The Best Way to Optimize Physician Workflow
Imagine a future scenario where Dr. Leonard McCoy is conferring with his patient, Mr. Spock, and he’s telling him, “I’m looking at data concerning patients with a condition similar to yours, who have similar genetic profiles, and they’re all from the same part of the Vulcan home world. Many treatments have been tried on this group, but this particular one has shown to be most effective. I can tell you that it will cost exactly $450. Based on all this information, I believe it is the most logical treatment and it’s what I’d recommend for you.” Imagine Mr. Spock saying “Doctor, your logic is impeccable. I cannot dispute the data. I believe we should proceed with this treatment.” This type of interaction between patient and provider embodies some of the future promise of precision medicine.
The Present State of Physician Workflow
Unfortunately, the present state of the union when it comes to physician workflow doesn’t allow a good connection between what a physician sees while using an EHR on a daily basis and the analytic data she needs to improve patient care. What would be really helpful is for physicians to have the data they need to make better clinical decisions presented to them in their regular daily workflow within the EHR. Or to have some kind of hybridized interface of what the EHR and what analytics currently show. But EHRs were developed as repositories of information that replaced the old paper charting systems. Many EHRs even mimicked the structure of old paper charting systems to help physicians feel more comfortable as they transitioned from the old to the new. However, these days, that model doesn’t lend itself to improving patient care with the use of data.
Time Is Ticking to Create Physician Satisfaction
For physicians, time is a precious commodity. We have very little of it to spend with patients and document. Anything additional creates physician angst. It’s just one more thing piling on to an already busy day. We are inundated with alerts and popups…whatever the EHR vendor has developed to remind us of important details. We get to the point where there’s too much going on. We just want to talk to our patients, take the best care of them that we can, and not get bogged down with all this other stuff. There simply isn’t enough time in the day.
We also get inundated with quality metrics, then we have to decide how much time and effort to spend on them. Part of it is mistrust in the value of the data. We have so many other things to do, do we really care about increasing a metric by five percent? We are so busy taking care of everyone day to day: patient appointments, ordering tests, documenting encounters, reviewing test results, communicating feedback to patients, following up on orders, and then making sure none of this falls through the cracks. Patient care is the preferred, although major, time consumer.
If I’m sitting down and looking at everything in the EHR, making sure that immunizations, preventive screenings, and lab tests are done, and trying to fill every care gap, it takes a lot of time and it’s not very efficient. Whenever we talk about adding something to the existing workflow, we have to think in terms of how we will accept and implement it. What kind of impact is it going to have on our workflow and satisfaction? How will it help us be more efficient so we can spend time in the ways that we prefer, i.e., extra minutes with our patients? Improved physician satisfaction translates to improved patient satisfaction.
Data Is the Workflow Fuel of the Future
We need to have data influence the care of patients in many different ways. We are moving into an era of the empowered patient, where software and analytics are used to influence patient and physician decision making. This is partly because our population is shifting. The older generation hasn’t been as technically savvy, but the younger generation is more so. They are impatient for information, they are well connected, and they seek value from their healthcare services. Their expectations of being a patient are different and how they access their care is different.
Improving Workflow across the Continuum of Care
As payment models are shifting to paying physicians for taking care of populations of patients, physicians need to have a broader view of their patient panels. It’s one thing to use data and analytics to improve physician workflow in a single setting like a hospital, but the tendency is to think that it won’t carry over into an outpatient clinic or other setting. MultiCare Health System, an integrated delivery system in Washington State, undertook an initiative in February of 2014 to find the best practices for identifying and treating pneumonia. They organized and got feedback across multiple care settings: emergency department, inpatient and outpatient units, transitional care and nursing home providers, community physicians, nursing, respiratory, pharmacy, operations, information technology, organizational effectiveness, and physical therapy. They were able to build a consensus using clinical best practice guidelines combined with local disease patterns, and produced protocols and guidelines that were integrated into the decision-making process across the continuum of care in their area. Then they tracked their progress with their data warehouse and analytics to see how they were doing. Among other significant improvements, they reduced their pneumonia mortality rate by 28 percent and their pneumonia readmissions by 23 percent.
Having the right data was absolutely critical to improving patient care. This type of evidence-based workflow with data driven protocols and guidelines helped to eliminate care variation and improved patient outcomes.
Data to Improve Care for the Individual
The use of data to improve population care is vitally important, but the future vision may include much more. How are we going to use data to really impact the care of patients on a more precise personal level? To try and answer this question, Health Catalyst is changing the delivery of our services. In the words of Dale Sanders, Executive Vice President at Health Catalyst, “We are evolving from an offline, data aggregator and analytics company, to a real-time data production and decision support company, integrating the knowledge derived from analytics into the workflow of our clients, wherever that workflow occurs.”
We need to focus on getting the right data to the right person at the right time in the right modality. With this in mind, we can replace Dr. McCoy’s futuristic conversation with this real-world statement that every physician should be able to say today. Again from Dale Sanders: “I can make a health optimization recommendation for you, informed not only by the latest clinical trials, but also by our local and regional data about patients like you; the real-world health outcomes over time of every patient like you; and the level of your interest and ability to engage in your own care — and in turn I can tell you within a specified range of confidence, which treatment has the greatest chance of success for a patient specifically like you and how much that treatment will cost.”
Data and Analytics Alone Aren’t Enough
We have the ability to get all this great data that tells us everything we need to know about a patient’s medical condition, with comparable global and local data, as well as the latest research. But then we have to get this to the point of care, closing the analytics loop, so doctors can use it to actually take of patients. Most of the time, data sits abandoned and isn’t used to inform or personalize care. We must take the data and its analysis back through the enterprise data warehouse (EDW) and link it into the EHR.
Closed-loop analytics for individual patients begins with external evidence. The data governance body in an organization sets and monitors improvement priorities that shape the evidence for the local EHR, clinical, and analytics teams, which personalize care using evidence-based practice standards. Working with EHR data, the Clinical Decision Support team highlights individual health status and care plans; and Clinical Quality Analytics, working with the EDW, supports personalized health and care of the patient.
Closing the loop is a matter of getting the right data to the right people, but healthcare doesn’t do a good job of this right now. We’re able to view the universe of data from the EDW and analytics applications, aggregate it, and get an understanding of care delivery, variation of care, and variation of cost of care, but we have a hard time getting this back to the people who need it in order to affect change.
One Application in Progress
Health Catalyst has a Clinical Analytics and Decision Support application called Patient Flight Path – Diabetes. It’s an app for delivering more efficient diabetes care and it’s currently in testing with one of our healthcare systems. Patient Flight Path delivers diabetes disease specific metrics, labs, demographics, complications, and associated costs. It provides a population view for clinicians to summarize all patients under their care and a patient view with projected costs and next likely complications to avoid. The app recommends treatments in various categories (lifestyle, medications, checkups, etc.) and it gives physicians the ability to view population risk and patient risk over time.
The next step is for the physician to meet with individual patients to review their current “flight path.” This means showing the patient in real time what their current state of care is, and what the predicted outcomes would be with no change in care. And then showing the patient the potential impact to their health outcomes and cost outcomes, if positive evidence-based changes were made to their care.
For example, we can present multiple scenarios to the patient: maintain current glucose control, add a new medication, or implement a weight-loss program. Then the program will predict the various outcomes. For example, lose ten pounds and it will result in improved blood sugar and the long-term chances of having a complication, like retinopathy or heart attack, or nephropathy will decrease by 10 percent. In addition, expected medical costs will be reduced by 5 percent.
Using data at the point of care, where the physician is showing the patient potential outcomes based on predictive analytics, has the potential to better include patients in their care decisions and foster more patient engagement in their own care. This type of application with aggregated data from an EDW can close the loop, so the physician can have data, analytics, decisions, visualizations, and a treatment plan right at her fingertips without having to change any of her normal workflow.
We Can Improve Physician Workflow through Analytics
We can overcome most of the limitations discussed here with better use of data. Going forward, we have to supplement the retained human knowledge of physicians with the abundance of other medical knowledge that is continuously evolving. We haven’t found the holy grail of how to do this yet, but a lot of what Health Catalyst does is to aggregate data and show people what they are currently doing. Then we create this knowledgebase of clinical evidence and best practices. We use analytics to inform the health system about where they are currently, and what they should be doing according to the latest evidence. Then we try to help them change what they’re doing to get to the better state.
Imagine the future of medicine driven by data and analytics informing all aspects of patient care. Boldly going where the data takes us. Informing physicians with precision data, integrated into their workflow with the goal of helping patients live long and prosper. This is our ongoing mission.
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