The Power of Data

© 2014 Health Catalyst
www.healthcatalyst.com
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www.healthcatalyst.comProprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics
John L. Haughom, MD
May 2014
The Power of Data:
Igniting, Scalable and Sustainable Change

Healthcare: The Way It Should Be
Part One – Forces Driving Transformation
• Chapter One – Forces Defining and Shaping
the Current State of U.S. Healthcare
• Chapter Two – Present and Future
Challenges Facing U.S. Healthcare
Part Two – Laying the Foundation for
Improvement and Sustainable Change
• What will it take to successfully ride the
transformational wave?
Part Three – Looking into the Future
• What will it take to successfully ride the
transformational wave?
2
http://www.healthcatalyst.com/ebooks/healthcare-transformation-healthcare-a-better-way/

Poll Question
1. On a Scale of 1-5, how would you rate your
organization’s ability to manage complexity?
a. 5 – 8%
b. 4 – 26%
c. 3 – 45%
d. 2 – 17%
e. 1 – 4%
3

Implementing an Effective System of
Production in Healthcare
Analytic
system
Content
system
Deployment
system
Scalable
and
sustainable
outcomes

Analytic System Components
5

Using Data Appropriately
Micromanage
Kill the Messenger
(denial, shift blame)
Fear
Filter the data
(game the system)
Scherkenbach’s Cycle of Fear

Using Data: Learning vs.
Acountability
7
Accountability
• Knowledge used by consumers,
regulators, other physicians, etc.
• May encourage gaming the system
• Reward centric
Learning
• Knowledge used by
care delivery
organizations and
improvement teams
• Nourishes intrinsic
motivation
• Result centric
Measure, manage & improve
the system
Suboptimize Game the number
Berwick DM, James B, Coye MJ. The connections between quality measurement and improvement. Medical Care. 2003; 41(1Supplement): 30-38.

less transformation
Provider
Patient
Bad Debt
Diagnosis Procedure
Facility
EncounterCost
Charge
Employee
Survey
House
Keeping
Catha Lab
Provider
Census
Time
Keeping
more transformation enforced referential integrity
Enterprise data model
FINANCIAL SOURCES
(e.g. EPSi, Lawson,
PeopleSoft)
ADMINISTRATIVE
SOURCES
(e.g. API Time Tracking)
EMR SOURCES
DEPARTMENTAL
SOURCES
(e.g. Apollo)
PATIENT SATISFACTION
(e.g. NRC Picker)
EDW

EMR SOURCE
Oncology
Diabetes
Heart
Failure
Regulatory
Pregnancy Asthma
Labor
Productivity
Revenue Cycle
Census
SOURCES
(e.g. NRC Picker)
DEPARTMENTAL
SOURCES
(e.g. Apollo)
FINANCIAL SOURCES
(e.g. EPSi, Lawson,
PeopleSoft)
ADMINISTRATIVE
SOURCES
less transformationmore transformation
Dimensional data model
Redundant
data
extracts

Metadata: EDW Atlas security and auditing
Common, linkable
Vocabulary
Financial
Source Marts
Administrative
Source Marts
Departmental
Source Marts
Patient
Source Marts
EMR
Source Marts
HR
Source Mart
Diabetes
Sepsis
Readmissions
Less transformationMore transformation
FINANCIAL SOURCES
(e.g. EPSi, Peoplesoft,
Lawson)
ADMINISTRATIVE
SOURCES
EMR SOURCE
DEPARTMENTAL
SOURCES
(e.g. Apollo)
SOURCES
(e.g. NRC Picker, Press
Ganey)
Human Resources
(e.g. PeopleSoft)
Late-Binding™ Data Warehouse

ACADEMIC
STATE
Early versus late binding of Data
SOURCE
DATA CONTENT
SOURCE MARTS CUSTOMIZED
DATA MARTS
DATA
ANALYSIS
OTHERS
HR
FINANCIAL
CLINICAL
SUPPLIES
INTERNALEXTERNAL
ACADEMIC
STATE
OTHERS
HR
FINANCIAL
CLINICAL
SUPPLIES
RESEASRCH
REGISTRIES
QlikView
Microsoft Access/
ODBC
Web applications
Excel
SAS, SPSS
Et. al
OPERATIONAL EVENTS
CLINICAL EVENTS
COMPLIANCE AND PAYER
MEASURES
DISEASE REGISTRIES
MATERIALS
MANAGEMENT
1
Data rules and vocabulary binding points
early binding
low volatility vocabulary or business rules?
late binding
high volatility vocabulary or business rules?
2 3 4 5 6

DATA CAPTURE
• Acquire key data elements electronically
• Assure data quality
• Integrate data capture into workflow
DATA ANALYSIS
• Interpret data
• Discover new information in the data
(data mining)
• Evaluate data quality
DATA PROVISIONING
• Move data from transactional systems into
the data warehouse
• Build visualizations for use by clinicians
• Generate external reports (e.g., CMS)
Automating data gathering

Population Health Management
Paradigm shift
Acute
care-centric
management
Inpatient Outpatient
Home
Clinic
care
Hospice Cemetery
Skilled
nursing
facility
Inpatient
Home
health
care
Population-centric management

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Home
(patient portal)
* To Invasive
Care Processes
Clinic Care
non-recurrent
Clinic Care
chronic
Acute Medical
IP Med-Surg
Acute Medical
IP ICU
Invasive
Medical
Invasive
Surgical
Diagnostic work-up
Bedside care
Triage to treatment venue
Substance
preparation
Invasive*
subspecialist
Chronic
disease
subspecialist
Screening & preventive Symptoms
Anatomy of Healthcare Delivery
Diagnostic algorithms
Indications for referral
Indications for intervention
Triage criteria
Diagnostic Algorithms,
Triage Criteria, Referral &
Intervention Indications
Utilization
management
knowledge assets
Substance selection
Substance selection
Clinical supply chain management
Procedure
Treatment and
monitoring
algorithms
Admission order setsAdmission order sets
Supplementary order sets
Pre-procedure order sets
Post-
procedure
order sets
Discharge
Bedside care practice guidelines, risk
assessment and patient injury prevention
protocols, bedside care procedures,
transfer and discharge protocols
Treatment and monitoring algorithms
Health maintenance and
preventive guidelines
Standardized
follow-up
Post-acute
care order sets
IP (SNF, IRF)
Home health
Hospice
Management of Preventive,
Ambulatory, Acute Medical,
Invasive & PAC Modules
Prevention and
treatment
knowledge assets
Clinical ops procedure guidelines and
patient injury prevention
Post-procedure care

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Clinical Integration hierarchy - care process families
Hyperlipidemia
Acute
Myocardial
Infarction
(AMI)
Percutaneous
Intervention
(PCI)
Coronary
Artery Bypass
Graft (CABG)
Cardiac
Rehab
Ischemic Heart Disease
care process family
Home OutpatientClinic Care Inpatient SNF Home Health Hospice
Coronary
Atherosclerosis

Clinical Integration hierarchy - clinical programs
Vascular Disorders
care process family
Heart Rhythm Disorders
care process family
Heart Failure
care process family
Ischemic Heart Disease
care process family
Cardiovascular clinical program
Home OutpatientClinic Care Inpatient SNF Home Health Hospice

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Clinical Integration hierarchy
Clinical programs – ordering of care
Primary
Care
care
process
families
e.g.,
Diabetes
CV
care
process
families
e.g.,
Heart
Failure
W&C
care
process
families
e.g.,
Pregnancy
GI
care
process
families
e.g.,
Lower GI
Disorders
Resp-
iratory
care
process
families
e.g.,
Obstructive
Lung
Disorders
Neuro
Sciences
care
process
families
e.g.,
Spine
Disorders
Musculo-
skeletal
care
process
families
e.g.,
Joint
Replace-
ment
Surgery
care
process
families
e.g.,
Urologic
Disorders
General
Med
care
process
families
e.g.,
Infectious
Disease
Oncology
care
process
families
e.g.,
Breast
Cancer
Peds
Spec
care
process
families
e.g.,
Peds
CV Surg
Mental
Health
care
process
families
e.g.,
Depression

Primary
Care
Care
Process
Families
e.g.,
Diabetes
CV
Care
Process
Families
e.g.,
Heart
Failure
W&C
Care
Process
Families
e.g.,
Pregnancy
GI
Care
Process
Families
e.g.,
Lower GI
Disorders
Resp-
iratory
Care
Process
Families
e.g.,
Obstructive
Lung
Disorders
Neuro
Sciences
Care
Process
Families
e.g.,
Spine
Disorders
Musculo-
skeletal
Care
Process
Families
e.g.,
Joint
Replace-
ment
Surgery
Care
Process
Families
e.g.,
Urologic
Disorders
General
Med
Care
Process
Families
e.g.,
Infectious
Disease
Oncology
Care
Process
Families
e.g.,
Breast
Cancer
Peds
Spec
Care
Process
Families
e.g.,
Peds
CV Surg
Mental
Health
Care
Process
Families
e.g.,
Depression
Diagnostic Clinical Support Services (workflow models)
(e.g., pathology and laboratory medicine, diagnostic radiology)
Ambulatory Clinic Clinical Support Services (workflow models)
(e.g., primary care clinics, chronic disease specialty clinics, subspecialty clinics)
Acute Medical Clinical Support Services (workflow models)
(e.g., Emergency Care, ICU/CCU/NICU/PICU, General Med-Surg)
Invasive Clinical Support Services (workflow models)
(Interventional Medical [e.g., cath lab, interventional radiology, GI lab, L&D, rad onc] and Surgical [e.g., amb, IP])
Therapeutic Clinical Support Services (workflow models)
(e.g., pharmacy, transfusion medicine, respiratory therapy, physical, occupational, speech therapy)
Clinical Integration construct
Clinical support services – delivery of care

Value Stream Protocols to Help
Prevent Patient Harm
19
Clin Path Anat Path Radiology Peds Adult ECU ICU/CCU Med-Surg IP Surg ASC Interv Med
Substances
Pharmacy x x x x x x x x
Medications x x x x x x x x x
Fluids x x x x x x
Electrolytes x x x x x x x x
Parenteral nutrition (TPN) x x x x
Transfusion Medicine x x x x
Glycemic Control (Glucose Mgmt) x x x x
Healthcare Associated Infections
Ventilator Associated Pneumonia x
Urinary Catheter Infections x x x x x x
Surgical Site Infections x x x
Central Line Assoc Bldstream Inf x x x x
Venous Thromboembolism x x x x
Pressure Injury (Decubitus Ulcers) x x
Falls (Strength, Agility, Cognition) x x x
Patient/Procedure Control x x
Value Stream Map
Diagnostic CSS Ambulatory CSS Acute Medical CSS Invasive CSS

Mapping – admin codes to clinical

21
Medicare FFS payments by venue – 2008-2012
OutpatientClinic Care Inpatient SNF Home Health Hospice
$ 152 Billion
11.8%
372 Billion
28.7%
447 Billion
34.5%
$ 133 Billion
10.3%
$ 90 Billion
6.9%
$ 48 Billion
3.7%
LTCH/IRF
$ 53 Billion
4.1%
Clinic Care Outpatient Inpatient SNF LTCH/IRF Home Health Hospice
$ $

Top 10 care process
families account for
over 40% of the
opportunity
Top 32 care process
families account for
80% of the opportunity
Care process families by resources consumed (high to low)
Percentoftotalresourcesconsumed
Inpatient per case KPA

In Summary…
• Organizations need a comprehensive framework to help them implement
a solid strategy and foundation for the future
• The Three Systems (Analytic, Deployment, Content) is an example of a
comprehensive framework that can lead to future success
• Use data primarily for learning rather than judgment
• The late binding data model is the quickest to set up, cheapest to
maintain, and most importantly, offers the flexibility required to support
continuous improvement
• Automating data distribution allows frontline workers to become self-
service gatherers and analyzers of data
• The Anatomy of Healthcare Delivery and Clinical Integration Hierarchy
can help organizations focus their improvement efforts and maximize
value for the investment
23

Coming Attractions (next webinar)
The Analytic System: Bringing it all together
• Understanding variation and the role of SPC charts in
quality improvement
• A thoughtful approach to improvement
• Finding meaningful patterns in the data
• Demonstration of the power of modern analytical tools
• We have come along way, and yes, clinicians can use
these tools!
24

Poll Question
2. On a Scale of 1-5, how effective is your
organization’s analytical strategy and capability
(as described today)?
a. 5 – 4%
b. 4 – 16%
c. 3 – 31%
d. 2 – 35%
e. 1 – 14%
25

Poll Questions
3. Does your organization have a robust strategy to
identify high value improvement opportunities?
a. 5 – 14%
b. 4 – 13%
c. 3 – 37%
d. 2 – 30%
e. 1 – 6%
26

Thank You
Upcoming Educational Opportunities
Data Driven Care: The Key to Accountable Care Delivery from a Physician Group
Perspective
Date: May 29th
Presenter: Dr. Gary Spencer, CMO, Crystal Run Healthcare, Luke Skelly, Health Catalyst
Register at http://healthcatalyst.com/
Accountable Care Transformation: The Four Building Blocks of Population Health
Management
Date: June 4th, 2014 Presenter: Dr. David Burton, MD, Chairman, Health Catalyst
Time: 1:00 - 2:00 PM ET
Register at http://healthcatalyst.com/
Healthcare Analytics Summit
Join 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, Utah
Save the Date: http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014
For the New World of Healthcare, A Declaration of Independence Is Only the Beginning
On April 28, 2014, Dr. Daniel Craviotto, Jr. published an editorial in the Wall Street Journal, “A Doctor’s
Declaration of Independence,” in which he argued that it is time to “defy healthcare mandates issued by
bureaucrats not in the healing profession.”
Read Dr. Haughom’s response on how the medical profession needs to move beyond frustration and cynicism
to create a vision for a better, more effective healthcare system. http://healthcatalyst.com/
For Information Contact: John.Haughom@healthcatalyst.com

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Obtain unbiased, practical, educational advice on
proven analytics solutions that really work in healthcare.
The future of healthcare requires transformative thinking
by committed leadership willing to forge and adopt new
data-driven processes. If you count yourself among this
group, then HAS ’14 is for you.
OBJECTIVE
MOBILE APP
Access to a mobile app
that can be used for
audience response and
participation in real time.
Group-wide and individual
analytic insights will be
shared throughout the
summit, resulting in a more
substantive, engaging
experience while
demonstrating the power
of analytics.

The Power of Data

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