Create Real-Time Actionable Outcomes Using Data Warehouses March 3, 2016

Transcription

1 Create Real-Time Actionable Outcomes Using Data Warehouses March 3, 2016 Scott M. Klein, MD, MHSA Roni H. Amiel Blythedale Children s Hospital

2 Conflict of Interest Scott M. Klein, MD, MHSA Has no real or apparent conflicts of interest to report. Roni H. Amiel, CIO / CISO / CTO Has no real or apparent conflicts of interest to report.

3 Agenda 1. Blythedale s Trek into Real Time, Actionable Outcomes 2. Designing Meaningful Outcome Measures 1. Dashboards vs Scorecards 2. Structure, Process, Outcome 3. Descriptive, Predictive, Proscriptive 3. Achieving/Maintaining Results and the Need to Engage Clinicians 4. IT/Clinician Partnerships 5. Why Data Warehousing? 6. Real Time Dashboard Examples

4 Learning Objectives Explain fundamental concepts of outcome design and measurement Identify key performance measures for the organization Create real-time, actionable outcome dashboards Illustrate ways to engage clinicians in the use of the dashboards

5 An Introduction of How Benefits Were Realized for the Value of Health IT Clinician and IT Staff Satisfaction Increased Higher Quality and More Efficient Care Delivery Enhanced Communication and Data Reporting

6 Our Trek Joint Commission preparation consultant identified: "Reassessment and staging of wounds not clearly documented"

7 Action Plan 1. Identifying gaps in wound rounding practice 2. Define wounds 3. Distinguish between pressure ulcers and all other wounds 4. Educate MD s and RN s 5. Revise Policy and Procedure 6. Monitor process and outcomes

8 Follow Up Tasks IT - Wound rounding application: Identify in real-time wounds documentation in the EMR Push notifications - Notify the staff Escalation engine Track and complete wound rounding cycle. Measure & Report to clinical leadership EMR - Build template for documentation by physicians Clinical Leadership Team - Define process for consult by wound nurses

9 Milestones Along the Quality Measurement Journey Lloyd in The Healthcare Quality Book, 2008

10 Dashboard vs. Scorecard Dashboard real time / near real time Ongoing performance of critical processes Lead to organizational success but not the success itself Dashboard in Car Fuel, Speed, Temperature How you get to destination, but not the destination itself Scorecard - retrospective Record and report past performance not real-time performance Outcome measures rather than process measures Investment disclaimers Past performance does not guarantee future results

11 Donabedian Structure = Wound Care Nurses Exist Process = Policy on Wound Management, Consults and Frequency Outcomes = % of patients with wounds seen by Wound Team within policy timeframe

12 Next Steps Dashboard shows Outcome Can t intervene on things that already happened Want measures to be actionable NOW How to use real-time data to facilitate process and change outcomes before they even show up on the dashboard? Ask Wayne Gretzky

13 Descriptive/Predictive/Prescriptive A great hockey player skates to where the puck is going to be. Wayne Gretzky

14 Identifying Key Performance Measures 1. Relevant 2. Reliable 3. Valid 4. Cost-effective 5. Under the control of the provider 6. Precisely defined and specified 7. Interpretable 8. Risk adjusted or stratified

15 Kotter Leading Change 1. Establishing a sense of urgency 2. Forming a powerful guiding coalition 3. Creating a vision 4. Communicating the vision 5. Empowering others to act on the vision 6. Planning for and creating short term wins 7. Consolidating improvements and producing still more change 8. Institutionalizing new approaches Kotter, Leading Change, HBR Press, 2012

16 Clinician Engagement Shift the culture: Punitive Reactive It s our policy Opportunity for Improvement Proactive It s best practice Evidenced Based Practice drives the outcomes Front line staff are the KEY

17 IT and Clinician Partnership 1. Clinicians and IT need to understand how to frame questions in a way they each will understand 2. Clinicians come up with variables to study 3. IT identifies where the data resides and how to access, manipulate and present the data 4. Clinicians and IT work together to find best ways to present the data in order for clinicians to know what to do next

18 Implementing New Systems 1. Analysis of current workflows 2. Training of end users 3. Implementation 4. Post-Implementation Issues 5. Ongoing support and follow-through 6. Messaging to the CEO and Board

19 Data Strategy High Value Data Set - Administrative and Clinical Data Ingestion Aggregated, Targeted insight Data Normalization Unique, related and identifiable Real-time / Scheduled data capturing from clinical systems. Reporting - Push / Pull to Intranet Role Based Access / SSO & RFID login at point of care

20 Visualization, Dashboards, Reports, Ad hoc query, Push/Pull Alerts Integration, Collaboration, Access Control Administrative Systems Knowledge Clinical Systems Information Data Data Warehouse

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25 Telling a Story with Dashboards Visual vs Raw Data Learners Visuals should help tell the story not be the story Will front line clinicians know what to do with the information?

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28 Pitfalls People, Process, Technology Scope creep Time availability of staff for training Time commitment by leadership Is the process realistic? Are the tools being used? Is there Drift? Measuring metrics on the metrics

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30 An Summary of How Benefits Were Realized for the Value of Health IT Clinician and IT Engagement Led to a Front- Line Driven Process Patients Seen within 72 Hours Increased from 61% to 100% within 2 Quarters Transparent and Real Time Metrics Drove Process Change

31 Questions Scott M. Klein, MD, MHSA Roni H. Amiel Blythedale Children s Hospital