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Survival tactics in a sea of salty data

Data, data, every where, Lest tumor boards should shrink ; Data, data, every where, No time to stop to think. Survival tactics in a sea of salty data. —with apologies to Winslow Homer and Samuel Taylor Coleridge. Case studies. Vermont Project State-sponsored single payor initiative

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Survival tactics in a sea of salty data

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  1. Data, data, every where, Lest tumor boards should shrink; Data, data, every where, No time to stop to think. Survival tactics in a sea of salty data —with apologies to Winslow Homer and Samuel Taylor Coleridge

  2. Case studies Vermont Project • State-sponsored single payor initiative • Large & diverse partner group White paper: Bloomberg Highlights Vermont Cancer Pilot; PCD Partners Plays Key HIT Role • Unique care delivery environment White paper:PerverseIncentives, Clumsy Laws, and the Value/Volume & RVU Conundrum in Medical Quality Tennessee Project • Large, diverse metropolitan environment • Competitive business landscape White paper: Decreasing Complexity, Improving Care Quality, and Reducing Cost in Oncology

  3. Context Both projects have similar characteristics: • Large-scale care integration • Payment reform • Clinical improvement & innovation And similar system requirements: • Data-driven • Process controlled • Continuous improvement A lot to do and a lot to learn—and quickly

  4. Our Approach: QMS  Rapid Learning Tools of Industry Quality Clinical Care Rapid learning system Quality Lean Six-Sigma CAPA Swim lanes ISO-14972 ISO-9001 Ohno circle Process maps Clinical pathways QMS SOPs Kaizen Value stream maps Process and outcome metrics ISO-13485

  5. Our Approach: QMS  Rapid Learning Tools of Industry Quality Clinical Care Process control & efficiency Data becomes information Rapid Learning Six-Sigma SOPs Lean Ohno circle Kaizen Swim lanes Clinical pathways Process and outcome metrics CAPA QMS Quality Process maps Value stream maps Rapid learning system ISO-14972 ISO-13485 ISO-9001 Outcome metrics

  6. Our Approach: QMS  Rapid Learning Tools of Industry Quality Clinical Care Process control & efficiency Data becomes information Rapid Learning Quality Management in Complex Systems Six-Sigma SOPs Lean Ohno circle Kaizen Swim lanes Clinical pathways Process and outcome metrics CAPA QMS Quality Process maps Value stream maps Rapid learning system ISO-14972 ISO-13485 ISO-9001 Outcome metrics White paper: Medical Quality Systems: The Elusive Goal of Quality in Complex Systems

  7. Metrics/Quality & Process Change Process Metrics: • Measure compliance; almost all metrics are process metrics Outcomes Metrics • Only viable in context of uniform processes CMS AHRQ, NQF ASCO, ACS CoC, ACCC, ASTRO, NCCN Other oncology organizations Who provides these? See A Taxonomy of Leading Oncology OrganizationsandPatient-Reported Outcomes: Choosing Appropriate Metrics From a Still-Evolving Toolset

  8. Drowning in a sea of data: necessary and sufficient? Best practice data Process/efficiency data Registries, QOPI, NCCN, Press Ganey, HCHAPS Compliance, e.g. multi-modality care plan Efficiency, e.g. radiographic imaging incidence, chemotherapy protocol adherence Process, e.g. queuing issues, overtime Large corpus. Matters to Payors and used in ranking. Doesn’t measure anything but itself. Necessary, but not sufficient for improvement. Small corpus. Valuable only internally and in DTP marketing. Cheap to gather. Expensive to gather. Does it change cost? Improve process? Change outcomes?

  9. The Trick/Secret Sauce Integrate documents and data into a single system Novel functionality of a cloud-based relational database: • Integrated process definition (ISO) and monitoring with flexible and defined data feeds. • Yields ISO control and auditability in a data-driven environment; easy to show effectiveness. • Data model exactly mimics the real world; connects the components of the SOP to the way things truly work.

  10. E.g.: The Problem of Two Worlds Registries & Best Practice Data Document Management & SOPs PROs: Meets regulatory requirements May improve payment Affords some comparison within industry Epidemiologically important Fits EMR data fields CONs: Significant auditing problems Definitional variability Not process-directed Little or no impact on outcomes PROs: Meets regulatory requirements May improve payment Affords some comparison within industry Required for clinical trials CONs: Significant auditing problems Definitional variability Not data-directed Feels like a straight-jacket Sits alone, ignored and unloved

  11. Are Green Lights enough? p r o c e s s s t a t u s Looks good! Process A Process B Process C

  12. Are problems being addressed? Improvements made? Data-defined process = Auditable outcome PROCESS CHANGE NO CHANGE CHANGE EFFECTIVE

  13. rQMS DASHBOARDS Process Data Entry EMR REPORTS AUDIT REPORTS ! ALERTS Process Def. & Target Collaborative CARE PLAN

  14. RLS/QMS = Process Control & Improvement Required to make it work: • Define the processes & train for competent operation • Collect data to monitor process performance & fix issues • Audit processes for compliance and improvement needs • Improve processes as needed • Review the entire system and align with strategy

  15. RLS/QMS in Action CMO Oncology Hospital Partner Management Review RLS CMA Audit QMS Audit Audit P C D PROCESS B PROCESS A Monitoring Monitoring D A T A T R A I N I N G . . . Definition: SOP Definition: SOP repeat

  16. Rapid Learning CMO Oncology Strategic change Management Review Improvement Audit P. R.O. PROCESS A Fix Monitoring C A P A s M E D I C A L C A R E P A T I E N T . . . Definition: SOP repeat

  17. Framing the Problem Historical Care / Payment Arrangements Incentives for More Process Steps Treatment Patterns: Fee for Service $ Primary Care Variable end points Uncoordinated care Undocumented outcomes System-optimized for $ size and frequency $ $ $ $ Med Onc $ $ $ $ SurgOnc $ $ $ $ Rad Onc $ Palliation Data: chargemaster only RCM-optimized

  18. Framing the Solution Changes in Care Management System integrates ISO / Lean Six Sigma Clinical data confirms protocol compliance $ Single plan Integrated care delivery Best-practice driven Patient objectives integrated $ $ $ PCP Palliation Med Onc SurgOnc Rad Onc Hospice Patient Care Plan PlanUpdates

  19. Framing the Solution ISO-style RLS/QMS controls compliance and CAPAs ISO-STYLE RLS/QMS controls compliance and CAPAs Control Reporting CLINICAL PATHWAYS specify care plan Spec & Planning D A T A S T R E A M S LEAN & SIX SIGMA optimize care delivery Optimization PLANNED & EXECUTED CARE DELIVERY Patient-specific Med Onc, SurgOnc, Rad Onc, Palliation, PCP, Other Outcomes Patient ED Off-ramp

  20. Behind the curtain: the RLS/QMS ISO-style cloud-mandatory Rapid Learning System cloud-optional Pathways Rules Engine Care Plan Design & Implementation Lean / Six Sigma D A T A S T R E A M S Patient-reported Outcomes External Data Feeds EMR & Chargemaster Data Warehouse

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