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Closed-Loop EHR Integration Targets Burnout, Improves Workflows

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The widespread adoption of EHRs has significantly altered the workflows of physicians and other healthcare workers. However, while EHRs were developed to better organize patient data and improve care coordination, most require significant and sometimes duplicative documentation, often resulting in workforce burnout.

Health Catalyst’s new Closed-Loop Analytics™ service tackles the EHR workload challenge by helping healthcare providers optimize their use of analytics in existing workflows. Closed-Loop Analytics leverages the knowhow of Health Catalyst clinical workflow experts with work experience at EHR vendors such as Epic, Cerner, and Allscripts. The team works with health systems to deploy analytics solutions directly into the EHR and better leverage analytics to simplify workflows and improve outcomes.

In this webinar, you will learn how Closed-Loop Analytics can help you:

- Determine where end-users are wasting time on duplicative tasks and how to optimize the EHR build to develop efficiencies.
- Develop analytical tools and deploy them into the EHR for increased utilization and improved insights at the point of decision-making.
- See the value of expanded integration capabilities with an analytics tool embedded into the EHR, such as launching to a patient’s chart or initiating an update to a treatment team.
- Understand how interoperability and FHIR are revolutionizing workflow integration and how you can put them to work.

Published in: Healthcare
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Closed-Loop EHR Integration Targets Burnout, Improves Workflows

  1. 1. Closed-Loop EHR Integration Targets Burnout, Improves Workflows October 2, 2019 Jeffrey Wu - Senior Director, Product Development
  2. 2. • Background / Introduction • What’s Going on with Burnout? • The 1, 2, 3’s of Closed-Loop Integration • The Health Catalyst Way for Closed-Loop Integration • Questions Agenda
  3. 3. Who is This Guy? Winkelman Elementary School Northbrook, IL 6th Grade Special Needs 2005-2006 2006-2012 Senior Application Director – OpTime/Anesthesia Implementation Management Product Management 2012-2014 Senior Solutions Architect Healthcare 2013-2015 Graduate Researcher – Population Health BI/EDW Developer 2014 2016-present Senior Director – Product Development Closed-Loop Integration and Interoperability BI Director (Consultant) Epic Cogito EDW Director (Consultant) 3
  4. 4. A Short Story on Short Cases… Projected EHR Workflow = “not too long” 5-10 minutes Average Case Length = 7-12 minutes Myringotomy (Ear Tubes) 4
  5. 5. Care Happens… Here! Not Here! 5
  6. 6. Image source: Athena Health 6
  7. 7. © 2018 Health Catalyst The Problem of Burnout 1. Providers spend a lot of time in the EHR completing repetitive and sometimes duplicative administrative tasks. Arndt B G, Beasley J W, et al.Tethered to the EHR: Primary care physician workload assessment using EHR event log data and time-motion observations. Ann Fam Med. 2017, http://www.annfammed.org/content/15/5/419.long 7
  8. 8. © 2018 Health Catalyst Primary care physicians spend nearly 2 hours on EHR tasks per hour of direct patient care. ~6 hours per 10-hour shift spent in the EHR. 8
  9. 9. © 2018 Health Catalyst The Problem of Burnout 1. Providers spend a lot of time in the EHR completing repetitive and sometimes duplicative administrative tasks. 2. It’s not the EHR’s fault. We’ve designed these systems poorly and used them in ways they weren’t intended. Gawande A.Why doctors hate their computers. The New Yorker; 2018. https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers 9
  10. 10. “…a system that promised to increase my mastery over my work has, instead, increased my work’s mastery over me.” 10
  11. 11. © 2018 Health Catalyst The Problem of Burnout 1. Providers spend a lot of time in the EHR completing repetitive and sometimes duplicative administrative tasks. 2. It’s not the EHR’s fault. We’ve designed these systems poorly and used them in ways they weren’t intended. 3. The EHR enforces workflows and tasks that take doctors away from what they feel is their priority – the patient. Moral Injury Talbot, Simon G. and Wendy Dean, Physicians aren’t ‘burning out.’ They’re suffering from moral injiry. Statnews; July, 26, 2018. https://www.statnews.com/2018/07/26/physicians-not-burning-out- they-are-suffering-moral-injury/ Damaya, Z, MD. It’s Not Burnout, It’s Moral Injury. https://zdoggmd.com/moral-injury/ 11
  12. 12. © 2018 Health Catalyst “Electronic health records, which distract from patient encounters and fragment care but which are extraordinarily effective at tracking productivity and other business metrics, overwhelm busy physicians with tasks unrelated to providing outstanding face-to-face interactions.” 12
  13. 13. © 2018 Health Catalyst Poll Question #1 How much do you think the EHR contributes to provider burnout? A) The EHR is the primary cause of provider burnout. – 8% B) The EHR is a contributing cause of provider burnout. – 90% C) The EHR is not contributing to provider burnout. – 2% 13
  14. 14. Who Spends Their Time in the EHR? *Bureau of Labor Statistics 12,556,690* Americans classified as working in healthcare as practitioners, technical or support occupations. Only 5.13% of the U.S. Healthcare workforce are physicians.
  15. 15. 1 What. 2 Why’s. 3 How’s. 1, 2, 3’s of Closed-Loop Integration Services 15
  16. 16. © 2018 Health Catalyst 1 – What… is Closed-Loop Analytics™? The delivery of analytical insights in a manner that can be immediately acted on. 16
  17. 17. © 2018 Health Catalyst We’re Used to Closed-Loop Analytics, Just Not in Healthcare… Products Transactions Users Analytics Engine 17
  18. 18. © 2018 Health Catalyst We’re Used to Closed-Loop Analytics, Just Not in Healthcare… Movies Preferences Users / Utilization Analytics Engine 18
  19. 19. © 2018 Health Catalyst We’re Used to Closed-Loop Analytics, Just Not in Healthcare… Historical Traffic Current Traffic Geographic Data Analytics Engine 19
  20. 20. © 2018 Health Catalyst 20 We’re Used to Closed-Loop Analytics, Just Not in Healthcare… Audience Score Critic Scores Theater Data and localization Analytics Engine
  21. 21. © 2018 Health Catalyst Healthcare Analytics… Electronic Health Record Reports BI Dashboards Data Warehouse Algorithms and Logic Advanced Modeling ΣY = ⅖X² / Ω NLP & Machine Learning Web Apps Analytics Engine Workflow Tool External Data End Users 21
  22. 22. © 2018 Health Catalyst Healthcare Analytics… Reports BI Dashboards Web Apps End Users Electronic Health Record 22 …Uses End Users as Integration.
  23. 23. © 2018 Health Catalyst Closed-Loop Analytics in Healthcare… 23 Bundled opportunities. Recommendations for like patients.
  24. 24. © 2018 Health Catalyst Closed-Loop Analytics in Healthcare… 24 Peer/Patient data Multiple treatment options.
  25. 25. © 2018 Health Catalyst Closed-Loop Analytics in Healthcare… 25 Guidance. Not Directives.
  26. 26. © 2018 Health Catalyst Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005 Apr 2;330(74794):765. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC555881/ Bright TJ, Wong A, et al. Effect of clinical decision-support systems: A systematic review. Ann Intern Med. 2012; 157:29-43. http://annals.org/aim/article/1206700/effect-clinical-decision-support-systems-systematic-review Clinicians are 15x more likely to act on a best practice when presented with the opportunity at the point of care. 26
  27. 27. © 2018 Health Catalyst 2 Why’s… Improves Utilization. Improves Effectiveness. 27 Closed-Loop Analytics is the delivery of analytical insights in a manner that can be immediately acted on. Create Better Workflows!
  28. 28. © 2018 Health Catalyst COPD Problem 1: Unity Point had more than 20,000 patients suffering from or at risk of acquiring COPD. How can they adequately manage this population of chronic patients with limited resources? 28
  29. 29. © 2018 Health Catalyst We did what we do best. • Organized the complicated data around understanding this cohort. • Applied the best evidence base to develop a tool to help monitor and manage/prioritize these patients. 29
  30. 30. © 2018 Health Catalyst Problem 2: This tool is great, but the end- users (Nurses and Care Managers) need to work in the EHR to validate patients that are escalating via chart abstraction before clinical intervention or enrollment in more aggressive care management. Without some sort of integration with the EHR, the tool will go unused. 30
  31. 31. © 2018 Health Catalyst What we did: • Configured the Unity Point COPD Tableau application to embed directly within their EHR (Epic) • Configured the application to launch directly into the Epic Activity Chart Review. The result: This reduced the barriers to accessing the Tableau application and simplified the intervention/actions they needed to take from the insights it provided. Improved Utilization! 31
  32. 32. © 2018 Health Catalyst • 83 percent relative reduction in clicks and keyboard interactions. • 150 hours saved annually for the registered nurses and care coordinators providing care to patients with COPD, the result of closed-loop analytics and click reduction. • Significant improvement in documentation of process aims for high-risk patients. Case Study Improved Effectiveness! 32
  33. 33. © 2018 Health Catalyst Poll Question #2 In the next 3-5 years how much will advanced analytics through things like machine learning and AI improve healthcare workflows? A) Inconsequentially. The EHR is difficult to configure and many EHR’s have incompatible infrastructures. –2% B) Insignificantly. For niche workflows, advanced analytics might provide targeted interventions and/or improvements. – 12% C) Significantly. All workflows will receive a significant boost from advanced analytics. – 68% D) Disruptively. Technological innovation and changes in care delivery models will introduce net new workflows that augment or replace much of what the EHR does today. – 18% 33
  34. 34. © 2018 Health Catalyst 3 How’s… Data Connect the analytics environment to the EHR transactional database. Use native EHR functionality to expose analytical data. Solution Embed applications directly in your EHR Decrease barriers to access of analytical data and build data literacy. Workflow Create or augment existing workflows with analytical data. Trigger activities within the EHR or complete actions that update the EHR. for Closed-Loop Analytics Integration 34
  35. 35. © 2018 Health Catalyst Closed-Loop Analytics Data Integration Electronic Health Record Data Warehouse Algorithms and Logic Advanced Modeling ΣY = ⅖X² / Ω NLP & Machine Learning Analytics Engine Data Integration Workflow Tool External Data End Users Risk Score Use Cases… • Decision Support • Patient Headers • Patient List • Prioritization • Bed planning 35
  36. 36. © 2018 Health Catalyst A A AA API’s & Web Calls Native Web API’s and EHR Web Calls that allow integration with a specific system. Interface Engine Standardized Interface Engines that allow communication with multiple systems through one interface language such as HL7. Movement towards use of FHIR that allow common standard integrations of data and system actions Integrating Data back to the EHR Flat File Imports Structured flat file imports completed on batch schedules. Low tech way to get output of analytics back to the EHR for data that is less time dependent. EHR Tools Tools such as Epic’s data link that allow mapping of external databases to the EHR transactional system. EHR 36
  37. 37. © 2018 Health Catalyst When should you do a data integration project? • Leverage Analytical capabilities not inherent in the EHR to boost EHR functionality. – Data Science (Machine Learning, AI) – Workflow Prioritization in native EHR tools. – Leverage native EHR functionality with smarter capabilities. Things to remember… • Don’t just send data back. Data Should have a purpose. – Every analytical value sent back should replace at least one existing data element – otherwise it’s just adding noise. • Increasing decision support sensitivity with analytics can inherently decrease alert fatigue! Closed-Loop Analytics Data Integration 37
  38. 38. © 2018 Health Catalyst Closed-Loop Analytics Solution Integration Electronic Health Record Reports BI Dashboards Data Warehouse Algorithms and Logic Advanced Modeling ΣY = ⅖X² / Ω NLP & Machine Learning Web Apps Analytics Engine Solution Integration Workflow Tool External Data End Users 38 Use Cases… • HAI surveillance • Census Planning • Discharge Planning
  39. 39. © 2018 Health Catalyst What content can you embed? Where can you embed into? Almost any web-deployed content is possible! 39 Web-enabled EHR’s and any system that allows external web content.
  40. 40. © 2018 Health Catalyst Closed-Loop Analytics Solution Integration When should you do a solutions integration project? • Built analytical products that need increased visibility. • Surveillance based tools that can help end-users keep a pulse on their domain responsibilities. – Census – Infection Control – Patient Throughput Things to remember… • Think through how users should interact with embedded solutions. It should be consistent. • It should leverage single-sign on whenever possible. 40
  41. 41. © 2018 Health Catalyst Closed-Loop Analytics Workflow Integration Electronic Health Record Reports BI Dashboards Data Warehouse Algorithms and Logic Advanced Modeling ΣY = ⅖X² / Ω NLP & Machine Learning Web Apps Analytics Engine Workflow Integration Workflow Tool External Data End Users 41 Use Cases… • Known interventions • Care Gaps • Bundle Compliance • Care Management • Population Health • Home Health
  42. 42. © 2018 Health Catalyst Closed-Loop Analytics Workflow Integration When should you do a workflow integration project? • Analytics that provide a defined intervention. – Care gaps or patient monitoring. • Analytics that can initiate or prioritize a workflow. • Analytics that are needed to sync external data about a patient. • Inventing a new workflow. Things to remember… • Think about the workflow. It can’t be additive! • Analytics integration needs to make a workflow better – Increase speed – Decrease clicks – Optimize information – Prioritize work 42
  43. 43. © 2018 Health Catalyst Advancing Analytical Integration Increasing complexity and resource needs 43 Data Connect the analytics environment to the EHR transactional database. Use native EHR functionality to expose analytical data. Solution Embed applications directly in your EHR Decrease barriers to access of analytical data and build data literacy. Workflow Create or augment existing workflows with analytical data. Trigger activities within the EHR or complete actions that update the EHR.
  44. 44. © 2018 Health Catalyst Denials Management Problem 1: MultiCare prepares thousands of claims for the various business lines within it’s organization. How could they prioritize the work of their accounting and billing staff to minimize denials of claims for avoidable things like missing documentation? 44
  45. 45. © 2018 Health Catalyst We did what we do best. • Organized the complicated data around understanding Revenue Cycle and Denials Management. • Applied the best evidence base to develop a tool to help monitor and manage/prioritize these patients. 45
  46. 46. © 2018 Health Catalyst Problem 2: This tool is great, but the end- users (billers and AR staff) need to work the accounts within the EHR which provides the hospital and professional billing software to update missing documentation or address mismatched documentation. Without some sort of integration with the EHR, the tool will go unused. 46
  47. 47. © 2018 Health Catalyst What we did: • Configured the MultiCare Revenue Cycle Explorer Qlikview application to embed directly within their EHR (Epic) • Configured the application to launch directly into the Epic Hospital Account Maintenance. The result: This reduced the barriers to accessing the QlikView application and simplified the intervention/actions they needed to take from the insights it provided. Improved Utilization! 47
  48. 48. © 2018 Health Catalyst • $14.99M Reduction in denials and avoidable write-offs. • Max Monthly Distinct Users Sep 2016 = 37 • Max Monthly Distinct Users Sep 2017 = 92 • Max Monthly Sessions Sep 2016 = 130 • Max Monthly Sessions Sep 2017 = 497 • % of Users accessing via Epic = 56.5% Case Study Improved Effectiveness! 48 +248.6% +382.3%
  49. 49. © 2018 Health Catalyst Health Catalyst Integration Services 49 Not a Health Catalyst Customer We can assist as a strategic service in helping understand your analytical environment and workflows and deliver integrated capabilities within your organization. A New Health Catalyst Customer We can help deploy your analytics projects with Closed Loop capabilities right out of the gates, increasing the opportunity for adoption and effectiveness of your outcomes improvement projects. An Old Health Catalyst Customer We can help evaluate your existing products and provide guidance around Closed Loop capabilities for what’s been deployed with the intention of improving utilization and effectiveness.
  50. 50. © 2018 Health Catalyst Implementation Project Deliverables Deliverable Data Solution Workflow Integration Assessment Project Plan Elbow-to-Elbow Build & Testing Assistance Steering Calls with Project Champion End User Training Guides (Developer + End User) Go-Live Support Calls 1,3,6 Month Follow Up Meetings Ongoing Maintenance Health Catalyst Data Loaded into External Database Health Catalyst Product Embedded into External Platform Health Catalyst Product Augmented with Activity Integration 50
  51. 51. © 2018 Health Catalyst Full scoping and assessment questionnaire provided by Integration Services to our prospective customers. Project Deliverables 51 Customized project plans will be provided by Integration Services to each customer.
  52. 52. © 2018 Health Catalyst Project Timelines/Resource Needs Data 4-6 weeks (Dependent on Integration) .1 - .25 EHR builder .25 data architect Solution 4-6 weeks (Dependent on Solution) .1 - .25 EHR builder Workflow 6-10 weeks (Depending on workflow) .1 - .25 EHR builder 52
  53. 53. © 2018 Health Catalyst Solution Integration Implementation Timeline Assessment 1 week • Dedicated integration assessment call(s) to determine business needs and associated workflows • Complete Integration Assessment • Develop customer- specific project plan and timeline Build 2-4+ weeks • Working with customer analyst(s) to embed our solutions into their EHR or other software platform • Security and Data Authorization discussions • Testing workflows and solution features to ensure we meet customer needs Adoption 1 week + • Pushing the workflow into production and rolling out across the health care system • Enabling end users to use the integrated solution effectively • Education materials drafted by consultant Optimization Follow up • Follow up conversations with customers at 1, 3, 6 months to learn about workflow success and discuss optimization strategy • Ongoing maintenance and support 53
  54. 54. © 2018 Health Catalyst 54 EHR Integration Subject Area Marts • Patient Chart • Patient Problem List • Patient History • Hospital Account • Etc. Many EHR’s are built to allow EHR API’s/triggers for content that’s been embedded within them. Nov 2019 Q2 2020 (projected) (TBD)
  55. 55. 1 What. The delivery of analytical insights in a manner that can be immediately acted on. 2 Why’s. Improved utilization and effectiveness of data. 3 How’s. Data, Solution and Workflow integrations with the EHR can drastically improve end-user workflows. 1, 2, 3’s of Closed-Loop Integration Services 55
  56. 56. Thanks! “Make it impossibly easy for me to do the right thing.” - Dr. John McCreary Jeffrey.Wu@healthcatalyst.com Questions?

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