create real-time actionable outcomes using data warehouses
TRANSCRIPT
Create Real-Time Actionable Outcomes Using Data Warehouses
March 3, 2016
Scott M. Klein, MD, MHSARoni H. Amiel
Blythedale Children’s Hospital
Conflict of InterestScott M. Klein, MD, MHSA
Has no real or apparent conflicts of interest to report.
Roni H. Amiel, CIO / CISO / CTO
Has no real or apparent conflicts of interest to report.
Agenda1. Blythedale’s Trek into Real Time, Actionable Outcomes2. Designing Meaningful Outcome Measures
1. Dashboards vs Scorecards2. Structure, Process, Outcome3. Descriptive, Predictive, Proscriptive
3. Achieving/Maintaining Results and the Need to Engage Clinicians
4. IT/Clinician Partnerships5. Why Data Warehousing?6. Real Time Dashboard Examples
Learning Objectives• Explain fundamental concepts of outcome design and
measurement
• Identify key performance measures for the organization
• Create real-time, actionable outcome dashboards
• Illustrate ways to engage clinicians in the use of the dashboards
An Introduction of How Benefits Were Realized for the Value of Health IT
http://www.himss.org/ValueSuite
Clinician and IT Staff Satisfaction Increased
Higher Quality
and More Efficient
Care Delivery
Enhanced Communication
and Data Reporting
Our TrekJoint Commission preparation consultant identified:
"Reassessment and staging of wounds not clearly documented"
Action Plan1. Identifying gaps in wound rounding practice2. Define “wounds” 3. Distinguish between pressure ulcers and all other wounds4. Educate MD’s and RN’s5. Revise Policy and Procedure6. Monitor process and outcomes
Follow Up Tasks• IT - Wound rounding application:
– Identify in real-time wounds documentation in the EMR– Push notifications - Notify the staff– Escalation engine – Track and complete wound rounding cycle.– Measure & Report to clinical leadership
• EMR - Build template for documentation by physicians
• Clinical Leadership Team - Define process for consult by wound nurses
Milestones Along the Quality Measurement Journey
Lloyd in The Healthcare Quality Book, 2008
Dashboard vs. Scorecard• Dashboard – real time / near real time
– Ongoing performance of critical processes• Lead to organizational success but not the success itself
– Dashboard in Car• Fuel, Speed, Temperature• How you get to destination, but not the destination itself
• Scorecard - retrospective– Record and report past performance not real-time performance– Outcome measures rather than process measures– Investment disclaimers
• “Past performance does not guarantee future results…”
Donabedian• Structure = Wound Care Nurses Exist
• Process = Policy on Wound Management, Consults and Frequency
• Outcomes = % of patients with wounds seen by Wound Team within policy timeframe
Next Steps• Dashboard shows Outcome
• Can’t intervene on things that already happened
• Want measures to be actionable NOW
• How to use real-time data to facilitate process…
…and change outcomes before they even show up on the dashboard?
• Ask Wayne Gretzky
Descriptive/Predictive/Prescriptive• “A great hockey player skates to where the puck is going to
be.” Wayne Gretzky
Identifying Key Performance Measures1. Relevant2. Reliable3. Valid4. Cost-effective5. Under the control of the provider6. Precisely defined and specified7. Interpretable8. Risk adjusted or stratified
Kotter “Leading Change”1. Establishing a sense of urgency2. Forming a powerful guiding coalition3. Creating a vision4. Communicating the vision5. Empowering others to act on the vision6. Planning for and creating short term wins7. Consolidating improvements and producing still more change8. Institutionalizing new approaches
Kotter, “Leading Change”, HBR Press, 2012
Clinician Engagement• Shift the culture: “Punitive” “Opportunity for Improvement” “Reactive” “Proactive” “It’s our policy” “It’s best practice”
• Evidenced Based Practice drives the outcomes
• Front line staff are the KEY
IT and Clinician Partnership1. Clinicians and IT need to understand how to frame questions in
a way they each will understand
2. Clinicians come up with variables to study
3. IT identifies where the data resides and how to access, manipulate and present the data
4. Clinicians and IT work together to find best ways to present the data in order for clinicians to know “what to do next”
Implementing New Systems1. Analysis of current workflows2. Training of end users3. Implementation4. Post-Implementation Issues5. Ongoing support and follow-through6. Messaging to the CEO and Board
Data Strategy• High Value Data Set - Administrative and Clinical• Data Ingestion – Aggregated, Targeted insight• Data Normalization – Unique, related and identifiable • Real-time / Scheduled data capturing from clinical systems.• Reporting - Push / Pull to Intranet• Role Based Access / SSO & RFID login at point of care
Clinical SystemsAdministrative Systems
MedicationEMR
Other Clinical System
Nurse Call
Finance
ReferralsHR
Procurement
Other Administrative
SystemsData
Warehouse
Data
Knowledge
Information
Visualization, Dashboards, Reports, Ad hoc query, Push/Pull Alerts
Integration, Collaboration, Access Control
Telling a Story with Dashboards• Visual vs Raw Data Learners
• Visuals should help tell the story not be the story
• Will front line clinicians know what to do with the information?
Pitfalls• People, Process, Technology• Scope creep• Time availability of staff for training• Time commitment by leadership• Is the process realistic?• Are the tools being used? Is there Drift?• Measuring metrics on the metrics
An Summary of How Benefits Were Realized for the Value of Health IT
http://www.himss.org/ValueSuite
Clinician and IT Engagement
Led to a Front-Line Driven
Process
Patients Seen within 72
Hours Increased from 61% to 100%
within 2 Quarters
Transparent and Real
Time Metrics Drove
Process Change
Questions• Scott M. Klein, MD, MHSA
• [email protected]• http://www.linkedin.com/in/scottkleinmd
• Roni H. Amiel• [email protected]• https://www.linkedin.com/in/roniamiel
• Blythedale Children’s Hospital • http://www.blythedale.org