HIMSS: Getting to profitable decision support

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LAS VEGAS—Collapsing reimbursement, accountable care and the massive complexity of the healthcare system is making profitable clinical decision support more important than ever, said Adrienne Edens, system vice president and CIO, St. Luke’s Health System, during a lecture at the 2012 Healthcare Information and Management Systems Society conference. The six-hospital system is based in Boise, Idaho.

More and more organizations are increasing their sites of care, she said, and the “data [they] have are insufficient to manage. It’s all new and it’s all on different systems.” Taking any measures that would reduce volume would create a financial crisis for many institutions, she said, while waiting to address the complexity “allows others to steal your patients.”

Most healthcare organizations don’t have the staff required to manage “the exploding complexity of data,” Edens said. Reports and spreadsheets are not meeting the need; better analytics is crucial to manage that complexity. “Sometimes emotion trumps logic. Only when we start putting together really accurate information can we ground ourselves in the reality of the care we’re actually providing,” she said. "That data are also required to demonstrate that integrated care is producing better results than the previous fragmented care.”

Mandatory change

“Change was mandatory,” said Celinda Snyder, senior healthcare solutions manager, WhiteCloud Analytics. St. Luke’s partnered with the consulting firm to implement WhiteCloud Performance Analytics. “When you transform your data and harness the power of the information it holds” you can create indicators and enough visibility that you know exactly what questions to ask," Snyder said. “We literally married cost and quality,” she added, pointing out that low quality drives up costs.

Snyder said the team created a central repository that includes data on risk-adjusted mortality, complications index, core measures, readmissions, safety, patient satisfaction, transitions-in-care and more. “When you marry all of these different aspects of quality, you start to get the full picture of what you’re doing with patient care. You can drill into different service lines and engage the physician community.” In fact, Snyder recommended bringing physicians into discussions early so they can embrace new systems and processes upon implementation.

Edens recommended that organizations form a physician IT steering committee which has “been so critical to our success. That committee should include some group practice administrators because they’re the ones who have to live with the data and they’re very knowledgeable.” One of the initiatives the committee undertook was service line optimization, particularly for imaging. They found that their physicians weren’t choosing to use the facility’s imaging. “We had to start looking at data and seeing where the opportunities were. You need lots of measurable results to do that.”

Additionally, Edens said the analytics helped the organization visualize care gaps. By finding out where and why patients were going outside of the network for certain services, they could take steps to prevent “system leakage.” In one case, the team discovered capacity issues that caused appointment delays of three weeks. In another example, after some digging, they found the clinicians weren’t using the St. Luke’s PACS because it was outdated and inconvenient, so they sent their patients to other providers for imaging studies. “We needed to learn this to support care," she said. "Every time we built on these applications, we absolutely achieved our intended return on investment. It’s all sequential. We are delivering so much value behind the analytics. The fruit was hanging so low for so long, it’s rotting.”

The revenue cycle was the starting point because “we knew we’d get our return on investment [ROI] and drive that focus on to other initiatives,” Snyder said. A close look at just how many different people handled a claim before its submission helped streamline the process.

Another effort was readmissions. Since heart failure is a primary reason for readmissions, a new scorecard unearthed poor discharge instructions, both when given and thorough patient follow up. “Root cause analysis is very important,” Snyder said. “You can automate the next layer all the way down to billing.” The team identified the care management teams doing the best job with heart failure discharge instructions, found out what they were doing and replicated and scaled those best practices. In 12 months, St. Luke’s reduced heart failure mortality by half.

The easiest way to solve problems is to find someone doing it right, said Edens. “It’s important to find these bright spots within our organization.” Leaders can then develop new ways of educating and sharing across the organization, making this continual improvement “part of the way we operate.” Those who have experienced success have credibility and they can help their colleagues do as good a job, she said, resulting in “a more collaborative, collegiate approach.” That also prevents fruitless efforts that she compared to “trying to boil the ocean.”

This kind of transformation “absolutely requires breaking down data silos,” Snyder said. The end results have been well worth it for St. Luke’s. The small, sequential steps the organization has taken regarding analytics have gotten employees very energized, Edens said. “It’s not so formidable to make these changes. If people’s hearts and minds are not engaged, nothing is going to happen.”

Healthcare reform will require rapid cycle improvement, said Snyder. “One- and two-year plans aren’t going to cut it.” Snyder recommended to the audience that they determine where they have the most variation in care. “About 80 percent of your patients should be cared for in the same way and 20 percent of that variation is warranted.”

Edens recommended a close look at business intelligence and decision support strategy. "Is it current? Does it cover people, processes and priorities?" She also said ROI should be clearly defined and quantified. "That gives you momentum to keep going."