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.

The Never-Ending Burden of Reporting Patient Safety & Quality Metrics

Quick: how long does it take you to collect, aggregate, and report your SCIP, PN, AMI, and HF Core Measures? How about infection control metrics like rates of CLABSI, VAP, UTI, and MRSA? Or for that matter, any patient safety and quality metric that is mandated by JCAHO, CMS, your Department of Health, or anyone else? If you answered anything less than 2 months, and if I was a betting man, I’d bet you were lying.

There is a never-ending burden strapped to the backs of hospitals to collect, aggregate, analyze, validate, re-analyze, re-validate, report, re-validate, report again….quality measures. Reporting of these quality metrics is meant to benchmark institutions across the industry on their level of care, and inform patients of their treatment options. Fortunately for the majority of institutions, it is not difficult to achieve a high rate of compliance (>80-90%) because clinicians genuinely want to provide the best standards of care. Unfortunately though, the standards for achieving the highest designation according to CMS guidelines (achieving top percentile >99%) requires hospitals to allocate a disproportionate amount of time, money, and people to increase very small increments of compliance. I sat with a SCIP Nurse Abstractor last week and we spent 90 minutes drawing out, on 2 consecutive white boards, the entire process from start to finish of reporting SCIP core measures. There are over 50 steps, 5 spreadsheets/files, 4 hand-offs, 3 committees, and a partridge in a pear tree. It takes 2.5 months. I wonder how much money that is if you were to translate that time and effort into hard money spent? I also wonder what the return on investment is for that time, effort, and money. If we’re going to start running healthcare like a business, which I argue we should, this seems like a great place to start.

STEP 1: Reduce the amount of time spent on this process by ensuring the data is trustworthy There are way too many “validation” steps. Most people do not trust the data they’re given, and therefore end up re-validating according to their own unique way of massaging the data.

STEP 2: Integrate data from multiple sources so your Quality Abstractors and Analysts aren’t searching in 10 different places for the information they need. I’m currently helping a client implement interfaces for surgery, general lab, microbiology, blood bank, and pharmacy into their quality reporting system so their analysts can find all the information they need to report infection rates, core measures, and patient safety metrics. In addition, we built a Business Objects universe on top of the quality data store and they can do dynamic reporting in near real time. The amount of time saved is amazing and we have been successful in dramatically shifting the type of work these people are responsible for. The BI Capability Maturity Model below depicts our success helping them move from left to right.

STEP 3: Empower your analysts. With much more time to actually analyze the information, these people are the best candidates to help find errors in the data, delays in the process, and opportunities for improvement.

STEP 4: Create a mechanism for feedback based on the information you uncover. Both overachievers and underperformers alike need to be recognized for the appropriate reasons. Standardize on the best of what you find, and be sure to localize your intervention where the data is inaccurate or the process breaks down. This will also demonstrate greater transparency on your part.

Healthcare Analytics – A Proven Return on Investment: So What’s Taking So Long?

So what do you get when you keep all your billing data in one place, your OR management data in another, materials management in another, outcomes and quality in another, and time and labor in yet another? The answer is…………..over 90% of the operating rooms in America!

That’s right; the significant majority of operating rooms DO NOT have an integrated data infrastructure. In the simplest terms, that means that the average OR Director/Administrator CAN’T give answers to questions like, “of all orthopedic surgeons performing surgery within your organization (single or multi-facility), what surgeon performs total knee replacements with the lowest case duration, least number of staff, lowest rate of complication, infection, and re-admission rate at the lowest material and implant cost with the highest rate of reimbursement?” In other words, they can’t tell you who their highest quality, most profitable, least risky, least costly, best performing surgeon is in their highest revenue surgical specialty. Yes, I’m telling you that they can’t distinguish the good from the bad, the ugly from the, well, uglier, and the 2.5 star from the 5 star. Are you still wondering why there is such a strong push for transparency of healthcare data to the average consumer?

You’re sitting there asking yourself, “Why can’t they answer questions like whose the least costly, most profitable and highest quality surgeon?” and the answer is simple, “application-oriented analysis”. Hospitals have yet to realize the benefits of healthcare analytics. That is, the ability to analyze information that comes from multiple sources in one location, instead of trying to coordinate each individual system analyst and have them hand their spreadsheet off to the other analyst that then adds in her data and massages it just right to hand it off to the next guy, and then….ugh you get the point. If vendors like McKesson, Cerner, and Epic could make revenue off of sharing data and “playing well with others” they would, but right now they don’t. They make their money off of deploying their own individual solutions that may or may not integrate well with other applications like imaging, labs, pharmacy, electronic documentation, etc. They will all tell you that their systems integrate, but only once you’ve signed their contract and read that most of the time, it requires their own expertise to build interfaces, so you’ll need to pay for one of their consultants to come do that for you – just ask anyone who has McKesson Nursing Documentation how long it takes to upgrade the system or how easy it is to integrate with their OR Management system so floor nurses can have the data they need on their computer screen when the patient arrives directly from surgery. Out of the box integrated functionality/capability? Easy-to-read, well documented interface specifications that a DBA or programmer could script to? Apple plug-n-play convenience? Not now, not in healthcare.

Don’t get too upset though, there are plenty of opportunities to fix this broken system. First, understand that organizations such as Edgewater Technology have built ways to integrate data from multiple systems and guess what – we integrated 5 OR systems in a 7 hospital system and they saved $5M within the first 12 months of using the solution, realizing a ROI 4 times their original cost.  Can it be done? We proved it can. So what is taking so long for others to realize the same level of cost savings, quality improvement and operational efficiency? I don’t know, you tell me? But don’t give me the “it’s not on our list of top priorities this year” or the “patient satisfaction and quality mandates are consuming all our resources” or don’t forget the “we’re too busy with meaningful use” excuses. Why? Because all of these would be achievable objectives if you could first understand and make sense of the data you’re collecting outside the myopic lens you’ve been looking through for the past 30 years. Wake up! This isn’t rocket science, we’re trying to do now what Gordon Gekko and Wall Street bankers were doing in the 80’s – data warehousing, business intelligence, and whatever other flashy words you want to call it – plain and simple, it’s integrating data to make better sense of your business operations. And until we start running healthcare like it’s a business, we’re going to continue to sacrifice quality for volume. Are you still wondering why Medicare is broke?

How to heighten core measure compliance

How do you go from SCIP compliance that looks like this?

To SCIP Core Measure compliance that looks like this?

It all starts with the documentation in your OR! How are the nurses, surgeons, and anesthesiologists documenting the data and information they collect throughout the patient visit as he/she moves from Holding to Pre-Op to the OR to PACU? The most critical aspect of high core measure compliance, whether its SCIP in the OR or Pneumonia, AMI, and HF in the ED, is electronic, discrete data capture.

One of the biggest problems in healthcare is the free-text field available in most healthcare applications, also known in the data and IT worlds as the “catch-all bucket”. Whenever users can’t find the right location within an application to put the information they’re documenting, they by default chose a “memo” field, or “case note” or just free text area for any and everything that could be typed from a computer keyboard. The problem is, this information can’t be mined and reported automatically. So what happens, nurses and other medical record professionals are paid to simply do chart abstraction which is a more professional way of saying “paper chasing”. The last 3 hospitals I consulted with paid nurses with 25+ years experience and a deep domain knowledge of core measure compliance over $70k / year to chase paper and make sense of free-text documentation. What a waste of expertise, skills and money. Wouldn’t these same resources be infinitely more valuable finding ways to improve the dips in core measure compliance instead of spending the significant majority of their time just chasing down the 10-12 different places SCIP data can end up (case notes, discharge summary, case record, op notes,  paper chart, order sets, etc.)?

First Steps Towards Higher Core Measure Compliance

So now we know the main problem, what steps can you take to change the nature of clinical documentation to naturally improve your ability to report SCIP compliance and heighten your performance?

  1. Make sure your end users know, “the [OR] applications are as good as they help make them”. No one should be locked into user interfaces, drop down fields, and data points that can’t be changed to accommodate clinical workflows. If you can’t change now, wait until the next upgrade or version release, collect the nursing feedback and address changes later on. And if your vendor rep says there’s nothing he/she can do, slap them! These are CMS mandated measures and the systems need to help in raising compliance in every way they can.
  2. Build values that CMS mandates directly into the documentation – make being compliant a default behavior. If CMS says that for SCIP-3 the only acceptable reasons for continuing an antibiotic past 24 hours are: “Infection”, “Possible Infection”, or “Documented spillage of fecal contents during abdominal surgery” then make those values options in your drop down menu. Don’t make it easy for users to be non-compliant.
  3. Create communication standards for feedback and accountability: OR Directors and Nursing Managers must have a consistent way for communicating breakdowns in compliance. This makes a strong case for Data Governance; there must be a way for you to have conversations with your clinicians that may not be easy or popular, but must be done nonetheless. No surgeon wants to be told he/she has done something wrong, it hurts their ego’s…but as my mother once told me, “you don’t always get what you want”.
  4. Equate high core measure compliance with benefits that relate directly to clinicians top priorities – Patient Care, Patient Satisfaction, Reputation, and Financial Incentives (in that order). The diagram below depicts the tremendous benefits realized when an institution can achieve high compliance consistently over time.

Unfortunately for you, these first steps are the easiest in any organizations quest towards higher core measure compliance or a move towards electronic documentation in general. I promise, there will be frustration before there is elation. Lucky for you, Edgewater has done this plenty of times with a high degree of success with healthcare providers of all shapes and sizes because we know the proper way in which to achieve these goals. So, when you’re ready, give us a call and we can help get you started or move you on to the next step because I promise, it’s much easier than it looks.