healthcare gis and lean thinking - esri · patient population maps wh t d k b t ti t t t fit bilit...

2008 OACHC Annual Conference“United for a Healthy Ohio”

Healthcare GIS and Lean Thinkingg

Edward [email protected]

(513) 322-5141(513) 322-5141

Mark Carrozzamcarrozza@healthfoundation [email protected]

(513) 458-6722


Cincinnati, Ohiowww healthlandscape orgwww.healthlandscape.org


About HealthLandscape• Powered by ESRIPowered by ESRI• Developed at Univ of Cincinnati• Sponsored by The Health Foundation of Greater Cincinnati and the

American Academy of Family PhysiciansAmerican Academy of Family Physicians• Conceived: May, 2004• Launched: Dec, 2008

• Web based mapping of public health data at www.healthlandscape.orgprovided compliments of the sponsoring organizations (free)p p p g g ( )

• Web based mapping of private enterprise data (subscription)

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What is HealthLandscape?

l hL d i i t ti b tl th t ll h lth• HealthLandscape is an interactive web atlas that allows health professionals, policy makers, researchers, and planners to combine, analyze, and display information in ways that promote better understanding of health and the forces that affect it sing geospatial mapsof health and the forces that affect it using geospatial maps.

H1N1 Swine Flu

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H1N1 Swine Flu

Datasets Built-In to HealthLandscapeCommunity DataEconomics

Substance Abuse and PreventionAll Substance Abuse Arrests, Uniform Crime Reports, 2005 SAMHSA F iliti 2007Appalachian Counties Economic Status

Area-Based Socioeconomic Measures, 2000 BEA County Income & Employment Summary, 2007 BEA Economic Profile, 2006 BEA Economic Profile, 2007 BEA Farm Income & Expenses, 2007 BEA Personal Current Transfer Receipts 2007

SAMHSA Facilities, 2007

United States2000 Health Workforce for Counties Larger than 100,000 Population Active Physicians and Doctors of Medicine in Patient Care AHRQ State Healthcare Quality Ranks 2007 AHRQ State Healthcare Quality Rates 2007 Assisted Housing ProfileBEA Personal Current Transfer Receipts, 2007

County Poverty, 2005 (US Census, SAIPE) HUD Fair Market Rents, 2008 Labor Force Size and Unemployment by County, 2007 Labor Force Size and Unemployment By County, 2008 Small Area Income & Poverty Estimates, 2006 Small Area Income & Poverty Estimates, 2007

Assisted Housing Profile BRFSS (Age 40-64), 2006 BRFSS (Ages 18-39), 2006 BRFSS (Ages 65+), 2006 BRFSS (Men Only), 2006 BRFSS (Women Only), 2006 BRFSS, 2004

Health EconomicsHealth Insurance Coverage by County, 2000 Health Insurance Coverage by County, 2005 Health Insurance Coverage by State, 2006 Health Insurance Coverage by State, 2007 Hospital Employment & Payroll Data by State, 2007 Medicaid Recipients Recipients in Managed Care Payments Per Recipient Recipients Per 100

BRFSS, 2006 Commonwealth State Health System Performance Ranks, 2007 County Age-Adjusted Death Rates, by Race, 1999-2005 Health Access Deprivation Index (ADI) Infant Mortality by Race, by County, 2003-2004 Local Government Health Employment & Payroll Data, by State, 2007 Medically Disenfranchised/County Medicaid Recipients, Recipients in Managed Care, Payments Per Recipient, Recipients Per 100

Persons Below Poverty Level, 1989-2004 Medicare Enrollees, Percent in Managed Care, Payment Per Enrollee, Short-stay Hospital

Utilization, 1994-2004 Persons Enrolled in Health Maintenance Organizations (HMOs) per State, 1980-2006 Persons Without Health Insurance Coverage by State, 1995-2005 State Mental Health Agency Per Capita Expenditures, 1983-2004

H lth Q lit I di t

y yMortality by County, 1979-1998 Mortality by County, 1999-2004 Mortality By Underlying Cause Among Children, 1990-2005 Natality and Prenatal Care by County, 2005 Nursing Homes, Beds, Occupancy Rates and Residents Rates by State, 1995-2006 Physician per Population by County Physicians and Spending by StateHealthcare Quality Indicators

AHRQ 2007 Cancer Measures of Healthcare Quality AHRQ 2007 Diabetes Measures of Healthcare Quality AHRQ 2007 End Stage Renal Disease Measures of Healthcare Quality AHRQ 2007 Heart Disease Measures of Healthcare Quality AHRQ 2007 Respiratory Diseases Measures of Healthcare Quality

HRSA Geospatial Datawarehouse

Physicians and Spending by State State and County Mortality per 100,000 State Health Systems Performance, Ranked Vaccination Coverage Among Children 19-35 Months, 2002-2006 Virginia County Mortality Data

Health Workforce DataUS Medical Schools 2007HRSA Geospatial Datawarehouse

Ambulatory Surgical Centers Critical Access Hospitals Federally Qualified Health Centers Hospices Hospitals Nursing Facilities (NF)

US Medical Schools, 2007 Medically Underserved Areas/Populations Physician Scarcity Areas (ZIP), 2005 Health Professional Shortage Areas, 2004 Health Center Locations

Population & EconomyNursing Facilities (NF) Skilled Nursing Facilities

Poverty & Income Age & Gender PopulationFamily Characteristics Race & EthnicityHousehold Characteristics Social Characteristics

www.HealthLandscape.org

Who is Using Who is Using HealthHealthLandscapeLandscape??• Over 2,400 registered users since the beta release in July 2007• Great for Non-Profits and Community Health CentersGreat for Non Profits and Community Health Centers• Sponsored by The Health Foundation and American Academy of

Family Physicians/Robert Graham Center

Top User Categories are:– Academic Researchers (33%)– Residency Programs (20%)– Physicians (16%)– Other Medical Professionals (15%)– Foundations (10%)– General Public (4%)– Other/Unknown (2%)( )


H lth GIS d L Thi kiHealthcare GIS and Lean Thinking


Healthcare Roundtable 5/21/09

The Traditional GIS Approach

F th ti– Frame the question– Select your data– Choose your analytic approachy y pp– Process the data– Read the results

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What is special about GIS for Healthcare?

• Layering of co-dependent health factors• “Worth a million words”• Predictive vs Prescriptive• Real time “command & control”• It’s all about Outcomes



An Alternative Approach

Th T di i l GIS A h G l C i A hThe Traditional GIS Approach– Frame the question– Select your data

Goal Centric Approach– Define the problem– Show the problemy

– Choose your analytic approach

– Process the data

p– See the problem– Solve the problem

Sustain the Solution– Process the data– Look at the results

– Sustain the Solution

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Goals Centric Approach

EnvironmentMaps

Co-Dependencies

TrackingTrackingMaps

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Sample ProblemsSample ProblemsHealth Mapping for Urology

Problems:– Location of Practice Sites– Patient Retention– Patient Growth– High Cost of Health Procedures– Profitability– Quality of Care (Patient Perceived)– Underutilized Resources– Equipment Placement– Others?

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Patient Population MapsWh t d k b t ti t t t fit bilit t ti f ti h t ?What do we know about our patients e.g. count, cost, profitability, outcomes, satisfaction, churn, etc?

All Patients Top 1-5 ICD9 Re-Admits <30 Days Repeat Visits

AnalysisPatient Profile – Count, Density, Cost, Profitability, Diagnosis Dispersion

Hot Spot AnalysisLocation/Allocation Model

Kernel DensitySpider Diagram

Spatial Interaction ModelsGravity Models

Population DistributionMean or Weighted Mean Center

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Environmental MapsWhat factors impact the quality, cost, delivery of care to our patients?

Proximity to Care Quality of Care ??? ???(Patient Perception)

•Income Level•Age Distribution•Sex Distribution•Insurance Coverage•etc

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Intervention MapsWhat can we do about it?

Move Locations Quality of CareHome Visitation ???(Patient Perception)

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Tracking MapsHow can we maintain and improve the current condition?

Proximity to Care Re-Admits Quality ???y(patient perceivwd)

???

Red Zone AnalysisRed Zone Analysis

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Next Steps?

• Clarify the problems?• Extract the data• Generate Maps

• Populationp• Environment• Intervention• Tracking

• “Read” the Maps

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Lean ThinkingLean Thinking


Lean Six Sigma

• Process methodology for improving quality and eliminating waste & “defects”

• Initially used in manufacturing industries• Introduced by Toyota, Motorola, General ElectricIntroduced by Toyota, Motorola, General Electric• Data Driven

Begins by capturing the “Voice of the Customer”• Begins by capturing the “Voice of the Customer”


What is special about Lean Six Sigma in Healthcare?

• Methodology to eliminate waste, minimize errors, improve quality reduce costimprove quality, reduce cost

• Data Driven…understanding the customer/patient populationpopulation

• Process…not an event• Addresses the complete problem many questionsAddresses the complete problem…many questions



The Lean Process

22Source: John Shook Lean Enterprise Institute “Managing To Learn”


Health Mapping Process…A Lean Approach

P l ti M D fi th blPopulation Maps Define the problemUnderstand the current conditionSet a target condition

Environmental Maps Root Cause Analysis

Intervention Maps Potential CountermeasuresPlan

Tracking Maps Follow-up

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Lean Lexicon

T P d i S M d M M i• Toyota Production System• Six Sigma• Value Stream Mapping

• Muda, Mura, Muri• Andon• Balance ScorecardValue Stream Mapping

• Statistical Process Control• Just In Time

Balance Scorecard• Root Cause Analysis• FMEA

• Kaizen• Kanban

5S

• Theory of Constraints• QFD

14 P i t• 5S• 5 Whys• Gemba

• 14 Points• Deming• SCRUMGemba

• TQMSCRUM


Lean Bibliography

• “The Machine That Changed The World”• “Lean Thinking in Healthcare…Doing More With Less”• “Lean Hospitals”• “Making Hospitals Work”• “The Nun and the Bureaucrat…How they found a cure

for the sick hospital”

2008 OACHC Annual Conference“United for a Healthy Ohio”Healthcare Roundtable 5/21/09Healthcare Roundtable

5/21/09

Sample Case

Wh f l iMayfield Clinic

• Where are my referrals coming from and are my offices located appropriately? Has this changed over time?

• Have I lost revenue because of my office locations or those of myoffice locations, or those of my competitors?

• Which geographic areas of the k t id th b tmarket provide the best

opportunities for growth?

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For a copy of this presentation and sample case

[email protected]

513.322.5141


In Summary

• Healthcare delivery must do more with less by elliminating waste and errors…which will improve quality and reduce costand reduce cost

• Mapping for healthcare is a process, not an event• Lean GIS starts with problem definition from which many• Lean GIS starts with problem definition from which many

questions/maps are derived

healthcare gis and lean thinking - esri · patient population maps wh t d k b t ti t t t fit bilit...

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