Business Intelligence for Sepsis & Heart Failure Readmissions April 2015

Transcription

1 Business Intelligence for Sepsis & Heart Failure Readmissions April 2015 Christopher Kodama, MD, MBA President, MultiCare Connected Care DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Christopher Kodama, MD, MBA Has no real or apparent conflicts of interest to report. 1 HIMSS 2015

3 Learning Objectives Identify common gaps in the care delivery process that interfere with high quality care focus on care processes that represent the biggest opportunities for improvement and cost savings through the application of best practices Explain the benefits of using analytics within clinicalintegrated multi-disciplinary teams to define and deploy more effective care pathways. Describe the risks and benefits of different approaches to shifting your organization s perspective to embrace data and business intelligence. 2

4 An Introduction to the Benefits Realized for the Value of Health IT SATISFACTION Patient, Provider, Other Inspired by real-time access to information TREATMENT Safety, Quality of Care, Efficiency ELECTRONIC Evidence-Based, Data Sharing, Reporting PREVENTION & PATIENT EDUCATION SAVINGS Financial Business, Efficiency/Operational Savings 22% reduction in sepsis mortality 15% reduction in CHF 30-day Readmissions Evidence-based performance improvement Population-based care $1.3M in savings associated with sepsis 3

5 MultiCare Health System Overview 10, , B 4

6 Top 100 5

7 Physician Leadership Role Steward Facilitator Translator 6

8 Once Upon A Time Value-based Reimbursement Operational Efficiency Delivery System Consumer Expectations 7

9 Once Upon A Time Value-based Reimbursement Operational Efficiency Information Driven Insight TM Consumer Expectations 8

10 Getting Started Technology Standards Clinical Improvement 9

11 Proof of Concept Sepsis: CHF: Acute - Episodic Continuum of Care - Chronic CHF: Congestive Heart Failure 10

12 Clinical Collaboratives - Attributes Physician-led Evidence-based Multi-disciplinary Dedicated resources 11

13 Clinical Collaboratives - Purpose DESIGN & DEPLOY EMPOWER MEASURE IMPROVE 12

14 The Collaborative Journey Phase I Phase II Phase III Phase IV Local Improvement Initiatives Concept Development System Initiative ACO Engine Launch of Systemwide Teams 2010: DRG Continuous Improvement OB Delivery, Ortho Joint, Cardiac Stents, Peds Dental, Inpatient Rehab 2011: DRG Clinical Variation (DRG CV) Part of Cost Structure Improvement Initiative Sepsis, Chest Pain, Peds Asthma 2012 : DRG CV Sepsis Systemwide team evolves to Critical Care Collaborative which continues to monitor Sepsis; add Respiratory Failure, Heart Failure Collaborative. 2013: DRG CV Critical Care Collaborative, OB Collaborative, Heart Failure Collaborative 2014: Collaboratives Launch of 6 systemwide collaboratives with 2 work teams each: Critical Care (sepsis/resp failure) Women s (OB/Hysterectomy) Cardiac (Heart Failure/AMI) Medicine (Pneumonia/ COPD) Surgery (Colon/Joints) Pediatrics (Obesity/Appy) 2015: ACO/Collaboratives 6 Collaboratives continue Work plan: -Back Pain/ Spine -Glycemic Control -TBD C. McCarren, MHS VP Retail Health & Service Line Development 13 1

15 Sepsis Reducing Mortality Rates 14

16 Sepsis DESIGN/DEPLOY Standard care pathway EMPOWER MEWS automated Standard order sets Coding standardized MEASURE Analytics to support dashboard reporting IMPROVE mortality rate decreased from 15-17% to 7-8.5% as of Dec 28,

17 Sepsis In Process Measures 16

18 Sepsis 17

19 Information Driven Insight TM In-process Lagging Considerations In-process measures are not as relevant? Data integrity? Are we measuring the right things? (luck) Data integrity? Continue periodic audits to ensure data integrity Improving performance Worsening performance 18

20 Sepsis Lessons Learned 1. Initiative vs. Ongoing Work 2. Rapid Sequence Improvement 19

21 Congestive Heart Failure Reducing 30-Day Readmissions 20

22 Congestive Heart Failure (CHF) DESIGN/DEPLOY Standard care pathway EMPOWER Heart Failure Ejection Fraction standard data point Discharged patient lists MEASURE Dashboard reporting inpatient & ambulatory In-process/lagging indicator performance IMPROVE 30-day all-cause CHF readmission rate decreased from 25.4% to 20-21% 21

23 Congestive Heart Failure Notify Primary Care Physician of discharge On-time discharge summary Readmission Risk Assessment Education with Teach Back Advanced Care Planning Discharge instructions Medication Reconciliation Interim follow-up phone call Timely follow-up appointments Specialty Consult 22

24 Congestive Heart Failure 23

25 Congestive Heart Failure By Provider Type By Facility 24

26 Congestive Heart Failure 25

27 Congestive Heart Failure Lessons Learned 1. Bricks & Mortar vs. Continuum of Care 2. Deployment and Adoption 3. The Intersection with Operations 26

28 Governance Integrating Your Business Intelligence Efforts 27

29 Getting Started Technology Standards Clinical Improvement 28

30 Data Governance Structure Operations Council Direct, Prioritize Data Needs and System Resources Knowledge Management (KM) Oversight Oversight to KM Ops Team Clinical Informatics-Information Services Oversight Committee Oversight of clinical, business and other information systems Visual Management Tools Tools Predictive Analytic Tools Content Management Tools KM Ops Team Define Data Strategy, Oversight of Tools and Process Teams Data Quality Process Team (Ongoing) Deploy Education Functional Teams Define Style Guide Dictionary Objective Based Teams Security and Access Technology Foundation Report Standardization Data Management Enterprise Data Warehouse Information Technology Strategic Plan Validate Data Integrity Reference and Master Data Team Visualization Standards 29

31 Data Governance Structure Operations Council Direct, Prioritize Data Needs and System Resources Knowledge Management (KM) Oversight Oversight to KM Ops Team Clinical Informatics-Information Services Oversight Committee Oversight of clinical, business and other information systems Visual Management Tools Tools Predictive Analytic Tools Content Management Tools KM Ops Team Define Data Strategy, Oversight of Tools and Process Teams Data Quality Process Team (Ongoing) Deploy Education Functional Teams Define Style Guide Dictionary Objective Based Teams Security and Access Technology Foundation Report Standardization Data Management Enterprise Data Warehouse Information Technology Strategic Plan Validate Data Integrity Reference and Master Data Team Visualization Standards 30

32 Data Governance Structure Operations Council Direct, Prioritize Data Needs and System Resources Knowledge Management (KM) Oversight Oversight to KM Ops Team Clinical Informatics-Information Services Oversight Committee Oversight of clinical, business and other information systems Visual Management Tools Tools Predictive Analytic Tools Content Management Tools KM Ops Team Define Data Strategy, Oversight of Tools and Process Teams Data Quality Process Team (Ongoing) Deploy Education Functional Teams Define Style Guide Dictionary Objective Based Teams Security and Access Technology Foundation Report Standardization Data Management Enterprise Data Warehouse Information Technology Strategic Plan Validate Data Integrity Reference and Master Data Team Visualization Standards 31

33 Lessons Learned 32

34 Approach 1. Grassroots vs. Top Down 2. Concurrent vs. Rapid Sequential Program Development 3. Change Management 4. Resource Infrastructure and Deployment 5. Education & Fluency 6. Prioritization and Focus Don t Boil the Ocean! 7. From design to deployment: the intersection of What and How 8. Don t let perfection stand in the way of good enough 9. Decision-making and approval processes 33

35 Work Plan Timeline Ideal 1 st & 2 nd Month 3 rd & 4 th Month 5 th & 6 th Month 6 months Reality 3 months 2 months 4 months 9 months ID Root Cause for complex LOS, Readmits, and Mortality Pull data, vet & document baseline Identify best practice (Internal & External) Develop & Test interventions Create supporting documents EPIC order sets, MHS policies, etc Plan Implementation Implement Obtain Med Staff Approval ILD CBL s Conduct staff education & training 34

36 An Introduction to the Benefits Realized for the Value of Health IT SATISFACTION Patient, Provider, Other Inspired by real-time access to information TREATMENT Safety, Quality of Care, Efficiency ELECTRONIC Evidence-Based, Data Sharing, Reporting PREVENTION & PATIENT EDUCATION SAVINGS Financial Business, Efficiency/Operational Savings 22% reduction in sepsis mortality 15% reduction in CHF 30-day Readmissions Evidence-based performance improvement Population-based care $1.3M in savings associated with sepsis 35

37 36