Why Most Analytic Applications Will Never Be Able to Significantly Improve Healthcare Outcomes
The sheer number of health IT solutions promising to improve outcomes and solve the healthcare industry’s most pressing issues is staggering. Just ask anyone who trekked across row after row at the HIMSS15 Conference and Exhibition in Chicago.
It is very easy to get lured into thinking that the solution to an organization’s challenges is just a technology purchase away. Many of the vendors, especially those that are focused on data and/or analytics, certainly make it appear that way. In reality, however, it is not quite that simple.
A new category of healthcare analytic applications is emerging, however, that deliver clinical best practices along with visualizations enabling clinicians to uncover issues, determine a solution, and implement changes to improve outcomes.
Health Catalyst has thoughtfully developed a range of applications that integrate best practices and support systematic rollout plans. Each optimized for your current environment and scalable to meet future analytics needs.
Applications That Focus On Improving Clinical Outcomes
Healthcare is shifting from gathering data and reporting metrics to improving outcomes along the lines of the IHI’s Triple Aim. CMS, which has traditionally focused on the reporting of process measures, is proposing changes that would focus more on outcomes.
Accumulating data through EHRs and using an analytics solution to identify high levels of variance in treatments, costs, and outcomes doesn’t make an organization data-driven. The organization must turn the data in to action to improve outcomes and it must also possess the organizational skills necessary to empower clinicians to drive change.
For example, the Health Catalyst Heart Failure Advanced application helps a clinical improvement team visualize the CMS measure, as well as related measures such as the 90-day readmission rate, and balanced metrics such as ED or Observation encounters to ensure patients are not just being administratively handled. Part of an improvement application is an agreement among clinicians regarding the best practices for improving the outcome. In this case that might be ensuring patient medications are properly reconciled prior to discharge, that the patient has a follow up appointment with their physician, and a follow-up phone call has been made to the patient. These process measures can then be used to identify gaps or weakness and monitor the corrective actions. Predictive analytics and risk modeling can be used to identify those patients with the greatest risk of readmission and help prioritize the follow-up activities.
Heart Failure Advanced Application
Making Information from the Application Actionable
Or suppose a hospital or health system analysis reveals the number of Caesarian sections being performed is above the national average? Unnecessary Caesarian sections increase the risks to the mother, infant, and the hospital as well as increase the per-capita costs of births. Commercial payers that are part of a shared risk program will want to address this issue quickly.
If the organization has a best practice system in place, the literature can be reviewed and guidelines established to provide clear direction for scheduling early Caesarian section deliveries. The organization must also drive and manage the change.
What is the process if an OB physician requests an early cesarean section be scheduled? With strong organizational change management and support in place, the scheduling nurse will be empowered and feel safe declining the request. The physician can appeal to the medical director to explain why an exception should be made.
The skillset required to successfully drive change is not typically taught in medical or nursing school or even as part of healthcare administration programs. However, essential to the success of any improvement initiative the entire organization, as well as the team accountable for implementing the strategy, must be ready for and willing to change.
Using Applications to Guide Starting Improvement Efforts
Often the long-term success of a quality improvement program is determined by the first few projects. It’s important to choose an area the data shows has high volume and variance. Using an application called the Key Process Analysis healthcare organizations can combine clinical and financial data to highlight the best opportunities for improvement and cost reduction. It’s also imperative that the need for change is recognized, supported, and welcomed. If the initial initiatives are successful, excitement and support will spread throughout the organization. Conversely, if the results do not meet expectations enthusiasm will dampen for fear the change won’t be sustainable.
ACOs Bring Urgency to Using Analytics Applications
The need for quality improvement and cost containment is more urgent for ACOs, whose successes are based on value rather than volume. These organizations need to find ways to reduce costs without lowering quality; ideally, of course, they would prefer to enhance clinical outcomes while reducing costs. Recognized leaders in healthcare quality such as Intermountain Healthcare and Allina Health have shown that improving quality most often also reduces costs.
All too often, however, an ACO administrator’s focus shifts from achieving far-reaching goals to ensuring that she is reporting on the metrics required by CMS or commercial payers (ACO Measures application). That is unfortunate, because many of the measures ACOs use are some of the best in the healthcare industry. The ACO Measures application can help organizations identify poor performance and put a population health or operational efficiency improvement team in place prior to actual CMS reporting of a poor measure.
Taking an Agile Approach to Clinical Improvement
Taking an agile, iterative approach that delivers continuous process improvement has proven far more effective than trying to make one big change to an entire department. As the organization begins implementing improvements, it is important to ensure metrics are being met at both the process and outcome levels.
A second advantage of continuously monitoring and measuring process improvement is to protect against changes in the original conditions. The only constant is change. Using an agile approach can greatly shorten that timeframe while delivering measurable and sustainable improvements. In our heart failure readmission example above monitoring of the process measures (medication reconciliation and follow ups) does not end when the next CMS report comes out, it must be a continuous and sustainable process.
Applications Not Just For Clinical Improvements
Implementing a Late-Binding™ enterprise data warehouse provides access to a broad swath of clinical, financial, claims, patient satisfaction, and other data to help the organization make better, more-educated decisions. Having all that data available for analysis, as well as the best practice and adoption systems in place to make it actionable, allows the process to be leveraged to drive change in other areas, such as revenue cycle management or operations.
Consider the performance of an ambulatory clinic. All appointment slots are filled for the week so it would be easy to draw the conclusion that the clinic is working efficiently and no major improvements are needed. However, the measure fails to account for patient satisfaction. Using the Practice Management Explorer: Patient Access application the clinic can get the big-picture insight. The applications allow visibility to appointment volumes by location, specialty, and provider. It can also help perform root cause analysis on unusual variations, among many other things.
Applications for Analyzing Patient Satisfaction
For example, if patients must wait a week to see a physician when they’re ill or injured, their satisfaction scores may be unsatisfactory. The high level of importance now being placed on patient satisfaction through measures such as Healthcare Effectiveness Data and Information Set (HEDIS), Press Ganey, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, means analyzing patient satisfaction data (which can be done through the Patient Experience Explorer application) in conjunction with utilization (from the Practice Management Explorer application) is more important than ever.
The ability to provide shorter wait times in emergency departments, as well as same-day, or 24-hour appointments for primary care physicians, may provide a healthcare organization with a distinct advantage in an increasingly competitive market. Using an application called Patient Flow Explorer, hospital leadership can view data about patient movement and ADT logs and find patterns or trends to help improve workflow throughout the department.
Applications for Hospital Finances
This approach can have a profound effect in another operational area: no-pays. Hospital-acquired conditions such as catheter-associated urinary tract infections or central line-associated bloodstream infections must be treated without reimbursement (no-pay), which negatively impacts the organization’s bottom line.
Using CAUTI Prevention and CLABSI Prevention Advanced Applications, health system leadership can address these issues. They would start with an analysis of infections across departments to uncover if similar procedures or best practices are being implemented in areas where instances are low. Once a best practice for reducing CAUTI or CLABSI has been determined, it can be implemented across the organization.
Applications for Accessing Patient Risk and Population Health Management
Using data from multiple systems is critical for, and has a substantial impact on, population health management and (as stated above) shared-risk arrangements, such as ACOs. These organizations can use data analytics to identify improvement opportunities for quality, outcome, and costs among their most expensive patient populations using the Patient Risk Stratification application. Without this information, the ACO will be hard pressed to implement necessary changes and improve performance.
Driving Continuous Improvement through Analytics Applications
There are many confusing healthcare applications available today. Unfortunately, most don’t really help improve care. However, a new approach to application development is bringing together clinical best practices along with a clear, straightforward path for adoption across the organization.
While there is no technology silver bullet, new types of healthcare applications allow health systems to integrate their best practices content and present the data in ways that clinicians can internalize and advocate. Applications such as these will enable the organization to significantly improve care.
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