The Future is Already Here: It is Just Not Evenly Distributed John L. Haughom, MD October 2014 The Future is Already Here: It is Just Not evenly Distributed John L. Haughom, MD October 2014 [John L. Haughom, MD] Thank you, Tyler. It’s my pleasure to meet with each of you once again. The world of healthcare is changing very fast. In fact, I believe the future is already here. If we look, we can see it. It’s just not evenly distributed. It exists it pockets around the country and it’s not readily apparent to everyone. To illustrate this point, I will highlight a number of real world success stories by organizations that are showing us the future. We have a lot to cover, so let’s get started. Poll Question #1 What is your primary functional area of expertise? Please take a moment to respond to this question. What is your primary functional area of expertise? Are you a clinician, an executive, data analyst or data architect, IT, or other? I’ll turn it over to you, Tyler, for a few minutes and a few seconds. [Tyler Morgan] Alright. We’ve got that poll up and we’ll leave that up for just a few more seconds. Okay. We’re going to go ahead and close that poll now and let’s share the results. Dr. Haughom, it looks like 20%, we’ve got an audience of 20% clinician, 19% executive, 12% data analyst or data architect, 16% IT, and 32% have represented themselves as other. [John L. Haughom, MD] Well it’s a nice good mix. I’m always thrilled to see a variety of different people because, in fact, healthcare accomplishes what it does because of the skills of a lot of different people. So thank you for the information. It’s Time to Engage Alright. When I write or speak about healthcare transformation, I’m often asked why I do not criticize more, criticize health system leadership, criticize governmental policies, criticize burdens of regulations. It’s a long list. Why avoid criticism? Well to me the answer is simple. Getting involved in emergent solutions is much more productive and fun. We are living during a very interesting period of history in healthcare. No doubt it is the time of great transition. We are passing from one time to another. The traditional approach to delivering care has served us well and accomplished great things over the past century. Yet it is also being overwhelmed by complexity and producing inconsistent quality, unacceptable levels of harm, too much waste, and spiraling cost. The traditional method of delivering care is struggling and another is emerging to take its place. Because the traditional approach has served us well and accomplished great things, we want to believe that the present state will continue forever – because conditions have change, this will not happen. We are in need of a new approach, an approach that carries the best of the past forward. It also addresses present day challenges. It just might be that on the other side of this current transition is potentially a time unmatched by any other in the history of healthcare. Thanks to visionary clinical leaders and institutions across the country. There is growing evidence this is not only possible, it’s likely. Who does the future belong to? If we look closely at other transition periods in history, two groups of people are apparent. The first are what we recognize as critics. They are people whose response to the need for change is criticism. Critics always exist but in times of transition like we’re currently living through, they tend to multiply. What do they criticize? They criticize the new, they criticize the change, they criticize the change for being unnecessary or too fast, or they criticize the change for being too slow. The question we should ask ourselves is will criticism solve problems? Typically, it does not. While constructive criticism certainly has its place, it alone is not likely to accomplish much, especially when the world is yearning for innovative solutions. The second group of people, that major transition yield, is leaders. They are men and women of vision, courage, persistence, integrity, creativity, and enthusiasm. They see transitions as periods of opportunity. They have the ability to ignore the turmoil confusion and difficulties that characterize transitions and remain focused on the task at hand and looking in the future and imagine new possibilities. They spend the majority of their time in the present working tirelessly to bring a new vision to reality. No matter what the odds, doubts and criticisms, these leaders carry on, and eventually they are recognized as heroes. Is there evidence that this is happening now? Yes, there are many. We will discuss several of them today. It’s time for leadership in healthcare. Let’s criticize less and dare greatly more. Transforming Healthcare Through Analytics For those who are not able to attend the first healthcare analytic summit, I’d like to talk for a moment about what I observed at that 2-­‐day meeting a couple weeks ago in my (06:04). Key Summit Observations Here are some of my personal observations about the 2-­‐day summit. The meeting was filled with energy and excitement. It was palpable over the 2 days of the event. The keynote speakers were thought-­‐provoking and inspirational. Even more importantly, a group of innovative healthcare organizations demonstrated quite clearly that the future is already here. It’s just in pockets and not evenly distributed throughout the industry. Driven by a series of powerful forces, I believe we will see this innovative energy spread throughout the healthcare industry over the next four or five years. In short, the summit was exciting, interesting, informative, and a great success. I would encourage each of you to save the date for next year’s summit and plan to attend on September 9th and 10th 2015. The Future Belongs to the Leaders This is a list of some of the organizations that presented some of their amazing work at the summit. The future belongs to people and organizations such as these. They are leaders. They did not spend much of their time criticizing anything or anyone because they are too busy getting the job done, designing a new and better way of delivering care. In the process, they are defining what is on the other side of the transition healthcare is currently undergoing. They are literally creating the future. A Revolution Roughly Every 50 Years It’s interesting to note that roughly every 50 years healthcare experiences significant disruptive changes leading to revolutionary advances in clinical care. In the 1870’s, the Germ theory of disease, antiseptic techniques and advances in anesthesia made life-­‐saving surgeries possible and drove significant and lasting advances in public health. In the early 20th century, a few dozen visionary clinicians laid the foundation for modern clinical care by designing the initial physical layout and operational structure of the modern hospital, creating the basic 4-­‐year medical school curriculum, establishing post-­‐graduate educational requirements, installing strict licensure requirements for physicians, and launching the first modern nursing practices. With the discovery of penicillin in 1928, the use of medication as a treatment for disease was dramatically accelerated over. In the 1960’s, the adoption of the randomized controlled trial as the goal standard for evidence, ushered in the era of evidence-­‐based medicine, thereby defining healthcare as we know in practice of today. The next revolution is now upon us. After decades as a technological laggard, the healthcare industry has entered the digital age. The enabling technology for this transformation fell into place over the past two decades with the emergence of massive ubiquitous and increasingly cheap processing power and more recently the widespread adoption of electronic health records. These trends, coupled with advances in analytic software, mobile technology, sensors and genomic sequencing, have made it possible to capture and analyze vast amounts of information about digital patients, populations and the environment in which they live. Collectively, these advances have laid the foundation for a core component of the next revolution, data-­‐driven healthcare. Data-­‐driven healthcare can be defined as the effective use of vast amounts of data collected in the process of managing the health and well-­‐being of millions of patients in a continuous effort to improve the quality, efficacy and cost of care. Data-­‐driven healthcare also creates the possibility of delivering care that is highly personalized to each individual patient, while also shifting more control and responsibility from doctors to the largest untapped healthcare workforce in the country, patients and their families. Healthcare: The Way It Should Be As many of you know, we are nearing the end of a series of webinars based on the book, ‘Healthcare: A Better Way’. Let’s take a moment to very briefly recap our journey to this point. Change is Inevitable There is no doubt that modern healthcare is the best the world has ever seen. The evidence that supported this is overwhelming. Still, there is also overwhelming evidence that we face many challenges that must be addressed. Quality is inadequate, harm is too frequent, waste is widespread and cost are spiraling under control. The world of healthcare needs to change and it is indeed changing. Why Change? I do not plan to cover the challenges in any detail because I did that in the prior webinar, but I do want to share this one slide with you. It was used by a presenter at a recently completed summit. If food prices had risen at the rate of medical inflation since the 1930’s, this is what a basket of commonly purchased food items would cost. Imagine for a moment paying $114 for a dozen oranges, $108 for a pound of butter, and almost $130 for a pound of bacon. Prices such as these for food are hard to imagine and certainly would lead to public unrest. Yet, that is what’s happened to healthcare cost. As insurance premium drives, as policy deductibles reach into the thousands of dollars for patients and families, and as more of the cost of care gets shifted to consumers, we can expect consumers to begin to feel the price pressures such as these. This will inevitably lead to resistance, perhaps even unrest and growing demands for healthcare to produce more value for each dollar spent. All About Creating Value… It is increasingly clear that the future of healthcare will be all about value. Regardless of how you want to define value, we will need to provide more goods for each unit of cost. Michael Porter is a renowned professor at the Harvard Business School. He is recognized as a lean authority on application of competitive principles and competitive strategic approaches to social needs, such as healthcare, innovation, and organizational responsibility. He is noted for saying quality improvement is the most powerful driver of cost containment. This has been proven true in many industries and it will be no different in healthcare. One of the common themes that presentations by innovative healthcare organizations that presented their work at the summit was that quality improvement does in fact correlate with lower costs. There are obvious exceptions to that rule but the presenters presented compelling evidence based on their experience that quality improvement does in fact lead to cost containment in healthcare. What We Pay For… A big reason for this relates to the amount of waste that exists in our current delivery system. These studies have estimated that the amount of healthcare waste ranges between 30% and 50%. Let’s assume for a moment that the true amount of waste is in the middle, 40%. 40% of the $2.7 trillion spent on healthcare in the United States represents over $1 trillion. This is why some had commented that healthcare does not have a cost problem. It has a waste problem. Even if the amount of waste is at the lower end, 30%, it still adds up to near a trillion dollars. This is why we can expect the pressures to eliminate waste that control cost will be increasingly extreme over the coming years. In recent years, as reimbursement has declined and costs have escalated, the average profit margin for hospitals has fallen to a very slim 2.2%. Inevitably, healthcare organizations were required to drive out waste if they expect to survive and maintain a bottom line. A Time for Revolutionary Thinking It’s clear that that disruptive and probably revolutionary change lies in healthcare’s future. In times such as these, I believe highly creative and innovative ideas and leadership are required. In that regard, I like this quote by Lord William Beveridge, a prominent British economist. He said, “A revolutionary moment in the world’s history is a time for revolutions, not for patching.” There is ample evidence to suggest that healthcare has reached such a moment. We are being overwhelmed by complexity, the incidents of more avoidable harm is too high, quality is too inconsistent, costs are out of control, and waste is widespread. We need to design a system of healthcare that optimally meets the country’s needs while also being affordable and socially acceptable. Clinicians should be at the center of this debate if care delivery is to be designed in a way that puts quality of care before financial gain. This challenge is far too important to be left to politicians, the policymakers. There is an urgent need for clinicians to step up, lead to debate, and design a new future for healthcare. Placing professional responsibility for health outcomes enhanced to clinicians and healthcare’s operational leaders rather than bureaucrats or insurance companies must be in ambition for all of us. We need to find the formula that meets the needs of patients and communities we serve. A sincere collective effort by committed clinicians and operational leaders to design an effective system will lead to a healthcare system that has a democratic mandate and the appropriate focus on optimizing the outcomes patients and society need. Adapting to Change is Optional As I observe healthcare providers around the country, I’m seeing them fall into three categories. There are those that are taking the hunkering down approach. They are hoping against hope that the wave of change is not for real and essentially trying to ignore the need for change. This mentality is not likely to be successful in the present environment. In fact, I would argue that this group has a high likelihood of being unsuccessful. While many of them may not fail outright, they will ultimately need to find a partner that understands the future and has prepared for it. On the other end of the spectrum, I am seeing organizations that are embracing the need to change and putting plans in place that are designed to assure success. In a moment, we’ll highlight some of these organizations. Then there are those in the middle. These folks would gradually accept the changes likely, but they’re waiting for others to show them the way. Without data, you are just another person with an opinion It all starts with good access to data. In the future, any healthcare organization that does not base its decisions and its care on good data will not be successful. The reality is without data, you are just another person or organization with an opinion. Success in the future will demand more than unverified opinions. Level of Evidence I used this slide in my last webinar but I want to use it again to highlight the importance of data. If we are going to effectively use the data at our disposal, we need to understand the concept of levels of evidence. This is a concept that has emerged over the past 30 years. Some research designs provide a stronger level of evidence than others based on their inherent characteristics. Systems designed to stratify evidence based on the quality of the evidence have been developed. A hierarchy depicting levels of evidence has often been illustrated as a pyramid, like the one you see in this slide. The pyramid is an appropriate shape for this graphic as it represents the quality of research designs by level, as well as the quantity of each studied design in the body of the published literature. That is, more low quality evidence exists than high quality evidence. Levels of evidence range from level 1, the goal standard randomized controlled trial, down to level 4, personal anecdote. Clearly, the goal would be to use the highest level of evidence possible. However, as we discussed previously, it is often the case that we must settle for lower levels of evidence. It’s been estimated that randomized controlled trials cover only about 20% to 30% of the care we currently deliver across the country. Level of Evidence Shared common baselines Generally, the preponderance of evidence we have at our disposal to improve care is actually our own data, the data we collect and the process of delivering care. There are essentially observational studies, not as good as the randomized controlled trial, but certainly much better than opinion or personal anecdote. Our own data can be a rich source of information to assess and to improve care. [Tyler Morgan] While Dr. Haughom is looking on that, we’d like to remind everyone that if you’ve got questions or comments, you can enter those into the questions pane on your control panel. Enterprise Data Warehouse in 90 days [John L. Haughom, MD] When I started working on data-­‐driven improvement in the mid-­‐1990’s, there were no viable solutions available on the market that we could purchase. As a result, we had to build our own analytic capability from scratch. It took many years and it cost many millions of dollars. Along the way, we experienced many learning opportunities, otherwise known as mistakes. Fortunately, it’s no longer necessary to take this approach. Organizations do have market-­‐
based options that could be implemented much more quickly and cheaply. Take the example of the Indiana University Health System. “IU Health had previously struggled to create a data warehouse that would serve as the organization’s source of truth.” Their early attempts ended with a few data source, each with a particular partial picture of the system but no long-­‐term viable enterprise-­‐wide analytic solution. Working with Health Catalyst, IU Health was able to create a data warehouse and integrate it into IU Health’s EHR, which is based on Cerner, within just 90 days. Health Catalyst successfully loaded 14 billion rows of data into the EDW, fully 10 years of clinical and operational data from a cost IU’s health network. Clinical events, encounters, lab and radiology and other patient data were included as were key pieces of IU’s performance management revenue cycle on patient satisfaction data. Within 90 days of the EDW’s completion, IU Health put in place a newly developed interactive dashboard, effectively a window into the EDW. It provides IU Health’s leadership with the daily operational and clinically insights they need to solve the quality cost equation. It offers visibility into key operational metrics and trends so that IU Health’s leadership can easily track the performance measures critical to controlling costs and to maintaining quality of care. This implementation pace is truly phenomenal. Rating IT Priorities With so many priorities clamoring for healthcare executive’s attention, one could reasonably ask whether advanced data management is being viewed as the foundational element for the future. A recently privately commissioned CHIME survey of chief information officers and other senior IT executives of US healthcare organizations demonstrated broad agreement that value-­‐
based care will require health systems to use sophisticated analytics to comb through Terabytes of clinical and financial data to reveal actionable opportunities for improving quality and efficiency. The survey’s findings confirm that view with 54% responding is rating analytics as their highest priority, followed by investments and population health initiatives 42%, ICD-­‐10 30%, accountable care and shared risk initiatives 29%, and consolidation-­‐related investments 11%. When asked which initiatives were the most important drivers of analytics, population health management surfaces the top driver. In terms of the biggest obstacle for implementing the analytics, the lack of analytics expertise and resources ended up first. Obviously, the need to employ advanced data management tools is being widely recognized. It is noteworthy that all of these extremely important initiatives are interrelated in the sense that they create the capability for organizations to be responsible for the health and well-­‐being or of large populations of patients – in other words, population health. Linking the three systems Clinical Integration Hierarchy In part two of the book and over the last few webinars, we have focused on the components of a sound strategy for managing complexity and change, with the goal of achieving scalable and sustainable improvements and outcomes over time. This slide attempts to pull all of those concepts together and illustrate how they interrelate. Every healthcare organization that wants to remain viable in the future will need to develop a strategy and a systematic approach to improvement and perceived value. In fact, those who attempt to set value-­‐oriented goals without a viable plan to achieve those goals simply represents wishful thinking. This slide illustrates the key components for a successful highly integrated improvement strategy that has been developed by Health Catalyst. First, it divides the strategy into three critically important components that in combination can ignite sustainable, meaningful, and scalable change. This includes an analytics system capable of unlocking an organization’s data to make it readily available for improvement teams to identify meaningful patterns in the data. It also includes a deployment system which creates the organizational structure an organization needs to achieve, spread and sustain improvements over time. And the content system that helps an organization optimally manage both internal and external knowledge in pursuit of value. These three systems are integrated into the clinical integration hierarchy that we discussed in the webinar this summer. This organizes care into clinical programs which are made up of a series of care process families, which in turn are made up of a series of care processes. A cardiovascular example is illustrated here. Cardiovascular is made up primarily of four care process families – heart rhythm disorders, vascular disorders, ischemic heart disease, and heart failure. Looking at heart failure alone, it is primarily composed of four care processes, pulmonary heart disease, cardiomyopathy, congestive heart failure, and valve disorders. It should be noted that the 80/20 rule has been applied in this hierarchy, that is what 20% of care process families and care processes make up 80% of cardiovascular care. By taking this approach, organizations can focus their improvement efforts and ensure them the greatest possible return for their precious investments and improvement projects. Finally, the organizational team structure inherent in an effective deployment system can help achieve, spread, and sustain gains over time using data and the clinical integration hierarchy. Focus Increases ROI Using the 80/20 rule and mapping the ICD-­‐9 diagnosis codes to the clinical integration hierarchy has produced the results shown in this slide, that is 11 clinical programs, 102 care process families, and 535 care processes, which make up roughly 80% of the care we provide for patients. This is a manageable number and allows organizations to focus their improvement efforts and increases the likelihood of a substantial ROI for their efforts. Care delivery is all about the reliable and efficient execution of process It’s important to remember care delivery is all about a reliable and efficient execution of process. Therefore, achieving high quality, safe, efficient, and low cost care is all about designing and managing processes well. Because the majority of what we do in care delivery organizations is deliver care, there is a need to engage clinicians in this important and necessary work. Healthcare’s Greatest Asset: People We all need to remember that people tend not to do things if they do not understand them and if they are not inspired. If they are engaged and inspired, they will move mountains. That’s’ the first step in a transformational journey – is educating and engaging our people. Healthcare is amazingly blessed with a highly intelligent, well-­‐educated, and highly committed workforce. The vast majority of them get up every day with a strong desire to be the best they can be. Our job is to help them see why the world needs to change and how they can play a meaningful role as architects of the future. In that regard, Health Catalyst is launching a training program early next year that will be based on the book and designed to educate and engage people who are involved in healthcare and who want to be architects’ change. If you’re interested, please stay tuned for future announcements about this program. [Tyler Morgan] While you’re working on that, I just want to say we do have several questions regarding the slides. We’ll let you know that, yes, we’ll be providing the slides after this event. We’ll have a recording of the webinar, as well as the presentation slides and so on will be distributed to everyone. Creating the Future We Want [John L. Haughom, MD] Okay. Buckminster Fuller once said, “We are called to be the architects of our future, not its victims.” I believe that is true and leading organizations in healthcare are already architects in the future. Let’s take a look at some examples of their great work. Two Quick Comments As I head into these real-­‐world examples of success, I want to make two quick comments. First, all of these examples and others are reviewed in great detail on the Health Catalyst website under the “Success Stories” tab, which can be found at the web address listed on the slide. Secondly, all of them use the analytics capabilities and the three systems that we’ve covered over the last several webinars and are also covered in the book. I will only focus on outcomes rather than go into details for each success story. Population Registries So let’s take a look at some of the architects of our future. Texas Children established a formal entity, the Evidence-­‐Based Outcomes Center or EBOC, that was (33:40) its efforts to make clinical practice consistent with the best medical science throughout its facilities. Texas Children’s had implemented an electronic health record which contained a wealth of data but hospital leaders found that the data didn’t meet clinicians’ expectations for usefulness. It was the EBOC’s task to mobilize the usefulness of the Epic implementation as it related to guideline-­‐
driven care to analyze the data, create and support evidence-­‐based guidelines and deliver actionable information to clinicians. Historically, it would take the committee as many as 6 months to develop and kick off clinical program improvement projects and needed more time to determine whether the initiative was yielding positive results. The committee’s teams had to collect data from hospital systems, cobble together reports to evaluate the data, define patient cohorts, analyze baseline data, address data quality issues, and establish target metrics, all using time consuming and resource consuming manual methods. Rather than needing 6 months to develop a clinical improvement initiative, once the three systems were in place, the committee could define patient cohorts, analyze baseline data, address data quality issues, and define target improvement goals in only 90 days. But this 50% improvement in process time was just the beginning. By subsequently implementing the population explorer application to run on the EDW, Texas Children’s was able to far up to even that distinct improvement, reducing the time to a mere 2 weeks. Reduced Heart Failure Readmissions A large medical center used the Health Catalyst key process analysis tool to identify heart failure readmission as a definite area of opportunity. They set a motion of process improvement team and their results were very impressive. A 14% seasonally adjusted reduction in 90-­‐day heart failure readmissions, a 21% seasonally adjusted reduction in 30-­‐day heart failure readmissions, a 2-­‐fold increase in every phone calls made to patients within 48 hours of discharge, which is an important determinant of avoiding readmissions, and a 63% increase in physician med reconciliation post discharge which also helps prevent heart failure readmissions. Impressive results. Improved Surgical Outcomes Texas Children’s Hospital was concerned because they found that appendectomies represented one of their largest categories of surgical cases, performing more than a thousand appendectomy procedures each year. With such a large volume of cases and variance in outcomes, they wanted to make sure that quality, process, and cost were optimized. They knew they needed data to support their review but they had a big problem. They couldn’t easily get the data or it didn’t exist at all. But the data they had was delayed and retrospective and wasn’t gathered in a uniform systematic way. The typical method for gathering the necessary data was manual chart abstraction which was not either flexible or efficient. Texas Children is alarmed when it discovered tremendous variability in length of stay, cost, and outcomes. They knew they needed reliable data and information but they knew that wouldn’t be enough by itself. They knew it would also take a cultural transformation with education and in workflow analysis and evidence-­‐based practices. That’s when they turned to Health Catalyst. Working hand in hand, Health Catalyst and Texas Children’s put together an interdisciplinary team of surgeons, nurses, patient safety and quality experts, business analytics and IT experts. They redesigned workflows and processes and implemented evidence-­‐based best practices. With their cultural transformation, clinician engagement, evidence-­‐based practices, and new analytic platform placed, they reduced simple appendectomy postoperative length of stay by 36%, reduced the average variable direct cost for a simple appendectomy by 19%, increased postoperative simple order set adoption rates by 36%, and postoperative complex order set adoption rates by 9%, and increased their percentage of patients receiving recommended antibiotics, penicillin as the first antibiotic, by 53%. Outcomes for patients admitted with appendicitis subsequently dramatically improved. Improved Sepsis Outcomes Using a combination of analytics and advanced process improvement techniques, MultiCare was able to reduce septicemia mortality in just 12 months by an average of 22%, leading to more than $1.3 million of validated cost savings over that same period of time. Two major factors contributed to the rapid reduction in septicemia mortality. First, the implementation of an advanced analytical infrastructure allowed them to organize a simplified data for multiple data sources across the continuum. It became the single source of truth required to seek care improvement opportunities and to measure change. It also proved to be an important means to unified clinical IT and financial leaders and to drive accountability for performance improvement. They were also able to more precisely define sepsis and identify the severe sepsis cohort. Second, through the establishment and collaborative efforts of permanent integrated teams consisting of clinicians, technologists, analysts, and quality personnel, MultiCare was able to accelerate the reduction of septicemia mortality. Reduced Surveillance Waste All healthcare systems face the same dual challenge. They need to ring out expenses at the same time that government is imposing new regulatory challenges, the least of which are the increased hospital-­‐acquired infection reporting requirements. A large medical center needed to streamline its process for identifying patients with Central-­‐Line Associated Bloodstream Infections, (40:57) by the acronym CLABSI and catheter-­‐associated urinary tract infections. These hospital-­‐acquired infections are associated with longer patient stays, increased mortality, as well as increased care cost and estimated $20,000 per central line infection, and they are largely preventable. Using Health Catalyst hospital-­‐acquired infection advanced application, the health system was able to deliver more accurate regulatory reporting of HAI rates with a 90% reduction in surveillance resources within 6 months. In addition, they created a near real-­‐
time reporting dashboard that displayed analytics in a highly visual and easy-­‐to-­‐interpret display. The fact is that the infection preventionists now spend far more time focusing on education, clinical interventions, and analysis versus surveillance waste. Over time, these interventions have led to decrease in infection rates and significant cost savings. [Tyler Morgan] Again, we’ll take the time to remind everyone that if you’ve got any questions or comments, we’re getting some great ones in by the way, Dr. Haughom. If you’ve got a question or comment, be sure to type that into the questions panel in your control panel. Alright. Back up. Reduced Unnecessary Elective Deliveries [John L. Haughom, MD] Like many health systems, North Memorial Healthcare in the northwest metro area of Minneapolis-­‐St. Paul has spent the last few years battling for financial stability. They needed to find a way to improve care and improve the bottom line. Using data from their analytics system, North Memorial’s leadership selected women and newborn’s department as the first target for the new data-­‐powered quality improvement process. Their initial goal was to reduce unnecessary elective deliveries. North Memorial’s use of Health Catalyst analytical tools and the team process that put in place reduced the health system’s rate of elective early term deliveries by 75% in just 6 months. The percentage of all deliveries that were elective pre-­‐39 weeks surgeries plummeted from 1.2% to just 0.3%, shattering the payer’s goal of 0.6% and earning North Memorial a six-­‐figure bonus payment. Improved Women and Newborns Population Health Promoting exclusive breast milk feeding for infants is increasingly important from a population health perspective. Studies show that breast feeding benefits the health of both babies and mothers. The problem for many healthcare systems and for this healthcare system is that they don’t have the data to report and/or their data isn’t accurate. In the caste of this healthcare system, they could only report on one of the measurements and they had serious data quality issues. The reporting that they did have was done through a manual chart abstraction process that equated to 60 hours of lost nurse productivity each month across their healthcare system. They deployed an EDW and the Health Catalyst population health advanced application to establish baselines and quickly realize they needed to work with the EMR team to address data capture workflow issues. As the team began to analyze the data, it discovered that much of the information they needed was missing and incomplete. Because nurses have to chart feedings every two or three hours for each newborn, the team needed to establish an easy, consistent, structured way for the nurses to capture the data. Healthcare system addressed this challenge by working with their EMR vendor. A rapid cycle process was utilized, holding assigned team meetings over a few weeks. Approval was elicited and obtained from appropriate clinical governance bodies. An education training plan was formulated and spread system-­‐wide. For the population of normal newborns, the breast milk feeding rate increased from 69% to 84%, a 21% increase. For the population of normal newborns, the breast milk feeding rate increased from 80% to almost 91%, a 13% increase for the same period. They have also increased their clinician productivity and lowered cost by an estimated $54,000 and nurse chart abstraction savings and 12,000 fewer charting hours per year. Streamlined Radiology Operations In addition to improving care, these same methods can improve operations. So I put a one operational example in here but we could present many others. Texas Children’s Hospital’s radiology practice management administrators used to dedicate several hours each week performing manual reports, interfering the time they could be spending on streamlining operations and delivering patient care. Using analytics, they are improving their operations and increase patient satisfaction while reducing cost by an estimated $400,000. They have also increased billable charges by over $1 million by minimizing referral leakage. Own Your Tomorrow In each of these examples, there are organizations that are creating their own tomorrow. The future belongs to those who prepare for it today. So often we think of the future is far often completely unrelated to the effects of today’s planning. How wrong we are when we adopt that philosophy. Regardless of what congress does, healthcare will be transformed by those who work in the industry, by people like those listening to this webinar and those who are doing the type of innovative work that I just illustrated. The future belongs to people such as these. They are the leaders. The present turns the tables in favor of people who consciously work for maximizing the value of process by taking control of it. When you’re able to control your today, you’re going to make your future even brighter with each passing day. Gradually, you could become the master of your own destiny. One day, those that take this approach will suddenly realize they have created the future. The future will be what we make it. Leadership is not a special class. It’s a role each of us can assume. It’s a position of influence. No doubt some people are able to exert more influence than others but all of us can have an impact especially when we work collectively. The voice of clinicians and operational leaders can be profound. Particularly if our sincere goal is improving care for patients, people will hear what we say. They will listen and be affected. Many are eager for healthcare providers to act in this fashion. They need us to be confident, optimistic and visionary. Let’s not disappoint them. That concludes my remarks. I’ll conclude with one more poll question. Poll Question #2 Do you believe that your organization is actively architecting its future? Do you believe that your organization is actively architecting its future? 5 – definitely, down to 1-­‐ not at all. Tyler, I’ll give you a few minutes. [Tyler Morgan] Alright. We have this poll question up. Again, do you believe that your organization is actively architecting its future? And I’ll leave this up for just a few more moments. So while I do, I would like to remind everyone that we will provide the responses to this poll, as well as the slides and the recorded webinar out to everybody shortly after the event. Let me go ahead and close this poll now and let’s share the results. Alright. It looks like, Dr. Haughom, that 29% noted 5 – definitely, 32% -­‐ 4, 28% -­‐ 3, 10% -­‐ 2, and only 2% -­‐ 1 or not at all. [John L. Haughom, MD] Oh I find those results very encouraging and I think it reflects the movement towards data-­‐
driven healthcare that I’ve seen across the country. Different organizations are in different parts of the journey but it’s pretty clear that the bell-­‐shaped curve was moving up to 5. So thank you for sharing that. Well, I’ve got one more slide here. Thank you Upcoming Educational Opportunities [John L. Haughom, MD] So thank you all for participating today. I do plan to point out some upcoming educational opportunities. Dale Sanders, Senior Vice President of Strategy will be presenting a webinar on patient registries on November 12 from 1 to 2 PM Eastern Standard Time. I’ll be presenting chapter 8 of the book, Innovation in Healthcare: Creating Tomorrow, on December 10th. And then January, I’m going to do a webinar, Viewing Healthcare as a Complex Adaptive System. The topic is being talked about a great deal now as the organizations become more complex and larger. So with that, I’ll pause and answer any questions I can. [Tyler Morgan] Dr. Haughom, one of the big themes that we received a question that came in over the weekend, how to do with big data. Did you want to comment on that? Is that something that you’ll be addressing in future webinars? [John L. Haughom, MD] Yes. Yes. I appreciate you reminding me that. Tyler, I was going to include that. There were questions on population health, EHR usability, big data, genomics, all excellent questions. I’ll be hitting those head on in the December webinar, entitled Innovation in Healthcare: Creating Tomorrow. The short answer is that healthcare is not really in big data quite yet but we are going to rapidly get there as a number of technologies unfold, things like genomics, sensors, etc. So, it’s a very pertinent and very important topic and I’ll discuss it in detail in December. QUESTIONS AND ANSWERS QUESTIONS ANSWERS In addition to hospitals and clinics, who in the Wow. The list is broad. I’m going to start value chain of patient care, especially with the group that we really need to tap and population health management, could engage and that’s patients and their families. benefit from data and analytics? I think I’m a strong believer that if given access to they’re asking which stakeholders would information about their health and well-­‐
benefit from the data and analytics? being, it’s motivating for patients and families that will create the possibility for us to understand behaviors that are determinants of health better and perhaps even move the dial. So for sure the patients and families and the communities we serve. But then you could go to many other areas, public health will be huge because we’ll have vast amounts of data that will be useful and helpful to advance public health measures. By going down this road, it’s interesting when you think about, what we’re talking about is ultimately every healthcare provider, every healthcare organization becoming its own learning laboratory. We will essentially turn the country into one large data-­‐driven learning laboratory. And when you think about the possibilities there for research and Next question we have is, let me start with a couple of facts about physician-­‐led ACOs showing savings in year 1 compared to hospital-­‐sponsored ACOs. And the question is, do you believe physician leadership is a major perquisite for the successful transition from fee for volume to fee for value? advancing clinical care, understanding the reactions to medicines and to the efficacy of various treatments, it’s huge. And it’s not going to replace randomized controlled trials but it will greatly augment the modern knowledge we have at our disposal to understand how to improve care. Thank you. Oh absolutely, I do. And the reason is very, very logical. In our old way of being reimbursed, it was basically the more you do, the more you get paid. I would say kind of a volume-­‐based business, a true-­‐put business, the more patients you can click through the ED or through the cath lab or through the OR, the more you’re going to be paid. As soon as you start going to value, it becomes all about the process of care and outcomes because it doesn’t matter if you look at quality, safety, or cost. Roughly about 80% of outcome, quality, safety, and cost outcomes are driven by physician decisions. And so, when we go into the era of value-­‐
based reimbursement, it’s going to require people at the center of that that really understand the process of care, and in healthcare, that’s largely physicians and nurses. And so, I’m not surprised actually, the health (56:57) a whole addition three or four months ago focused on ACOs in the future and I was kind of surprised when I saw that of the existing ACOs, 50% are led by physicians and 34% of the rest are co-­‐led by physicians and an operational leader. What surprised me was the numbers, not the trend. I felt all along that as we move into value, we’re going to see more clinicians step into leadership roles because they understand the process of care. But I was surprised that the number had already During the slide discussing healthcare costs, a key element could be added to the waste category or not value-­‐added category government regulatory support. And government and commercial payer support functions all add to the infrastructure required to provide care today, then comes additional costs associated with affecting change at the delivery of care level. Your comments? gotten to 50%, that’s pretty phenomenal. So I see a very bright future for clinician leadership in this space for physicians and nurses and it’s going to be very very important in the value-­‐based era. I completely agree. I touched that slide that said the clinicians need to get engaged and play a much more prominent leadership role than they’re currently doing and it would be a major mistake for us to not do that and by default to have bureaucrats and regulators write the rules. Bureaucrats and regulators I’m sure are well-­‐meaning but they don’t understand the complex environment we live and work at. They don’t understand the process of care and it’s very easy for them to write regulations that actually attribute to waste that drive up costs and we see many examples of that. But I guess I would turn it around and say it’s a very strong reason why clinicians and healthcare operational leaders need to get into this game and join these pioneers that we talked about today to show that there’s a better way, because if we do not do that, we’re going to have more misguided attempts by federal and state governments to try to do it for us. So I agree with you. [Tyler Morgan] Alright. Well, we reached our time today. If we haven’t been able to address your question at this time, we will respond to all questions asked and we thank you so much for your time. Before we close this webinar, we do have one final poll question. Our webinars are meant to be educational about various aspects affecting our industry, particularly from a data warehousing analytics perspective. We have had many requests, however, for more information about what Health Catalyst does and what our products are. If you are interested in the Health Catalyst introductory demo, please take the time to respond to this last poll question. I will remind everyone that actually after this webinar, you will receive an email with links to the recording of this webinar, the presentation slides, and the poll question results. Also, there were several questions about Dr. Haughom’s ebook. We will provide a link to the ebook within the presentation slide that we’ll provide to you. Also, please look forward to the transcript notification we will send you once the transcript is ready. On behalf of Dr. Haughom, as well as the folks at Health Catalyst, thank you for joining us today. This webinar is now concluded. [END OF TRANSCRIPT]