Paddling Upstream:
Data Capture to Improvement
Cynthia Davis, Principal
Who We Are

October 1, 2013 CIC ADVISORY 2
Mission
CIC Advisory is a nationally recognized leader in
helping healthcare organizations use technology to
provide high ...
How We Are Different
Improving care and efficiency results requires
better processes rather than new or better tools.
Bett...
Healthcare Analytic Adoption Model

October 1, 2013 CIC ADVISORY 5
Where is the Stream Going?

October 1, 2013 CIC ADVISORY 6
The Healthcare Challenge
How to best manage the
dynamics of the shift

Results (quality, ROI)

Operational (efficiency, pr...
Moving Upstream
Define:
Triple
Aim

Care team
engagement
Control

Workflow

October 1, 2013 CIC ADVISORY 8

Improve

HIT
M...
Direction Moving Upstream in Alignment
•
•
•
•
•
•

Configure and Adopt New HIT Tools
Triage and Select Interventions
Coor...
Navigating the Stream with Paddle Alignment
Intervention Efficacy

Track Process,
Outcome:
Care Management

Define:
Triple...
Enablers of Smooth Paddling:
The Quality and Quantity of Your Data

• Goals and
Preferences

Place

Time
• Interventions
•...
How to Paddle

October 1, 2013 CIC ADVISORY 12
Transformation Approach
“Maintain and improve”
Sustain
“Take action”

7. Don’t let up
8. Create a new culture

Conversion
...
The Overall Process:
Methodology + Technology
1. Break Ground: Start building Level 0 and Level 1
infrastructure
2. Analyz...
The Four Key Questions

Who are we monitoring?

Identify patients with condition or
attribute of interest

What are we mea...
Data Governance (why)
We did a great Data
Cleanup effort last year but
the data is corrupt again.
Shouldn’t that effort ma...
Data Governance Benefits
• Data Governance (DG) are rules, policies, procedures, roles,
and responsibilities that guide ov...
Use Case Discharge Location
Need:
• At D/C patients need to have correct discharge location
entered in XYZ
• Data will be ...
Team Process
• Team selection:
– Target– Delivery (cohort)
– Members: Knowledge Manager, Subject Matter Experts
(both Phys...
Data Quality Issues
• Gestational age charted in four different locations in
EHR[clinical peer groups changed operational ...
Indication For C-Section – The Problem

Not documented 15% of the time.
When documented,
it was not informative.

October ...
Next Steps: Requirements
Systematic Approach across all setting with effective Clinical and Data Governance
Communication ...
Thank You

October 1, 2013 CIC ADVISORY 24
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Paddling Upstream from Data Collection to Improvement

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Paddling Upstream from Data Collection to Improvement

  1. 1. Paddling Upstream: Data Capture to Improvement Cynthia Davis, Principal
  2. 2. Who We Are October 1, 2013 CIC ADVISORY 2
  3. 3. Mission CIC Advisory is a nationally recognized leader in helping healthcare organizations use technology to provide high quality and safer care for patients, families and communities. October 1, 2013 CIC ADVISORY 3
  4. 4. How We Are Different Improving care and efficiency results requires better processes rather than new or better tools. Better processes are a people solution: using data effectively calls for strategic and thoughtful governance. Effective leadership is also necessary to ensure underlying data integrity. October 1, 2013 CIC ADVISORY 4
  5. 5. Healthcare Analytic Adoption Model October 1, 2013 CIC ADVISORY 5
  6. 6. Where is the Stream Going? October 1, 2013 CIC ADVISORY 6
  7. 7. The Healthcare Challenge How to best manage the dynamics of the shift Results (quality, ROI) Operational (efficiency, productivity) Clinical (analytics, workflow) Technology (infrastructure, data) October 1, 2013 CIC ADVISORY 7 Regulatory (payment reform, meaningful use) Financial (risk, referrals, revenue) Network (owned, affiliated, contract) Legal and Governance (antitrust, liability)
  8. 8. Moving Upstream Define: Triple Aim Care team engagement Control Workflow October 1, 2013 CIC ADVISORY 8 Improve HIT Measure Analyze Analytics
  9. 9. Direction Moving Upstream in Alignment • • • • • • Configure and Adopt New HIT Tools Triage and Select Interventions Coordinate Care Assess Patient Compliance Evaluate Outcomes Determine Intervention Efficacy • • • • Care Team Engagement Connect Patient Data Improve Speed and Accessibility Enable Workflow Improve Adoption, Usability Define: Triple Aim Control Measure Workflow HIT Improve • • • • • Automate Care Guidelines Enable Care Team Support Patient Engagement Capture Compliance Measures Align Performance with At-Risk Contract October 1, 2013 CIC ADVISORY 9 Analyze Analytics • • • • • • Transform and Stratify Data Identify and Prevent Risk Alert Physicians, Patients Measure Quality, Cost Performance Determine Intervention Efficacy Measure At-Risk Performance
  10. 10. Navigating the Stream with Paddle Alignment Intervention Efficacy Track Process, Outcome: Care Management Define: Triple Aim Integrate The Data: Single Patient Record Control Measure Triage, Intervention Selection: Care Management Transform and Stratify: Population Analytics Improve Analyze Predict and Alert, Population Analytics October 1, 2013 CIC ADVISORY 10
  11. 11. Enablers of Smooth Paddling: The Quality and Quantity of Your Data • Goals and Preferences Place Time • Interventions • Drugs • Therapy • Education • Symptom • Management • Visits • Location • Providers • Behavior • Activity • Nutrition • Outcomes Connections October 1, 2013 CIC ADVISORY 11
  12. 12. How to Paddle October 1, 2013 CIC ADVISORY 12
  13. 13. Transformation Approach “Maintain and improve” Sustain “Take action” 7. Don’t let up 8. Create a new culture Conversion “Set the Stage and Decide What to Do” Start hardwiring: transformation action plan Engage 4. Secure buy-in 5. Empower team members to act 6. Create short-term wins Prepare 1. Create urgency 2. Pull together a guiding council 3. Develop transformation vision and strategy October 1, 2013 CIC ADVISORY 13 Adapted From: Kotter J. Our Iceberg Is Melting. 8-step process for successful change. Pages 130-131
  14. 14. The Overall Process: Methodology + Technology 1. Break Ground: Start building Level 0 and Level 1 infrastructure 2. Analyze Opportunities: Run the Key Process Pareto Analysis to identify clinical and cost variability 3. Prioritize: Select the care processes or disease states for targeted improvement 4. Organize: Establish the clinical process improvement teams 5. Set the Goals: Choose the AIM (Analytically Informed Medicine) statement 6. Measure Precisely: Build the underlying Subject Area Mart for precise analytics October 1, 2013 CIC ADVISORY 14
  15. 15. The Four Key Questions Who are we monitoring? Identify patients with condition or attribute of interest What are we measuring? Patterns of best practice, clinical outcomes, costs What are our goals? Targets for adherence, outcomes and costs How will we achieve them? Cultural behaviors October 1, 2013 CIC ADVISORY 15 Protocols, orders, workflows…modifi cations to the EMR
  16. 16. Data Governance (why) We did a great Data Cleanup effort last year but the data is corrupt again. Shouldn’t that effort made sure that errors don’t creep in again? I get two different results from two different systems and, guess what, they are both wrong I need to do a study/research that looks at our revenue for the last 5 years. I was told that the data is all archived but no one knows where it is or how to retrieve it. October 1, 2013 CIC ADVISORY 16 I clean up the data that is usually unclear and inconsistent when I receive it I am trying to determine why we have different formulas for inventory in different systems. Doesn’t anyone own or have responsibility for this data through the company? I just reviewed a Data Model of our business to prepare for an acquisition. It looked very nice but it used indecipherable terminology, a very old business model and not current
  17. 17. Data Governance Benefits • Data Governance (DG) are rules, policies, procedures, roles, and responsibilities that guide overall management of data • Governance provides the guidance to ensure that data is accurate and consistent, complete, available, and secure • Governance body based on people, process, & technology • Data centric organization • Master Data Management • Prepare us towards effective and efficient changes • Comprehensive and accurate data gives us the competitive advantage in the market area Data Governance helps us to manage our date October 1, 2013 CIC ADVISORY 17
  18. 18. Use Case Discharge Location Need: • At D/C patients need to have correct discharge location entered in XYZ • Data will be used for Readmission Analytics and for follow up survey call Issue: • Require entry in 2 systems to D/C a patient • Current process follows two slightly different workflows in XYZ for FirstNet and IP • Data is a radial button selection for disposition but free text detail for location October 1, 2013 CIC ADVISORY 18
  19. 19. Team Process • Team selection: – Target– Delivery (cohort) – Members: Knowledge Manager, Subject Matter Experts (both Physician & Nurse), Data Analyst, and Data Architects – Kick-off meeting • • • • • • Weekly work meetings Identified Aim Statement & long term goal Selected, built, and refined metrics Created dashboard visualizations to display metrics Published dashboards for targeted audience Identified next Aim Statement -> repeat process October 1, 2013 CIC ADVISORY 19
  20. 20. Data Quality Issues • Gestational age charted in four different locations in EHR[clinical peer groups changed operational use of EHR] • Chart times for Stage 1 labor duration present only 68% [clinical peer groups changed operational use of EHR] • Errors in documentation (nurse name as provider for C-Section) [correction process with Health Information Mgt] • Delivery records missing the ‘Marked as Delivered’ indicator [tracking process on units & correction process with HIM] October 1, 2013 CIC ADVISORY 20
  21. 21. Indication For C-Section – The Problem Not documented 15% of the time. When documented, it was not informative. October 1, 2013 CIC ADVISORY 21
  22. 22. Next Steps: Requirements Systematic Approach across all setting with effective Clinical and Data Governance Communication and Collaboration tools that assist providers and coordinators Resources to perform coordination tasks • Proximity and close working relationship between coordinators and clinicians • Patient contact with a coordinator, 24x7 access Initial Focus on transitions of care, medication management, notification of and access to info on hospitalizations, ED visits Patient Engagement (Activation) Health Information Exchange Teleservices, Mobile Health Analytical Tools to Manage Populations – assess medical/socioeconomic risk, define populations at risk, measure outcomes • Integrations of Financial and Clinical data to support analytics • Ability to operate in Multiplayer Environment, different risk models October 1, 2013 CIC ADVISORY 22
  23. 23. Thank You October 1, 2013 CIC ADVISORY 24

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