The Content System: Making the Best Medical Knowledge Standard Practice

© 2014 Health Catalystwww.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics


John L. Haughom, MD

September 2014

The Content System:Making the Best Knowledge Standard Practice

© 2014 Health Catalystwww.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics 2

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“American physicians are increasingly unhappy with their once-vaunted profession, and that malaise is bad for their patients”

Sandeep Jauhar, MD

It does not have to be this way…

…there is a better way.


Imagine for a moment…

Most up-to-date evidence

Focus on an individual patient’s needs and

desires

Minimize complexity

Drive out waste

Ignore the mundane

Efficient care

… where the right thing to do is the easy thing to do…


Knowledge Management

Why is it important?

• Facilitates decision-making

• Builds learning organizations by making learning routine part of clinical care• “To move ahead, one must look behind.”

• Stimulates cultural change and innovation


Deploymentsystem

Analyticsystem

Content system components

Define clinically driven

cohorts

Standardize delivery through shared baselines

Use evidence to identify and

eliminate waste


A Demonstration…

Discovery ApplicationsFoundational Applications Advanced Applications`

Population Suitese.g., Ischemic Heart Disease

Workflow / Operational Suitese.g., Acute Medical

Patient Injury Prevention Suites e.g., Infection Prevention

Patient Injury Prevention Modules

e.g., CAUTI, CLABSI, SSI

Workflow/Operational Modulese.g., ICU, MedSurg, Emergency

Population Modulese.g., CABG, Stent, AMI

Labor Management Explorer

Rev Cycle Explorer

Patient Satisfaction Explorer

General Ledger Explorer

Readmission Explorer

Population Explorer

Patient Flow Explorer

Practice Management Explorer Suite

Financial Management Explorer

CAFE—Comparative Analytics Framework and Exchange—across Healthcare Systems and National Benchmarks

EDIT—Executive Dashboard Integration Tool (Key Performance Indicator editable collage from all app categories)

Key Process Analysis (KPA)

Cohort Builder

Comorbidity Analyzer

Payment Model Analyzer

Readmission Predictor

Patient Flight Plan Predictor

ACO Explorer Suite

Metric Correlation Analyzer

Regulatory Explorer

Attribution Modeler


The Healing Profession

We put patients first● As clinicians, we place the patients’ health needs and well-being before any other

end; we act as the patients’ advocates; we accept, promote, and honor a fiduciary trust on behalf of patients.

We maintain a special body of knowledge● As clinicians: (1) we practice – we maintain, apply and transmit a special body of

knowledge not generally available outside of the profession. (2) We learn – we improve the knowledge we ourselves received; clinician scientists generate new medical knowledge as they practice medicine. (3) We teach – we transmit knowledge to each other, to patients and to the next generation.

We reserve to ourselves the right to evaluate our own quality

● Given the body of special knowledge that defines the medical profession, only clinicians are qualified to assess medical quality. We honor that obligation: we hold one another accountable for our behavior and for the outcomes we achieve on behalf of our patients.


The Practice of Medicine

Every clinician commits…

…to track the treatments they give to their patients…

…and the outcomes they achieve…

…with the aim to improve treatments and outcomes for future patients…

That is what it means to “practice” medicine


The craft of medicine is no longer tenable

Evidence our minds conclusion actions

• Inability to stay current• Professional interests• Fatigue • Personal distractions• Financial interests• Personal tastes• Desire to have something to offer• Love for the work• Wishful thinking• Selective memory• Pressure from patients & family• Legal considerations

Limited, complex Huge ranges of uncertainty Massive variation,inappropriate care

Eddy DM. Evidence-based Medicine: A Unified Approach, Health Affairs, 24(1):9-17


The Medical Profession is Changing

From craft-based practice• individual physicians, working alone

• handcraft a customized solution for each patient

• based on a core ethical commitment to the patient and

• vast personal knowledge gained from training and experience

To profession-based practice • groups of peers, treating similar patients in a shared setting

• plan coordinated care delivery processes (e.g., standing order sets)

• which individual clinicians adapt to specific patient needs


Protocols Can Improve Care

A multidisciplinary team of health professionals:

1. Select a high priority care process

2. Generate an evidence-based “best practice” guideline

3. Blend the guideline into the flow of clinical work● Staffing

● Training

● Supplies

● Physical layout

● Education resources

● Measurement/information flow

4. Use the guideline as a shared baseline, with clinicians free to vary based on individual patient needs

5. Measure, learn form, and (over time) eliminate variation arising from professionals; retain variation arising from patients


Two Ways to Manage Complexity

Subspecialize

• Analytic method; reductionism; ‘divide and conquer’

Mass customize • Using protocols and a shared baseline, focus on the

relatively small subset of factors that are unique for each individual patient concentrating your most important resource – the trained human mind – where it can have the greatest impact.


Why Use Practice Protocols?

Practice protocols help address clinical uncertainty

…based on best available evidence…

…allows clinicians to ignore the routine and focus on what is most important…


Limitations of Protocols

When abstract guidelines hit real patient care,

experience clearly shows that (with very rare exception)

No protocol fits every patient;

more important,

No protocol (perfectly) fits any patient.


Are Practice Protocols…

A case management system…

− or −

…a research system (for continuous learning,

to improve medical outcomes)


Why a Single Protocol?

A single, standard protocol for a given clinical process…

…improves patient safety…(multiple protocols for the same process add to complexity)

…produces a shared common baseline…

…and helps eliminate waste.


Why is a Shared Common Baseline Important?

To determine baseline performance…

…to determine whether a change is anImprovement…


Levels of Evidence

Level I:

Evidence from one or more RCTs

Level II-1: Evidence from controlled trials without

randomization

Level II-2: Evidence from cohort or case-control analytic studies

Level II-3: Evidence from multiple time series (observational studies)

Level III: Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert

committees (ideally using formal consensus methods)

Level IV: “Evidence” based on personal anecdote (“In my experience…”)

Shared common baselines


Protocols are about…

…making it easy to do it right…


Ordering waste Workflow waste Defect waste

Ordering tests, care, substances and

supplies that do not add value

Variation in efficiency of delivering tests, care

and procedures ordered

Patient injuries incurred in delivering tests, care and procedures ordered

21

Three forms of waste


22

Ordering waste — diagnostic tests

Was

tefu

l

Tests that are ordered and don’t help in diagnosis of those or those that are omitted that would aid

diagnosis

Con

trib

utor

yHelp confirm the diagnosis

Diagnosti

c

Aid the clinician in making care decisions


Was

tefu

l

Cardiac ventriculography to measure ejection fraction

Con

trib

utor

yTwo-view chest X-rayArterial blood gases

Diagnosti

c

Cardiac echo to measure ejection fraction

Brain natriuretic peptide (BNP)

Heart failure ordering waste example


Response to Change

Change is inevitable…

…adaptation is optional…

intentional

interesting

…fun

rewarding


Poll Questions

2. Does your organization have an effective system for managing knowledge and incorporating the latest evidence into the process and flow of care?

61 respondents

a. 5 – Definitely – 9%

b. 4 – 26%

c. 3 – 28%

d. 2 – 28%

e. 1 – Not at all – 9%


In Summary… • Effectively managing knowledge is important in healthcare.

• The first step in the process is to identify a clinically driven cohort for whom we want to improve care.

• Healthcare is moving toward a professional-based model of care delivery.

• Standard, evidence-based protocols help care providers deal with uncertainty and complexity.

• Protocols also allow the development of shared common baselines that help us assess our performance and improve over time.

• Standard, evidence-based protocols are also important in eliminating waste in any clinical or operational process.


Poll Question

3. Do clinicians in your organization routinely establish shared common baselines to assess their performance and from which to measure whether a change is an improvement?

65 respondents

a. 5 – Very Frequently – 5%

b. 4 – 15%

c. 3 – 43%

d. 2 – 31%

e. 1 – Never – 7%


Thank You

Healthcare Analytics SummitJoin top healthcare professionals for a high-powered analytics summit using analytics to drive an engaging experience with renowned leaders who are on the cutting edge of healthcare using data-driven methods to improve care and reduce costs.Date: September 24th-25th Location: Salt Lake City, UtahSave the Date: http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014

For Information Contact:Dr. John Haughom: [email protected]

http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014

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© 2014 Health Catalystwww.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2014 Health Catalyst

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Governor Mike LeavittFormer Secretary of HHSFounder of Leavitt Partners

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The Content System: Making the Best Medical Knowledge Standard Practice

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Transcript of The Content System: Making the Best Medical Knowledge Standard Practice