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Copyright 2018. College of Healthcare Information Management Executives (CHIME)
All rights reserved. Reprints with permission only. 1
Healthcare Analytics: How Can We Identify Variations
That Support Change?
James Jose, MDChildren’s Healthcare of AtlantaOctober 16, 2018
Analytics and the “Big Picture”
Copyright 2018. College of Healthcare Information Management Executives (CHIME)
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Getting to “All Better”
Use of visual analytics to map variations in asthma care in the emergency department
From: Understanding variations in pediatric asthma care processes in the emergency department using visual analytics, J Am Med Inform Assoc. 2015;22(2):318-323. doi:10.1093/jamia/ocu016. Rahul Basole, Mark Braunstein, Vikas Kumar, Hyunwoo Park, Minsuk Kahng, Duen chau, Acar Tamersoy, Daniel Hirsh, James Bost, Burton Lesnick, Beth Schissel, Michael Thompson.
Copyright 2018. College of Healthcare Information Management Executives (CHIME)
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Realizing Value from Analytics
From: Understanding variations in pediatric asthma care processes in the emergency department using visual analytics, J Am Med Inform Assoc. 2015;22(2):318-323. doi:10.1093/jamia/ocu016. Rahul Basole, Mark Braunstein, Vikas Kumar, Hyunwoo Park, Minsuk Kahng, Duen chau, Acar Tamersoy, Daniel Hirsh, James Bost, Burton Lesnick, Beth Schissel, Michael Thompson.
“Analytics Maturity”Descriptive AnalyticsPredictive AnalyticsPrescriptive AnalyticsDiscovery Analytics
What about Implementation Science?
Questions and ChallengesHow can analytic tools make a real difference for patient care?
1. How can we configure partnerships to design effective analytic strategies?
2. What must we know about a process to make analytic insights meaningful?
3. How can we promote lasting value?4. Beyond “analytic and presentation tools” – What are
we missing?
Copyright 2018. College of Healthcare Information Management Executives (CHIME)
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Thinking about variation
Walter Shewhart’s 1924 Memo to Western Electric Employees
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Process Control Chart - Rules for Identifying “Special Cause” Variation
Why does variation matter?
Standards are of little service if there is no “process control” to administer them.
Studies have shown that simple elimination of variation can reduce cost and improve quality.
Transforming an organization or building an effective culture, requires elimination of “useless variation.”
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Approach to Variation• Determine your strategic focus to reduce variation • Set measurable goals • Acquire and analyze data • Understand your data • Identify areas of focus • Implement improvements
“Health Care Leader Action Guide: Understanding and Managing Variation” report of the American Hospital Association’s Task Force on Variation in Health Care SpendingAccessible at: http://www.hret.org/quality/projects/healthcare-leader-action-guide-understandingmanaging-variation.shtml
Approach to Managing Variation• Determine a strategic focus to reduce variation based
on value to organization and individuals. Engagement starts here.
• Set measurable goals that fit sustainable operational activities.
• Acquire and analyze data to understand and influence. • Understand your data. Understand the roles and
workflows that produced your data. • Identify areas of focus. Understand how your data
motivates clinicians and staff. • Help your clinical partners implement improvements.
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Bronchiolitis Guideline and Analytics • Purpose: Reduce unnecessary use of bronchodilators
and diagnostic testing • Process Design:
Clinical Practice Guideline updated to reflect practice changes of unnecessary use of treatments
Qlik Application designed to monitor resource use.
13
The “Bronchiolitis App”
Bronchiolitis analytics prior to new program
Previous Analytic Tools• Hard to interpret• Reports not real time• Took months to drill
down on data.
14
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Chest X-ray & albuterol use decreased – Why?ED Chest x-Ray usage 2012-2016
IP Albuterol Use 2012-2016 IP ALOS 2012-2016
ED Albuterol Usage 2012-2016
Startup: 2014 – Compliance with Bronchiolitis Pathway Goals
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Year 1: StartupCompliance with Bronchiolitis Pathway Goals
Year 2: Post InterventionCompliance with Bronchiolitis Pathway Goals
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Year 3: Post InterventionCompliance with Bronchiolitis Pathway Goals
Year 4: Post InterventionCompliance with Bronchiolitis Pathway
Goals
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2012-2018: Sustained ChangeCompliance with Bronchiolitis Pathway Goals
1. Reassuring clinicians interventions are safe2. Elimination of variation has therapeutic value
ED Chest x-Ray usage 2012-2016
ED Albuterol Usage 2012-2016
IP Albuterol Use 2012-2016
IP ALOS 2012-2016
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The “Burnout Quadrant:”Provider ( ) with Low Efficiency and High Workload
WorkloadIncreasing Workload
Increasing Efficiency
Efficiency Score
Specialty AverageProvider
Provider Example #1“Efficient Provider” Reputation – Why Low Score?
Workload
Increasing Efficiency
Efficiency Score
Increasing Workload
Specialty AverageProvider
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Provider Example #1Physician Efficiency Metrics: Guiding Optimization
Minutes Use/Hrper Day
EMR Activity by Hour of Day
7am 6pmHour of Day
Provider Example #1 Provider Improvement Over 6 Months
Workload
Increasing Efficiency
Efficiency Score
Increasing Workload
Specialty AverageProvider
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Provider Example #2: High Work Load / Low Efficiency Provider
Workload
Increasing Efficiency
Efficiency Score
Increasing Workload
Specialty AverageProvider
Provider Example #2: High Work Load / Low Efficiency ProviderBaseline Data
Minutes Use/Hrper Day
EMR Activity by Hour of Day
Hour of Day7am 6pm
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High work load / low efficiency provider Provider Example #2: Results after 6 months
Workload
Increasing Efficiency
Efficiency Score
Increasing Workload
Specialty AverageProvider
Provider with Excessive Notes Activity Effort
Minutes Use/Hrper Day
Hour of Day
EMR Activity by Hour of Day
Increasing Efficiency
Increasing Workload6pm7am
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Minutes Use/Hrper Day
Hour of Day
Minutes Use/Hrper Day
Hour of Day
Increasing Efficiency
Increasing Workload
Increasing Efficiency
Increasing Workload
6pm7am
6pm7am
EMR Activity by Hour of Day
EMR Activity by Hour of Day
Provider with Excessive Notes Activity EffortResult of 3 meetings, 6 months at-elbow support
Time in Notes Activity During Intervention with Low Efficiency Providers
Time in Notes Activity
Minutes/Month2017 Average
2018 March April May June July Aug Sept
(Lower numbers reflect higher efficiency)
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After Hours Charting Time During Intervention with Low Efficiency Providers
Self-service analytics workflow:Probing for Excessive Variation
“Non-standardization” as probe for sub-optimal care
POINT
TASK
Quality manager looks at distribution of diagnostic tests, medications to determine if wide variation in care patterns
WORKFLOW
1) Effective in Identifying need for guidelines2) Helpful tool in driving consensus
RN Manager Quality and Clinical Effectiveness
Who?
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“Pop-Disco” Self-Service Analytics Tool”
12
79
38
29
64
31
42 4348
25 24
62
20
60
10
20
30
40
50
60
70
80
Tota
l Num
ber
of V
isit
s
Guideline Off guideline
Variation as a Probe for Sub-optimal Care
Medications used for behavioral health
Getting Value from Healthcare Analytics for 0perational/ClinicalChange
1. Effective Analytics require comprehensive knowledge of a process: who are the people, what is the goal?
2. It’s all about the “personal mission” … as perceived by each partner in the process you are controlling.
3. Think sustainable. Is your product embedded in a standard process? Used by an aligned partner?
4. Are the metrics getting traction? See step #1? • Do your metrics prove the change’s value? • Do they recruit and influence people who will act?
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AcknowledgementsWe gratefully acknowledge material contributions by:
James Bost, PhDDaniel Hirsh, MDEric Housel, RNBurton Lesnick, MDRobert Palmer, PhDEdwin Ray, RNBeth Schissel, MDJavier Tejedor-Sojo, MDNatalie Tillman, RNMichael ThompsonChildren’s Healthcare of Atlanta Outcomes Center