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Terhilda Garrido, VP HIT Transformation and Analytics                                                                     ...
Value         About              Who we are   Kaiser Permanente        Our HIT investment                            Cl...
About Kaiser Permanente                    Nation’s largest nonprofit health plan                            Integrated ...
Our investment in technology:Kaiser Permanente HealthConnect                           ®    The world‟s largest and one o...
Integrating health care across thecontinuum                     Inpatient and outpatient clinical care:                  ...
I LOVE data         About              For our clinicians   Kaiser Permanente        For our system                     ...
What do you know?Not everythingthat can bemeasuredcounts, andnot everythingthat counts canbe measured.A. Einstein         ...
Data is a necessity in our care model                                                                        DATA         ...
“Conclusions: Our findings indicate no consistentassociation between Electronic Health Records and   Clinical Decision Sup...
Kaiser Permanente compared to U.S. market                                29 total top rankings – 13 Medicare & 16 commerci...
Information is power at many levelsInformation is power:                  1. Health care knowledge level Power to know wh...
1. Health care   knowledge level   research / guidelines                 Copyright © 2013
1. Health Care Knowledge Level:    A tale of two studies   Tale of Study 1 – It was the best of times, it was the worst of...
1. Health Care Knowledge Level:   A tale of two studiesTale of study 2 – Meanwhile in Denver, David Magid,MD had an idea…....
1. Health Care Knowledge Level:   A tale of two studiesRCTs are the traditional gold standard for health care research. EH...
2. Organization level –   Big Q                  Copyright © 2013
2. Organization Level: Big QUnlike other industries,where the commondenominator is oftenprofit, health care requiresa bala...
3. Patient population   level                 Copyright © 2013
3. Taking accountability for patient   populations       Clinical Outcomes in Southern California                Metric   ...
Mary Gonzales Story          Mary Gonzales Kaiser Permanente story                                                   Copyr...
3. Patient population toolsThe Panel Support tools have been shown to be effective in improving patientquality of care and...
4. MD level –   performance feedback                Copyright © 2013
4. MD Level:    Performance Feedback Loops                                                                                ...
4. MD Level:   Performance Feedback LoopsMD leaders                                                   Analysts extractiden...
4. MD Level:   Performance Feedback Loops          Monitoring MD inbaskets resulted inLab70- InBasket Messages > 14 Days  ...
5. Patient level –   empowerment                     Copyright © 2013
I feel much more                                                                                                   I try t...
5. Patient Engagement Rewards:   Loyalty & Quality of Care        Member Retention                My Health Manager users...
Value                            For our clinicians      Connectivity          For our system                          ...
Everyone, everything, every interactionleaves a vapor trail                                Copyright © 2013
Layers of data      Exogenous Data - e.g. SES (socio economic),           Credit Card Purchases, Weather      Patient Repo...
Data, data everywhereand not a thought to think  The „Big Data‟ era will be characterized by:           Variety           ...
Care Models – Past, Present, Future                                              Stratified              Patient-Centered ...
Our Vision for the Future: “Blue Sky”                                                                              Home as...
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iHT2 Health IT Summit in Phoenix 2013 – Terhilda Garrido, VP, HIT Tranformation & Analytics, Kaiser Permanente Case Study "Big Data, Little Data: Value and Transformation stemming from KP's HIT"

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Case Study "Big Data, Little Data: Value and Transformation stemming from KP's HIT"

Learning Objectives:

∙ Learn about KP's investment in the EHR and its transformative value
∙ Learn how data and access to information has impacted clinical operations, the patient experience and how we approach research
∙ Learn how this data is more patient centric and patient empowering

Published in: Education
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iHT2 Health IT Summit in Phoenix 2013 – Terhilda Garrido, VP, HIT Tranformation & Analytics, Kaiser Permanente Case Study "Big Data, Little Data: Value and Transformation stemming from KP's HIT"

  1. 1. Terhilda Garrido, VP HIT Transformation and Analytics iHT2 Summit January 2013 Big Data, Little Data: Value and Transformation Stemming from Kaiser Permanentes HITHARVESTING VALUEHIT Transformation & Analytics – National Quality & Care Delivery ExcellenceCopyright © 2013
  2. 2. Value About  Who we are Kaiser Permanente  Our HIT investment  Clinical Evidence / Guidelines  Organizational metrics Data –  Patient population From Big to “Little”  MD Feedback  Patient empowerment Heading to Big(ger)  The Opportunities and Challenges Data Copyright © 2013
  3. 3. About Kaiser Permanente  Nation’s largest nonprofit health plan  Integrated health care delivery 3 Organizations in one: Health insurer, hospital system, physician partnerships  9 million members  16,658 physicians  172,997 employees  Serving 9 states and DC  37 hospitals  611 medical offices  $47.9 billion annual revenues (2012) Copyright © 2013
  4. 4. Our investment in technology:Kaiser Permanente HealthConnect ®  The world‟s largest and one of the most advanced civilian deployments of an electronic health record  KP HealthConnect was implemented 2004-2010 specifically to transform care and service delivery  Our greatest benefits are the resulting improvements in quality and effectiveness of patient care Copyright © 2013
  5. 5. Integrating health care across thecontinuum  Inpatient and outpatient clinical care: documentation, ordering, decision support  Hospital and outpatient practice management: billing, scheduling, registration, ADT (admission, discharge and transfer)  Ancillary systems: pharmacy, labs, radiology, etc.  Online access to personal health record: My Health Manager on kp.org  One data model underlying all EHR components  40 million records  3.7 petabytes of stored information Copyright © 2013
  6. 6. I LOVE data About  For our clinicians Kaiser Permanente  For our system  Clinical Evidence / Guidelines  Organizational metrics The Miracle of Data  Patient population  MD Feedback  Patient empowerment Standardization &  A Goldmine of Data The Advent of  A Hotbed of Innovation Big Data  The Blue Sky Vision Copyright © 2013
  7. 7. What do you know?Not everythingthat can bemeasuredcounts, andnot everythingthat counts canbe measured.A. Einstein Copyright © 2013
  8. 8. Data is a necessity in our care model DATA REPORTABLE INFORMATIONAMOUNT GAP GAP KNOWLEDGE CLINICAL UTILITY TIME Source: Michael N. Liebman, PhD Executive Director Windber Research Institute Copyright © 2013 8
  9. 9. “Conclusions: Our findings indicate no consistentassociation between Electronic Health Records and Clinical Decision Support and better quality.” Archives Internal Medicine January 24, 2011 Copyright © 2013
  10. 10. Kaiser Permanente compared to U.S. market 29 total top rankings – 13 Medicare & 16 commercial – the most No. 1 rankings for health plans in the country 563 applied for Star ratings 11 plans across the country received 5 stars 6 of those were Kaiser Permanente plans: California, Hawaii, Northwest, Colorado, Mid-Atlantic States, Ohio 17 Top Hospitals 33 Hospitals among safest in the nation Mail-order pharmacy programs rated at the highest level of customer satisfaction in the entire country four years J.D. Power in a row & Associates Highest ranking in member satisfaction among health plans in all five of our larger regions Copyright © 2013
  11. 11. Information is power at many levelsInformation is power: 1. Health care knowledge level Power to know what the research / guidelines problem is Power to know where to act 2. Organization level – Big Q Power to know what to changeInformation driving 3. Patient populationtransformation: levelFive levels of information work 4. MD level – performancetogether to drive improvement in feedbackthe health care system. They are allenabled and dependant on data. 5. Patient level – empowerment Copyright © 2013
  12. 12. 1. Health care knowledge level research / guidelines Copyright © 2013
  13. 13. 1. Health Care Knowledge Level: A tale of two studies Tale of Study 1 – It was the best of times, it was the worst of times for researchers in the city of San Antonio… ALLHAT* – a classic RCT – randomized control trial  42,418 patients  $120 million  Conducted over 8 years  Results – Thiazide-type diuretics are most effective at controlling hypertension  Given the low cost of this diuretic class, they postulated $3.1 billion savings over 10 yearsALLHAT* – Antihypertensive , lipid lowering treatment to prevent health attack trial. Sponsored by the national heart, lung and blood instituteBegley, Sharon, "The Best Medicine," Scientific American 305, no. 1 (2011):50-55 Copyright © 2013
  14. 14. 1. Health Care Knowledge Level: A tale of two studiesTale of study 2 – Meanwhile in Denver, David Magid,MD had an idea….ALLHAT – a classic RCT – randomized Magid* studycontrol trial • 4,000,000 patients 42,418 patients • $200,000 $120 million • Conducted over 1.5 years Conducted over 8 years Results – Thiazide-type diuretics are • Results – For the 60% of patients that were not most effective at controlling under control / complete hypertension control, hypertension ACE Inhibitors and beta blockers are effective as 2nd line medications. *Magid, David J.; Shetterly, Susan J.; Margolis, Karen L.; Tavel, Heather M.; O’Connor, Patrick J.; Selby, Joe V.; Ho, P. Michael, “Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors Versus β-Blockers as Second-Line Therapy for Hypertension”, Circ Cardiovasc Qual Outcomes, 2010;3:453-458. Copyright © 2013
  15. 15. 1. Health Care Knowledge Level: A tale of two studiesRCTs are the traditional gold standard for health care research. EHRs and their vaststore of data (in depth and breadth) offer an alternative with pros and cons. ALLHAT Study Magid Study Statistical Randomized Control Trial Retrospective observational Design - Eliminate Patient Bias - Adjust for patient bias: Matched case control. N.b. needs a large sample - Limited target group - Cross-sectional population - Controlled conditions - Real World conditions Results $120,000,000 over 8 yrs $200,000 over 1.5 yrs 42,418 patients 4 million patients Copyright © 2013
  16. 16. 2. Organization level – Big Q Copyright © 2013
  17. 17. 2. Organization Level: Big QUnlike other industries,where the commondenominator is oftenprofit, health care requiresa balanced scorecardapproach.  Clinical Effectiveness  Safety  Patient satisfaction  Cost efficiency  Equity in care Copyright © 2013 17
  18. 18. 3. Patient population level Copyright © 2013
  19. 19. 3. Taking accountability for patient populations Clinical Outcomes in Southern California Metric Improvement Lives Saved Per Decade1 Blood Pressure Control 38.9% 5,341 Lives Over Colorectal cancer screening 30.2% 4,788 Lives Cholesterol Control 21.8% 1,751 Lives 14,000 Blood sugar control 11.5% 1.088 Lives Smoking Cessation 17.0% 955 Lives Lives Breast Cancer Screening Cervical Cancer Screening 11.4% 5.9% 570 Lives 59 Lives Saved1 Copyright © 2013
  20. 20. Mary Gonzales Story Mary Gonzales Kaiser Permanente story Copyright © 2013
  21. 21. 3. Patient population toolsThe Panel Support tools have been shown to be effective in improving patientquality of care and reducing “care gaps” by up to 21% Copyright © 2013
  22. 22. 4. MD level – performance feedback Copyright © 2013
  23. 23. 4. MD Level: Performance Feedback Loops Analysts extract data MD leaders and craft report to identify info reflect focus needs Count of Untouched Messages by Location / Department / Recipient 6 Department Message Recipient Count XYZ MEDICAL OFFICE DEPT FIRSTNAME, LASTNAME 3 MD DEPT FIRSTNAME, LASTNAME 15 MD FIRSTNAME, LASTNAME 3 MD FIRSTNAME, LASTNAME 2 MD XYZ MEDICAL OFFICE DEPT FIRSTNAME, LASTNAME 4 MDMonitoring MD inbaskets DEPT FIRSTNAME, LASTNAME MD 28resulted in a 70-90% decrease DEPT FIRSTNAME, LASTNAME MD 9 Untouched Abnormal Lab Results InBasket Messages > 14 Daysin ‘untouched abnormal labresults 14 days+’ 900 800 700 Dept MD 600 Chiefs share Count with MDs 500 400 300 200 MD maintains / improves 100 0 8/09 9/09 10/09 11/09 12/09 1/10 practice. Reports track August 2009 - January 2010 progress Copyright © 2013
  24. 24. 4. MD Level: Performance Feedback LoopsMD leaders Analysts extractidentify info data and craftneeds report to reflect focus Count of Untouched Messages by Location / Department / Recipient 6 Department Message Recipient Count XYZ MEDICAL OFFICE DEPT FIRSTNAME, LASTNAME MD 3 DEPT FIRSTNAME, LASTNAME MD 15 FIRSTNAME, LASTNAME MD 3 FIRSTNAME, LASTNAME MD 2 XYZ MEDICAL OFFICE DEPT FIRSTNAME, LASTNAME MD 4 DEPT FIRSTNAME, LASTNAME MD 28 DEPT FIRSTNAME, LASTNAME MD 9 Copyright © 2013
  25. 25. 4. MD Level: Performance Feedback Loops Monitoring MD inbaskets resulted inLab70- InBasket Messages > 14 Days Untouched Abnormal a Results 90% decrease in ‘untouched abnormal lab results 14 days+’ 900 800MD maintains / 700 600improves Count 500practice. 400 300Reports track 200progress 100 0 8/09 9/09 10/09 11/09 12/09 1/10 August 2009 - January 2010 Dept MD Chiefs share with MDs Copyright © 2013
  26. 26. 5. Patient level – empowerment Copyright © 2013
  27. 27. I feel much more I try to learn as much as confident, and I also feel possible about diabetes. I I feel more in control over my closer to my physician that have been controlling it with medical condition. I have access I had before. I don’t feel diet and exercise for 3 yrs. to information, access to people I intimidated anymore. Dr. says I am doing a good need to consult with, so it puts me job, thanks to your site. back in charge. KP NW Member, 2004 Online survey NCal 2010 The website has improved my relationship with my doctors. It’s soI was curious what they had to say. I easy to communicate with them, andhave a heart condition, and the they are all willing to respond quickly.words they use are so big that I I am very impressed with this methodwanted to go back and be able to and feel it has made taking care ofactually look at what it was. It was a myself easier and more palatable. Igood thing for me to look at it and to feel supported in this way becauseget it to stick with me that I need the computer is available 24/7.to take better care of myself whenI saw it in black and white. I think it’s empowering. As It’s made it better because I feel individuals we need to take care of there is a closer partnership. It’s I feel more in touch with ourselves, and we have to like instead of not seeing him the sum and substance assume responsibility and it for six months, we have of my medical condition. gives us that. communicated in between. Copyright © 2013
  28. 28. 5. Patient Engagement Rewards: Loyalty & Quality of Care Member Retention  My Health Manager users were 2.6 times more likely to choose to remain members than were those who did not use it.1 Following membership tenure and illness burden, MHM use was the third strongest predictor of remaining a member. The newer the member; the stronger the impact of MHM. Quality of Care Improved!  In a matched-control analysis published in Health Affairs, secure email was associated with a 2.0 to 6.5% improvement in performance on HEDIS measures, such as glycemic (HbA1c), cholesterol, and blood pressure screening and control2 High Patient Satisfaction!  85% rated encounters 8 or 9 on a 1-9 scale31 Turley, Marianne; Garrido, Terhilda; Lowenthal, Alex; Zhou, Yi Yvonne, “Association Between Personal Health Record Enrollment and Patient Loyalty,” Am J Manag Care. 2012;18(7):e248-e253 (web exclusive)2Zhou, Yi Yvonne; Kanter, Michael H; Wang, Jian J; Garrido, Terhilda, “Improved Quality at Kaiser Permanente Through E-Mail Between Physicians and Patients,” Health Affairs, Vol 29, No 7 (2010); 1370-1375.3 Internal KP study, “Harvesting Value: Early Findings from Kaiser Permanente HealthConnect™” presented to Center for Informati on Therapy by T Garrido, C Serrato, J Oldenburg (1/15/2008) Copyright © 2013
  29. 29. Value  For our clinicians Connectivity  For our system  All info; all patients; all the time  Redefining Access / Empowering patients The Miracle of Data  Tackling Care Gaps  A Backbone for Reliability Standardization &  The Challenges Heading to Big Data Copyright © 2013
  30. 30. Everyone, everything, every interactionleaves a vapor trail Copyright © 2013
  31. 31. Layers of data Exogenous Data - e.g. SES (socio economic), Credit Card Purchases, Weather Patient Reported Outcomes, Surveys, Fit Bit… External Data – Claims, Biomed Device.. KP HealthConnect Copyright © 2013
  32. 32. Data, data everywhereand not a thought to think The „Big Data‟ era will be characterized by: Variety Volume Velocity Veracity Time is passing and expectations are rising Copyright © 2013
  33. 33. Care Models – Past, Present, Future Stratified Patient-Centered Reactive Care Care Care Individual is their Focus Clinical Encounter Care of Cohorts own „control‟ „Exhaust‟ of A cornucopia of Data EHR / Clinical data encounter data sources Offline data „Real-time learning Bench to Bedside „17 years‟ analysis health care system‟ -months- Wellness & $ FFS Value-based care Prevention „Wellness Theme “Illness Cured” „Disease Stratified‟ Quantified‟ Copyright © 2013
  34. 34. Our Vision for the Future: “Blue Sky” Home as the Hub The home, and other settings, will grow significantly as a locale of choice for some care delivery (diagnostics). Integration & Secure and Leveraging seamless IT functionality transitions enables us to “Warm Handoffs” leverage scarce or The human skill specialized sets and operational expensive clinical processes to deliver resources - MDs, RNs care and service and other clinical staff. effectively, We use data to focus efficiently, and care delivery and compassionately. create evidence based practices. Customization Occurs at any level of the members‟ journey with Kaiser Permanente (choosing health plans, cost sharing, individual care pathways, and communication modalities).Brentari, Ruth; Garrido, Terhilda; Mittman, Robert; Liang, Louise; Weiland, Allan; Wiesenthal, Andrew; Cordova, Richard (2003) “Blue Sky Care Delivery 2015, Part I,” The Permanente Journal, Vol 7, No. 4, Fall 2003, pgs 47-50Brentari, Ruth; Garrido, Terhilda; Mittman, Robert; Liang, Louise; Weiland, Allan; Wiesenthal, Andrew; Cordova, Richard (2004) “Blue Sky Part II: The Health Encounter,” The Permanente Journal, Vol. 8, No. 1, Winter 04, pgs 93-97Brentari, Ruth; Garrido, Terhilda; Mittman, Robert; Liang, Louise; Weiland, Allan; Wiesenthal, Andrew; Cordova, Richard (2004) “Blue Sky Part III: The Chronic Care Encounter,” The Permanente Journal, Vol. 8, No. 2, Spring 04, pgs 71-75 Copyright © 2013

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