Implementation Network Webinar

1. Implementation Network Webinar April 25, 2014

2. Welcome!This is our first "Implementation Network Webinar" • Objectives for today • Present why we believe in Outcomes Measurement • Share our perspective on the "Implementation Journey" • Present support offered by ICHOM: the "Implementation Network" Free For organizations actively implementing our Standard Sets

3. Who is presenting today Dr. Jens Deerberg Mrs. Lisa van Maasakkers Mr. Jean Stoefs • President of ICHOM • Faculty Member of Harvard Business School • Background • Medical Doctor • COO of a large private hospitals chain in Europe • Project Leader at ICHOM • Background • Expert in Outcomes Measurement • Head of Quality of a leading European Hospitals chain • ICHOM Vice-President of Implementation • Background • Master in Business • Consultant specialized in Value-Based Health Care

4. Many participants from all over the world today!228 participants from 28 countries This Webinar is recorded for the ones in less convenient time zones

5. Agenda The case for outcomes measurement: 20 minutes (Jens Deerberg-Wittram, President, ICHOM) What the implementation journey looks like: 30 minutes (Lisa van Maasakkers, Project Leader, ICHOM) How to join the Implementation Network: 10 minutes (Jean Stoefs, VP Implementation, ICHOM) Questions and answers

6. Variation in health outcomes is an international problem variation in 30-day mortality rate from heart attack in US variation in bypass surgery mortality in the UK variation in complication rates from radical prostatectomies in the Netherlands variation in reoperation rates after hip surgery in Germany variation in mortality after colon cancer surgery in Sweden variation in capsule complications after cataract surgery in Sweden 2x 4x 9x 18x 20x 36x Variations in health outcomes can be found in care teams, within institutions, nationally, internationally…

7. Localized prostate cancer – what is the right therapy?

8. Mortality rates alone are not the answer Death from prostate cancer Death probably or definitely due to prostate cancer or prostate cancer treatment Source: Wilt et al., N Engl J Med 367;3 2012

9. Florence Nightingale – one of the first women studying mathematics and statistics

10. “If the function of a hospital were to kill the sick, statistical comparisons of this nature would be admissible..”Florence Nightingale, 1863

11. Outcomes are the 'real world' experience of patients Example prostate cancer Patient initial conditions Protocols/ guidelines Structure Processes Patient experience/ engagement e.g., Staff certification, facilities standards PSA Gleason Score Surgical margin (…) Indicators Survival Complications Quality of life Continence Erectile function Anxiety (Health) outcomes

12. Patient-reported outcomes one year after prostatectomy - average German and Swedish hospitals* Ø 80,0 % Ø 75,5 % Ø 56,7 % Ø 50,0 % Ø 10,0 % Ø 4,5 % *Swedishdataroughestimatesfromgraphs Source: National quality report for the year of diagnosis 2012 from the National Prostate Cancer Register (NPCR) Sweden, BARMER GEK Report Krankenhaus 2012, Patient-reported outcomes (EORTC-PSM), 1 year after treatment, 2010

13. Martini Klinik, nine consultants focusing on outcome improvement in prostate cancer

14. Martini Klinik Hamburg is openly discussing detailed outcome data in regular quality reviews and achieve excellent results Martini Klinik 93,5 % Ø 80,0 % Ø 75,5 % Ø 56,7 % Ø 50,0 % Martini Klinik 34,7 % Ø 10,0 % Ø 4,5 % Martini Klinik 0,4 % Swedishdataroughestimatesfromgraphs Source: National quality report for the year of diagnosis 2012 from the National Prostate Cancer Register (NPCR) Sweden, Martini Klinik, BARMER GEK Report Krankenhaus 2012, Patient-reported outcomes (EORTC-PSM), 1 year after treatment, 2010

15. Aravind Clinic created web portal for physicians to review their just in time outcome data Web portal evolved from Excel-based reports, as physicians required more user-friendly tools Source: Aravind Eye Care Hospitals Cataract Surgery Outcome Monitoring training document illustrative report view

16. Memorial Sloan Kettering Cancer Center is running a surgeons' performance feedback system • Screen shot from the Memorial Sloane Kettering Cancer Center surgeon performance feedback system: • The proportion of a surgeon’s patients who are recurrence free at two years on the x axis is graphed against the proportion of patients both potent and continent at two years (y axis). Both estimates are adjusted for case mix. Source: Vickers et al.,Eur Urol. 2012 February ; 61(2): 284–289

17. ICHOM is dedicated to accelerating the development and impact of outcomes measurement at a Global level Our mission How we achieve it We develop Standard Sets of Outcomes We enable organizations to implement them and measure outcomes We facilitate Global Comparisons (as of 2015) 1 Our Mission We are transforming health care by empowering clinicians worldwide to measure and compare their patients’ outcomes and to learn from each other how to improve. Value = Patient health outcomes achieved Cost of delivering those outcomes 2 2

18. Agenda The case for outcomes measurement: 20 minutes (Jens Deerberg-Wittram, President, ICHOM) What the implementation journey looks like: 30 minutes (Lisa van Maasakkers, Project Leader, ICHOM) How to join the Implementation Network: 10 minutes (Jean Stoefs, VP Implementation, ICHOM) Questions and answers

19. There are four key stages in the implementation journeyHow to transform a Standard Set in a tool to drive change Convince and create buy-in Get ready Measure Drive change Convince your board/management Obtain support from your staff Identify "Evangelists" Set up governance and project team Assess your starting point Assess the business case for outcomes measurement in your organization Use tools to capture data Ensure quality of data Analyze data Report data Learn from your data to identify and disseminate best practices ICHOM can assist you in every stage of the journey

20. Measuring outcomes requires the buy-in of both the top management and the teams on the field Convince and create buy-in Get ready Measure Drive change What will resonate with them • Increasing quality typically reduces costs • Proving superior outcomes attracts more patients • Measuring outcomes allows to actively manage staff • Introducing new pricing models • Be proud of your results • Care even better your patients • Identify what to improve • Measure impact of decisions and improvements • How ICHOM can help you • Ready-to-use documents to present the initiative to your Board/Management and to your team • Success stories and proof of impact QUALITY MANAGEMENT

21. Set up governance and project structure Convince and create buy-in Get ready Measure Drive change The "ideal team" you need... ... ready for a one-year journey • A Steering Committee • Physician leader • Nurse leader • Senior administrator • Senior representative from IT • A team on the field to drive effort • One Junior doctor, passionate • One nurse • One admin staff • Analyst (preferably from IT) • Support from a central team (e.g. quality team) They will dedicate a few hours a week to drive Outcomes Measurement • How ICHOM can help you • Ready-to-use Project Charter • Detailed role descriptions • Ready-to-use Project Timeline It's key to have people from the field involved

22. Assess your starting pointGap analysis will inform the effort Convince and create buy-in Get ready Measure Drive change What is already measured? How to measure what's missing? Outcomes domains (e.g. for Localized Prostate Cancer) • How ICHOM can help you • Ready-to-use Excel tool to assess your starting point • Overview of existing solutions to help choose the right technical tool to capture outcomes Measured Paper-based questionnaires Major surgical complications Major Radiation complications Urinary incontinence Urinary frequency/urgency/ irritation Bowel irritation Sexual dysfunction Vitality Biochemical recurrence Metastasis Cause-specific survival Overall survival Patient baseline (age, co-morbidities,...) Other definition Other definition Other definition Standalone IT solutions Solutions integrated with your EMR/EHR What is the effort to measure ICHOM recommended Standard Set?

23. Build the business case: how much does it cost ? Convince and create buy-in Get ready Measure Drive change Key sources of costs • Financial resources: investments in an IT tool, in equipment (e.g. scanner,...),... • How ICHOM can help you • Ready-to-use framework to assess costs/resources • Impact stories • People: How many people will you need to set-up and run outcomes measurement? • IT resources: dedicated software, data warehouse,... • Time investments from key staff: Physicians, nurses and admin staff to collect outcomes and analyze them

24. When you go-live, the journey is not over... storage and quality of data must remain two key concerns Convince and create buy-in Get ready Measure Drive change Capture data Define your data capture plan Store them in a database Several options depending on context Local database (e.g. MS Access) Electronic Medical Records Hospital Data warehouse • How ICHOM can help you • Template of data capture process • Ready-to-use questionnaires • Ready-to-use MS Access database Ensure Quality • Results can be quickly disqualified if teams are not convinced by the quality of data • Regular touch point with key staff (physicians, nurses) to validate findings • Continuous improvement process in place to fix "bugs"

25. Learn from your data to drive change and unlock the power of value-based health care Convince and create buy-in Get ready Measure Drive change • How ICHOM can help you • Examples of reporting • Change management best practices • Guides to organize "Improvement workshops" with your clinicians Transparent outcomes data reporting • Discuss data at different levels • Between physicians • Between sites/hospitals • Take actions Continuous feedback&learning Increased health care value + Drive adoption of changes Improved Outcomes Reduced Variation Reduced Medical Cost

26. Agenda The case for outcomes measurement: 20 minutes (Jens Deerberg-Wittram, President, ICHOM) What the implementation journey looks like: 30 minutes (Lisa van Maasakkers, Project Leader, ICHOM) How to join the Implementation Network: 10 minutes (Jean Stoefs, VP Implementation, ICHOM) Questions and answers

27. Implementing Outcomes Measurement is not straightforwardICHOM can assist you with 3 different levels of support Download our "Reference Guides" Join the Implementation Network Get on-site support Clear and unambiguous definitions to implement our Standard Sets Resources to help you get started Community to connect with your peers and ask questions Regular Webinars to share content and discuss your issues Official recognition of your efforts • Our ICHOM team provides on-site support to select partners • E.g. 4-weeks diagnostic, seminars,... • This is only offered to selected ICHOM Sponsors Free on our website $500 per Medical Condition (launch price) Contact us

28. We will host regular Webinars to accompany you through your implementation journey - one year to measure outcomes! Our objective: Whatever your starting point, you will be able to measure our full Standard Set within a year We will accompany you in this journey! Key topics for the call Date1 Convince & Create Buy-in • Objectives of the Implementation Network, calls agenda and your expectations • What is the case for outcomes measurement? • What the Implementation journey will look like Today • Typical call (1:30) • Milestones of the month • Success story of one of our members • Content discussion (with an expert or a guest who will share his experience) • Presentation of useful material available on the Implementation Network • Key milestones for the next month(s) • How to assess the resources I will need? (financials, team,...) • What is the best strategy to get started? (small vs. big) Early June Get Ready • What are the legal requirements I should consider (patient consent, data collection,...) ? What are my obligations? August '14 • What are the tools available to help me measuring outcomes? • Should I outsource parts of the process? September '14 • How to store the data collected? What are the best practices? • How to risk adjust? How to ensure validity and accuracy? November '14 • How to analyze my data and make sense of it? • How to report data in an appealing way? What does a typical report look like? January '15 Measure & Drive Change • How to report it back to the clinicians? • What does the typical feedback process look like? (data validation,...) February '15 All resources will be available online on our Implementation Network website so that you can progress at your own pace • How to learn from our findings and drive change that lasts? March '15 • Wrap-up April '15 Dates and exact agenda will be refined and confirmed to the Implementation Network members. Agenda might evolve based on Participants needs

29. How to join us? www.ICHOM.org

30. Agenda The case for outcomes measurement: 20 minutes (Jens Deerberg-Wittram, President, ICHOM) What the implementation journey looks like: 30 minutes (Lisa van Maasakkers, Project Leader, ICHOM) How to join the Implementation Network: 10 minutes (Jean Stoefs, VP Implementation, ICHOM) Questions and answers

31. Any questions? • Thanks for joining today! • Send your remarks or questions to • Implement@ichom.org