Five Tips to launching Hospital Analytics

Hospitals everywhere are driving to a new era of Data. Some are jumping in head first to the bleeding edge technologies that promise to deliver value and others are waiting until it’s been proven before even putting their toe in the water. There is not a magic formula to healthcare data and analytics yet, but there are emerging best practices that should lead us all to more effective uses of data in our hospital environments.

Saint Luke’s is a 10 campus 1303 bed Health System in the Kansas City area. They are near and dear to my heart since I have delivered at their beautiful East campus. They are well known in the area for being high touch and high quality. I have had the pleasure of working with several of their leaders on projects and knowing others in the community.

Debe Gash has been the CIO of the health system since 2006 and has lead the organization to be well respected and win awards such as Most Wired, and recently lead them through the selection process of a new EMR. Debe has been on an Analytics journey for the past 18 months as the health system identifies and defines analytics goals and usage for their facilities.

“Health reform has driven an emphasis to analytics. Health Systems must perform as efficiently as possible while delivering positive outcomes. The only way to do this effectively is by using analytics” said Gash

1)   Get an education

Gash started her journey by seeking out wisdom of those who have been down the road before her. Her memberships at CHIME and the Health Data Warehouse Association have been invaluable resources for her to gain wisdom from her peers.

“The Health Data Warehouse Association provides webinars to its membership where my peers are presenting…not vendors” said Gash.

In a good peer group you can get the good, the bad, and the ugly without any bias or spin based on the vendors needs to sell to survive. While vendors have provided insight into the process they should not define how or what you are doing.

2)   Create a Data Governance Strategy Board

The phrase “death by committee” is a fear for many CIO’s with a vision. Saint Luke’s determined not only that there needed to be a committee who was well informed, autonomous, and had authority but they also needed to create a new role (FTE) for the organization to manage it all.

“We put in place a Director of Data Governance who works with committees to define, prioritize, execute, and evaluate our Data Governanceneeds“ said Gash

The team is comprised of key stakeholders who were committed to identifying things that could be improved by applying data.

3)   Create a Data Governance Strategy

Data Governance covers a whole range of topics within the overlying umbrella that is analytics. It is the rules and goals for the organization which allows identification, prioritization, application, and evaluation of the information.

The Data GovernanceBoard is responsible to define and maintain the following pillars of data management:

· Collection
· Storage
· Distribution
· Display

“People struggle with what should I look at and what do I need to do with it and why is it important? Our Data Governance defines all of those things for our hospitals so we can align system wide goals with system wide information.”

While the health system does use committees for subject matter expertise the core responsibility for data governance falls on theBoard and Director and they are accountable for compliance with the set standards.

4)   Select vendors only AFTER you have defined a process, and require compliance with your data governance.

Data and Analytics are the buzz words on every vendor’s lips. Vendors believe to sell their product they must have a “dashboard” or information display. The challenge is with multiple dashboard, and proprietary methods it is challenging to drive end user usage compliance. Saint Luke’s determined that vendors will be evaluated by their ability to conform to hospitals defined governances for data collection.

“Big Data is how you manage the data not the “what” it’s the architecture behind it.”

A common faux-paux of health systems is allowing vendors or groups within the hospital to define their own path for data evaluation. The hospital must create a single source of truth for all data, then a consistent metric for real effectiveness.

5)   Drive Compliance & Usage by creating organization goals for outcomes and operational efficiencies

The only way to drive behavior change and consistent usage is to attach economics that mean something to the individual or team.

“Our health system’s ROI is not determined by how much data is collected, or how great your dashboard is – it’s defined with what you do with the information and how you are able to impact patient care by increasing efficiency and improving outcomes.”

Through engaged leadership Saint Luke’s is working to drive meaningful change in their organization to improve patient care. Debe’s leadership has created focused culture of accountability using real data to make informed decisions. We will keep tabs on Saint Luke’s progress throughout their EMR implementation and launch of its analytic dashboards.

 

Hospital CIO series: Steve Huffman of Beacon Health System

I have decided to do a series of blog posts on hospital CIOs perspective on data and analytics and vendors…. I have talked to a lot of industry people (which has been fantastic fun and really great mentorship for me) but now really want to focus on what does the hospital want, need, think…..I believe that we, as vendors, focus a lot on what we think they want and what we think they need. In the world of analytics – there is a lot of newness so there is some providing them with what we “think”. However, how many times are you in a hospital each year trying to gain perspective from end users and from patients? How many times are you actively seeking to identify how your niche really applies to the day to day activity of the nurse or patient?

Recently, I was sitting at Denver International and playing on twitter. A CIO, who always is insightful, was posting a series of tweets on what not to do in a web ppt. As he published his disdain for vendors use of the popular sales medium (I was feverishly taking notes to send to @sphere3kyle) I thought – how many times do we as vendors believe we are enlightening a hospital. I was so inspired, I emailed him and he graciously agreed to chat on the phone with me – what ensued was one of the best conversations I have ever had with a CIO. Probably because I wasn’t selling a thing – I was listening to the perspective of someone who lives it everyday and was willing to share his thoughts.

Steve Huffman has been CIO of Memorial Health System – now Beacon Health System (South Bend, Indiana) since 2008. Prior to working for the health system he worked for the “startup” Medical Manager/WebMD. I rarely call someone brilliant but interviewing him was a lot like when I interviewed Tom Herzog….a wild ride of ideas and statements that each in its own could define an entire blog post. I will focus on a few in this post and maybe pull a few out for another.

One statement that stuck with me (as a vendor and business owner) was this “CIOs who spend more time with vendors than observing what is actually occurring with end users are doing it wrong.” I think back to that scene from Backdraft when Kurt Russell tells whichever Baldwin brother that is “You’re doing it wrong – if you do it that way it will fly open and you will die.” How many CIOs go from meeting to meeting and instead of engaging the end users ?  They are stuck hearing it second hand. If they continue down the exhausting path of being segregated from the actual floor experiences and perspectives of end users and patients...they will in essence die from project failure or burn out. As a vendor my mind immediately went to, how do I facilitate that process more effectively - instead of standing up with a ppt.....

Steve's next statement I will take to all my startup friends.  “Not everything can revolutionize healthcare, and that’s ok.” His cynicism has grown as every excited sales person stands up with a vision of a revolutionary change provided by their product. This is completely contrary to what every academic professor tells you when creating a “High Profit Venture” Steve’s contention was – revolutionizing healthcare cannot be done with a product – it can only be done by those who are working in the hospital. The change is not a technology – the change is an action and while it can be enabled by technology it cannot be caused by technology. Not even the EMR is revolutionizing healthcare, its recording data….which is good but not the change agent needed to meet the expectations that are coming down from the government.

The last thing I asked Steve was for a real world example of how analytics has impacted his career. This was the most exciting part of our conversation. An analytics team was asked by leadership to examine why they were having so many readmissions in the Emergency Department. They began observing and analyzing the EMR data regarding the consistencies of the patients diagnosis. “I was sure it was going to be heart related....”Steve had no idea how heart related it really would become to him. The consistencies were not related to a medical diagnosis that could be healed with pills, the consistent diagnosis was alcohol and drunkenness. So to reduce the number of readmissions, Steve began to seek out where in the community individuals with this challenge could go for help. He found that the local shelters did not accept people who had been drinking or were on drugs – even in the cold weather. That winter a man died in a garage due to exposure to the cold. Steve said “I didn’t hear the audible voice of God, but I knew that He was telling me – you know too much to do nothing.” So Steve and a small team had a mission and set out to find a solution. He and his wife and the small team set out to start a ministry to provide a place to sleep, eat, and be spiritually fed for the down and out of South Bend Indiana. Several churches stepped up to help. Now Steve spends his free time feeding the stomachs and souls of those in need.

For us an experience created a mission for analytics. For Steve an analytics created a mission.  Sometimes it's not about "revolutionizing" healthcare but it's learning to care for others. 

Follow Steve @SteveHuffmanCIO

Compiling and Comparing Data

I work at a lot of coffee shops.  It’s not that we don’t have an office but there is something about being in a space with music, coffee, and energy.    There are always people there meeting for business – to stop collaborate and listen.   I have done it dozens of times myself – reached out to people who have expertise in a specific area or have started a business and can give insight from a been there, done that perspective.   This blog is spattered with some of those stories.

My one regret is how I have managed all the information that I have gathered in the last few years.  I take really crazy notes mostly with doodles and pictures.  When people say a picture speaks a thousand words- they are right (plus it’s easier to remember a picture).  The team jokes I have an addiction to spiral notebooks, there are about 50 in my office full of “valuable” information.   While I have gotten better about giving the algorithms to Kristal to be properly documented for evaluation, testing, and roadmapping  – there is a lot of information that is not that square – not a number, not an equation, more anecdotal but still important.   Those feelings that are just as important as a data point. 

I once had a friend describe working for a startup and watching the CEO of that company change in the years of its build.  The story itself was not uncommon to many I have heard before, but for some reason his words describing his perception of the emotional state of the CEO were.  Perception of the event or process – feelings – are as important as hard data.

We are working on ways to capture those thoughts of caregivers and nurses so that the square data can be compared to squiggly line data – thoughts, impressions, and ideas.  Active comparison to perception vs the reality of a situation will help to create more accurate benchmarks….just because you can be staffed to have a 10 second response time….is it necessary?  That was a hard question for me – my gut says YES of course if we can and we should but reality is there is always a cost associated with the movement.  I almost hate to say it but in this dynamically changing industry…. Is that worth the cost….

The balance between delivering the hospital leadership perception of service excellence and delivering an “Always” can be two different things. 

The “Always” can be more accurately attained if you understand the reality of the perception of the patient – if you create an expectation and meet it.  The “Always” cannot be obtained when we set unreasonable expectations with our patients, or we fail to meet a basic level of expectation.

Best Coffee Shops in KC for Working....

Mildreds in The CrossRoads District
Roasterie in Brookside
Latte Land in Briar Cliff

Haven't found any I love out South so open to suggestions....

A Passion for Patients

I am often on planes – seems to be the blessing and curse of success - I have to admit, after working and being away from my family for several days, I usually just want to slip on my head phones and look out the window, but sometimes my seat mate just wants to chat. 

It was a Thursday, I missed #2’s baseball game the night before so I was a little grouchy, and I was eager to get home to spend time with my boys.  I had splurged $50 to upgrade to Airtran “1^st class” which generally translates to a comfortable quiet trip home.  As I was praying the plane wouldn’t break, in walked my seat buddy – a 6’5  55+year old woman carrying a 10 month old baby.  There went quiet….though the conversation that followed was much more than I ever imagined.

We talked about the airplane – we talked about raising children – we talked about travel abroad - we talked about the Lord and then we talked about her adorable baby.   Soon I learned her name was “Mary” and it was her grandson who was only 4 months old when his mother, her youngest daughter, had passed away.  The story struck me, but more than that - staring into the face of the little boy on her lap - it broke my heart to imagine my boys growing up without me. 

Her daughter was a vibrant healthy young woman who became ill and deteriorated over several months.  She had several visits to the emergency room of their rural hospital with little answers.   Eventually, she was admitted to that hospital, Mary kept her children and her husband stayed with her as her advocate.  The baby became ill and Mary had to bring him to ER, when she arrived her son-in-law left his wife alone and met her to check in and see his son.  While he was gone, his wife pressed her call light – with no response she went to the bathroom alone then returned to her bed.  When he returned to the floor, he saw the call light on in the hallway outside her room.  He found his wife unresponsive.  In his confusion, he pressed the call button and began yelling for help – with no answer he ran to the nurses’ station.  The unit secretary ran to another patient’s room to find the nurse.   A few moments later – Mary heard a Code Blue call to her daughter’s room.  Leaving the baby with the ER nurse she flew to the floor, but nothing could be done.  Her daughter had died.

My mind immediately went to Regina and the E-patient movement. I shared about the Walking Gallery and my dear friend’s story of the loss of her husband.  How she had inspired me, and how the people in the gallery inspire me. 

She asked me what I did in healthcare – so I shared about Noah, and what we do at Sphere3.  She asked if I could get the data about her daughter’s incident. “I am not sure” I responded – seeing disappointment flush her face – I tried to explain that some technology does not support historical records – some technology does not save any records at all especially in small rural hospitals.  There are ways for me to get to data on a go forward basis, but many times it's a challenge to get to the retrospective data if it was not planned for when the initial technology was installed.  However, I would take a look if she ever wanted me too.

I wrote a while back about the drive to do more, to make a greater impact, to intercept the incidents, to save lives…..when patients are your driver – when people are your purpose - you do more.  You find yourself listening on an airplane - when you just wanted to look out the window.  You connect with people who inspire you and will drive you to go further.   

Are you doing this for the sake of profits?
Are you doing this for the sake of the patients? 
Are you inspiring a conversation in the HIT community or are you riding on the wave of government funded HIT? 

Don't ride the wave - find your inspiration and drive for change that matters.  

The Art of the Report

I always really enjoyed stories but a confession - and I hope Mrs. Karnes is not reading thi s- I rarely read an entire book.   Generally, the beginning was interesting and so was the end but everything else was just filler.  Most  of the time after I got to know the characters a bit – I would just make up my own story.   (That's why now I stick with non-fiction)

The challenge with reading for school was the book report….due at the end of the designated reading time.  As I have started working with my kids on their book reports the reason behind the reports is becoming clear.  It’s less about the “report” of the book and more about the function of the activity.

A book report had several purposes but mainly it helps a child move from basic reading skills to true understand of the authors intent.   It teaches you to look into the materials you are reading and disect important information.  You don’t start out in 1^st grade being able to read a book and describe the message.   You must first start with pulling the phonograms (sounds) into words – the words into sentences – the sentences into paragraphs – the paragraphs into stories – the stories to interpreting the materials to find its meaning. 

This is the way I look at data – right now it’s pretty dispirit – it’s a lot like phonograms.  If you don’t know about phonograms – they are a single or small group of letters that makes a sound.  My favorite is “er” as in her.   As in that example, however, “er” is part of several words – such as deter – same ending phonic but when coupled together with “de” instead of “h” it’s a different word.  Data is kind of like that too – depending on how we look at it – what pieces we add together the different pieces of data can give us different words.  The phonic does not change but the word does.  Once we build those words we can begin to link them together into sentences and so on. 

All the pieces of information could be pulled together to tell an overlying story but today – in health IT  - as we look at data most are just trying to make the phonograms say a word.    Once we are able to get the words we will be able to pick out simple attributes such as  characters names, locations, time period, etc   Once we are able to move past those simple attributes - We can progress to inferred things such as attitudes.   For example, she cried when she found out her beloved dog died.  Nowhere in the sentence does it say she was sad but you can figure it out based on what you know about crying and what you know about the death of a beloved pet.  As you progress to high school you are asked to identify big picture items such as theme.  We apply knowledge filters every day to assumptions – what do we already know to be true and how does that influence what we are looking at to get to the next level.  We reference other materials - we talk to teachers who know.

Eventually, we will be able to take the attributes and the inferred understanding of situations then apply it into a bigger picture understanding of the story – what is the theme – what is the message – what is it saying about society in general.

So what?  My small group leader at church says that at the end of each Bible Study – meaning so what does this mean to me – how do I apply this towards real life today.

The data in the medical devices, the medical records, and other technologies are independent data sets – the parts and pieces within them are the phonograms which need to be pulled together into words and will tell us a story about the patient.  As we begin to compile that data – review it across a population – it will tell us more.  Think about research papers you wrote in college – did you reference only one book? The challlenge before us is the sheer quantity of data that will need to be analyzed to get to the final answers.  Note: Not impossible.....just a challenge. :-)

HIMSS12 ReCap

I liked how Colin Hung (@Colin_Hung) put it in his blog “white space dominates” at HIMSS12  - I was afraid maybe it was just me – was I working too much and not looking hard enough for the new and exciting.   So, I have waited an entire weekend before writing my final blog HIMSS12.  I went back and reread some of the blogs I posted after HIMSS11 including two of my favorites The Patient as a Consumer and The New Economy.   Ironically, not most heavily trafficked but a good glimpse into the way I see things.

I debated back and forth about what to post – I could blast a few people and companies for same-o-same-o booths, technology that is still behind the times, promising more than they can deliver, or when people said or did things that were “just business” but were frankly just wrong.    It seems like everyone was focused on refinement of existing ideas instead of pushing anything new.   The most disappointing comments I heard circled around “proprietary” databases and not sharing information.   I wish I would have had the gumption to say…… brrring brrring – that’s the 80’s calling and they want their proprietary database back.  Or quote my friend Epatient Dave "Give me my Darn Data" (this is a G rated blog so I changed the wording a bit)  I know that sounds a little childish as a response but after I got over being angry (which for me equated to tears) – I realized that companies that believe that it’s better to stifle innovation are going to get left behind at some point.  Proprietary databases are just pride lived out in our geekery.

The most exciting things were announcements from the government on ICD-10 and MU #2 – I read a great blog about this by @JohnSharp  http://healthworkscollective.com/node/29411

“Big Data” we are generating more data than ever before – the EMR is just part of it – the tip of the clinically documented iceberg.   I was enamored by @ReginaHoliday ’s profound statement that her husband posted 6 different times on his facebook conditions that could have indicated he had kidney cancer.    We document our lives to 400 of our closest friends….if the data were analyzed what would it tell us?   I have a fb friend who's husband is manic depressive and you can tell distinctly when he is not taking his medication by her status updates.  The scary thing – that’s just a second subset of self-reported data.   How about the 5 medical devices that are hooked to you when you are in the hospital – how about fitbit – how about (you fill in the blank) etc.  I could more than 20 areas where data resides that “could” tell us something about an individual health.   I live in the acute care space because that’s where my data resides today – but the lines are blurring which is a good thing.   To me – this is really the most consuming part of my career.  Do you devour information in a manner that let’s you apply it into other learning? 

Before my head explodes – I want to share with you my favorite comment at the HIMSS show.  I was able to meet a Kevin from North Shore LIJHC.  He comes from outside of healthcare into a fast changing world – which he likened a lot to the other industries he has been in where technology and data changed the way we do things.  As we started talking about big data – medical device data – EMR reference data - my hands were waving as I got more and more excited…… He replied with a fantastic east coast mixed with Irish accent – “Kourtney, you are trying to win the Super Bowl when today all we need is a first down.” 

Folks, don’t let big data scare you.  We each have a subset of information that we are good at – that we know and understand better than anyone else.   Today – by the next HIMSS – we need a first down.  We need to gain 10 yards.   Sustainability will be driven by our ability to work with others.

The ER Visit Blog

As some of you saw in a recent tweet, I had to journey to the Emergency Room for a brief visit.  While it wasn’t intended to give me material for a blog post – it has provided me with some thoughts that are worth sharing to my fellow technologists.

During the visit one of the questions I was asked by my fabulous nurse was "Who is your primary care physician?" This should be an easy one, right?  Well, it’s easy if you have been to a PCP more recently than your last year of college.  Yes, a little known fact about me is I have a terrible phobia of Doctors (ironic right?) As part of my discharge process both the Nurse and the Doctor said I needed to followup with a PCP.   I told them I understood and thanked them for their help – fully knowing in my mind that I had no intention of going to see a PCP….that’s where sick people go and I am not sick…I am healthy, OCD about eating right, I don’t need a doctor.   My husband had other thoughts and soon I was scheduled to see a PCP.

As I bemoaned the coming doctors visit I had a call from my conscious the voice of reason since age 12  (her name is Carrie) and without belittling me she made mention that you can’t improve when you don’t know where you start.  Then, in a way only she can, she reminded me that I preach to dozens of clients and businesses.  "Kourtney, don't you tell people there is a need for “baseline” data before starting an improvement process.  Yet there is not one ounce of data pertaining to your medical care over the past 10 years."   (other than my calorie counting iphone ap)

Sometimes, even when we are healthy we need a doctor.  Technologist, do you make products that make sick hospitals better or do you create products that enable the on-going health management of hospitals?  At some point isn't the goal for the hospital to be well - doesn't that somehow work you out of a job if you are always focusing on sick?  

Even if you are focused on fixing a pain - How do you know that your technology or service has improved their facility?  Do you know specifically what processes you impact and what things within the processes you are measuring that link directly to patient satisfaction and improved care?  Can you measure them? Will you measure them?  Or are you satisfied with the status quo technology buying cycle where people by a feature and are not guaranteed a result.

Technology enables a process.  A process is NOT worth changing or implementing if the steps are not measurable and the data derived is not linked to a meaningful goal.

Technologist, if you are not providing a baseline that is documented with data directly from an existing technology prior to implementing a new technology then you are doing the hospital, it’s clinicians, and it’s patients a huge disservice. 

In case you were wondering - There is value in driving the wellness of organizations as well as fixing a pain.

In the end – I did go to see a Primary Care Physician. To all of you doctors out there, I chose him on a few factors - he was recommended by someone I trust, time spent with patient exceeded the norm, but my final decision point for choosing him..... what made the biggest portion of my decision?  He was part of the network of the hospital that I visited and he had automatic access to my electronic patient record from my Emergency Room experience.  No phone calls – no faxes just a few clicks and there I was in all of my single entry glory.  I drive 35 minutes to his office.

I know my Data is important in decisions and that on-going my data available to my care providers for logical diagnosis decisions is critical.

Reflections of a Former Fat Girl

A wise CEO I know said that “Trended Change is the only Change of Value.”  In terms that most of us can relate to – if you lose 10lbs and can’t keep it off then you have failed.  I have been on as many diets as Oprah Winfrey and failed as many times.  At my largest I was well over 215lbs, my smallest around 140lbs.  Now, I am somewhere in between.    Whether it was a pill or a plan I would move blindly towards the current fad diet searching for my magic bullet.   I call it experiential learning, after years of failure I have figured out that the magic bullet does not exist.  

The only way to succeed in consistent long term weight loss and management is by lifestyle change.   Which is a lot different than saying “I am going on another diet” A diet may provide a specific goal but it also implies a designated time frame, at some point we reach the goal.  How many of us look forward to reaching the goal so the diet is over and we can go back to “normal”?

A lifestyle change means that you not only have identified the functional causes, but you have established a starting point.   A lifestyle change involves education and understanding, which may require technology and data. Once you have identified the functional causes you can hone in on the decisions and behaviors that are creating the situation and begin to make a change.    I applaud my friends at Cerner for the KC Slimdown challenge and www.cernerhealth.com if you haven’t taken a look pop on and see.  If you are competing with Team S3 – good luck - I like to win and I really like Sporting KC. (It's one of the prizes)

At this point you may be asking – why is this CEO of a patient experience & safety analytics company writing a blog about diets?   Improvement whether its weight or patient experience is all about making a lifestyle change, and managing yourself after the change.     One of the reasons weight watchers works is because you are consistently watching your weight.  Hospitals need tools to consistently watch their weight.   I get on a scale nearly every day which some may find excessive but seeing the number motivates me towards doing the right things during the day.   

S3 Aperum is the like the scale I get on each morning.  It’s providing patient experience and safety data in a "weight management" format to allow leadership to make adjustments and alignments as needed.  I would love to tell you it is the magic bullet, but it’s only part of the puzzle.   Like any weight loss or management program technology is a tool that enables us to succeed it’s not the tool that makes us succeed.    We have developed 4 key areas called pickle points where hospitals have issues surrounding patient safety and satisfaction.  3 of the 4 are not technology based – they are identified using technology but the root is in people, policy, and behavior.

For fun – if you have a “Slimdown” story you would like to share – please post it as a comment.  We would like to hear of your success, your process, and on-going management.