ACO Disease Specific Analytics

“What can Edgewater’s Accountable Care Analytics do for me that we cannot already do with our EHR and patient financials reporting?”

To be successful, ACOs and other integrated health systems must bring together both clinical and claims data – and they must make the data available for use by clinical, operational and financial leadership across the entire organization.  The biggest challenge our clients face is an ability to provide management this data now, to drive early operational decisions. This is what Edgewater’s Accountable Care Analytics can do – provide organization-wide dashboards for decision support in advance of the complex and time consuming integration projects these health systems face.

This podcast shows a quick demonstration of the capabilities our ACA application.

Edgewater Healthcare Analytics

I recently read an article called “The 4 Biggest Obstacles ACOs Face” on that I found really interesting. In it, the author identifies what I think are the primary challenges for Accountable Care Organizations (ACO). But, I would change the order.

ACOs need a management structure in place to make critical operational decisions. But those decisions should be made leveraging enterprise wide data. So, the primary challenge for ACOs — Providing management with accurate, actionable data to make management decisions, before all of the technical integration challenges have been addressed.

To learn more about Edgewater’s Accountable Care Analytics application, and how it can help you get meaningful data to ACO decision makers, email us.

Epic Clarity Is Not a Data Warehouse

It’s not even the reporting tool for which your clinicians have been asking!

I have attended between four and eight patient safety and quality healthcare conferences a year for the past five years. Personally, I enjoy the opportunities to learn from what others are doing in the space. My expertise lies at the intersection of quality and technology; therefore, it’s what I’m eager to discuss at these events. I am most interested in understanding how health systems are addressing the burgeoning financial burden of reporting more (both internal and external compliance and regulatory mandates) with less (from tightening budgets and, quite honestly, allocating resources to the wrong places for the wrong reasons).

Let me be frank: there is job security in health care analysts, “report writers,” and decision support staff. They continue to plug away at reports, churn out dated spreadsheets, and present static, stale data without context or much value to the decision makers they serve. In my opinion, patient safety and quality departments are the worst culprits of this waste and inefficiency.

When I walk around these conferences and ask people, “How are you reporting your quality measures across the litany of applications, vendors, and care settings at your institution?,” you want to know the most frequent answer I get? “Oh, we have Epic (Clarity)”, “Oh, we have McKesson (HBI),” or “Oh, we have a decision support staff that does that”. I literally have to hold back a combination of emotions – amusement (because I’m so frustrated) and frustration (because all I can do is laugh). I’ll poke holes in just one example: If you have Epic and use Clarity to report here is what you have to look forward to straight from the mouth of a former Epic technical consultant:

It is impossible to use Epic “out of the box” because the tables in Clarity must be joined together to present meaningful data. That may mean (probably will mean) a significant runtime burden because of the processing required. Unless you defer this burden to an overnight process (ETL) the end users will experience significant wait times as their report proceeds to execute these joins. Further, they will wait every time the report runs. Bear in mind that this applies to all of the reports that Epic provides. All of them are based directly on Clarity. Clarity is not a data warehouse. It is merely a relational version of the Chronicles data structures, and as such, is tied closely to the Chronicles architecture rather than a reporting structure. Report customers require de-normalized data marts for simplicity, and you need star schema behind them for performance and code re-use.”

You can’t pretend something is what it isn’t.

Translation that healthcare people will understand: Clarity only reports data in Epic. Clarity is not the best solution for providing users with fast query and report responses. There are better solutions (data marts) that provide faster reporting and allow for integration across systems. Patient safety and quality people know that you need to get data out of more than just your EMR to report quality measures. So why do so many of you think an EMR reporting tool is your answer?

There is a growing sense of urgency at the highest levels in large health systems to start holding quality departments accountable for the operational dollars they continue to waste on non-value added data crunching, report creation, and spreadsheets. Don’t believe me? Ask yourself, “Does my quality team spend more time collecting data and creating reports/spreadsheets or interacting with the organization to improve quality and, consequently, the data?”

Be honest with yourself. The ratio, at best, is 70% of an FTE is collection, 30% is analysis and action. So – get your people out of the basement, out from behind their computer screens, and put them to work. And by work, I mean acting on data and improving quality, not just reporting it.

Please Stop Telling Everyone You Have an Enterprise Data Warehouse – Because You Don’t

One of the biggest misconceptions amongst business and clinical leaders in healthcare is the notion that most organizations have an enterprise data warehouse. Let me be the bearer of bad news – they don’t, which means you also may not. There are very few organizations that actually have a true enterprise data warehouse; that is, a place where all of their data is integrated and modeled for analysis, from source systems across the organization independent of care settings, technology platform, how it’s collected, or how it’s used.  Some organizations have data warehouses, but these are often limited to the vendor source system they’re sitting on and the data within the vendor application (i.e., McKesson’s HBI and Epic’s Clarity). This means that you are warehousing data from only one source and thus only analyzing and making decisions from one piece of a big puzzle. I’d also bet that the data you’ve started integrating is financial and maybe operational. I understand, save the hard stuff (quality and clinical data) for last.

This misconception is not limited to a single group in healthcare. I’ve heard this from OR Managers, Patient Safety & Quality staff, Service Line Directors, physicians, nurses, and executives.

You say, “Yes we have a data warehouse”…

I say, “Tell me some of the benefits” and “what is your ROI in this technology?”

So, what is it? Can you provide quantitative evidence of the benefits you’ve realized from your investment and use of your “data warehouse”?  If you’re struggling, consider this:

  • When you ask for a performance metric, say Length of Stay (LOS), do you get the same results every time you ask independent of where your supporting data came from or who you asked?
  • Do you have to ask for pieces of information from disparate places or “data handlers” in order to answer your questions? A report from an analyst; a spreadsheet from a source system SME, a tweak here and a tweak there and Voila! A number whose calculation you can’t easily recreate, that changes over time, and requires proprietary knowledge from the report writer to produce.
  • What is the loss in your productivity, as a manager or decision maker, in getting access to this data? More importantly, how much time do you have left to actually analyze, understand and act on the data once you’ve received it?
  • Can you quickly and easily track, measure and report all patient data throughout the continuum of care? Clinical, quality, financial, and operational? Third-party collected (i.e., HCAHPS Patient Satisfaction)? Third-party calculated (i.e., CMS Core Measures)? Market share?

Aside from the loss in productivity and the manual, time-consuming process of piecing together data from disparate places and sources, a true enterprise data warehouse is a single version of the truth. Independent of the number of new applications and source systems you add, business rules you create, definitions you standardize, and analyses you perform, you will get the same answer every time. You can ask any question of an enterprise data warehouse. You don’t have to consider, “Wait, what source system will give me this data? And who knows how to get that data for me?”

In the event you do have an enterprise data warehouse, you should be seeing some of these benefits:

  1. Accurate and trusted, real–time, data-driven decision making
    • Savings: Allocate and deploy resources for localized intervention ensuring the most efficient use of scare resources based upon trusted information available.
  2. Consistent definition and understanding of data and measures reported across the organization
    • Savings: Less time and money spent resolving differences in how people report the same information from different source systems
  3. Strong master data – you have a single, consistent definition for a Patient, Provider, Location, Service Line, and Specialty.
    • Savings: less time resolving differences in patient and provider identifiers when measuring performance; elimination of duplicate or incomplete patient records
  4. A return on the money you spend in your operating budget for analysts and decision support
    • Savings: quantitative improvements from projects and initiatives targeted at clinical outcomes, cost reductions, lean process efficiencies, and others
    • Savings: less time collecting data, more time analyzing and improving processes, operations and outcomes
  5. More informed and evidence-based negotiations with surgeons, anesthesiologists, payers, vendors, and suppliers

In the end, you want an enterprise data warehouse that can accommodate the enterprise data pipeline from when data is captured, through its transformations, to its consumption. Can yours?

Why EMR’s Are Not Panacea’s for Healthcare’s Data Problems

So, you’ve decided to go with Epic or Centricity or Cerner for your organization’s EMR.

Think your EMR is Hamlin’s Wizard Oil?

Good, the first tough decision is out of the way. If you’re a medium to large size healthcare organization, you likely allocated a few million to a few hundred million dollars on your implementation over five to ten years. I will acknowledge that this is a significant investment, probably one of the largest in your organizations history (aside from a new expansion, but these implementations can easily surpass the cost of building a new hospital).  But I will argue: “Does that really mean the other initiatives you’ve been working should suddenly be put on hold, take a back seat, or even cease to exist?”Absolutely not. The significant majority of healthcare organizations (save a few top performers) are already years and almost a decade behind the rest of the world in adapting technology for improving the way the healthcare is delivered. How do I know this? Well, you tell me, “What other industry continues to publicly have 100,000 mistakes a year?” Okay, glad we now agree. So, are you really going to argue with me that being single-threaded, with a narrow focus on a new system implementation, is the only thing your organization can be committed to? If you’re answer is yes, I have some Cher cassette tapes, a transistor radio, a mullet, and some knee highs that should suit you well in your outdated mentality.

An EMR implementation is a game-changer. Every single one of your clinical workflows will be adjusted, electronic documentation will become the standard, and clinicians will be held accountable like never before for their interaction with the new system. Yes, it depends on what modules you buy – Surgery, IP, OP, scheduling, billing, and the list goes on. But for those of us in the data integration world, trying every day to convince healthcare leaders that turning data into information should be top of mind, this boils down to one basic principle – you have added yet another source of data to your already complex, disparate application landscape. Is it a larger data source than most? Yes. But does this mean you treat it any differently when considering its impact on the larger need for real time, accurate integrated enterprise data analysis? No. Very much no. Does it also mean that your people are suddenly ready to embrace this new technology and leverage all of its benefits? Probably not. Why? Because an EMR, contrary to popular belief, is not a panacea for the personal accountability and data problems in healthcare:

  • If you want to analyze any of the data from your EMR you still need to pull it into an enterprise data model with a solid master data foundation and structure to accommodate a lot more data than will just come from the system (how about materials management, imaging, research, quality, risk?)
    • And please don’t tell me your EMR is also your data warehouse because then you’re in much worse shape than I thought…
    • You’re not all of a sudden reporting real time. It will still take you way too long to produce those quality reports, service line dashboards, or <insert report name here>. Yes there is a real time feed available from the EMR back end database, but that doesn’t change the fact that there are still manual processes required for transforming some of this information, so a sound data quality and data governance strategy is critical BEFORE deploying such a huge, new system.

The list goes on. If you want to hear more, I’m armed to the teeth with examples of why an EMR implementation should be just that, a focused implementation. Yes it will require more resources, time and commitment, but don’t lose sight of the fact that there are plenty more things you needed to do with your data before the EMR came, and the same will be the case once your frenzied EMR-centric mentality is gone.

Thoughts on 2011 AHA Health Forum Leadership Summit: Coach K’s Five Challenges

The opening keynote address by Tom Brokaw was a motivational, inspiring start to the AHA Leadership Summit. Coach Mike Krzyzewski (Coach K) reluctantly spoke after Mr. Brokaw, his long-time friend and admittedly, “a tough act to follow.” Coach K spoke about what good leadership is and how it relates to those of us in healthcare. One of the most impactful lessons his mother ever taught him was told as a simple metaphor: “On the bus you drive through life, be sure to only let good people on…and if you’re trying to get on another bus, make sure there are only good people on that bus too.” It’s pretty straight forward – recruiting and scouting is everything. Just kidding….as he was, but it means a lot. The way you lead is reflective of the type of company you keep, and the ways in which people feel about your company and leadership.

In addition, Coach K emphasized the importance of a cohesive, collaborative healthcare environment. He leveraged a story Tom Brokaw told. Tom mentioned how during the Nixon Watergate scandal, the political environment was so divided, that before a Republican and Democrat came on his news show one day, they called ahead and wanted to be sure each other was not in the Green Room at the same time. How were these political leaders supposed to achieve anything if they literally couldn’t even stand in the same room as one another?! Coach K spoke about his emphasis on team-building exercises because every year he had new players to incorporate into their offensive and defensive schemes. The challenges, though, were similar. Players would come from backgrounds in different systems with unique styles, and the coaching staff had to find the right ways to make the collective team mesh. More importantly, he had to help his team win. Most importantly, he had to turn boys into men and prepare them for challenges bigger than a basketball court.

The challenges he posed to the audience were these:

  1. Communicate – “When you communicate, do you look your patient in the eye? Do you address them by their name and remember their kids sport? Their husbands name?”
  2. Trust – “Are the principles and practices of your office/hospital/clinic trustworthy? Are you honest and straightforward with your patients about your level of care? Compared to others? Is there full transparency to all the things you do?”
  3. Collective Responsibility – “When was the last time you/your people got hit? Something that knocked you back, knocked you down…and you really felt it? When something bad happens does everyone get together and help solve the problem? Or does a blame game start? You’re all in this together; you got into healthcare to help people. Make sure they know you’re a team.”
  4. Care for One Another – “Anger is a good emotion if it destroys something bad. Cancer is bad, diabetes is bad, and Alzheimer’s is bad. You should be angry at these diseases and, at the same time, empathetic with those struggling to survive with them. Always put yourself in the patients’ shoes before saying or doing anything” – healthcare must become more patient-centric, or as one comprehensive cancer center has tagged it, “personalized medicine”.
  5. Pride (in something bigger than yourself) – “You have to feel it (visualize it, hear it) in order to effectively address, resolve, and improve it.”

“You can want to win, but you must prepare to win”. Preparation starts with an understanding that healthcare has become a team sport –specialists and clinicians must leverage each other’s experiences and expertise to provide patients the best possible outcomes. And since this is my area of expertise – I can add, “it starts with sharing data!”

Will there be a greatest generation of healthcare?

I was fortunate enough to attend this year’s 2011 AHA Health Forum Leadership Summit in San Diego, CA and have a few thoughts I think are worth sharing. The keynote speaker lineup was unrivaled and from each came a call to action to the audience for one common thread – “find more opportunities to work together, than let excuses keep you divided.” Tom Brokaw, Coach Mike Krzyzewski (“Coach K”), Dr. Atul Gawande, Fareed Zakaria, and Amy Woodruff all graced the stage and had messages that seemingly united the crowd, if for just a short few days.
Tom Brokaw opened the conference with a simple thought: “When I wake up these days, I find myself asking, ‘Is this still the same America that was able to achieve so much coming out of World War II?’ From civil and women’s rights to mobilizing an entire country for not one but two world wars – I’m discouraged by the divide that seems to have permeated our society.” Mr. Brokaw wrote The Greatest Generation so his view may be slightly bias, but nonetheless, I couldn’t help but agree with him. It seems there are fewer opportunities for finding common ground. Too many people are so caught up in “sticking to their principles” that the benefits of compromise are often overlooked. It is no longer what is best for the country, rather what’s best for me or my party or my agenda or my industry…
Mr. Brokaw highlighted the opportunities for improving the healthcare industry starting with two fundamental principles: greater transparency and information sharing. He told a story of how he asked a room full of American company CEO’s one question that none of them knew the answer to, “how much did you spend on healthcare last year?” The industry must improve its ability to empower patients (consumers) with better access to cost information. In addition, the sharing of data across physician practices, acute care settings, and disparate business entities like health plans, physician groups, and hospital must enable a better coordination of care. Patients, especially the ones with chronic conditions, will never be able to properly manage their disease without these critical links. Unfortunately for those of us in the healthcare industry, we have an uphill climb.

Healthcare’s Conundrum: (IN)Decision by Committee – Good at Making Friends, NOT at Making Progress

I should start by mentioning the fact that I clearly hit a nerve on my last blog post about the huge cost “Decision by Committee” adds to the healthcare system. People agree with me, yet are hesitant about being as straightforward as I was….so be it.

Having said that, I should be straightforward about my next point – “decision by committee” impedes progress. If you know Moore’s law, or have seen the new Best Buy commercial about the “outdated world” (which I must admit is funny) you know that technology advances very quickly. Not just in retail or gaming and entertainment, but in almost every industry. Therefore, healthcare executives are inherently doing themselves a disservice by delaying their technology upgrade and new purchasing decisions. This problem isn’t restricted to just hardware and software either, but integration technology (SQL Server), business rules engines, data warehousing, knowledge management sites (SharePoint), patient relationship management applications (Microsoft CRM), patient portals, etc. By the time an organization identifies the need for new technology they have a short window to capitalize on the benefits without sacrificing some of the downsides of waiting to implement. Whether the driver is to achieve a competitive advantage, meet the demands of an evolving market place, comply with regulations, or satisfy individual stakeholders, they all would benefit from a faster implementation schedule. So why does everything take so long?

Everyone knows time is money. The problem is no one is cognizant of the opportunity cost associated with delayed and prolonged decision making. They think the money clock starts ticking once the project starts. What an outdated way of managing! The clock starts ticking as soon as you’re organization has agreed that the need exists and you need to find someone or something to meet it! This isn’t rocket science people.

“Progress” in the context of this blog is when healthcare finally starts to achieve the efficiencies from utilizing IT that retail, banking, and even life sciences did 20 years ago. The main point we should all agree on: “healthcare should be run like a business” and the last two blogs I’ve written speak directly to this. If for some reason you think this is a bad idea because “it takes away from the focus on the patient” then stop reading because I know you don’t work in healthcare or understand where the inefficiencies in the system lie and we shouldn’t be talking anyway.

Unfortunately, efficient and appropriate decision making is an important organizational component that is not characteristic of large committees in healthcare organizations.  There is typically a concern that too much risk may be made that could compromise patient care or safety.  However the opportunity lost with indecision may be as much or more costly.

Healthcare’s Conundrum: (IN)Decision by Committee – Good at Making Friends, NOT at Making Sense

As anyone in sales, or consulting, or technology, or materials management, or vendor hardware, or you name it will tell you, the healthcare industry has a ridiculously long sales cycle. It takes months and even years to get approval on even the most basic goods and services. Bedpans, paint colors, implants, EMRs, servers, everything! Why? Because everything (and I really mean everything) is decision by committee. Good for fostering relationships, getting everyone’s buy-in, and singing “Kumbaya”….Bad for business.

Recent headlines and national debates have centered on the “rising costs of healthcare” as the Baby Boomers start and continue to retire in record-breaking numbers. Yes there are ways to cut costs in almost every facet of healthcare. Why not start with the continuously rising cost of making decisions? The average American will never hear about this cost because they are not exposed to the inner-workings of the healthcare industry. But ask anyone who actually works in healthcare, and they’ll be the first to admit that it simply takes way too long to make decisions, at every level in the organization. Everyone in the industry is a culprit – IT, doctors, researchers, nurses, administration, finance, and of course let’s not forget procurement. Talk about the left hand not knowing what the right hand is doing. If I had a nickel for every time a business or IT executive told me to avoid procurement at all costs, well I’d be broke because I would’ve invested it in the stock market, but that’s another story. I would estimate that the time it takes, on average, to get signature on contracts in healthcare adds anywhere from 10% to 40% of an additional cost to the actual project. This is not chump change; this is hundreds of thousands of dollars!

So, why does this inefficient, ineffective process persist? Well for some it’s simply job security, but for the industry as a whole, I’m not sure. Why is it that healthcare provider’s pay executives, top managers, and other leaders tons of money only to limit their ability to lead? It is not difficult to identify the most qualified person in the room. Let him or her make the decision. Yes, supporting details are needed and blah blah blah…my point is this – it should not take 4 monthly steering committee meetings, 12 operational committee meetings, hundreds of back and forth emails and spreadsheets, and a few executive or board presentations sprinkled in to determine what should’ve been obvious within the first few days (maybe weeks depending on the complexity of the decision). If you can’t make a decision, find someone that will.  And then stop asking for more time, more “phone calls to discuss”, or a delayed start date. Why? – because it’s wasting your money and my time.

Healthcare’s New Mantra

Reduce Costs;
Improve Outcomes & Quality; Increase Revenue & Growth

Everything we do for our healthcare clients’ improves these fundamental core principles – Everything! I mean it, seriously, we have a history of delivering innovative solutions to common problems and each one of them helps accomplish these goals.

REDUCE COSTS: I know you have too many people collecting and scrubbing data – patient safety data, quality data, financial data, operational data….and so on. I also know you pay these people too much money to just be data collectors. Stop wasting your money and their skill sets. Data collection should be a commodity, it’s definitely NOT a competitive advantage. We’ll integrate your data, clean it up before it’s used, and present it in a way that is intuitive and actionable. We’ve done it before and guess what happened….yup $$$$ Millions $$$$$ of dollars saved.

IMPROVE OUTCOMES: I know you spend the majority of your time collecting data, leaving very little time to analyze and act on it. Your patients don’t benefit from data collection. They benefit from your ability to take the data you’ve collected, interpret it, and embed the best practices you’ve uncovered back into the clinical workflows. They also rely on you to identify areas of improvement to educate clinicians before a small problem turns into a big lawsuit. Let us enable advanced analytics with strong data governance to improve clinical processes across the continuum of patient care.

IMPROVE QUALITY: Question: Are you quality driven or compliance driven? Ok now be honest with yourself and answer again. You can have the best processes in the world in place to massage your numbers and report out to CMS in a timely and efficient manner but guess what, that doesn’t translate into better outcomes. BUT…if you have the processes in place to ensure high quality outcomes, your quality numbers will naturally improve. Outcomes first! We’ll align your data needs with your reporting needs, automate the collection and aggregation, and put data in the hands of people who know what to do with it…(before the patients are discharged).

INCREASE REVENUE: Do you know where your high revenue drivers lie? What procedures physicians, payers, discharge service codes, and DRG’s make you the most money? Can you plan and forecast your net patient revenue based on these changing dimensions and their expected volume 3, 6, 9 months out? If you can, congratulations you’re one step ahead of your competition. If you can’t, we can help you accomplish all of these goals as well as any other need your CFO and Strategic Planners have.

GROW: Do you want to track where you patient referrals are coming from to get a better ROI on your marketing dollars? We’ve implemented healthcare XRM (the “X” is for any stakeholder group – patients, physician groups, managed care plans, you name it) to tie the marketing campaign directly to the patient visit.