Transcript Closed Loop Analytics: The Triple Aim

Healthcare 2.0:
The Age of Analytics
Dale Sanders, Aug 2013
© 2013 Health Catalyst
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© 2013 Health Catalyst
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• Preserving Agility:
Analytic Data Binding
• The Triple Aim:
Closed Loop
Analytics
• The Roadmap:
Healthcare Analytic
Adoption Model
• Strategy & Vendor
Options
• A Checklist:
Population Health
Management
Organizational Issues
• Every Industry:
How Data
Management
Evolves
Evaluating Options
Key Principles
Overview
• ACO Data
Acquisition
Timeline
• Data Governance
Time Allowing: Health Catalyst Screen Shots
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Evolution of Data Management
Every industry follows the same pattern
1
Data Collection
Billing, Radiology and Lab systems; EMRs, etc.
2
Data Sharing
Local Area Networks, Health Information Exchanges
3
Data Analysis
Enterprise Data Warehouses (EDW)
3
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The Four Questions of Analytics
Regularly return to these fundamentals
Who or what
are we
monitoring?
Data and
Technology
What are we
measuring?
What are
our goals?
Organization
and Culture
How will we
achieve them?
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Binding Data to Create Information
Atomic data must be “bound” to business rules about that data and
to vocabularies related to that data in order to create information
Vocabulary binding in healthcare is pretty obvious
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Unique patient and provider identifiers
Standard facility, department, and revenue center codes
Standard definitions for gender, race, ethnicity
ICD, CPT, SNOMED, LOINC, RxNorm, RADLEX, etc.
Examples of binding data to business rules
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Length of stay
Patient relationship attribution to a provider
Revenue (or expense) allocation and projections to a department
Revenue (or expense) allocation and projections to a physician
Data definitions of general disease states and patient registries
Patient exclusion criteria from disease/population management
Patient admission/discharge/transfer rules
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Data Binding
Software
Programming
Pieces of
meaningless
data
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60
Vocabulary
Binds
data to
“systolic &
diastolic
blood pressure”
Rules
“normal”
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Why Is This Concept Important?
Knowing when to bind data, and how
tightly, to vocabularies and rules is
THE KEY to analytic success and agility
Comprehensive
Agreement
Is the rule or vocabulary widely
accepted as true and accurate in
the organization or industry?
Persistent
Agreement
Is the rule or vocabulary stable
and rarely change?
Two tests for tight, early binding
Acknowledgements to
Mark Beyer of Gartner
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Six Points to Bind Data in an Analytic System
INTERNAL
SOURCE
DATA CONTENT
SOURCE SYSTEM
ANALYTICS
SUPPLIES
SUPPLIES
CLINICAL
CLINICAL
FINANCIAL
FINANCIAL
HR
DATA
ANALYSIS
MATERIALS MANAGEMENT
QlikView
DISEASE REGISTRIES
Microsoft Access/
ODBC
COMPLIANCE AND PAYER
MEASURES
Web applications
CLINICAL EVENTS
Excel
OPERATIONAL EVENTS
SAS, SPSS
RESEASRCH REGISTRIES
Et al
HR
OTHERS
EXTERNAL
CUSTOMIZED
DATA MARTS
OTHERS
STATE
STATE
ACADEMIC
ACADEMIC
1
2
3
4
5
6
Data Rules and Vocabulary Binding Points
High Comprehension &
Persistence of vocabulary &
business rules? => Early binding
Low Comprehension and
Persistence of vocabulary or
business rules? => Late binding
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Words of Caution
Healthcare suffers from a low degree of
Comprehensive and Persistent agreement on
many topics that impact analytics
The vast majority of vendors and home grown
data warehouses bind to rules and vocabulary
too early and too tightly, in comprehensive
enterprise data models
Analytic agility and adaptability suffers greatly
• “We’ve been building our EDW for two years.”
• “I asked for that report last month.”
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Closed Loop Analytics:
The Triple Aim
Google: “Intermountain antibiotic assistant”
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Center of the Universe Shifts
Analytics
& EDW
EMR
Ptolemy
EMR
Analytics
& EDW
Copernicus
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Healthcare Analytic Adoption Model
Level 8
Cost per Unit of Health Reimbursement &
Prescriptive Analytics
Contracting for & managing health.
Customizing patient care based on population
outcomes.
Level 7
Cost per Capita Reimbursement &
Predictive Analytics
Diagnosis-based financial reimbursement,
managing risk proactively, measuring true
outcomes
Level 6
Cost per Case Reimbursement
& The Triple Aim
Procedure-based financial risk and applying
“closed loop” analytics at the point of care
Level 5
Clinical Effectiveness & Population
Management
Measuring & managing evidence based care
Level 4
Automated External Reporting
Efficient, consistent production; agility, and
governance
Level 3
Automated Internal Reporting
Efficient, consistent production; widespread
access to KPIs
Level 2
Standardized Vocabulary & Patient
Registries
Relating and organizing the core data
Level 1
Integrated, Enterprise Data Warehouse
Foundation of data and technology
Level 0
Fragmented Point Solutions
Inefficient, inconsistent versions of the truth
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Healthcare Analytic Adoption Model
Level 8
Cost per Unit of Health Reimbursement & Prescriptive Analytics: Providers Analytic motive expands to wellness management and mass
customization of care. Physicians, hospitals, employers, payers and members/patients collaborate to share risk and reward (e.g., financial reward to
patients for healthy behavior). Analytics expands to include NLP of text, prescriptive analytics,©and interventional decision support. Prescriptive analytics
are available at the point of care to improve patient specific outcomes based upon population outcomes. Data content expands to include genomic and
familial information. The EDW is updated within a few minutes of changes in the source systems.
Level 7
Cost per Capita Reimbursement & Predictive Analytics: Analytic motive expands to address diagnosis-based, fixed-fee per capita reimbursement
models. Focus expands from management of cases to collaboration with clinician and payer partners to manage episodes of care, using predictive
modeling, forecasting, and risk stratification to support outreach, triage, escalation and referrals. Patients are flagged in registries who are unable or
will not participate in care protocols. Data content expands to include external pharmacy data and protocol-specific patient reported outcomes. On
average, the EDW is updated within one hour or less of source system changes.
Level 6
Cost per Case Reimbursement & The Triple Aim: The “accountable care organization” shares in the financial risk and reward that is tied to clinical
outcomes. At least 50% of acute care cases are managed under bundled payments. Analytics are available at the point of care to support the Triple
Aim of maximizing the quality of individual patient care, population management, and the economics of care. Data content expands to include bedside
devices and detailed activity based costing. Data governance plays a major role in the accuracy of metrics supporting quality-based compensation
plans for clinicians and executives. On average, the EDW is updated within one day of source system changes. The EDW reports organizationally to a
C-level executive who is accountable for balancing cost of care and quality of care.
Level 5
Clinical Effectiveness & Population Management: Analytic motive is focused on measuring clinical effectiveness that maximizes quality and
minimizes waste and variability. Data governance expands to support care management teams that are focused on improving the health of patient
populations. Permanent multidisciplinary teams are in-place that continuously monitor opportunities to improve quality, and reduce risk and cost, across
acute care processes, chronic diseases, patient safety scenarios, and internal workflows. Precision of registries is improved by including data from lab,
pharmacy, and clinical observations in the definition of the patient cohorts. EDW content is organized into evidence-based, standardized data marts that
combine clinical and cost data associated with patient registries. Data content expands to include insurance claims. On average, the EDW is updated
within one week of source system changes.
Level 4
Automated External Reporting: Analytic motive is focused on consistent, efficient production of reports required for regulatory and accreditation
requirements (e.g. CMS, Joint Commission, tumor registry, communicable diseases); payer incentives (e.g. MU, PQRS, VBP, readmission reduction);
and specialty society databases (e.g. STS,NRMI, Vermont-Oxford). Adherence to industry-standard vocabularies is required. Clinical text data content
is available for simple key word searches. Centralized data governance exists for review and approval of externally released data.
Level 3
Automated Internal Reporting: Analytic motive is focused on consistent, efficient production of reports supporting basic management and operation
of the healthcare organization. Key performance indicators are easily accessible from the executive level to the front-line manager. Corporate and
business unit data analysts meet regularly to collaborate and steer the EDW. Data governance expands to raise the data literacy of the organization
and develop a data acquisition strategy for Levels 4 and above.
Level 2
Standardized Vocabulary & Patient Registries: Master vocabulary and reference data identified and standardized across disparate source system
content in the data warehouse. Naming, definition, and data types are consistent with local standards. Patient registries are defined solely on ICD
billing data. Data governance forms around the definition and evolution of patient registries and master data management.
Level 1
Integrated, Enterprise Data Warehouse: At a minimum, the following data are co-located in a single data warehouse, locally or hosted: HIMSS EMR
Stage 3 data, Revenue Cycle, Financial, Costing, Supply Chain, and Patient Experience. Searchable metadata repository is available across the
enterprise. Data content includes insurance claims, if possible. Data warehouse is updated within one month of changes in the source system. Data
governance is forming around the data quality of source systems. The EDW reports organizationally to the CIO.
Level 0
Fragmented Point Solutions: Vendor-based and internally developed applications are used to address specific analytic needs as they arise. The
fragmented Point Solutions are neither co-located in a data warehouse nor otherwise architecturally integrated with one another. Overlapping data
content leads to multiple versions of analytic truth. Reports are labor intensive and inconsistent. Data governance is non-existent.
2-4 YEARS
1-2 YEARS
NOW
The ACO Data Acquisition Checklist
1
Billing data
2
Lab data
3
Imaging data
4
Inpatient EMR data
5
Outpatient EMR data
6
Claims Data
7
HIE Data
8
Detailed cost accounting
9
Bedside monitoring data
10
External pharmacy data
11
Familial data
12
Home monitoring data
13
Patient reported outcomes data
14
Long term care facility data
15
Genomic data
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Real-time 7x24 biometric monitoring for all patients in the ACO
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Evaluating Options
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Strategy and Analytic Options
Strategy
Option
Pros & Cons
Example Vendors
Buy & Build from an
Analytics Platform
Vendor
 Highest degree of analytic flexibility and adaptability
 Requires a data driven culture with high aspirations that views analytics as a clear
business differentiator
 Best suited for a culture with a higher degree of data literacy and data
management skills
 Slow initial time-to-value plagues some vendors
 Inconsistent ROI track record, but when ROI occurs, it’s big
 Caradigm Intelligence Platform
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Healthcare Data Works
IBM Healthcare Data Model
Oracle Healthcare Data Model
Recombinant (Deloitte)
Buy from an
Analytics Service
Provider
 Best suited for cultures that want to avoid the details of analytics and data
management, but aspire to improve basic internal and external reporting
 Inter-organizational benchmarking and comparative analytics is a natural part of
the business model and service
 Limited analytic flexibility and adaptability
 Substantive ROI is not well-documented nor widely acknowledged
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
Explorys
Humedica
Lumeris
Premier Alliance
Truven Analytics Suite
Buy “Best of Breed”
Point Solutions
 Leverages expertise and very specific analytics applications in business and clinical
areas that are not always available in other options
 Does not facilitate data integration; i.e., does not provide a single analytic
perspective on patient care and costs
 Costly and complicated to maintain
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AltaSoft
Crimson Suite
EPSI
MedeAnalytics
Medventive
Midas
Omincell
Buy from your EMR
Vendor
 Offers the possibility of “closed loop analytics” driving analytics back to the point
of care, in the EMR and clinical workflow
 No proven track record with analytics to date from the EMR vendors
 Tend to be very focused on analytics that are specific to the EMR vendor’s data
 Less flexible and adaptable to new sources of data and analytic use cases,
especially complex ones
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Allscripts Sunrise
Cerner PowerInsight
Epic Clarity & Cogito
McKesson Horizon
Meditech Data Repository
Siemens Decision Support
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 Health Catalyst
Population Health Management
A Checklist for Requirements and Functionality
1.
Evidence based definitions of
patients to include in the PHM
registries
7.
Risk stratified work queues for
outreach that feed care
management teams and processes
2.
Clinician-patient attribution
algorithms
8.
3.
Discrete, evidence based methods
for flagging patients in the
registries that are difficult to
manage in the protocol, or should
be excluded from the registry,
altogether
Access to test results and
medication compliance data
outside the core healthcare
delivery organization
9.
Patient engagement and
communication system about their
care, including coordination of
benefits
10.
Patient education material and a
distribution system, tailored to their
status and protocol
4.
Evidence based triage and clinical
protocols for single disease states
5.
Evidence based triage and clinical
protocols for comorbid patients
11.
Metrics and monitoring of clinical
effectiveness and total cost of care
(to the system and the patient)
Patient reported outcomes
measurement system, tailored to
their status and protocol
12.
Inter-physician/clinician
communication system about
overlapping patients
6.
Data Governance
Govern to the least extent required for the common good
Base your committee charter on…
Encouraging more,
not less, data access
Increasing data content
in the EDW
Enhancing data quality
Establishing standards for
Master Reference Data
Campaigning for
data literacy
Resolving analytic priorities
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In Summary
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Analytics is the R in the ROI of IT investments
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•
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C-level executives need to be highly literate in data
management
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•
•
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This is a new chance for healthcare to do the right thing, the
first time, with IT strategy and investments
Unlike the bumpy road of EMR adoption
You can’t delegate all the details. The consequences to the
business are too significant.
All industries now move at the speed of software and
analytics
Test for Comprehensive and Persistent understanding
Follow the curriculum of the Analytic Adoption Model
•
Be deliberate and stick to the fundamentals
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Thank You!
•
Questions?
•
Contact information
•
[email protected]
•
[email protected]
•
@drsanders
•
www.linkedin.com/in/dalersanders
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Catalyst Screen Shots
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Key Process Analysis
Identifying Variability
Opportunities For Waste Reduction and
Quality Improvement
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Hospital and Clinical
Operations
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Executive Dashboard
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Population Explorer
On The Path To
Population Health Management
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Population Health Management
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