Transcript Healthcare Quality Catalyst

Healthcare Transformation:
A Guide to Success in the Journey to High-Value Healthcare
John L. Haughom, MD
October 2013
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Some Important Points
• Most American hospitals and caregivers provide
safe and effective care for the vast majority of
patients, the vast majority of the time
• The vast majority of caregivers are well trained
and conscientious
• Western medicine’s ability to save and extend
life, and to improve the quality of life for the ill
and injured is nothing short of miraculous
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…but that does not change a harsh reality…
…care is far too unsafe…
…quality is too inconsistent…
…and costs are too high…
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American healthcare
"gets it right”
54.9%
of the time.
McGlynn EA, Asch SM, Adams J, et al. The quality of healthcare delivered to
adults in the United States. N Engl J Med; 2003;2635-2645
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$60
$45.6 trillion
Medicare ~$30 trillion
U.S. Net worth ~$48 trillion
U.S. Comptroller General David Walker, 2006
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30% to 50% waste
(Anderson C, 1991, and James B, et al 2006)
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Feeling vulnerable?
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Deming 101…
Quality improvement
is the
science of process management
(healthcare delivery is a system made up of
thousands of interlinked processes)
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Deming 101…
If you cannot measure it…
…you cannot improve it…
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Deming 101…
“In God we trust…
…all others must bring data.”
W. Edward Deming
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Brent James, MD, 101…
“Managed care” means
“managing processes of care” ...
…not managing physicians and nurses.
(clinicians are the ones who manage the process of care)
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Deming 101…
…the right data
…in the right format
…at the right time
(and place)
…in the right hands
(the clinicians who operate the process)
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Deming 101…
…engaging the “smart cogs”
of healthcare…
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“…historically encumbered and
demoralized…”
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Are Physicians Willing to Change?
Yes…
Physician Willingness to Change
16%
Unwilling
84%
Willing
Source: McKinsey Physician Survey, 2011
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“…historically encumbered and
demoralized…”
...inform, engage and inspire…
…ENLIGHTENMENT…
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Innovation
Roger’s Diffusion of Innovation Model
Innovations do
not spread
equally over
2º
different society
segments (social
groups) but
Many studies have looked at how these groups differ:
through 5 stages
• Innovators are highly cosmopolite and open to new things.
with particular
• Early adopters tend to be opinion leaders.
profile of
• Early majority provide “legitimization” of the innovation.
reaction
• Late majority are skeptical.
• Laggards put trust in the status quo.
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You can buy the piano (EHR, EDW), but you will
have to learn to use it effectively to produce great
music (greater safety, improved outcomes, lower
costs, etc.)…
Who is responsible for
producing great music
in healthcare?
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Unlock
Your data will be integrated, cataloged, and secured in
the Catalyst platform
Metadata: EDW Atlas Security and Auditing
Common, Linkable
Vocabulary
Financial Sources
(e.g., EPSi,
Peoplesoft, Lawson)
Financial
Source Marts
Departmental
Sources
(e.g., Apollo)
Departmental
Source Marts
Cardiovascular
Valves
Administrative
Sources
(e.g., API Time
Tracking)
Administrative
Source Marts
Surgery
Patient
Source Marts
KPA
Cohort Finder
EMR
Source Marts
HR
Source Mart
EMR Source
Human Resources
(e.g., PeopleSoft)
(e.g., Epic, Cerner)
More Transformation
Patient Satisfaction
Sources
(e.g., NRC Picker,
Press Ganey)
Source: Catalyst’s Adaptive Model
Less Transformation
Proprietary and Confidential
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What will success look like?
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North Memorial
Women’s and Newborn: Elective Inductions
“We wouldn’t have had a chance to do some of the things we’ve done in last 18 months to enhance
care, reduce waste and lower costs without Catalyst. It’s amazing how differently and effectively we
can gather and use data now.”
-Jon Nielsen, MD, Medical Director Women and Children’s Services at North Memorial Health Care
Objective
• Define existing workflows
and identify improvement
opportunities
• Establish baseline
measures
• Define evidence based
standards for elective
inductions
• Reduce rates of pre-39
week deliveries from 1.2%
to 0.6% to qualify for a
payer partner bonus
Health Catalyst Solution
Results to date
• Late-bindingTM Data
Warehouse Platform
• Standardized workflows to
improve data reliability
• Cohort Finder
• Key Process Analysis
Application
• Established elective
delivery baseline
measurements to track
quality improvement gains
• Population Advanced
Application Module, Early
Induction Application
• Reduced early-term
deliveries from 1.2% to
0.3%
• Installation Services
• Payer partner bonus
payment
• Clinical Improvement
Services
Proprietary and Confidential
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HF Readmissions
Large Medical Center
Objective
• Define Congestive Heart
Failure (CHF) baseline
measures for 30 and 90day readmissions rates
• Implement evidencebased practice
interventions to drive CHF
readmission rate
reductions
• Establish balance metrics
including ED visits,
observation days and
patient satisfaction
• Develop sustaining
processes for evaluating
readmission rates to
ensure continuous process
improvement
Health Catalyst Solution
• Late-bindingTM data
warehouse that enables
faster time-to-value
• Integration of clinical,
patient satisfaction and
financial data to establish
baseline, ongoing and
balance measures
• Discovery, Foundational
and Advanced HF
applications including
cohort finder, registry and
evidence- based clinical
content
• Healthcare analytic
visualization including
gauges and trend lines for
at-a-glance view
Results to date
• Seasonally adjusted rate
reduction of 21% in 30-day
and 14% in 90-day CHF
readmissions
• 2X increase in the
number of phone calls
made to patients within 48
hours of discharge
• Average of 63 % increase
in physician medication
reconciliation within 48
hours of discharge
• Follow-up appointment
intervention baseline and
balance measures
established
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Proprietary and Confidential
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Winner CHIME-AHA Transformational Leadership Award!
Improving Outcomes and Reducing Waste in Asthma
Healthcare: The Impact of Data
“It’s one thing to establish an order set and another to actually drive its adoption.
Seeing how well this process works—how well and how quickly our clinical
improvement teams and evidence-based care experts are able to encourage
clinicians across our organization to standardize processes—is very gratifying..”
- Dr. Charles Macias, TCH Attending Physician and Director,
Evidence Based Outcome Center.
Objective
• Improve clinical outcome
for asthma patients across
the care continue
• Better manage populations
in a new Valued Based
Purchasing environment
• Measure and ensure
sustained clinical quality
improvements
Health Catalyst Solution
Results to date
• Late-Binding™ Data
Warehouse
• Decreased average LOS
by 11 hours
• Key Process Analysis
(KPA) Application
• Achieved and sustained a
49% decrease in
unnecessary Chest X-rays
over 16 months
• Population Analytics
Advanced ApplicationAsthma Module
• Installation Services
• 80% order set utilization
…67% sustained increase
over 8 months
• Clinical Improvement
Services
• 90% usage of asthma
action plan by providers
Proprietary and Confidential
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Adversity
…is hard…
…and an opportunity…
…lean into it!
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“It is not the critic who counts; not the man who points out
how the strong man stumbles, or where the doer of deeds
could have done them better. The credit belongs to the
man who is actually in the arena, whose face is marred by
dust and sweat and blood; who strives valiantly; who errs,
who comes short again and again, because there is no
effort without error and shortcoming; but who does actually
strive to do the deeds; who knows great enthusiasms, the
great devotions; who spends himself in a worthy cause;
who at the best knows in the end the triumph of high
achievement, and who at the worst, if he fails, at least fails
while daring greatly, so that his place shall never be with
those cold and timid souls who neither know victory nor
defeat.”
Theodore Roosevelt, 1910
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“To have lived through a revolution, to have
seen a new birth of science, a new
dispensation of health, reorganized medical
schools, remodeled hospitals, a new outlook
for humanity, is an opportunity not given to
every generation.”
Sir William Osler (1849-1919)
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Healthcare Transformation
An Opportunity Not Often Given
Participating in the Creation of a New Era in
Healthcare
By John L. Haughom, MD
2013
FREE Book!
Available online
January, 2014
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Questions,
discussion,
comments…
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For Information Contact:
[email protected]
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