various types of charts; use column or line charts with time across x axis

x-axis

Application: Creating a column chart with a goal lines; formatting title and axis labels, column series color, data labels, y-axis

Dashboard report formatting

Rationale: Create an efficient layout of graphs for effective use in sharing data in various forums

Approach: Alignment with organization strategy, use of internal goals and external benchmarks

Application: Arranging multiple graphs on a single page; formatting page setup including margins header/footer fitting to one page