Engaging Clinicians to Reduce Care Variation Chris Wood MD Medical - - PowerPoint PPT Presentation

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Engaging Clinicians to Reduce Care Variation Chris Wood MD Medical - - PowerPoint PPT Presentation

Jul 11, 2023 381 likes •704 views

Engaging Clinicians to Reduce Care Variation Chris Wood MD Medical Executive, Intermountain iCentra Development VP Cerner WelshConfed18 Intermountain Healthcare: Engaging Clinicians to Reduce Care Variation CHRIS WOOD, MD MEDICAL

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WelshConfed18

Engaging Clinicians to Reduce Care Variation

Chris Wood MD

Medical Executive, Intermountain iCentra Development VP Cerner

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Intermountain Healthcare: Engaging Clinicians to Reduce Care Variation

CHRIS WOOD, MD MEDICAL EXECUTIVE INTERMOUNTAIN DEVELOPMENT FEBRUARY 2018

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Overview

  • Intermountain Healthcare has moved from a set of 15

independently run hospitals, to become one of the premier Health and Healthcare organizations in the United States with some of the best health outcomes at the lowest per capita price

  • How did this happen?
  • What principles learned here can be used in your work

tomorrow?

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4

Average Individual Insurance Premium

Alaska RhodeIsland Massachusetts Maine NewHampshire Vermont Wisconsin Michigan NewJersey Nevada Virginia Connecticut NewYork Delaware Minnesota Florida Ohio Texas SouthCarolina Illinois Wyoming Nebraska Maryland Kansas Oregon WestVirginia Colorado Montana Pennsylvania Oklahoma Tennessee Washington Mississippi Indiana Iowa Missouri NorthCarolina Kentucky California Louisiana SouthDakota Arizona Idaho Alabama NewMexico NorthDakota Georgia Arkansas Hawaii Utah

1000 2000 3000 4000 5000

Alaska RhodeIsland Massachusetts Maine NewHampshire Vermont Wisconsin Michigan NewJersey Nevada Virginia Connecticut NewYork Delaware Minnesota Florida Ohio Texas SouthCarolina Illinois Wyoming Nebraska Maryland Kansas Oregon WestVirginia Colorado Montana Pennsylvania Oklahoma Tennessee Washington Mississippi Indiana Iowa Missouri NorthCarolina Kentucky California Louisiana SouthDakota Arizona Idaho Alabama NewMexico NorthDakota Georgia Arkansas Hawaii Utah

Source: Kaiser Family Foundation, 2006

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Healthiness vs. Healthcare Cost per Capita

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  • Headquartered in Salt Lake City: 38,000+

employees

  • Created in 1975 when LDS Church donated its

15 hospitals to a Volunteer Community Board

  • Care for anyone who comes to you regardless of

their ability to pay

  • Be a Model Clinic

Beginnings to Integrated Health and Care System

EHR Data Organized Quality Improvement Disruptive Innovations

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SLIDE 7
  • 3 Million people
  • 28% covered by Select Health

Insurance

  • 24 Hospitals 2,700 beds
  • 186 Clinics
  • 4,500 affiliated physicians
  • 1,500 employed physicians and

APC

  • 37,000 employees 1,600

volunteers

  • 470 volunteer trustees

Intermountain service area

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Transition in the Practice of Medicine

  • So much information!
  • US National Library of Medicine Added ~ 10,000 articles/week to online

archives (40% of total)

  • 2005 > 14,000 RCT (1st in 1952)
  • Medical knowledge doubles:
  • In 1950: every 50 years
  • In 2016: every 73 days
  • “Personal experience” can be misleading
  • Memory limited to 7 + 2
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Practice of Medicine

THE RESULT OF THE STATE OF THE ART IS WIDE VARIATION IN HOW WE PRACTICE AND THEREFORE IN THE OUTCOMES WE ACHIEVE

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Transition in the Practice of Medicine

  • One physician, one patient – expert model
  • Care crafted by individual physician
  • Uses knowledge from training and experience
  • Changing – professional model
  • Working from “Shared baselines”
  • Iterative design and monitoring of care delivery
  • Demand that Physicians and Nurses step away from the baseline as

needed by their individual patients

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  • Unintended Negative Consequences of our Business Model

– The Bill you Better Game – Focus on provision of high margin procedures rather than on health of an individual patient – Necessity of Insurance

  • Federal
  • State
  • Private
  • Personal
  • With which Unintended Consequences are YOU dealing?

The Water We Swim In

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categorically

Reducing process variation improves processes, and thus improves outcomes

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The Intermountain Quality Model

  • Pareto approach

– Focus on the “right” projects – Do enough, not too much – You can lose your way deciding on the “Right Way”

  • Right Team Clinicians, statisticians, informaticists, finance, simple project management

administrative support

  • Develop a Shared Baseline of care (Care Process Model)

– Goal is rapid deployment of a good, not the best, Shared Baseline – Avoid “Latest” and “Completeness” arguments – Realize you will begin with an Interpretation of Evidence, but transition to evaluation of your Data

  • Physician/Nurse Dignity

– Demand them to deviate from the baseline as needed by their patient

  • Build organizational and team habits

– Cue, Response, Reward – As much as possible, build it into the workflow: paper, EHR, other tools

  • Monitor the outcomes at an Individual, Team and Organizational level and adjust
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Elements of success

  • Data Warehouse, Data Mart, Analysis capabilities to

develop dashboards and meaningful reports

– Are you Changing a Habit or Maintaining the New Habit?

  • Ability to build workflow process into EHR (Paper)
  • Ad Hoc Teams to own baselining Key Clinical Processes
  • Clinical Operations Leadership Team

– Set Priorities – Monitor outcomes and maintenance

  • Align incentives
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Key Clinical Processes

  • High volume process, affects a large number of patients
  • High Morbidity/Mortality, i.e. High Cost
  • Care is delivered by a definable clinical micro-system
  • Great variability in how care is delivered
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Neurosciences

Clinical Programs and Services

Working Together

Behavioral Health Oncology Primary Care Musculoskeletal Cardiovascular Women & Newborns Surgical Services Intensive Medicine Pediatrics

Seamless Integration Across Clinical Programs

SERVICES

  • Imaging
  • Pharmacy
  • Patient Flow
  • Rehabilitation
  • Nursing
  • Integrated Care

Management

  • Laboratory
  • Respiratory
  • Pain Management
  • Patient and Provider

Publications

  • Food and Nutrition
  • Patient Safety
  • Clinical Genetics
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Clinical Program Structure

Systemwide Guidance Council

Medical Director Operations Director

Medical Director Operations Officer Medical Director Operations Officer Medical Director Operations Officer Data Manager Data Analyst Nursing Admin. Nursing Admin. Nursing Admin.

Regional Management Team Regional Management Team Regional Management Team

Development Team Development Team Development Team

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Health Pathways

Health Pathway

Preventative Recovery

  • r

Rehabilitative Diagnosis Treatment Palliative Management

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Examples

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From Hundreds of Success Examples, Three:

  • Newborn Resuscitation and Sepsis
  • Chest Pain management
  • Diabetes Prevention & Groceries
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Women and Newborns’ Accomplishments and Successes

2014-2015

  • Improved management of women in labor

▪ Our highest volume process

  • Standardization of Newborn Intensive Care Unit (NICU) processes

▪ An area of very high cost

  • Decrease in mom/baby length of stay
  • Decrease in newborns treated for risk of Early Onset Sepsis (EOS)
  • Initial deployment of teleservices for newborn care
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North

iCentra Project Governance

Patient and Family Advisory Council iCentra Advisors, Region CMIOs, Region CNIOs iCentra Physician Consultants and Advocates Physician Coaches and Super Users

Clinicians, Pharmacists, Care Managers, Clinic Managers, Operations, Finance

iCentra Executive Committee

Model System Deployment Committee Affiliated Physician Workgroup Innovation Steering Committee

Acute Team Laboratory Imaging Emergency Department Pharmacy Revenue Cycle Ambulatory Team Practice Management

Clinical Programs

Medical Director Clinical Operations Director Guidance Council – Region Representation Development Teams – Region Representation CPOE Patient Engagement Population Health SelectHealth South Park City - Heber Southwest Primary Children’s Central

Physician Executive Lead, CHIO, CNIO Clinical Services

Pharmacy Laboratory Imaging Therapies

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Link

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Care Process Model Automation

Paper-based Care Process Model Basic Flow Digitized Care Pathway

Start Identify Assess Recommend Action Document

Suggest appropriate CPMs

  • Select

Show contextual views

  • Vital Signs, Lab, Allergies, etc

Tell me more

  • New data capture, decision flow

Produce Recommendations

  • Order sets

Interventions

  • Orders, Rx, Patient Education, etc.

Complete Documentation

  • Physician impression, decision logo

Monitor & Analyze

Measure

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Workflow Driven Example

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Application Experience Process Adoption Evidence Based Practice Outcomes

Do you use the system well and take advantage of preferences/techniques to improve efficiency? Do you complete the right tasks on time, correctly and in the right sequence? Did you follow Clinical Guidelines, Evidence,…any Adverse events or Unnecessary Variance Do you achieve the right health, financial, satisfaction

  • utcomes?

Doctors not adopting Meds Rec because of poor user experience Un-reconciled meds lead to downstream negative consequences Time to reconcile meds Meds Rec Adoption % % Meds Administered w/un-reconciled meds Adverse events from un-reconciled meds Adverse events lead to more labs, imaging, medications, labor, LOS, procedures Adverse Events Redundant Labs Unnecessary Imaging

  • Patient health

declines

  • Unreimbursed care
  • Patient and Family

Upset

  • Length of Stay vs

Baseline

  • Unreimbursed Care

(Never List)

  • Patient Satisfaction
  • Patient Functional

Status

Example Metrics

Continuum of Analytics

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Connect with me: LinkedIn: Chris Wood, MD Twitter: @CWoodMD