Implementation Network Webinar
April 25, 2014
Welcome!
This is our first "Implementation Network Webinar"
Objectives for today
▪ Present why we believe in Outcomes Measurement
▪ Share our perspective on the "Implementation Journey"
▪ Present support offered by ICHOM: the "Implementation Network"
Free
Implementation-Network-Presentation.pptx
For organizations actively implementing our Standard Sets
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
1
Who is presenting today
Dr. Jens Deerberg
Mrs. Lisa van Maasakkers
Mr. Jean Stoefs
President of ICHOM
Faculty Member of Harvard
Business School
Project Leader at ICHOM
ICHOM Vice-President of
Implementation
Background
▪ Medical Doctor
▪ COO of a large private
hospitals chain in Europe
Background
▪ Expert in Outcomes
Measurement
▪ Head of Quality of a leading
European Hospitals chain
Background
▪ Master in Business
▪ Consultant specialized in
Value-Based Health Care
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
2
Many participants from all over the world today!
228 participants from 28 countries
This Webinar is recorded for the ones
in less convenient time zones
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
3
Agenda
The case for outcomes measurement: 20 minutes
(Jens Deerberg-Wittram, President, ICHOM)
What the implementation journey looks like: 30 minutes
(Lisa van Maasakkers, Project Leader, ICHOM)
How to join the Implementation Network: 10 minutes
(Jean Stoefs, VP Implementation, ICHOM)
Questions and answers
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
4
Variation in health outcomes is an international problem
2x
variation in 30-day mortality rate from heart attack in US
4x
variation in bypass surgery mortality in the UK
9x
variation in complication rates from radical prostatectomies in the Netherlands
18x
variation in reoperation rates after hip surgery in Germany
20x
variation in mortality after colon cancer surgery in Sweden
36x
variation in capsule complications after cataract surgery in Sweden
Variations in health outcomes can be found in care teams, within institutions, nationally, internationally…
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
5
Localized prostate cancer – what is the right therapy?
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
6
Mortality rates alone are not the answer
Death from prostate
cancer
Death probably or definitely due to prostate cancer or prostate cancer treatment
Source: Wilt et al., N Engl J Med 367;3 2012
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
7
Florence Nightingale –
one of the first women studying mathematics and statistics
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
8
“If the function of a hospital were to kill the sick, statistical
comparisons of this nature would be admissible..”
Florence Nightingale, 1863
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
9
Outcomes are the 'real world' experience of patients
Example prostate cancer
Patient
initial
conditions
Protocols/
guidelines
e.g., Staff certification,
facilities standards
PSA
Gleason Score
Surgical margin
(…)
Survival
Complications
Quality of life
Continence
Erectile function
Anxiety
Implementation-Network-Presentation.pptx
Structure
Processes
Patient
experience/
engagement
Indicators
(Health)
outcomes
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
10
Patient-reported outcomes one year after prostatectomy average German and Swedish hospitals*
Ø
Ø
80,0 %
75,5 %
Ø
Ø
56,7 %
50,0 %
Ø
Ø
10,0 %
4,5 %
1 yr full continence
1yr severe erectile dysfunction 1yr severe urinary incontinence
*Swedish data rough estimates from graphs
Source: National quality report for the year of diagnosis 2012 from the National Prostate Cancer Register (NPCR) Sweden, BARMER GEK Report Krankenhaus 2012, Patient-reported
outcomes (EORTC-PSM), 1 year after treatment, 2010
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
11
Martini Klinik, nine consultants focusing on outcome
improvement in prostate cancer
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
12
Martini Klinik Hamburg is openly discussing detailed outcome
data in regular quality reviews and achieve excellent results
Martini
Klinik
Ø
93,5 %
Ø
80,0 %
75,5 %
Ø
Ø
56,7 %
50,0 %
Martini
Klinik
34,7 %
Ø
Martini
Klinik
0,4 %
1 yr full continence
Ø
10,0 %
4,5 %
1yr severe erectile dysfunction 1yr severe urinary incontinence
Swedish data rough estimates from graphs
Source: National quality report for the year of diagnosis 2012 from the National Prostate Cancer Register (NPCR) Sweden, Martini Klinik, BARMER GEK Report Krankenhaus 2012,
Patient-reported outcomes (EORTC-PSM), 1 year after treatment, 2010
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
13
Aravind Clinic created web portal for physicians to review their
just in time outcome data
Web portal evolved from Excel-based reports, as physicians required
more user-friendly tools
Source: Aravind Eye Care Hospitals Cataract Surgery Outcome Monitoring training document illustrative report view
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
14
Memorial Sloan Kettering Cancer Center is running a surgeons'
performance feedback system
Screen shot from the Memorial Sloane Kettering Cancer Center surgeon performance feedback system:
The proportion of a surgeon’s patients who are recurrence free at two years on the x axis is graphed against the
proportion of patients both potent and continent at two years (y axis). Both estimates are adjusted for case mix.
Source: Vickers et al., Eur Urol. 2012 February ; 61(2): 284–289
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
15
ICHOM is dedicated to accelerating the development and
impact of outcomes measurement at a Global level
Our mission
How we achieve it
1
We develop Standard Sets of Outcomes
2
We enable organizations to implement them and
measure outcomes
2
We facilitate Global Comparisons (as of 2015)
Our Mission
We are transforming health care by empowering
clinicians worldwide to measure and compare
their patients’ outcomes and to learn from each
other how to improve.
Patient health outcomes achieved
Value =
Cost of delivering those outcomes
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
16
Agenda
The case for outcomes measurement: 20 minutes
(Jens Deerberg-Wittram, President, ICHOM)
What the implementation journey looks like: 30 minutes
(Lisa van Maasakkers, Project Leader, ICHOM)
How to join the Implementation Network: 10 minutes
(Jean Stoefs, VP Implementation, ICHOM)
Questions and answers
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
17
There are four key stages in the implementation journey
How to transform a Standard Set in a tool to drive change
Convince and create
buy-in
Convince your
board/management
Obtain support from
your staff
Get ready
Set up governance
and project team
Assess your starting
point
Measure
Use tools to capture
data
Ensure quality of data
Analyze data
Identify "Evangelists"
Drive change
Report data
Learn from your data
to identify and
disseminate best
practices
Assess the business
case for outcomes
measurement in your
organization
ICHOM can assist you in every stage of the journey
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
18
Convince and
create buy-in
Get ready
Measure
Drive change
Measuring outcomes requires the buy-in of both the top
management and the teams on the field
What will resonate with them
Decision on
Measuring
Outcomes from
the Management
Define with teams
(physicians,
nurses, admin)
what and how to
measure
Implementation-Network-Presentation.pptx
▪ Increasing quality typically
reduces costs
▪ Proving superior outcomes
attracts more patients
▪ Measuring outcomes allows to
actively manage staff
▪ Introducing new pricing models
▪
▪
▪
▪
Be proud of your results
Care even better your patients
Identify what to improve
Measure impact of decisions and
improvements
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
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Convince and
create buy-in
Get ready
Measure
Drive change
Set up governance and project structure
The "ideal team" you need...
A Steering Committee
▪ Physician leader
▪ Nurse leader
▪ Senior administrator
▪ Senior representative from IT
... ready for a one-year journey
They will dedicate a few hours a week to drive
Outcomes Measurement
A team on the field to drive effort
▪ One Junior doctor, passionate
▪ One nurse
▪ One admin staff
▪ Analyst (preferably from IT)
▪ Support from a central team (e.g. quality team)
It's key to have people from the field involved
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
20
Convince and
create buy-in
Get ready
Measure
Drive change
Assess your starting point
Gap analysis will inform the effort
What is already measured?
Outcomes domains
(e.g. for Localized Prostate Cancer)
How to measure what's missing?
Measured
Paper-based
questionnaires
Major surgical complications
Major Radiation complications
Urinary incontinence
Other
definition
Urinary frequency/urgency/ irritation
Bowel irritation
Sexual dysfunction
Vitality
Other
definition
Other
definition
Standalone IT
solutions
Biochemical recurrence
Metastasis
Solutions integrated
with your EMR/EHR
Cause-specific survival
Overall survival
Patient baseline (age, co-morbidities,...)
What is the effort to measure ICHOM
recommended Standard Set?
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
21
Convince and
create buy-in
Get ready
Measure
Drive change
Build the business case: how much does it cost ?
Key sources of costs
▪ Financial resources: investments in an IT
tool, in equipment (e.g. scanner,...),...
▪ People: How many people will you need to
set-up and run outcomes measurement?
▪ IT resources: dedicated software, data
warehouse,...
▪ Time investments from key staff:
Physicians, nurses and admin staff to collect
outcomes and analyze them
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
22
Convince and
create buy-in
Get ready
Measure
Drive change
When you go-live, the journey is not over... storage and quality
of data must remain two key concerns
Capture data
Store them in a database
Define your data capture plan
Several options depending on context
Local database
(e.g. MS Access)
Electronic Medical
Records
Hospital
Data warehouse
Ensure Quality
Results can be quickly disqualified if teams are
not convinced by the quality of data
▪ Regular touch point with key staff (physicians,
nurses) to validate findings
▪ Continuous improvement process in place to fix
"bugs"
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
23
Convince and
create buy-in
Get ready
Measure
Drive change
Learn from your data to drive change and unlock the power of
value-based health care
Transparent
outcomes data
reporting
Discuss data at
different levels
▪ Between
physicians
▪ Between
sites/hospitals
Take actions
Continuous
feedback
& learning
Increased health care value
Drive adoption
of changes
Improved
Outcomes
+
Reduced
Variation
Reduced Medical Cost
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
24
Agenda
The case for outcomes measurement: 20 minutes
(Jens Deerberg-Wittram, President, ICHOM)
What the implementation journey looks like: 30 minutes
(Lisa van Maasakkers, Project Leader, ICHOM)
How to join the Implementation Network: 10 minutes
(Jean Stoefs, VP Implementation, ICHOM)
Questions and answers
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
25
Implementing Outcomes Measurement is not straightforward
ICHOM can assist you with 3 different levels of support
Download our
"Reference Guides"
Clear and unambiguous
definitions to implement our
Standard Sets
Join the
Implementation Network
Resources to help you get
started
Community to connect with
your peers and ask questions
Regular Webinars to share
content and discuss your issues
Get on-site support
Our ICHOM team provides onsite support to select partners
▪ E.g. 4-weeks diagnostic,
seminars,...
This is only offered to selected
ICHOM Sponsors
Official recognition of your
efforts
Free on our website
Implementation-Network-Presentation.pptx
$500 per Medical Condition
(launch price)
Contact us
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
26
We will host regular Webinars to accompany you through your
implementation journey - one year to measure outcomes!
Our objective:
Whatever your starting point, you will be able to measure our full Standard Set within a year
We will accompany you in this journey!
Date1
Key topics for the call
Convince &
Create Buy-in
Get Ready
Measure
&
Drive Change
▪ Objectives of the Implementation Network, calls agenda and your expectations
▪ What is the case for outcomes measurement?
▪ What the Implementation journey will look like
Today
▪ How to assess the resources I will need? (financials, team,...)
▪ What is the best strategy to get started? (small vs. big)
Early June
▪ What are the legal requirements I should consider (patient consent, data
collection,...) ? What are my obligations?
August '14
▪ What are the tools available to help me measuring outcomes?
▪ Should I outsource parts of the process?
September '14
▪ How to store the data collected? What are the best practices?
▪ How to risk adjust? How to ensure validity and accuracy?
November '14
▪ How to analyze my data and make sense of it?
▪ How to report data in an appealing way? What does a typical report look like?
January '15
▪ How to report it back to the clinicians?
▪ What does the typical feedback process look like? (data validation,...)
February '15
▪ How to learn from our findings and drive change that lasts?
March '15
▪ Wrap-up
April '15
All resources will be
available online on our
Implementation Network
website so that you can
progress at your own
pace
Dates and exact agenda will be refined and confirmed to the Implementation Network members. Agenda might evolve based on Participants needs
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
27
How to join us?
www.ICHOM.org
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
28
Agenda
The case for outcomes measurement: 20 minutes
(Jens Deerberg-Wittram, President, ICHOM)
What the implementation journey looks like: 30 minutes
(Lisa van Maasakkers, Project Leader, ICHOM)
How to join the Implementation Network: 10 minutes
(Jean Stoefs, VP Implementation, ICHOM)
Questions and answers
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
29
Any questions?
Thanks for joining today!
Send your remarks or questions to
Implement@ichom.org
Implementation-Network-Presentation.pptx
Copyright © 2014 by the International Consortium for Health Outcomes Measurement. All rights reserved.
30