1. 1. Keith Marton, MD1/18/12
2. 2. Founded in 1852 Catholic, non-profit Fairly highly integrated system across 5 westernstates 27 hospitals from critical access to largequaternary facilities Plus over 100 other kinds of facilities ~53,000 employees Annual revenue: ~$8.5 billion NOI typically 4.5-5% ~1500 employed physicians (out of 13,000medical staff members)
3. 3. An uncertain future that didntlook great
4. 4. Net Revenue Impact 2010-2012 (millions) ($29)($86) ($59)($160) ($109) ($340) ($283) ($428) ($530)($1,458) AK WAMTORCATotalBestWorstBest: 1.5% NSR Reduction, Worst: 6.5% NSR ReductionPa ge4
5. 5. People and Culture The ability to instill a culture of collaboration,creativity, and accountability. (i.e. a learningorganization that embraces a just culture) Business intelligence The ability to collect, analyze, and connect accuratequality and financial data to support organizationaldecision making. (More on this later)
6. 6. Performance improvement The ability to use data to reduce variability inclinical processes and improve the delivery , cost-effectiveness, and outcomes of clinical care. (More on this later ) Contract and risk management The ability to develop and manage effective carenetworks and predict and manage different formsof patient-related risk. (i.e. integrated ACOs with good data)
7. 7. And do it in many areas
8. 8. Categories of Focus1.Clinical Transformation2.MD Partnership Transformation3.Administrative Transformation4.Balance Sheet Maximization5.Contiguous Market GrowthPage 8
9. 9. Targeted ImpactCategories of Focus(millions)Clinical Transformation$784MD Partnership Transformation$ 87Administrative Transformation$257Balance Sheet Maximization $150Contiguous Market Growth $180Total$ 1,458Page 9
10. 10. Data Re-Use, AKA business intelligence,Unified Intelligence, Comprehensive dataWarehouse Relatively new concept for health care Uses still being defined and explored Quantification of costs are pretty clear Quantification of benefits: still emerging
11. 11. Reduce the cost of collecting/analyzing data Speed the decision making process and fasterspread of innovation, based on near real-timeaccess to information Preclude the need for many, future smalldatabase acquisitions Anticipate having data to answer questions thatwe didnt know wed want to ask Identify which data (among many) really need tobe standardized Reduced waste and injury Data backupPage12
12. 12. Selected after a look at the options: review by outside consultants (First, Gartner) site visits to other users (SJHS) Initial Implementation: 2 of 4 regions 7+ use cases Evaluation of technical deployment, user friendliness,future use, cost of ownership Enterprise agreement to support Providencedeployment Pa ge 13
13. 13. Initial Goal: identify the top 10 uses for initialimplementation Actually, we stopped after 47 potential uses Create the supporting infrastructure For managing the tool For spreading and implementing knowledge acrossthe system Connect as many data sources as possible. Pa ge 14
14. 14. System implemented in all 4 regions107different data inputs Governance/communications structure created Support staff hired--~26 FTEs (mostly internalstaff) Continued training of key users Initial focus on 8 key uses: Catheter-Associated UTIs Modified Early warning system (MEWS) Sepsis risk Central line blood stream infection Readmission trackingPage15
15. 15. Use cases, contd Core measureCHF D/C Patient transfer activity Glycemic monitoring. Key strategic concept: use system to identifypatients requiring standardized interventions(but allow staff to also do ad hoc inquiries)Page16
16. 16. In one (smaller) Providence region, it costs $7million per year to collect and report coremeasure data Due to brute force data collection: clinicians go on thewards to find core measure candidates and hand tallyresults. Amalga solution: Replace brute force method by using electronic data tofind those patients and alert ward staff. Expansion of core measures will only increasethe cost problem if a data warehouse does notexist.
17. 17. A pharmacy alert system Multiple electronic inputs (lab, pharmacy, ADT) Locally developed rules scan the inputs and alertpharmacist to intervene with at-risk patients. Impact (at 20 hospitals in 1 system): $4 million pharmacy savings/ month 70 serious events averted in 4 months Amalga could have done this, had it beenpurchased earlier (and will eventually replace thatsystem) Caveat: system worked best where pharmacistsworked on the wards.
18. 18. Improving sepsis outcomes Early detection and treatment of sepsis: up to 50%mortality improvement; 30% improvement in LOSand 30% improvement in cost of care. So, why stop at treating patients who already havesepsis? Next step: Use Amalga to ID patients at greatestrisk for sepsis for intensified monitoring andprevention of sepsis.
19. 19. Catheter-associated UTIs (CA-UTIs) 50% of HAIs In Providence, HAIs cost ~$45 million/yr Equivalent to 247 nurses, who could be put tobetter use Prior to Amalga it was impossible to even know whohad urinary catheters Now, catheter patients can be identified andevidence- based standards applied Expected outcome: 50% reduction in CA-UTIs
20. 20. Post MEWS75.465.455.4Pre MEWS45.435.4UCL25.4CL15.4 5.4 LCL-4.61/23/2012
21. 21. 14Total Pages for Code Team from "PEAT" areas12UCL10Post MEWS &PEAT rounds 8 6CL 4 2 0 1/23/2012
22. 22. $2,700 $453,60014Potential annualsavings using MEWS Average Admissionsreimbursement 35that couldshortfall for an be avoidedICU admission (HFMA July 2006) (McQuillan 1998)Monthlyescalations ofcare to ICUMore importantlyMEWS at PAMC saved lives1/23/2012
23. 23. Basic concept: use data mining to detect bestpractices within ones own system Internal best practices more likely to be adopted e.g. Most cost effective approach to stroke,pneumonia, hip replacement Also, need appropriate communicationssystem and infrastructure to support spreadand adoption Ultimately, more rapid adoption of innovationmeans faster savings, improvements.
24. 24. New clinical registriesfor relating inputs tooutcomes Orthopedics Thoracic surgery Real-time ICU dashboards More active data mining by qualitydepartment. Incorporation of cost data into the system.
25. 25. This is a new toolnot intuitive to many folks Communicate, communicate, communicate! Educate, educate, educate! Involve all stakeholders in the process. This is a pluri-potential tool Know which strategic goals are key This is an expensive tool Know (roughly) how its going to pay for itselftellstories to illustrate, know the costs that can bereduced, even though the actual results are not inyet; have an idea why real-time data are important. Pa ge 27
26. 26. This is not an expensive tool compared to thevarious alternatives Even with a state of the art EMR, this kind of toolmakes sense. This is not a magical tool Understand that it needs to be supported by a skilledstaff and effective infrastructure We have probably underestimated its potentialuses and value It is primarily limited by the amount of electronicdata available So, we expect that well want to generate even moresources of electronic dataPage28
27. 27. Access to real-time data reveals multipleopportunities to improve clinical outcomesAND financial returns In general, the actual benefits have turnedout to be greater than the estimated benefits Data alone are not sufficient; also requiredare: Skilled data mining and presentation Supporting infrastructure to act on the data
28. 28. Questions? Pa ge 30