using enterprise data to drive improvement

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Using Enterprise Data to Drive Improvement

Surgical Performance Improvement

Embedded Enterprise Analytics

Douglas ThompsonVice President Decision Support & Reinventing

Sentara Healthcare

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The Challenge- Integrating Clinical, Operational & Financial Perspectives

- Attaining a Complete View of the Enterprise

The Solution- Driving Surgical Improvement Through Enterprise Intelligence

- Building an Operation on a Foundation of Data & Evidence

The Value- Driving Quality & Operational Performance Improvement

- A Common Foundation of Data & Evidence

- Aligning Strategy Across the Enterprise

The Future- Embedding Analytics Across the Enterprise

- Pattern recognition

- Predictive Modeling

- Simulation and “What If” modeling leading to….

- Evolution into a “ Learning System”

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Environment

Growth in Knowledge…… Time for Knowledge to Double

1930

30 Years

1970

7 Years

Accelerating Growth in Information

2011

11 Hours

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Environmental Participants

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Enterprise Questions: Multiple Perspectives Needed

Clinical “ Where are we achieving our quality goals across service lines ? ”

Operational “ Are our resources deployed optimally to satisfy the patient mix ? ”

Financial “ What is profitability in surgery across Sentara for 2008 vs. 2007 ? ”

Anticipatory “ What can we do to intervene and change the outcome ? ”

FinancialSystems

ClinicalSystems

OperationalSystems

Application

Reports

Application

Reports

Database Database Database

Application

Reports

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Neglecting Analytics in IT Adoption*A

nal

ytic

al I

nfr

astr

uct

ure

Transactional Systems Infrastructure

ComprehensiveEnterpriseAnalytical

Capabilities

Analytical InsightsLimited to

Entity Level

Little or NoAnalytical

Capabilities

Financial andAdministrative

Systems

Ancillary andDepartmental

Systems

Fully FunctionalClinical

Systems * Research from The Advisory Board

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Industry showing three basic models*

* Research from The Advisory Board

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Health PlanData

Health PlanData

ORScheduling

ORScheduling

Lab Data

MaterialsManagement

MaterialsManagement

Costs

Billing &Reimbursements

Billing &Reimbursements

Legacy

MedAIMedAI

EpicEpic

Vision: Attaining a Complete View of the Enterprise

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Enterprise Questions: Single Hospital View

Costs, Charges &Reimbursements

SurgeryOperations

MaterialsManagement

Application

Reports&

GraphsApplication

Reports

Application

Reports

LaborAccounting

Database Database Database Database

Application

Reports

“ What is profitability in surgery across Sentara for 2008 vs. 2007 ? ”

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Surgery Reporting – Current State

Doug receives question: “What is surgical

profitability of orthopedics across Sentara for

FY06 vs. 07?”

Debbie Allen receives request

from Jean

1-3 day turnaround

Jean Potter receives Doug’s

request

Jean gives the time period,specialties, and/or surgeon

information needed

- Total patient charges- Reimbursement- RCC- Margins- Surgery info- Patient mix

Access query

Patient Accounts

1. RCC based2. 3-6 month lag (payer updates)3. Query may be inconsistentacross facilities (differing results)

*CDM # not linked to vendor

information

Excel Report: Summary of data (e.g. FY06-07) that

needs validation1. By product line 2. Volume (# cases)3. Total charges4. Reimbursement5. Cost (RCC)6. Margin

Jean validates data (e.g. wrong

surgeons/surgeries)

Debbie queries the data by: total system, hospital, physician, patient account and gets info about reimb, cost and margin for each

Drill-down Access queries

Data subsets with drilled-

down Casemix data

Surgery Ops

- Actual costs (fed from PMM) - Manufacturer info- List of supplies used- Labor minutes (RN, SA, ST, MD)- Medications- Peri-operative minutes (Pre-op, PACU, Anes)- Surgery times

**Does not include actual costs, manufacturer info, or list of supplies used (in PICIS)

2-4 hours

Because Casemix & PICIS don’t have all information necessary to answer question, must join with information from other systems

1-3 hours

In order to get supply info, patient account data must be linked to PICIS - where supply usage data lies

Pull information from PICIS to match up with

Casemix patient account list

Patient accounts list (from Casemix)

Excel Report

Data repository

Jean receives list

1-3 weeks

Retrieve vendor info (when doing

historical comparison)

Labor Accounting

- Labor time in/out- Hourly labor pay rates- OCC Code (fed from HRMS) - PAL/Sick balances (fed from Payroll)

Link labor minutes to

cost for Sentara

Data manipulation and summary

in Excel

PRIMARY KEY: Patient Acct#

PRIMARY KEY: Casemix ID#

PRIMARY KEY: Emp ID#

Materials Mgmt

- Supply costs - Vendor information- Supply types- Supply cost centers- Facility approvals

PRIMARY KEY: Item#

Data extract with cost info for labor,

facility, equip, current supplies and medication

Data extract with patient account # info, and facility,

equip, and medication costs

Data extract with supply

cost and vendor

information

Data extract of high level aggregate

data


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Surgery Reporting – Isolated Data Extraction

LaborAccounting

Surgery OpsMaterials

ManagementPatient Accounts

Data subsets with drilled-down

Casemix data

Data extract with cost info for labor, facility, equipment,

current supplies and medication

Data extract with patient account # info, and facility,

equip, and medication costs

Data extract with supply cost and

vendor information

Data extract of high level

aggregate data

Report

Combine and manipulate data?????????????

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Enterprise Questions: Multi-Hospital View


SurgeryOperations

Database

Application

Reports

SurgeryOperations

DatabaseDatabase

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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Sentara CarePlex Hospital

SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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Sentara Norfolk General Hospital

SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

DatabaseDatabase

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Sentara VA Beach Hospital

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Surgery Operations: Process Metrics

OR

ScheduleCase

RegisterPatient

Process Bill &Payments

Labor

Materials

Equipment

Procedure

Patient Times In/Out

MaterialConsumption

Actual vs.Schedule

BillingDiagnosis

Demographics& Status

PreferenceCard

Pick List

MaterialCosts

RoomCosts

LaborCosts

Charges

Payments

DischargePlanning

• Block / Non-Block• Requested Time vs. Average

• Procedure Code

• Confirm Privileges• Labor Rates

• Confirm Availability

• Demographics

EquipmentCosts

Billing Info,Payers

• Resource Utilization

• Resource Utilization• Time of Day• Day of Week

Total Costs

Profitability

• SupplierEquipment

Usage

PerformSurgery

• Re-Admits

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Operations: Process Metrics

OR

ScheduleCase

RegisterPatient

Process Bill &Payments

Labor

Materials

Equipment

Procedure

Patient Times In/Out

MaterialConsumption

Actual vs.Schedule

BillingDiagnosis

Demographics& Status

PreferenceCard

Pick List

MaterialCosts

RoomCosts

LaborCosts

Charges

Payments

DischargePlanning

• Block / Non-Block• Requested Time vs. Average

• Procedure Code

• Confirm Privileges• Labor Rates

• Confirm Availability

• Demographics

EquipmentCosts

Billing Info,Payers

• Resource Utilization

• Resource Utilization• Time of Day• Day of Week

Total Costs

Profitability

• SupplierEquipment

Usage

PerformSurgery

• Re-Admits

Embedded Process Metrics Operational Analytics

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A Common Foundation of Data & Evidence

Hospital Operations: Surgery

Hospital Administration: Surgery

• Surgical LOS: Financial Impact of Extended Stay

Corporate Operations & Decision Support

• Surgical LOS: Financial Impact of Extended Stay


SurgeryOperations

MaterialsManagement

LaborAccounting

Pulse Points

Pulse Points

Pulse Points

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Driving Improvement Through Data & Metrics


Requires Actionable Data

Organizationally-FocusedResource-FocusedProcess-Focused

Accountability for Focused Actionand Metrics


SurgeryOperations

MaterialsManagement

LaborAccounting

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Driving Improvement Through Data & Metrics


Superior Performance

Inferior Performance

Expected Performance

Actionable Data Enables Focused Response

Identify Areas of Under Performance

Localize and Intervene

Identify Areas of Over Performance

Characterize and Standardize

Review for Best Practices

Focused Interventions

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The Future: Embedded Analytics

Patient Seen inEmergency Dept

Admit Patient:PresumptiveDiagnosis:Pneumonia

DischargeMonitor

CareDelivery

StandardOrder SetsStandard

Order Sets

EquipmentEquipment

LaborLabor

MaterialsMaterials

FacilitiesFacilities

Nursing Orders:

Respiratory Therapy:

Medication Orders:

ResourceDemand

Day 1 Day 2 Day 3 Day 4 Day 5

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The Future: Predictive Analytics

StandardOrder SetsStandard

Order Sets

LaborLabor MaterialsMaterials FacilitiesFacilitiesEquipmentEquipmentDemand

Operating Plan& Schedule

Operating Plan& Schedule

LaborLabor MaterialsMaterials FacilitiesFacilitiesEquipmentEquipmentCapacity

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Enterprise View: Across the Full Spectrum of Care

IntegratedSentara EDW

Sentara CarePlex Hospital

SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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Sentara Norfolk General

SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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Sentara VA Beach

SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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Sentara Medical Group

SurgeryOperations

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SurgeryOperations

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SurgeryOperations

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Sentara Health Plans

SurgeryOperations

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SurgeryOperations

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AmbulatoryAmbulatory Acute CareAcute Care SNFSNF

Home CareHome CareEmergencyEmergency

Long-TermLong-Term

Longitudinal Medical Record

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High Refresh Rate

Easy Identification

Relevant / Timely

Flags for Variations in Care- With Escalation

- Pathway Variation

- Never Events

- Patient Satisfaction

- Pace of Care

- 5 Rights

Presented in an Action-Oriented Dashboard

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OPERATIONAL PERFORMANCE DASHBOARD

POSSIBLY POSSIBLY ‘DEATH IN LOW ‘DEATH IN LOW

RISK DRG’?RISK DRG’?PRODUCTIVITYPRODUCTIVITY

LABOR COSTS LABOR COSTS AS A % OF NET AS A % OF NET

REVENUEREVENUE

PATIENTS OVER PATIENTS OVER 30 DAY LOS30 DAY LOS

READMISSION READMISSION PERCENTAGEPERCENTAGE

HOURS HOURS PATIENTS HELD PATIENTS HELD

IN EDIN ED

ICU BEDS OPENICU BEDS OPEN

ED ED TURNAROUND TURNAROUND

TIMETIME

DAILY CENSUSDAILY CENSUS

MRI VOLUMEMRI VOLUME

CT VOLUMECT VOLUME

CATH CATH PROCEDURE PROCEDURE

VOLUMEVOLUME

PURCHASED LABOR

OVERTIME

PREMIUM PREMIUM HOURSHOURS

PAYER MIXGROSS GROSS

REVENUE : REVENUE : INPATIENTINPATIENT

GROSS GROSS REVENUE : REVENUE :

OUTPATIENTOUTPATIENT

SUPPLY COSTS

LEGAL & CONSULTING COST

FIXED COSTS

CT VOLUME PER HOUR

CATH PROCEDURE VOL PER HOUR

MRI VOLUME PER HOUR

RED LIGHT /GREEN LIGHT

SERIOUS SAFETY EVENT (SSE) COUNT

PATIENTS PENDING PLACEMENT

OR LATE STARTS, ROOM TURNAROUND

SURGEON CUT TO CLOSE TIME

AVERAGE OR TURNAROUND

CRITICAL PATIENT CARE SYSTEM

DOWNTIME

CUSTOMER SATISFACTION

MRI REVENUE MRI REVENUE PER HOURPER HOUR

CT REVENUE CT REVENUE PER HOURPER HOUR

CATH LAB CATH LAB REVENUE REVENUE PER HOURPER HOUR

MORTALITY RATIO

COMPLICATION RATIO

DAYS SINCE LAST SSE

Hig

h E

nd Im

agin

g

This could be daily, weekly, as opposed

to monthly like mortality ratio. This

would then be related to SSE. Look

to get actionable things on patient

experience KPIs first, then look at larger

trends?

Monthly report – drives executive pay, can link to this as a

PDF or Excel and show active data

when clicked.

Can analyze from either direction.

Using various attributes, can link to

patient charts.

MRI procedures per 24 hour period * # of MRI machines. Perhaps drill into

revenue per hour or procedures per hour for a specific facility.

MRI UTILIZATIONMRI UTILIZATION

CTCTUTILIZATIONUTILIZATION

Similar to MRI Utilization Review

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PRODUCTIVITY

LABOR COSTS AS % OF NET REVENUE

PATIENTS OVER 30 DAY LOS

READMISSION PERCENTAGE

HOURS PATIENTS HELD IN ED

ICU BEDS OPEN

ED TURNAROUND TIME

DAILY CENSUS MRI VOLUME

CT VOLUME

CATH PROCEDURE

VOLUME

PURCHASED LABOR

OVERTIME

PREMIUM HOURS

GROSS REVENUE - INPATIENT

GROSS REVENUE - OUTPATIENT

SUPPLY COSTS

LEGAL & CONSULTING

COSTS

FIXED COSTS

CT VOLUME PER HOUR

CATH PROCEDURE VOL PER HOUR

MRI VOLUME PER HOUR

RED LIGHT / GREEN LIGHT

SERIOUS SAFETY EVENT (SSE) COUNT

PATIENTS PENDING

PLACEMENT

OR LATE STARTS, ROOM TURNAROUND

SURGEON CUT TO CLOSE TIME

AVERAGE OR TURNAROUND

CRITICAL PATIENT CARE SYSTEM

DOWNTIME

CUSTOMER SATISFACTION

MRI REVENUE PER HOUR

CT REVENUE PER HOUR

CATH LAB REVENUE / HOUR

MORTALITY RATIO

COMPLICATION RATIO

DAYS SINCELAST SSE

PTCA in 30 Min CHF Protocol

Joint Replacement PT Ordered

Antibiotic in 4 hrs

OR Cases OT

Out of Area Transfers

Voluntary Turnover

Metrics and Dashboard focused around strategic and supporting operational imperatives

OPERATIONAL PERFORMANCE DASHBOARD

PAYER MIX

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Relevant, Timely and Escalating

Patient Seen inEmergency Dept

Admit Patient:PresumptiveDiagnosis:Pneumonia

DischargeMonitor

CareDelivery

StandardOrder SetStandardOrder Set

Nurse Station

2. Notify Nurse

1. Order Set includes: Labs Antibiotics in 4 hrs 4 hr Clock Starts

4. Notify Supervisor

3. List of Patients Approaching 4 hr Compliance Threshold

Supervisor Dashboard VP MA, VP RN, C-Suite

5. Performance Review6. Process Review

7. Review & Revise Order SetsAs Needed

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Surgical Performance Improvement

Embedded Enterprise Analytics

Douglas ThompsonVice President Decision Support & Reinventing

Sentara Healthcare

using enterprise data to drive improvement

Technology