It s Gonna be Epic Lehigh Valley Health Network and Tableau

Transcription

1

2 Welcome

3 # T C 1 8 It s Gonna be Epic Lehigh Valley Health Network and Tableau Walter J. Chesla Senior Clinical Business Intelligence Analyst Lehigh Valley Health Network Donna L. Wendling Senior Clinical Business Intelligence Analyst Lehigh Valley Health Network

4 Agenda About Lehigh Valley Health Network In the Beginning Challenges Clinical Data Platform Clinical Care Pathways Protected Health Information (PHI) Distribution & Tableau Server What s Next?

5 About Lehigh Valley Health Network

6 Who We Are 8 Campuses 3 Institutes 1 Children s Hospital 160+ Physician Practices 17 Community Clinics 22 Health Centers 18 ExpressCARE Locations 1 Children s ExpressCARE 45 Rehab Locations 81 Testing and Imaging Locations 18,000+ Employees 2,005 Physicians 834 Advanced Practice Clinicians 4,208 Registered Nurses 69,346 Admissions 274,879 ED Visits 1,838 Acute Care Beds

7 Health Information Awards Grand Slam HIMSS EMR Adoption Model Stage 7 designation Inpatient & Ambulatory, May 2017 Three Most Wired Awards Including Innovator and Advanced, June 2017 HIMSS Davies Award August 2017 Lehigh Valley Hospital Cedar Crest

8 In the Beginning

9 Epic Reporting Workbench Operational Real-time Reporting tool available only within Epic Hyperspace Slicer Dicer Only available within Epic Hyperspace Self-service reporting and visualizations SAP Crystal Reports Available within Epic Static reports, slow to develop and deploy SAP BOE, Webi, Lumira Web interface, available outside of Epic Allows users to run Crystals without Epic access Webi provides self service reporting with basic visualizations

10 Challenges Data! So many data points in Epic and finding the correct ones. Protecting PHI Ensure only appropriate end users have access. Time Consuming Report Development Traditional Waterfall Dev Cycle for Static Reports Spec, Dev, Test/Review, Release Large Backlog of Request Too much work, too few resources Difficult to Identify Trends and Outliers in a Timely Manner Delay in taking corrective action Finding Reports to Meet the Business Needs Large library existing only in Epic Hyperspace Limited Self Service Webi Slicer Dicer (limited to Hyperspace)

11 Why Tableau? Faster Development, Faster Insights Encourage discovery through filters and actions More easily identify trends Minimal End User Training Intuitive interactions Encourage Discovery Answer questions through filters and actions Easier distribution through Tableau Server Free the data! No longer locked into Epic Hyperspace. Drive transparency and culture change We are becoming a data driven organization Support process improvement efforts

12 Data Platform

13 Data Platform Epic Chronicles (Operational Database) Epic Clarity (Reporting Database) Tableau Server Users Tableau Desktop Developers Tableau Server Other Data Sources Non-Clinical (Excel, Text/CSV Files, HP Cloud, Oracle)

14 Clinical Care Pathways

15 Dumb boldness is the best way to approach a new challenge. Jerry Seinfeld Comedian

16 Clinical Care Pathways Define a standard of care for common procedures and illnesses. What questions are providers and clinicians trying to answer? What insights can we find? How is success measured? What are the key metrics?

17 Clinical Care Pathways Length of Stay Length of Stay is a high level indicator for quality of care and cost. A lower length of stay equates to lower cost for the network and patient, and indicates we are caring for our patients in a timely manner. Ileostomy Length of Stay Impact Overall Length of Stay Reduced from 26.4 hours to 10.9 days (15.5 day reduction) Post Op Length of Stay Reduced from 20.5 days to 8.7 days (11.8 day reduction)

18 Clinical Care Pathways CMI (Case Mix Index) A measure of the diagnosis grouper used in coding a hospital encounter. Target CMI = 1 Above 1 is ideal; Below 1 indicates less than optimal coding. Impact Every tenth of a point below 1.0 is $800k in potential lost revenue; above 1.0 is an $800k gain.

19 Clinical Care Pathways Readmissions If we re doing our job correctly you won t see us again. Impact Insurance won t reimburse for readmissions related to the original diagnosis or procedure. A lower readmission rate equates to less lost revenue.

20 Clinical Care Pathways Order Sets Order sets define a standard protocol for procedures and illnesses. Tableau helps us measure and improve usage. Impact Order set usage ensures consistent and proper care for similar diagnoses and procedures. Prevents extraneous orders that may drive up costs (and may not be reimbursable).

21 Clinical Care Pathways Order Sets But sometimes improvement is elusive. Impact With order set usage trending down, an optimal standard of care may not be met. Education should be provided to ensure the correct orders are used. Protocol should be revisited to verify the correct orders are included.

22 Clinical Care Pathways Pregnancy Episodes Pathway focused on improving pregnancy outcomes Knew what we should do needed to discover where to improve Chose key metrics to track Use workbooks to implement change and monitor effectiveness

23 Clinical Care Pathways Pregnancy Episodes Key tests and vaccines measured at specific points of the pregnancy Rubella: Weeks GBS: Weeks Tdap: Weeks Flu: Seasonal Measured percentage at pathway implementation (orange line). Continued to monitor weekly to measure improvement.

24 Clinical Care Pathways Pregnancy Episodes Educated providers and clinicians on pathway processes and measured results. December 2017: Noticed a downward trend, and identified a problem. New Prenatal Package was added to Epic, but not to the workbook metrics. New practices (offices) using Epic, but pathway was not yet implemented. Added new Prenatal Package and removed practices not yet utilizing pathway. Metrics immediately rebound.

25 Clinical Care Pathways Pregnancy Episodes A Patient Details Dashboard helps providers and clinicians identify patients to target for care, including those at high risk. Not Shown: Patient MRN Column Impact Identify patients requiring attention. Patients meeting all key metrics have better outcomes for mother and baby.

26 Clinical Care Pathways Pregnancy Episodes Key metrics measured throughout an active pregnancy result in better outcomes for mother and baby. Flu is affected by seasonality December through March seeing 60% acceptance of flu vaccine. Pathway Implementation November 2016 Pathway Continuation August 2018 Rubella 80% 92% Tdap 47% 78% GBS 70% 83% Flu 2% 36%

27 Clinical Care Pathways Acute Coronary Syndrome (ACS) The Pathway Overview provides the most pertinent high level metrics and trends at a glance.

28 Clinical Care Pathways Acute Coronary Syndrome (ACS) Improve patient safety and decrease complications related to morbidity and mortality in STEMI and NSTE ACS patients Increase clinical standardization Reduce LOS for patients with low to intermediate risk Reduce unplanned readmissions within 30 days Maximize quality, and lower costs for patients admitted with AMI

29 Clinical Care Pathways Acute Coronary Syndrome (ACS) Medication on Arrival and Discharge Medications such as aspirin on arrival are best practice guidelines from the ACC/AHA. Impact While we show a 4.4% increase (86.7% to 91.1%), aspirin is still not given on arrival for 8.9% of encounters. The patient should receive required medication every time when not contraindicated. As we are not at 100%, an opportunity for improvement remains.

30 Clinical Care Pathways Acute Coronary Syndrome (ACS) Cardiac Rehab Referral Cardiac rehab is recommended by the ACC/AHA and monitored by many of the registries we participate in. Real time monitoring ensures patients are getting the order. Impact An 11.7% increase year over year indicates more patients have a continuation of care. Even with an 11.7% increase, the overall 42.2% indicates continued opportunity for improvement

31 Clinical Care Pathways Acute Coronary Syndrome (ACS) Heart Score The heart score is a tool that helps assess risk for a major cardiac event. User education has led to improved documentation. Impact While modest, documentation has improved 6.8% since As users are educated, documentation should continue to improve.

32 Clinical Care Pathways By the end of 2019, approximately 90% of Inpatient services will be included in a Pathway 29 Pathways Exist Currently New Pathways will be added by July 2019

33 We really wanted to show how we handle Protected Health Information

34 Protected Health Information (PHI) but you don t have access.

35 PHI Security Create a Calculated Field: PHI Filter ISMEMBEROF( COPD_PHI') Add the PHI Filter to the Worksheet containing PHI Set Filter to True This will display details if the user is a member of the Active Directory Group.

36 PHI Security Create a worksheet for PHI Message Create calculated field PHI Text

37 PHI Security Create a new PHI Message Worksheet Use previously created PHI Filter calculated field as a filter, set to False On PHI Message Worksheet, drag PHI Text to Text Mark - Format as large red text. To test, select a user who should NOT have access to PHI. If successful, the message will appear.

38 PHI Security Combined the Details and PHI worksheets onto one dashboard, and test!

39 Distribution & Tableau Server

40 Distribution & Tableau Server Lehigh Valley Health Network Analytics Portal Repository for all things reporting Empowers self service users are trained to upload their own Tableau workbooks and PDFs All Tableau workbooks on the Analytics Portal are published to Tableau Server

41 Key Benefits and Measureable Impact

42 Key Benefits and Measureable Impact Length of Stay Shorter lengths of stay lead to lower costs for network and patient day reduction in overall length of stay for Ileostomy. Readmissions Insurance does not reimburse for readmissions related to the original procedure. CMI Ensure procedures are coded correctly. One Tenth of a point can equal $800,000. OB Improved overall care: Rubella by 12%, Tdap by 31%, GBS by 13%, Flu vaccine by 34% Order Set Usage Maintain a standard of care for procedures. Access to Data Availability of metrics outside of Epic Hyperspace for executive team.

43 What s next?

44 What s next? More Self-Service Analytics We have more developers than ever, in departments all over the network! New Data Sources (and Certified Data Sources) Leverage Caboodle the Epic Clinical Data Warehouse to create new data sources. Integration of Non-Epic Clinical Data Create a one-stop shop for all clinical data! Evolving Standards We keep learning! But when do we refactor older projects? New Developers Inside our team and across the network how do we support and train them?

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