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©2014 MFMER | 3338355-1
Ryan Uitti, M.D.
Deputy Director, Kern Center for the Science of Health Care Delivery
IHT2– April ...
©2014 MFMER | 3338355-2
©2014 MFMER | 3338355-3
The Science of Hitting – Ted Williams
©2014 MFMER | 3338355-4
The Science of Hitting – Ted Williams
©2014 MFMER | 3338355-5
©2014 MFMER | 3338355-6
Use of Home Telemonitoring
in the Elderly to Prevent Readmissions
©2014 MFMER | 3338355-7
Comparison:
Telemonitoring + Versus Usual Care
Telemonitoring Intervention
RN/MD team oversaw apx...
©2014 MFMER | 3338355-8
Results: Telemonitoring +
Versus Usual Care
Telemonitoring + Usual Care Statistics
Emergency Dept
...
©2014 MFMER | 3338355-9
Results: Telemonitoring +
Versus Usual Care
Telemonitoring + Usual Care Statistics
Emergency Dept
...
©2014 MFMER | 3338355-10
Epilogue – What Next?
Not ready for prime-time
©2014 MFMER | 3338355-11
Center for the Science
of Health Care Delivery
Improve patient health experience
Improve popula...
©2014 MFMER | 3338355-12
Value Framework
Patient
Provider Payer
Quality
Cost over time
(outcomes, safety, service)
©2014 MFMER | 3338355-13
Quality
Measures
Patient
Satisfaction
Costs
Big Data
Health and
Quality of Life
©2014 MFMER | 3338355-14
Value:
In the Eye of the Beholder
The importance
of reflecting and
respecting multiple
perspecti...
©2014 MFMER | 3338355-15
Patient
Satisfaction
CostsQuality
Measures
Big Data
Health and
Quality of Life
Example: AWARE
Qua...
©2014 MFMER | 3338355-16
Critical Care – Quality Care Crisis
©2014 MFMER | 3338355-17
Critical Care Unit
Situational AWAREness
DATA
Analytics
Metrics Outcomes
Thousands
of data points...
©2014 MFMER | 3338355-18
Paradigm Shifts
Clinical Management – EMR
Developed by intensivists
Organ/system based informat...
©2014 MFMER | 3338355-19
Provider Built
Field
observation
Surveys &
interviews
Workflow &
workshops
Simulated
tests
©2014 MFMER | 3338355-20
AWARE Goals
Better Care
>90% adherence to best ICU practices
 DVT prophylaxis
 Stress ulcer pro...
Doe
John
0-000-000
Doe
Jane
0-000-000
Doe
Jane
0-000-000
Doe
Jane
0-000-000
Doe
Jane
0-000-000
Doe
Jane
0-000-000
Doe
Jane...
Doe
John
0-000-000
Doe
Jane
0-000-000
Doe
Jane
0-000-000
Doe
Jane
0-000-000
Doe
Jane
0-000-000
Doe
Jane
0-000-000
Doe
Jane...
©2014 MFMER | 3338355-23
AWARE overview
Information organized by organ and systems
B) Historical
contextual data
E) Provid...
Patient View
Every value is clickable with trending options
Click on Bedside Monitor to see
live or click back to this mai...
©2014 MFMER | 3338355-25
Outcome:
Everyone’s Happy
Reduced Cognitive Load
(Happy Clinicians)
80
70
60
50
40
30
20
10
0
App...
©2014 MFMER | 3338355-26
©2014 MFMER | 3338355-27
3 months to collect data
to answer 2 questions
Seconds to collect and
answer the same questions
2...
©2014 MFMER | 3338355-28
2003
First Human Genome
Time: 10 Years
Cost: $1 Billion
TODAY
Genome Sequencing
Time: 1 Week
Cost...
©2014 MFMER | 3338355-29
Cost of Whole Genome Sequencing
?
$1,000 to sequence
one human genome
©2014 MFMER | 3338355-30
OPTUM LABS
©2014 MFMER | 3338355-31
Types of questions that may be pursued
Comparative
Effectiveness
Behavioral and
Policy Research
V...
©2014 MFMER | 3338355-32
Optum Labs — Data and Tools
Advanced Analytics and Data Visualization Data Growth Through Partner...
©2014 MFMER | 3338355-33
Optum Labs — Research Process
Data sets and resources are
integrated into a separate
“sandbox.” D...
©2014 MFMER | 3338355-34
Focuses on understanding the underlying behaviors driving patient and
provider behaviors, as well...
©2014 MFMER | 3338355-35
 Use of new anticoagulants in atrial fibrillation
 Longitudinal variation in care analysis of h...
©2014 MFMER | 3338355-36
• American Medical Group Association, Alexandria, Va.
• Boston University School of Public Health...
©2014 MFMER | 3338355-37
Patients are seen by outside providers/physicians.
Optum Labs data
Patients call and are given an...
©2014 MFMER | 3338355-38
Patients are seen by initial Mayo team.
Document patient expectations – “Pt Exp’n”
Patients indic...
©2014 MFMER | 3338355-39
Patients are presented medical vs. surgery information
Document education
Patients make a decisio...
©2014 MFMER | 3338355-40
Patients receive care
… some being treated medically, others with surgery
Collect risk factors an...
©2014 MFMER | 3338355-41
Patients complete care at Mayo
Collect discharge disposition data
Patients might be seen by outsi...
©2014 MFMER | 3338355-42
Surgical Process Flow
for Costing
- TDABC method
C (Circulator Nurse)
Surgical Assistant
Scrubs T...
©2014 MFMER | 3338355-43
The Value Equation Comes to Life
Quality outcome data:
Patient-centric outcomes
Practice performa...
©2014 MFMER | 3338355-44
Data are collected from all Mayo Clinic sites
Comparing and adopting best practice
helps improve ...
©2014 MFMER | 3338355-45
Age BMI Strength Exercise
85% probability
of going home 3 days postop
AND being able to stand/wal...
©2014 MFMER | 3338355-46
Questions and Answers
Upcoming SlideShare
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Health IT Summit Atlanta 2014 - Keynote Presentation "Big Data, Value Analysis and Population Health Science at Mayo Clinic"

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Keynote Presentation "Big Data, Value Analysis and Population Health Science at Mayo Clinic"

Ryan Uitti, M.D.
Professor of Neurology
Deputy Director
Center for the Science of Health Care Delivery
Mayo Clinic

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Transcript of "Health IT Summit Atlanta 2014 - Keynote Presentation "Big Data, Value Analysis and Population Health Science at Mayo Clinic""

  1. 1. ©2014 MFMER | 3338355-1 Ryan Uitti, M.D. Deputy Director, Kern Center for the Science of Health Care Delivery IHT2– April 16, 2014 Big Data, Value Analysis and Population Health Science at Mayo Clinic
  2. 2. ©2014 MFMER | 3338355-2
  3. 3. ©2014 MFMER | 3338355-3 The Science of Hitting – Ted Williams
  4. 4. ©2014 MFMER | 3338355-4 The Science of Hitting – Ted Williams
  5. 5. ©2014 MFMER | 3338355-5
  6. 6. ©2014 MFMER | 3338355-6 Use of Home Telemonitoring in the Elderly to Prevent Readmissions
  7. 7. ©2014 MFMER | 3338355-7 Comparison: Telemonitoring + Versus Usual Care Telemonitoring Intervention RN/MD team oversaw apx 100 patients and communicated with them via phone or video- conference if alerts arose Daily telemonitoring sessions (5-10 minutes) including weekends and holidays Collected weight, blood pressure, blood sugar, pulse and peak flow data Could arrange outpatient visits
  8. 8. ©2014 MFMER | 3338355-8 Results: Telemonitoring + Versus Usual Care Telemonitoring + Usual Care Statistics Emergency Dept Visits 35% 28% No difference Hospitalization 52% 44% No difference ED + Hospitalization 64% 57% No difference Note: Results are for a one-year period
  9. 9. ©2014 MFMER | 3338355-9 Results: Telemonitoring + Versus Usual Care Telemonitoring + Usual Care Statistics Emergency Dept Visits 35% 28% No difference Hospitalization 52% 44% No difference ED + Hospitalization 64% 57% No difference Deaths 15% 4% Very significant Note: Results are for a one-year period
  10. 10. ©2014 MFMER | 3338355-10 Epilogue – What Next? Not ready for prime-time
  11. 11. ©2014 MFMER | 3338355-11 Center for the Science of Health Care Delivery Improve patient health experience Improve population health Improve quality, control cost Improve medical practice through analysis and scientific rigor
  12. 12. ©2014 MFMER | 3338355-12 Value Framework Patient Provider Payer Quality Cost over time (outcomes, safety, service)
  13. 13. ©2014 MFMER | 3338355-13 Quality Measures Patient Satisfaction Costs Big Data Health and Quality of Life
  14. 14. ©2014 MFMER | 3338355-14 Value: In the Eye of the Beholder The importance of reflecting and respecting multiple perspectives Appreciating what we don’t know about the care experience Embracing multiple aims for improvement concurrently Source: Bellows J, Sullivan MP. Could a quality index help us navigate the chasm? http://xnet.kp.org/ihp/publications/docs/ quality_background.pdf. Accessed July 11, 2012.
  15. 15. ©2014 MFMER | 3338355-15 Patient Satisfaction CostsQuality Measures Big Data Health and Quality of Life Example: AWARE Quality Cost over time (outcome, safety, service)
  16. 16. ©2014 MFMER | 3338355-16 Critical Care – Quality Care Crisis
  17. 17. ©2014 MFMER | 3338355-17 Critical Care Unit Situational AWAREness DATA Analytics Metrics Outcomes Thousands of data points About 200 actions/day 1.7 errors/day 29% potentially serious injury or death
  18. 18. ©2014 MFMER | 3338355-18 Paradigm Shifts Clinical Management – EMR Developed by intensivists Organ/system based information organizer Database centered Provider centered Patient centered
  19. 19. ©2014 MFMER | 3338355-19 Provider Built Field observation Surveys & interviews Workflow & workshops Simulated tests
  20. 20. ©2014 MFMER | 3338355-20 AWARE Goals Better Care >90% adherence to best ICU practices  DVT prophylaxis  Stress ulcer prophylaxis  Lung protective mechanical ventilation  Daily assessment of – continuous sedation; ventilator weaning; need for intravascular devices and urinary catheter; physical therapy goals Better Health 50% reduction of preventable ICU complications 5% increase in discharge home vs other health care facility Lower Cost Cumulative $$ decrease up to 20% – length of ICU stay; length of hospital stay; resource utilization Areas Administrative Patient Clinical
  21. 21. Doe John 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 ©2014 MFMER | 3338355-21
  22. 22. Doe John 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Doe Jane 0-000-000 Home Screen Patient Box After selecting a unit, the rooms are shown with current patients. When placing your pointer over the patient (not clicking) it will enlarge (as shown) ©2014 MFMER | 3338355-22 Level of care – Click on to select ICU, PCU, or Floor Indicators for ventilators, vasopressors, dialysis, etc Icons (left to right): Discharge, Task List, Rounding Tool, Problem List, Med List, Claim Patient, and Room Number Patient name and MC# Primary service – Click on the service to text page Service Pager 7 system review – Placing pointer over a system will reveal why it is yellow or red.
  23. 23. ©2014 MFMER | 3338355-23 AWARE overview Information organized by organ and systems B) Historical contextual data E) Provider actions/support A) Organ identifier and status C) Current organ physiological status D) Status of relevant investigation Red values are Critical Yellow values are Abnormal
  24. 24. Patient View Every value is clickable with trending options Click on Bedside Monitor to see live or click back to this main AWARE patient view. White Board is a community area for communication. Each service can use it for different things. In 10-3/4 we use it for patient updated each shift. Problem List, Procedures, Operative Notes, & Hospital Admission  Everything is clickable linking to the note it originated from. Cardiac – Shows cardiac labs, meds, access dates, ECG, and ECHOs. Cardiac is RED here because the Lactate is 9.1. Click on them! Renal – Shows renal labs, and meds. Renal YELLOW because UO is low, noticeable change in wt, & electrolytes are abnormal. Hem – Shows labs, meds, blood products received & transfusion review (gives suggestions for transfusing or not to transfuse. Neuro – Shows meds, nursing assessment, neurology notes, pain, imaging, & EEG. Click on them! Respiratory – Shows meds, nursing assessment, airway grade, pulmonary notes, vent/O2 settings, imaging, ABG, & PF ratio. Click them! GI – Shows meds, nursing assessment, imaging, labs, & GI notes. ID – shows antibiotics given in the last 24 hrs, labs, micro, temp, & meds. Also Braden score is listed here.
  25. 25. ©2014 MFMER | 3338355-25 Outcome: Everyone’s Happy Reduced Cognitive Load (Happy Clinicians) 80 70 60 50 40 30 20 10 0 Application NASA-TLX Standard Novel Reduced Errors (Happy Patients) Application Errors (no.) 70 60 50 40 30 20 10 0 Standard Novel Reduced Time (Happy Administrators) Standard interface Novel interface Task attempt Time (sec) 250 200 150 100 50 0 1 2 3 4
  26. 26. ©2014 MFMER | 3338355-26
  27. 27. ©2014 MFMER | 3338355-27 3 months to collect data to answer 2 questions Seconds to collect and answer the same questions 20 Years Ago Today
  28. 28. ©2014 MFMER | 3338355-28 2003 First Human Genome Time: 10 Years Cost: $1 Billion TODAY Genome Sequencing Time: 1 Week Cost: $1,500
  29. 29. ©2014 MFMER | 3338355-29 Cost of Whole Genome Sequencing ? $1,000 to sequence one human genome
  30. 30. ©2014 MFMER | 3338355-30 OPTUM LABS
  31. 31. ©2014 MFMER | 3338355-31 Types of questions that may be pursued Comparative Effectiveness Behavioral and Policy Research Variation in Care Research Heterogeneity of Treatment Response Optum Labs H E A LT H C A R E R E S E A R C H A N D I N N O VAT I O N Provider Academic Professional/ Consumer Organization Government Payer Pharma/ Life Sciences An open, collaborative center for research and innovation for health care stakeholders interested in improving patient care. Projects must be primarily to improve patient care and lower the cost of improved care, and be transparent to the entire collaborative.
  32. 32. ©2014 MFMER | 3338355-32 Optum Labs — Data and Tools Advanced Analytics and Data Visualization Data Growth Through Partnership >149M “Administrative” >30M Clinical 315M US Population Mayo Health System 2 Health Plan 1 Health Plan 1 Health System 3 Clinical Research
  33. 33. ©2014 MFMER | 3338355-33 Optum Labs — Research Process Data sets and resources are integrated into a separate “sandbox.” Data contributions are tagged and valued. Contributor data is de-identified and stored in standardized data sets, on secure, private environments. Project research is done in the “sandbox” environment only according to the Research Proposal. Upon work completion, the “sandbox” is dissolved. Publications and clinical translation proceed as appropriate. Integration Research & Analytics OutputsData Health Economics Biostatistics ActuarialEpidemiology Innovative Health Care Insight Clinical Data Admin Data Pharmacy Data Population Data Data Sets Project “Sandbox” Researchers Real Estate
  34. 34. ©2014 MFMER | 3338355-34 Focuses on understanding the underlying behaviors driving patient and provider behaviors, as well as the evaluation of alternative policy initiatives Example: Can the application of economic theory to the analysis of claims data improve our understanding of patient medication adherence? Does the use of copays alter conclusions about the effects of benefit design on initial prescription fills and refills? Behavioral and policy research Explores the well-documented extensive variations in treatment patterns by geography and other dimensions Example: How are measures of geographic variation in care affected by the definition of geographic region? Variations in care Seeks to understand what patient subpopulations are most likely to respond to a particular treatment Example: Is a drug equally safe among all patient subpopulations? How could such information be used to design more efficient trials for future clinical development? Heterogeneity of treatment response Improves the quality of research from observational studies more generally through fundamental research on data infrastructure and statistical methodologies Example: What is the potential value of multiple imputation methods to fill gaps in the data? Methodology research Research Themes: Areas of Focus
  35. 35. ©2014 MFMER | 3338355-35  Use of new anticoagulants in atrial fibrillation  Longitudinal variation in care analysis of hip and knee surgery • National trends in the screening, diagnosis, and treatment of localized prostate cancer • Unplanned hospital readmission and emergency department care for acute diabetes complications • Utilization and variations in uses of proton beam therapy  Step-down protocols in asthma medication • Diagnosis, treatment, and service utilization for spine-related problems • GLP-based anti-hyperglycemic medications and risk of acute pancreatitis and pancreatic cancer Currently underway or awaiting publication  Likely candidate for clinical translation project Sample Research Projects
  36. 36. ©2014 MFMER | 3338355-36 • American Medical Group Association, Alexandria, Va. • Boston University School of Public Health, Boston, Mass. • Lehigh Valley Health Network, Allentown, Pa. • Pfizer Inc. (NYSE: PFE), New York, N.Y. • Rensselaer Polytechnic Institute (RPI), Troy, N.Y. • Tufts Medical Center, Boston, Mass. • University of Minnesota School of Nursing, Minneapolis, Minn. Seven Leading Health Care Organizations Join Optum Labs
  37. 37. ©2014 MFMER | 3338355-37 Patients are seen by outside providers/physicians. Optum Labs data Patients call and are given an appointment at Mayo. Example in Action
  38. 38. ©2014 MFMER | 3338355-38 Patients are seen by initial Mayo team. Document patient expectations – “Pt Exp’n” Patients indicate their expectations.
  39. 39. ©2014 MFMER | 3338355-39 Patients are presented medical vs. surgery information Document education Patients make a decision about their care: medical/surgery Shared decision making – SDM
  40. 40. ©2014 MFMER | 3338355-40 Patients receive care … some being treated medically, others with surgery Collect risk factors and other data Patients see medical/pre-operative Mayo team Collect treatment data Mean length of stay for primary TKA OPTUM (x age = 56.6) 3.0 days MAYO CLINIC (x age = 70) 2.85 days
  41. 41. ©2014 MFMER | 3338355-41 Patients complete care at Mayo Collect discharge disposition data Patients might be seen by outside providers Post-Mayo – Optum Labs data Patients later report their outcomes from medical care/surgery Patient-reported outcomes – PRO Discharge to home OPTUM (x age = 56.6) 81.4% MAYO CLINIC (x age = 70) 63% 30-day readmissions OPTUM (x age = 56.6) 4.4% MAYO CLINIC (x age = 70) 1.6%
  42. 42. ©2014 MFMER | 3338355-42 Surgical Process Flow for Costing - TDABC method C (Circulator Nurse) Surgical Assistant Scrubs Technician RN Anesthetist-NA Radiology Technician S (Surgeon) A (Anesthesiologist) AR (Anesthesiologist Resident) R (Resident/Fellow) Inpatient Space Operating Room Surgery Process Post Surgery E22 Patient Prep for Surgery C AR 20 A 5 20 20 R 20 C 20 E22 Operation (Incision to Closure) CAR 91 A 46 S 73 91 R 86 C 91 91 E28 Operation (Incision to Closure) CAR 88 A 44 S 71 88 R 83 C 88 88 10 E30 EMR documentation and contact family, supervision time, post procedure note, order tests S 10 R 5 Hip or Knee? Hip Knee FLOW 1
  43. 43. ©2014 MFMER | 3338355-43 The Value Equation Comes to Life Quality outcome data: Patient-centric outcomes Practice performance outcomes Cost: Outside Mayo At Mayo “Cost avoidance”
  44. 44. ©2014 MFMER | 3338355-44 Data are collected from all Mayo Clinic sites Comparing and adopting best practice helps improve value for all THA +22 +120% TKA +14 +110% PHM +0.96 +5.36% HD +3.34 +5.23% DHI +0.81 +3.
  45. 45. ©2014 MFMER | 3338355-45 Age BMI Strength Exercise 85% probability of going home 3 days postop AND being able to stand/walk without pain for 30-min 3 months postop Knee Replacement Value Proposition
  46. 46. ©2014 MFMER | 3338355-46 Questions and Answers
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