Business Intelligence:Supporting Delivery of High     Quality Care and Attainment of ACO Goals        iHT2 Summit in Atlan...
Learning Objectives• Identify the impact of business  intelligence (BI) on clinical areas• Understand unique ways to lever...
Denver Health Integrated public safety net  institution 5,300 employees Closed medical staff 500 bed hospital Extensi...
Denver Health     Over 160,000 patients     25% of Denver population     Payer mix      –   35% Medicaid      –   28% U...
Clinical Technology Strategy                                    Dashboard                                      Single     ...
Centers for Medicare and   Medicaid Services: ACO "an organization of health care providers that  agrees to be accountabl...
ACO Original Core Principals Provider-led organizations  – Strong base of primary care  – Accountable for quality and tot...
Payment Reforms Will Motivate andReward Innovation at a Whole New Level                   -Todd Park, Chief Technology Off...
BIGDATA
Big Data: 3 “V’s”                                        • Selective data retention Volume                                ...
Goals for Enterprise Business    Intelligence Strategy Baseline, documented strategy that includes the  standards, proces...
High-level Vision: Data IntegrationIntegrated Reporting, Registries and Analysis                    EDW           Financia...
Data Warehousing: Denver Health1998                                                                       Data            ...
Data Warehouse Overview
Data Warehouse Model                                      Web Rpts                                     External Rpts      ...
Data Facing Methods Excel “spreadmarts” and Data Cubes Crystal Reports/Data Cubes in Web  Publishing Microsoft SQL Serv...
Financial,                     Quality,                      Safety                     Reports                           ...
Financial,                     Quality,                      Safety                     Reports                           ...
CEO Dashboard
CEO Dashboard
Quality Scorecard & Registries 2010   – Electronic interface   – 102 measures – all with trend lines   – Ability to drill...
Data Warehouse-   Medical Quality and Safety Registries completed for:  – Colon Cancer  – Hypertension  – Diabetes  – Ami...
Quality Dashboard4/24/2012
Electronic Quality Scorecard
Printable Graphs
Printable Grids
Registry Reports             CHS Colorectal Cancer Screening Indicator                                                    ...
Colorectal Cancer Screening                       Registry                          CHS Colorectal Cancer Screening Indica...
Colorectal Cancer ScreeningColorectal Cancer Screening Registry               Registry Summary By Clinic                  ...
Performance Point Dashboardsand Reporting Services Reports
ArcGIS Heat Maps
Performance Point Strategy Maps
Financial,                     Quality,                      Safety                     Reports                           ...
Data Request Method -      Historical
Data Warehouse-Medical Quality          and SafetyExamples of clinical informational queries: Return to ED and Admit wit...
Data Request Process:              Outcomes 548 requests in 6 months 40% quick strike 30% critical priority Average re...
Financial,                     Quality,                      Safety                     Reports                           ...
4/24/2012   41
Financial,                     Quality,                      Safety                     Reports                           ...
Navigator Report Community Health outreach workers contact  patients on our hypertension or diabetes  registries in an ef...
Navigator Encounter Report Brings forward patient  demographics Displays clinical  characteristics for this  patient’s r...
Patient Outreach letters Letters sent to patients if they need to be  screened for breast, cervical, or colorectal  cance...
Financial,                     Quality,                      Safety                     Reports                           ...
Neonatalogist Competency - Length of Stay in                                               Premature Births (33-36 weeks) ...
Financial,                     Quality,                      Safety                     Reports                           ...
Data Sharing/Comparative     Effectiveness Research HVHC: High Value Healthcare Collaborative  (HVHC) UniversityHealth C...
Financial,                     Quality,                      Safety                     Reports                           ...
Chronic Care Management: Using a “CustomerRelationship Management (CRM)” Application                                      ...
Financial,                     Quality,                      Safety                     Reports                           ...
Clinical Quality Indicators80%            Denver Health                                                                 71...
Low O/E Mortality
“Obvious” Lessons Learned DSS can improve efficiency and provide easily  accessible data for quality and safety initiativ...
“Obvious” Lessons Learned Gain physician, financial and administrative buy in Allocate appropriate funding Clinical dev...
“Surprise” Lessons Learned Start with small wins at high levels Determine type of BI model the organization can  support...
“Surprise” Lessons Learned Almost every “project” can be leveraged    Registry “engine”    Data Management “engine”   ...
Future New hardware and software platform to  leverage the advancements in BI tools   Extensible data model to support n...
Case Study “Business Intelligence: Supporting Delivery of High Quality Care and Attainment of ACO Goals”
Case Study “Business Intelligence: Supporting Delivery of High Quality Care and Attainment of ACO Goals”
Case Study “Business Intelligence: Supporting Delivery of High Quality Care and Attainment of ACO Goals”
Case Study “Business Intelligence: Supporting Delivery of High Quality Care and Attainment of ACO Goals”
Case Study “Business Intelligence: Supporting Delivery of High Quality Care and Attainment of ACO Goals”
Case Study “Business Intelligence: Supporting Delivery of High Quality Care and Attainment of ACO Goals”
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Case Study “Business Intelligence: Supporting Delivery of High Quality Care and Attainment of ACO Goals”

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Healthcare institutions are aggressively moving towards meeting compliance with MU1 and MU2 with the implementation of full-featured Electronic Health Records. Concomitantly, there will be a massive increase in the amount of clinical data captured electronically. Business intelligence (BI) which traditionally has focused on financial data can be leveraged to use clinical data to support providers in delivering high quality, efficient care. In addition, BI coupled with population health analytics can help meet many Accountable Care Organization needs. This presentation will discuss the Denver Health journey in using BI in a variety of was to facilitate the attainment of high quality care.

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Case Study “Business Intelligence: Supporting Delivery of High Quality Care and Attainment of ACO Goals”

  1. 1. Business Intelligence:Supporting Delivery of High Quality Care and Attainment of ACO Goals iHT2 Summit in Atlanta Co April 25th, 2012 Andy Steele, MD, MPH, MSc Director, Medical Informatics Denver Health, Denver, CO
  2. 2. Learning Objectives• Identify the impact of business intelligence (BI) on clinical areas• Understand unique ways to leverage BI for supporting ACO goals
  3. 3. Denver Health Integrated public safety net institution 5,300 employees Closed medical staff 500 bed hospital Extensive primary care network Level I Trauma Center Public Health Department
  4. 4. Denver Health  Over 160,000 patients  25% of Denver population  Payer mix – 35% Medicaid – 28% Uninsured – 10% Medicare – 27% Other  $2B in unsponsored care since 1992  ~$400M in 2011
  5. 5. Clinical Technology Strategy Dashboard Single Enterprise Clinical Sign-on Master Patient Documentation Medication Index ResultsAdministration Repository CheckAnalytics / BI Patient and Workflow Dashboard Provider Data PACS/Imaging Warehouse Systems Enterprise CPOE and Document Immunization Clinical Rules Management Tracking
  6. 6. Centers for Medicare and Medicaid Services: ACO "an organization of health care providers that agrees to be accountable for the quality, cost, and overall care…
  7. 7. ACO Original Core Principals Provider-led organizations – Strong base of primary care – Accountable for quality and total per capita costs – Provide full continuum of care for a population of patients Payments that are linked to quality improvements that also reduce overall costs Use sophisticated performance measurement – Support improvement – Show savings via improved care
  8. 8. Payment Reforms Will Motivate andReward Innovation at a Whole New Level -Todd Park, Chief Technology Officer, U.S. Department of Health and Human Services IT Innovations Needed:Accountable • Shared savings; redesigned care Care processes for high quality, efficientOrganizations delivery Timely Clinical Data, Decision Support Patient • Organized outpatient care, Centered coordination and team-based Care Integration ToolsMedical Homes approaches Technology to Extend Bundled • Pilot program for episodes of care; Physician Reach incentivizes reduced costs around Payments eight conditions Consumer Engagement Tools/Platforms/Apps Readmission • Motivates hospitals to engage with Reduction care coordinators and better Programs organize delivery systems Data Mining/Analytics
  9. 9. BIGDATA
  10. 10. Big Data: 3 “V’s” • Selective data retention Volume • Offload “cold” data • Outsourcing • Data caches • Point-to-point data routing Velocity • Balance data latency with decision cycles • Inconsistency resolution Variety • Data access middleware and ETLM • Metadata managementhttp://blogs.gartner.com/doug-laney/files/2012/01/ad949-3D-Data-Management-Controlling-Data-Volume-Velocity-and-Variety.pdf
  11. 11. Goals for Enterprise Business Intelligence Strategy Baseline, documented strategy that includes the standards, processes, definitions, and approach that can be developed over time as business needs change – Organization wide consistency and coordination for business intelligence, analytics, and reporting efforts – Lower costs (people, systems, and software) by reducing redundancy and unbeneficial activities – Have an architecture that supports the Enterprise BI Strategy – Include plan for Governance of the BI environment – Communicate consistent vision across the entire organization
  12. 12. High-level Vision: Data IntegrationIntegrated Reporting, Registries and Analysis EDW Financial Claims& Eligibility Data Single source for complex data analysis Clinical and reporting Data
  13. 13. Data Warehousing: Denver Health1998 Data Warehouse Financial Demographics2007 Pathology Pharmacy Pulmonary GI Lab Radiology Laboratory Encounter2008 Orders Ultrasound EDM Forms Med Administration Custom Interfaces2009 Med Recon ED Fetal Monitoring OR2010 Scheduling Nursing Documentation Workflow Wait List/Referrals Vaccinations
  14. 14. Data Warehouse Overview
  15. 15. Data Warehouse Model Web Rpts External Rpts Internal Rpts End-user Value Executive Reporting Portal Design & Implementation Decentralized Reporting / TrainingPatient Value Disease Management / Registries Clinical Data Validation & Rpt Development Quality Clinical Interface Development & Testing Financial Data Validation & Rpt Development Financial Interface Development & Testing Maintenance, Upgrades and Support Foundation Cubes / Data Structures Development Security and Auditing Tool Implementation Basic Application Structure / Reporting Tool Implementation Network & Hardware Infrastructure Foundation
  16. 16. Data Facing Methods Excel “spreadmarts” and Data Cubes Crystal Reports/Data Cubes in Web Publishing Microsoft SQL Server Reporting Services (Microsoft SharePoint Integrated mode) VPSX delivery Microsoft Performance Point Dashboards Geo-coded Maps via ArcGIS Microsoft Report Builder ad hoc reporting model Microsoft Power Pivot
  17. 17. Financial, Quality, Safety Reports Ad-hoc mHealth Reports Clinical Registry (DW & EHR) Point ofResearch Care Support Employee Outreach Evaluation Programs
  18. 18. Financial, Quality, Safety Reports Ad-hoc mHealth Reports Clinical Registry (DW & EHR) Point ofResearch Care Support Employee Outreach Evaluation Programs
  19. 19. CEO Dashboard
  20. 20. CEO Dashboard
  21. 21. Quality Scorecard & Registries 2010 – Electronic interface – 102 measures – all with trend lines – Ability to drill down to clinic level – Most measures updated automatically from the data warehouse (others inputted into intranet site) – Much broader audience for most measures – Ability to secure access to sensitive metrics
  22. 22. Data Warehouse- Medical Quality and Safety Registries completed for: – Colon Cancer – Hypertension – Diabetes – Amiodarone Registries in progress for: – Breast Cancer – Cervical Cancer – Narcotic Users
  23. 23. Quality Dashboard4/24/2012
  24. 24. Electronic Quality Scorecard
  25. 25. Printable Graphs
  26. 26. Printable Grids
  27. 27. Registry Reports CHS Colorectal Cancer Screening Indicator All ClinicsColorectal Cancer Screening is defined as having a colonoscopy in the last 10 years or a flexible sigmoidoscopy in the last5 years or a fecal occult blood test in the last 15 months. (Eligible Patients with visits in last 18 months) (Eligible Patients with visit to SGU < 6 months) Summary By Clinic Eligible Patients Eligible Patients (50 - 75 years old) with visit to SGU < 6 months Site of Greatest Use (SGU) % Current Total % Current Total % Current with % Refused % Current Number with with Number with Colonoscopy Colonoscopy Screening FOBT < 15 screening <10 years monthsWebb FIM 3,390 49 26 1 28 2,169 57Westside Adult IM 2,977 51 26 1 29 2,017 57Eastside Adult IM 2,599 50 19 1 36 1,828 56La Casa/Quigg 1,699 26 20 0 8 1,036 30NewtonLowry 0 22 949 44 1,501 37 19DHMP 1,197 47 42 1 8 687 50Park Hill 1,140 49 21 0 33 749 55Westwood 945 41 19 4 25 611 45Montbello 569 42 12 0 34 337 53SGU Unassigned 23 30 13 0 17 0 0Others 9 33 11 0 22 8 38Total 16049 45 24 1 26 10391 51Report validated by DSS Development Data Current As of: 08/15/2009
  28. 28. Colorectal Cancer Screening Registry CHS Colorectal Cancer Screening Indicator All ClinicsColorectal Cancer Screening is defined as having a colonoscopy in the last 10 years or a flexible sigmoidoscopy in the last5 years or a fecal occult blood test in the last 15 months. (Eligible Patients with visits in last 18 months) (Eligible Patients with visit to SGU < 6 months)Summary By Clinic
  29. 29. Colorectal Cancer ScreeningColorectal Cancer Screening Registry Registry Summary By Clinic Eligible Patients Eligible Patients (50 - 75 years old) with visit to SGU < 6 months Site of Greatest Use (SGU) % Current Total % Current Total % Current with % Refused % Current Number with with Number with Colonoscopy Colonoscopy Screening FOBT < 15 screening <10 years monthsWebb FIM 3,390 49 26 1 28 2,169 57Westside Adult IM 2,977 51 26 1 29 2,017 57Eastside Adult IM 2,599 50 19 1 36 1,828 56
  30. 30. Performance Point Dashboardsand Reporting Services Reports
  31. 31. ArcGIS Heat Maps
  32. 32. Performance Point Strategy Maps
  33. 33. Financial, Quality, Safety Reports Ad-hoc mHealth Reports Clinical Registry (DW & EHR) Point ofResearch Care Support Employee Outreach Evaluation Programs
  34. 34. Data Request Method - Historical
  35. 35. Data Warehouse-Medical Quality and SafetyExamples of clinical informational queries: Return to ED and Admit within 7 days Unexpected transfers to Critical Care Hypertensives on HCTZ who develop Acute Gout
  36. 36. Data Request Process: Outcomes 548 requests in 6 months 40% quick strike 30% critical priority Average report completion – 6.3 days for quick strike requests
  37. 37. Financial, Quality, Safety Reports Ad-hoc mHealth Reports Clinical Registry (DW & EHR) Point ofResearch Care Support Employee Outreach Evaluation Programs
  38. 38. 4/24/2012 41
  39. 39. Financial, Quality, Safety Reports Ad-hoc mHealth Reports Clinical Registry (DW & EHR) Point ofResearch Care Support Employee Outreach Evaluation Programs
  40. 40. Navigator Report Community Health outreach workers contact patients on our hypertension or diabetes registries in an effort to improve their preventative care and disease management Desire for patient lists: – Need to be contacted – Already contacted – MOGED or Opt out Need ability to “write back” to DSS
  41. 41. Navigator Encounter Report Brings forward patient demographics Displays clinical characteristics for this patient’s registries Shows registry statuses for this patient Allows the Navigator to log contact and activity with the patient
  42. 42. Patient Outreach letters Letters sent to patients if they need to be screened for breast, cervical, or colorectal cancer based on national guidelines English or Spanish version mailed based on patient’s preferred language
  43. 43. Financial, Quality, Safety Reports Ad-hoc mHealth Reports Clinical Registry (DW & EHR) Point ofResearch Care Support Employee Outreach Evaluation Programs
  44. 44. Neonatalogist Competency - Length of Stay in Premature Births (33-36 weeks) For First Quarter 2008Premature births between 33 and 36 weeks included (ICD-9 codes 765.27 and 765.28). A B C D E n n n n n ia ia ia ia ia sic sic ys ic ys ic sic Phy Phy Ph Ph Phy Medical Discharge Length of Patient ID Patient Name Admit Date Record Date Stay (days) NumberPhysician A BETSEY CHAMBERS, 2940827 000105032718 PARAMO-TERRONES ,KARLA M 01/24/2008 01/29/2008 5 2941282 000105056055 MENENDEZ ,JOSE ALEJANDROD 01/25/2008 02/08/2008 14 2941288 000105056188 MENENDEZ ,ANTONIO MIGUELD 01/25/2008 02/14/2008 20 2944325 000105203970 GANO ,BOY D 02/01/2008 02/08/2008 7 2951097 000105518252 ARELLANO ,GIRL 02/16/2008 02/18/2008 2 Physician B JONES, M DOUGLAS 2931037 000104560032 CERRILLO-ZAPATA ,ANDY D 01/02/2008 01/15/2008 13 2934945 000104757307 BUSTOS-ARAIZA ,YOSAJANDID 01/11/2008 01/24/2008 13 2936290 000104812250 MONZON-GARCIA ,ADRIAN EMD 01/15/2008 01/26/2008 11 2940709 000105024517 PORTALES-MARZO ,JESSICA D 01/24/2008 01/28/2008 4 LANGENDOERFER, SHARON Physician C 2929548 000104504386 GONZALEZ ,GIRL 12/29/2007 01/04/2008 6 2931034 000104560024 CERRILLO-ZAPATA ,EMILY D 01/02/2008 01/16/2008 14 2949559 000105437925 RUBIO-GUTIERREZ ,ELIZABED 02/13/2008 02/27/2008 14 2955130 000105704316 DOMINGUEZ-CEBAL ,LIZBETHD 02/26/2008 03/19/2008 22Certified by DSS Data Warehouse Page 1 Report Date: 06/30/2008 Denver Health CONFIDENTIAL - DO NOT copy, disseminate or distribute this document.
  45. 45. Financial, Quality, Safety Reports Ad-hoc mHealth Reports Clinical Registry (DW & EHR) Point ofResearch Care Support Employee Outreach Evaluation Programs
  46. 46. Data Sharing/Comparative Effectiveness Research HVHC: High Value Healthcare Collaborative (HVHC) UniversityHealth Consortium (benchmarking) SAFTINet: Scalable Architecture for Federated Translational Inquires Network HMO Research Network CCTSI - Colorado Clinical & Translational Sciences InstituteHRSA Collaborative AHRQ “ACTION” (accelerated research)
  47. 47. Financial, Quality, Safety Reports Ad-hoc mHealth Reports Clinical Registry (DW & EHR) Point ofResearch Care Support Employee Outreach Evaluation Programs
  48. 48. Chronic Care Management: Using a “CustomerRelationship Management (CRM)” Application 55 55
  49. 49. Financial, Quality, Safety Reports Ad-hoc mHealth Reports ClinicalIs It All Worth It?Research Registry (DW & EHR) Point of Care Support Employee Outreach Evaluation Programs
  50. 50. Clinical Quality Indicators80% Denver Health 71%70% HEDIS (50th 64% percentile)60% 56% 54% 52% 52%50%40% 39% 35%30%20%10%0% Diabetes Blood pressure < Diabetes LDL < 100 mg/dL All Hypertension BP < 140/90 Breast Cancer Screening 130/80 mm HG mm HG
  51. 51. Low O/E Mortality
  52. 52. “Obvious” Lessons Learned DSS can improve efficiency and provide easily accessible data for quality and safety initiatives Executive staff must be fully engaged and supportive Clinical leadership needs to believe that IT efforts will improve patient safety and quality Patience is required to develop and maintain appropriate infrastructure Developing clinical registries is a challenging iterative process Integrated strategy needed to avoid silo solutions
  53. 53. “Obvious” Lessons Learned Gain physician, financial and administrative buy in Allocate appropriate funding Clinical development takes much longer then financial Primary care is multi-factorial, solutions need to be multi-pronged “Model” is better – The more model the source is, the easier it is to validate DSS – Customizations should be done outside the DSS database
  54. 54. “Surprise” Lessons Learned Start with small wins at high levels Determine type of BI model the organization can support Getting end users involved to early can cause loss of interest and support Grab as much data as possible Look for seed/grant money to start Data Warehouse data is e-discoverable (Litigation) and must be in compliance with HIM policy Physicians don’t know what they want until they see it
  55. 55. “Surprise” Lessons Learned Almost every “project” can be leveraged  Registry “engine”  Data Management “engine”  Business Intelligence “engine” “These reports are wrong”  Data is wrong/different at the source  The report is defined incorrectly  The data doesn’t mean what you think it means Not all Super Users are “super”  Training does not imply proficiency  More difficult the more data that is available
  56. 56. Future New hardware and software platform to leverage the advancements in BI tools  Extensible data model to support new and growing data sources  Predictive and “google-like” analytics Migrate from static reports to self-service BI tools  Transition “reports” team to BI tool development and expansion Revise governance model  More visionary role Transfer data warehouse functions into EHR

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