1 Using Data to Drive Health System Performance Commissioned from Ovations by the National Primary and Care Trust Development Programme.

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Using Data to Drive Health System Performance

Commissioned from Ovations by the National Primary and Care Trust Development Programme

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Scenario Planning for PCTsThe Art of the Long View - Peter Schwartz

Identify Focal Issue or Decision

Identify Key Forces in the Environment Influencing Success

Identify Driving Factors

Rank Factors by Importance

Select Scenario logistics

Flesh out the scenarios

Identify Implications

Select Leading Indicators

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Scenario Planning

Additional Considerations:

Don’t use more than three scenarios.

Develop scenarios with equal probability of success based on what you know.

Carefully name each scenario.

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Scenario PlanningFrom Derek Wanless - Securing Our Future

Health: Taking a Long-Term View, April 2002

Scenario 1: Solid Progress People become more engaged in

relation to their health

Scenario 2: Slow Uptake There is no change in the level of

public engagement

Scenario 3: Fully Engaged Public engagement in relation to their

health is high

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Scenario PlanningFrom Derek Wanless - Securing Our Future Health:

Taking a Long-Term View, April 2002

Note: handout from report - Summary of Scenarios

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Scenario Building

Scenario Scenario Scenario

Key Variables One Two Three

#1

#2

#3

#4

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Identification of Key PCT Data Sources

Why is Data Important? As we have learned, the correct data will help you

answer the key health questions you have. Data is key for determining:

What: Problem

Who: Populations, how many people

Where: Locations, geography

When: Period of time

Why: Why is this an issue

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Identification of Key PCT Data Sources

Why is Data Collection Important?

To track changes/stability of health over time

What is influencing changes

To evaluate the impact of prevention/health promotion, and health care interventions

To monitor resource allocation

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Identification of Key PCT Data Sources

Possible Issues and Controversies with Data

Example: A database for PCTs including medical records for virtually every hospital stay and physician visit.

Privacy View: Threat to patient privacy, damaging to the physician-patient relationship, misleading information results in worse care.

Public Good View: Needed to improve care, to reduce health care costs, to respond quickly to public health needs

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Identification of Key PCT Data Sources

Possible Issues and Controversies with Data

Example: Survey asking minors about topics such as drinking, smoking, and sexual behavior

Voluntary View: Parent permission, intrusive or controversial questions.

Mandatory View: Voluntary participation could skew the data, passive permission allows all to participate and gives a full picture of issue being addressed.

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Identification of Key PCT Data Sources

Applications & Functions

The major software application areas for information systems in modern health care organisations are:

Patient financial & administrative systems

Decision support systems

General financial management systems

Provider managed care systems

Clinical systems

Practice management systems

Home health systems

Enabling technologies

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Identification of Key PCT Data Sources

Source: DeLuca, Joseph, M., Enmark, Rebecca, The CEO’s Guide to

Health Care Information Systems, 2nd edition, Jossey-Bass, 2001. (ISBN :0-7879-5277-x)

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Identification of Key Data SourcesPatient Financial & Administrative Systems

These systems are obtained from a health information system supplier. They support the activities involved in tracking inpatient and outpatient care.

Application Function Data Required Data Uses

Admission/Discharge/ Transfer Registration

•Inpatient Admission, outpatient/clinic registration•Patient Transfer•Patient Discharge•Census/bed control•Preadmissions and insurance verification

•Patient demographic & insurance data•Current census info.•Treating Physician Info.•Patient clinical data•Discharge planning•LOS

•Population tracking, service, & market analysis•Census tracking/bed control•Initiate, conclude servicesQI, cost control measures• Utilization Review

Scheduling •Multiple procedure, resource, facility support•Conflict alert•Surgical facility support

•Patient demographic/clinical data•Test Requirements and procedures•Resource availability/costs•Surgical preference lists

•Cost Control•Productivity measurement,improvement•QA/UR•Costing by patient group•Conflict & resource m’gmt

•Chart and deficiency tracking•Coding•Abstracting

•Patient demographic, clinical, insurance data•Patient records number•Deficiency types and stds.•DRG Groupers•Coding indicies and edits•Patient abstracting stds.

•M’gmt /physicain reporting•Provider profiling•QA•Patient trending

Medical Records

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Identification of Key Data SourcesPatient Financial & Administrative Systems - con’t

Application Function Data Required Data Uses

UR

QA

Scheduling

•Estimated and actual LOS calculation

•Initial and final patient diagnosis procedures performed•Patient demographic data

•Utilization control•Patient trending•Outcomes studies•Management and regulatory reporting

•Potential quality problem alerts

•User defined quality and LOS stds.

•Quality control and risk m’gmt•Physician profiling•Outcomes studies•M’gmt and regulatory reporting

•Severity of illness classification•Health status evaluation•Aggregate data grouping for Quality Report Cards

•Patient financial, clinical and admin., data•Internally or externally defined qulaity indicators

•Quality evaluation and maintenance•Clinical Protocol Development•Regulatory, state reporting

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Identification of Key Data SourcesDecision Support Systems

These systems are obtained through a specialty group of HIS vendors.

Application Function Data Required Data Uses

Budgeting •Revenue/expense projections•Volume-adjusted projections

•Historical revenue/expense data•Case-mix data

•Budgeting

•Produce data for cost procedure, case, DRG, ambulatory visit grp.•Determine per procedure, case, DRG profit

•Labor hours•Supply costs•Number, types of procedures performed

•Cost identification•Budgeting•Measure variable cost-control technique effectiveness

•Revenue•Expense•Case Mix•Economic Modeling assumptions

•Establish appropriate pricing strategies•Contract negotiation and m’gmt

Cost Accounting

Reimbursement Modeling

•Project revenue expenses•Compare actual/expected reimbursement•Predict financial impact of changes

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Identification of Key Data SourcesDecision Support Systems - con’t

Application Function Data Required Data Uses

Case-Mix Analysis

Productivity Management

Clinical Process Improvement

•Analyse patient service mix by: point of service., department, physician, payer/contract, diagnosis

•Diagnosis procedure data from all dep’ts and point of service•Patient accounting and administrative data

•Population analysis•UR•Contract negotiation and m’gmt•Physician staffing & recruiting•Budget requirements by service line

•Management of labor hours •Labor hours and costs•Patient acuity data

•Staffing requirements and projections•Labor cost management

•Rules base processing alerts to patient events•Diagnostic and treatment prompts

•Patient clinical data•External databases•Critical paths and protocols

•QA•Risk Management•Cost Control•Clinician education/ awareness

Critical Paths Protocols

Physician/Provider Profiling

•Std trmt & procedures for cases•Variance tracking and research

•Diagnosis & procedure data•Drug cost ; patient outcome data

•Physician profiling & evaluation•Clinical cost ID, control, RM

•Treatment patterns; case-mix•Outcomes

•Diagnosis & Procedure data•Severity methods & protocols

•Variance reports•Clinical cost ID and control

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Identification of Key Data SourcesClinical Systems

Clinical systems support the documentation & management for direct patient care.

Application Function Data Required Data Uses

Nursing Care Planning

Critical Paths Protocols

•Clinical documentation•Care planning•Dosage calculation•Acuity classification

•Patient clinical data•Facility-defined care paths•Dosage stds

•UR/QA•Regulatory reporting and compliance•Provider profiling.case management

•Std trmt and procedures for similar cases•Variance tracking and alerts•Research support for clinical protocols

•Diagnosis and procedure data•Procedure drug cost data•Patient outcome data

•Physician profiling/ evaluation•Clinical cost Identification and control•RM

•Automated order verification•Online inquires for orders•Prompts for “best practice”•Order set Maintenance•Order explosion•Automated results reporting

•Patient demographic and clinical information•Ordering physician information•Testing procedures, results•Clinical protocols

•Management reporting•Cost control•RM•QA/UR•Medical records

Order Entry and Results Reporting

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Identification of Key Data SourcesClinical Systems - con’t

Application Function Data Required Data Uses

Clinical Process Improvement

Physician/Provider Profiling

•Rules based processing alerts•Diagnostic and treatment prompts

•Patient clinical data•External databases•Critical paths and protocols

•QA•RM•Cost Control•Clinician education and awareness

•Treatment patterns•Case-mix•Outcomes

•Clinical diagnosis and procedure data•Severity, risk adjustment methods•Standard protocols

•Variance reports•Clinical cost identification and control

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Identification of Key Data SourcesAncillary Department Clinical Systems

Ancillary systems support the internal activities of a health care organisation’s individual departments.

Application Function Data Required Data Uses

Pharmacy

Radiology

Laboratoryt

•Inventory tracking•Regulatory compliance•Medication risk management•Order fulfillment

•Type of controlled substances•Stock transfer data•Rx transfer data•Patient administrative and clinical data•Location/expiration dates•Rx service costs

•Regulatory reporting•Inventory cost and space planning•Patient/payer billing

•Order fulfillment•Film tracking•Regulatory compliance

•Patient, clinical administrative data•Location of films•Radiology service costs

•Management reporting•Patient/payer billing

•Type of controlled substances•Lab ranges and values•Pending orders•Coding data, costs of orders

•Regulatory compliance•Parameter definitions•Worklists management•Order fulfillment

•Patient /payer billing•Order fulfillment•Productivity management

Operating Roomt •Scheduling, OR prep•Inventory control

•Staffing, costs•Surgical supply preference

•Productivity•Cost identification and control

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Identification of Key Data SourcesPractice Management Systems

These systems support the clinical and administrative activities relating to physician practice.

Application Function Data Required Data Uses

Scheduling

Registration

Medical Records

•Multiple procedure resource•Conflict alert•Recalls/reminders•Variable time slots

•Patient demographic/clinical data•Test requirements/procedures•Resource availability and costs

•Cost control•Productivity measurement,improvement•QA/UR•Resource/supply costing by patient group

•Inpatient admission or outpatient clinic registration•Patient transfer or discharge•Referral tracking

•Patient demographic insurance data•Census information•Treating physician information•Patient clinical data•Discharge instructions

•Population, census tracking•Initiate and conclude services•QI•Cost control

•Chart & deficiency tracking•Coding•Retention/evaluation

•Management reporting•Patient/payer billing•Provider deficiency profiling•QA

•Patient demographic clinical, insurance data•Patient medical records #•Deficiency types, DRGs•Coding indices and edits

UR and Case Management

•Actual vs expected/contracted utilization

•Case mix by provider/contract•Contract terms•Patient diagnosis /procedures•Patient demographic/Hx data

•Compliance with contract terms•Provider profiling•Utilisation control•Contract profitability analysis

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Identification of Key Data SourcesSocial Services/Mental Health

These services support the integrated health care spectrum surrounding mental health and associated needs.

Application Function Data Required Data Uses

Scheduling

Clinical Documentation, Care Pathways/Plans/ Protocols

Patient Management

•By patient, physician, resource•Conflict alert•Recalls/reminders•Variable time slots

•Patient demographic/clinical data•Visit requirements and procedures•Resources•Patient eligibility

•Cost control•Productivity measurement•QA/UR•Resources•Case Management

•Automated visit notes•Assessments - ADL, SF-36)•Treatment and procedures for similar cases•Severity adjust care plans•Variance tracking•Research support

•Clinical diagnosis (ICD-9, NANDA)- procedure visits•Actual visits completed•Drug cost data•Outcome data,care paths•Severity of illness measurement

•Clinicain profiling and evaluation•Clinical cost identification/control•RM•UR/QA•Regulatory compliance reporting

•Patient demographics•Registration/discharge•Third party billing (UB-92)

•Patient demographics, medical Hx•Required billing form data

•Case-mix•Population studies•Health status outcomes•Patient tracking

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Identification of Key Data SourcesEnabling Technologies

Technologies have enabled providers to utilize new and more efficient methods of data communication.

Category What They Enable Technologies •Data warehouse; clinical data repository

•Enterprise area networks•Community health networks•EDI

•Clinical workstation•Data mining•#-D multimedia•Graphical user interfaces

•Scheduling•Case Management•Protocol management•Member health record•Uniform eligibility database

•Relational databases•Interface tools,Query languages•Graphical interfaces•Open systems•Client/server

Networking and Telecommunications Technologies

Networking and Telecommunications Technologies

Networking and Telecommunications Technologies

Networking and Telecommunications Technologies

More efficient, complete data storage and communication. New ways to capture and store raw data; ability to communicate required data across geography, facilities.

Technologies that broaden the potential IT user base, through more visual, intuitive presentation and interpretation of data.

Work to integrate information - with associated improvement in care quality and efficiency, cost maintenance and control.

Technology available to develo0p and support new applications. These technologies ease financial and risk barriers to new development and shorten application development timetables.

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Identification of Key Data SourcesKey System Focuses and Applications

System Focus Critical System Applications •Enterprise scheduling

•Enterprise patient index•Enterprise capabilities for eligibility, benefit, utilization and protocols

•Clinical data repository•Evolve toward electronic health record

•Contracting/profitability analysis•Clinical case management/analysis•Actuarial/risk-adjusted outcome analysis•Patient /enrollee satisfaction analysis•Budgeting and productivity m’gmt

•Common procedures, order protocols•Computerized protocols•Case management solutions•Integrated ambulatory acute care•Physician office result reporting

Patient Administration Applications

Medical Records

Decision Support

Clinical systems

Enterprisewide view; uniform; data accessible across the System; possibly uniform systems; support central business operations as required

Shift to single enterprise record; encounter-based longitudinal focus on patient/enrollee

Support multiple organisations and entities; used in pursuit of cost reduction, managed care contracting, clinical continuum

Managing efficacy of care within contract; support continuum of care

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Key Technologies Supporting Managed Care

EDI

Open Systems, Client/Server Technology

Interface Engines

Advanced Database Tools

EMR

Contract Management Tools

Automated Clinical Protocols, Critical Pathways

Case Management Systems