It may not always by easy for hospitals to foster a culture of quality in an era that places so much emphasis on cutting costs, but using big data can help mitigate that challenge.
Alan R. Spitzer, M.D., neonatologist and senior vice president of Research, Education, and Quality at MEDNAX — the national medical group specializing in neonatal, anesthesia, maternal-fetal, pediatric cardiology and other pediatric subspeciality services — offers some insight into quality outcome improvements and big data.
Note: Answers have been edited for length and clarity.
Question: How does MEDNAX use big data to improve clinical outcomes?
Dr. Alan Spitzer: Historically, the prospective randomized clinical trial has been considered the primary way that research advances medical care. What our company realized many years ago is that if we could create a data warehouse that contained information on a very large patient population, it might be possible, with appropriate statistical analysis, to make conclusions about various approaches to clinical care without having to subject babies to trials.
With our current EHR, 563 data points per patient are automatically extracted every day, de-identified and put in our Clinical Data Warehouse, giving us a very much up-to-date assessment of overall patient outcomes. Since we take care of about 20 percent of all of the neonates and newborns in intensive care units in the United States, there's a wealth of information there. We now have almost 1.1 million infants in the Clinical Data Warehouse and close to 20 million days of patient information. This is a huge repository of big data that can be analyzed and used to advance patient care and improve outcomes, both at a practice level as well as companywide. Further, our published research that is based on this data is being used to advance population health on a national scale.
Q: How do you educate your physicians about outcomes and improve care?
AS: MEDNAX hosts a clinical quality summit three times a year for our physicians. At the summits, physicians can present the problems they are currently dealing with and how they're trying to improve outcomes. The summits offer physicians the chance to exchange ideas with colleagues. The meetings also foster communication among the organization's practicing physicians that allow them to recognize that others may be struggling with the same quality issues and collaboratively develop solutions. MEDNAX also has developed an extensive volume of online presentations relating to clinical quality and outcomes that are accessible to our clinical practitioners as well as to subscribers to our site.
Q: What are some of the challenges encountered in trying to improve outcomes?
AS: Without extensive data, it's easy for physicians to think that everything is perfect. While it can be a challenge, getting physicians to look at their data helps them to realize that there can be improvement. The data also helps to drive healthy collaboration and competition between the physicians that yield better outcomes. The next step is to give them the support they need to improve those outcomes, which is where our online presentations and clinical quality summits come in.
Q: What's the difference between outcome measures and process measures?
AS: In adult medicine, process measures might be whether the physician took the patient's blood pressure or asked the patient about smoking. Those questions are looking at the management of the patient but they don't track results, such as if the patient actually stopped smoking, or if smoking cessation reduced the patient's chances of cancer or heart disease. In our practice of neonatal medicine, we not only look at the processes we think are important, we look at what the results have been from that process change in terms of the outcomes for the babies.
Dr. Spitzer will be presenting more on this topic at the Becker's Hospital Review 6th Annual Meeting, which will be held in Chicago at the Swissotel May 7-9. You can find him presenting, "Harnessing Data to Improve Care and Reduce Costs: Creating a Quality Culture in a Cost-Cutting Era" at 2:10 p.m. on Friday, May 8. To learn more about the conference, click here.
Additionally, conference attendees can speak with Dr. Spitzer at the MEDNAX Booth No. 25 throughout the event.