How partnering with health IT can support value-based care initiatives

Health IT leaders are becoming integral contributors to health system strategy as systemwide data gathering and reporting initiatives support process standardization and value-based care.

On April 2, three health IT leaders examined how IT contributes to clinical quality and best practices for data gathering during an executive roundtable hosted by Medtronic at Becker's Hospital Review's 10th Annual Meeting in Chicago. The panel featured participants Brian Patty, MD, vice president of clinical information systems and CMIO of Chicago-based Rush University Medical Center; Debbie Salas-Lopez, MD, MPH, chief transformation officer of Allentown, Pa.-based Lehigh Valley Health Network; and David McSwain, MD, CMIO of Charleston, S.C.-based Medical University of South Carolina.

The following summary touches on the key insights each panelist shared about their organization's journey and how their roles have become integral in producing quality outcomes and system growth.

Becoming an organization of data-gatherers

Dr. Patty has served as CMIO at several organizations for more than 15 years, most recently for Rush University Medical Center for the past four years, and offered a unique perspective on the lessons learned during initial EHR implementation as well as how the health system has changed its approach data management.

"One of the bigger things we are moving toward is care team redesign so everyone in the care team is working at the top of their license," he said. "Most organizations are dealing with burnout, likely over 50 percent of physicians [feel] some impact of burnout, so what we say is we want our physicians spending more time with the patient while they're at the clinic and more time with their families at home. So how do we do that? It's really about developing standards and measuring them, and in the process we're improving healthcare because we are allowing physicians to have a deeper dive with patients and understand their patients better."

Rush considers everyone at the organization, including patients, as data gatherers who provide integral information for the care episode. From pre-visit surveys to the payment information and data gathered at the point of care, Rush clinicians can use that insight in near real time to have meaningful conversations with patients, adjust medications and improve treatment protocols.

"We have a whole organization of data capturers, and we are using analytics tools to turn that data into knowledge and action," Dr. Patty said. "The more we learn how to do that in real time and deliver those bits of knowledge to the provider at the time to make those decisions, the better off we will be."

After revising the clinician's approach to data management, Rush physicians are now responsible for analyzing the data and discussing options with patients to develop personalized care pathways. This is an essential aspect of the transition from fee for service to risk-based payments; in the value-based world, healthcare organizations make more money by keeping patients healthy. Dr. Patty sees the alignment of payment models with improved outcomes and less expensive care forcing healthcare organizations to gather long-term data and take a wider view than the immediate episode of care. It may cost extra to use new technology on a patient's surgery, but if that technology improves outcomes over a long time period, it means less follow-up care and fewer costly readmissions.

"Patient outcomes often take three to five years to realize the impact of what you are doing today, and the quality of care you provide," he said. "It's hard to see the impact on the bottom line when the outcome is so far out there. But ultimately, that's where we need to go. We need to develop stable populations of patients that we are caring for and develop quality programs that really improve those outcomes."

Where quality meets consumerism

When considering quality, Dr. Salas-Lopez pointed out that most patients assume quality means access to convenient healthcare and prescriptions at lower costs. However, clinicians focus more on measurable patient outcomes. "We as the clinicians care about quality and patient outcomes, and we have a threshold to meet," she said. "How do we create that convenient, hassle-free access to our system and then provide patients with evidence-based, high-quality care with great outcomes over the long term?"

Lehigh Valley Health Network has invested in a technology company that combines clinical data with claims data from 14 payers and produces monthly reports for health system leaders to track patients within the system. Clinicians use the platform to deliver personalized patient care and improve prescription accuracy for 170,000 covered participants.

The health system also partnered with Medtronic on an enhanced respiratory care pathway, aiming to avoid adverse events after surgical procedures, especially those that involve opioid analgesia. The process allowed clinicians to examine data input in the EMR and analyze how it came together at the point of care. All members of the team now know why the information matters for the nurse, physician or other team members and have visually designed the platform to show actionable data.

"With that, we were able to proactively identify the right cohort of patients who might be at risk for post-procedural respiratory failure," Dr. Salas-Lopez said. "Our nurses go monitor that. When someone is at risk, the nurses visit them proactively because the patient was selected upfront."

Strategic importance of health IT

At MUSC, Dr. McSwain has been integral in developing and growing the health system's telehealth initiatives. Ten years ago, he developed a pediatric critical care teleconsultation program for the health system's emergency departments and applied it to other programs as part of dramatically expanded telehealth services across the South Carolina. Earlier this year, MUSC finalized the acquisition of four community hospitals, and Dr. McSwain believes strategic alignment of health IT will help the organization meet its integration goals.

"If you look at the way healthcare has evolved, whether you talk about payment structures, population health or individualized medicine, it all focuses on some aspect of technology. Leaders of their institutions would be very well served to have a collaborative relationship with their health IT leaders," he said. "Involve your technology teams in strategy decisions, get input and really listen to what their capabilities are and what the promises are of healthcare technology. Incorporate that into the vision of your organization. If you can do that, you'll be prepared for success."

The key to successful data gathering and reporting is proactively deciding on the right metrics. "This should not be an afterthought," said Dr. McSwain. "It shouldn't be a situation where you start building a program or an intervention and you get to the end of it and you consider how you are going to evaluate it. You have to think of that in advance because developing the metrics can drive the development of the program. If you know what it is you are trying to accomplish and goals you are trying to achieve, then you can answer the question of, 'How do we implement this?'"

Dr. McSwain encouraged health system executives to develop measurement protocols in a scalable way. "Make it easier for the person coming after you," he said. "Don't hoard knowledge. Make sure it's shared so you are building not just one program but the foundation for future programs."

In conclusion

All members of the panel agreed that strategically integrated health IT platforms can promote organization-wide transformation to value-based care in a way that minimizes stress on providers. Standardization is necessary for optimizing outcomes, but there is room for variation when experimenting with new protocols or pathways. Technology, including customizable EHRs, may facilitate incremental improvements as health systems grow more sophisticated and take on more risk.

 

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