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
© 2014 Health Catalystwww.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics
© 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
Healthcare: The Way It Should Be
Book now available
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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.
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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…
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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
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Deploymentsystem
Analyticsystem
Content system components
Define clinically driven
cohorts
Standardize delivery through shared baselines
Use evidence to identify and
eliminate waste
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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
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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.
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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
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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
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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
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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
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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.
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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…
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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.
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Are Practice Protocols…
A case management system…
− or −
…a research system (for continuous learning,
to improve medical outcomes)
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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.
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Why is a Shared Common Baseline Important?
To determine baseline performance…
…to determine whether a change is anImprovement…
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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
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Protocols are about…
…making it easy to do it right…
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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
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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
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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
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Response to Change
Change is inevitable…
…adaptation is optional…
intentional
interesting
…fun
rewarding
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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%
© 2014 Health Catalystwww.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics 26
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.
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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%
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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]
© 2014 Health Catalystwww.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics © 2014 Health Catalyst
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Billy BeaneGeneral ManagerOakland A’s
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