E. Kolker, PhD, Chief Data Officer, Seattle Children’s (Hospital-Research Institute-Foundation)
We all agree that it’s time to make fundamental transformations in the delivery, cost effectiveness, and quality of healthcare. No one is immune. In fact, there are so many areas of concern that it’s difficult for even the most experienced healthcare systems to know where to begin. Healthcare’s Triple Aim—improving patient care, including outcomes and satisfaction; reducing the per capita cost of healthcare; and improving the health of the general population—is achievable, but the question so often asked is: How? The answer: Apply data and analytics to enable decisions and actions based not only on expertise, intuition, and gut feeling, but also data. This will ensure that we effectively measure, benchmark, and transform healthcare for our patients, families, providers, and payers.
One place to begin is with an analysis of the current status of healthcare through clinical outcome metrics and benchmarking. Clinical outcome metrics quantify our top priority, patient care, in a way that allows for examination and improvement. The widespread adoption of EHRs, however bumpy the process has been, makes the data needed for such metrics available. Benchmarking requires additional information—a standardized set of data across hospitals, systems, and networks that when aggregated enables comparisons both within and between the participating groups. Integrating this information with organizational knowledge and insight enables the development of specific recommendations and effective strategies to improve and innovate, healthcare systems.
The majority of healthcare enterprises participate in one of the most popular performance benchmarks in the United States—U.S. News and World Report (USNWR). Not without its limitations, USNWR surveys rank hospitals as well as individual specialties (service lines) every year. Annually, USNWR readjusts the metrics, scores, and categories to improve both the general methodology and quality of the results.
The data your system already collected for this annual survey are very valuable and can be reused! The Data and Analytics Team of Seattle Children’s developed the methodology on how to do exactly that and has employed it for several years. These data can reveal significant insights into structural, process, and clinical outcomes of both your own healthcare system overall and its service lines specifically. No additional data collection time or effort is needed.
An example of this methodology in action is the work being done at Seattle Children’s (SC), an organization that consistently ranks among the best pediatric hospitals in the annual USNWR rankings. The leadership team was interested in determining how to leverage the USNWR surveys to develop more effective hospital benchmarks for improving care. With the collaboration of CMOs (former, David Fisher and current, Mark Del Beccaro) and CIOs (former, Wes Wright and current Jeff Brown), my Data and Analytics team and I were charged with creating a program to utilize the USNWR metrics, including outcomes, to benchmark and improve care, safety, and delivery for our patients and families.
A wide range of departmental performance metrics were analyzed, including clinical practices, structural and process metrics, survival rates, surgical outcomes, and subspecialist quality. The whole process is described in our recent article published in the Big Data journal. The analysis found, for example, that SCH does quite well in the categories of quality improvement, patient and family services, and specialized clinics and programs. In addition, the analysis identified the need to decrease ICU infection rates, a key opportunity to achieve the Triple Aim goal of improving patient care. As a result, SC incorporated a program for reducing the ICU infection rate into its strategic planning, and the rate has decreased dramatically. On June 9th, 2015 we learned that SC came back to the Honor roll of USWNR Best Children’s Hospitals and was ranked 6th in 2015 (improvement of over 20 ranks from the last year.)
This data-driven approach can be implemented by your healthcare organization to prioritize improvements within each service line, or for cross-departmental work such as readmissions, surgical complications and survivals. Priority can be given to service lines based on the goals of the enterprise. Depending on your available resources, you may focus on multiple service lines that need only small improvements to meet goals, or you can focus on the one service line with the greatest need.
Just as these data and outcome metrics are being used to improve processes and patient care, so too can they be used to develop Triple Aim metrics. Triple Aim metrics align performance and outcome metrics, along with financial and population health metrics, to support Triple Aim goals. Data can come from within the healthcare system (EHRs, personalized medicine recommendations, claims, and financial sources) and externally (government healthcare data, mobile health, patient experience feedback, and social media). This broader approach enables a 360-view of the complex problems that we are daily faced with in healthcare. Through developing of data stories, the Data and Analytics team reduces such complexity to a much smaller, more manageable number of alternative solutions to consider. In turn, it provides our executive leadership and key stakeholders with actionable insights for data-driven decisions on an enterprise-wide level.
Using data and analytics to drive organizational decisions is relatively new to healthcare. Effectively incorporating the data into day-to-day processes requires vision, strategy, and persistence. Leveraging data effectively is as much about people as it is about data. We all want the best patient care possible, for the lowest cost, and for the greatest good. We will be able to make the needed fundamental transformations in the delivery, cost effectiveness, and quality of healthcare, if we are ready to use the power of data.