Using Data to Drive Health System Performance Commissioned from Ovations by the National Primary and Care Trust Develo

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

2. 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

3. 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.

4. 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

5. Scenario PlanningFrom Derek Wanless - Securing Our Future Health:Taking a Long-Term View, April 2002 Note: handout from report - Summary of Scenarios

6. Scenario Building Scenario Scenario Scenario Key Variables One Two Three #1 #2 #3 #4

7. 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

8. 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

9. 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

10. 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.

11. Identification of Key PCT Data SourcesApplications & 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

12. Identificationof 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)

13. Identification of Key Data SourcesPatient Financial & Administrative SystemsThese 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 • 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 services • QI, cost control measures • Utilization Review • Inpatient Admission, outpatient/clinic registration • Patient Transfer • Patient Discharge • Census/bed control • Preadmissions and insurance verification Admission/Discharge/ Transfer Registration • Multiple procedure, resource, facility support • Conflict alert • Surgical facility support Scheduling • 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 • 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 • Chart and deficiency tracking • Coding • Abstracting

14. Identification of Key Data SourcesPatient Financial & Administrative Systems - con’t Application Function Data Required Data Uses • 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 UR QA • 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 • Quality evaluation and maintenance • Clinical Protocol Development • Regulatory, state 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 Scheduling

15. Identification of Key Data SourcesDecision Support SystemsThese 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 Cost Accounting • 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 Reimbursement Modeling • Project revenue expenses • Compare actual/expected reimbursement • Predict financial impact of changes • Revenue • Expense • Case Mix • Economic Modeling assumptions • Establish appropriate pricing strategies • Contract negotiation and m’gmt

16. Identification of Key Data SourcesDecision Support Systems - con’t Application Function Data Required Data Uses Case-Mix Analysis • 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 Productivity Management • Management of labor hours • Labor hours and costs • Patient acuity data • Staffing requirements and projections • Labor cost management Clinical Process Improvement • 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 • 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 Physician/Provider Profiling • Treatment patterns; case-mix • Outcomes • Diagnosis & Procedure data • Severity methods & protocols • Variance reports • Clinical cost ID and control

17. Identification of Key Data SourcesClinical SystemsClinical systems support the documentation & management for direct patient care. Application Function Data Required Data Uses Nursing Care Planning • 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 Critical Paths Protocols • 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 Order Entry and Results Reporting • 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

18. Identification of Key Data SourcesClinical Systems - con’t Application Function Data Required Data Uses Clinical Process Improvement • 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 Physician/Provider Profiling • Treatment patterns • Case-mix • Outcomes • Clinical diagnosis and procedure data • Severity, risk adjustment methods • Standard protocols • Variance reports • Clinical cost identification and control

19. Identification of Key Data SourcesAncillary Department Clinical SystemsAncillary systems support the internal activities of a health care organisation’s individual departments. Application Function Data Required Data Uses Pharmacy • 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 Radiology • Order fulfillment • Film tracking • Regulatory compliance • Patient, clinical administrative data • Location of films • Radiology service costs • Management reporting • Patient/payer billing Laboratoryt • Regulatory compliance • Parameter definitions • Worklists management • Order fulfillment • Type of controlled substances • Lab ranges and values • Pending orders • Coding data, costs of orders • Patient /payer billing • Order fulfillment • Productivity management Operating Roomt • Scheduling, OR prep • Inventory control • Staffing, costs • Surgical supply preference • Productivity • Cost identification and control

20. Identification of Key Data SourcesPractice Management SystemsThese systems support the clinical and administrative activities relating to physician practice. Application Function Data Required Data Uses Scheduling • 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 Registration • 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 Medical Records • Chart & deficiency tracking • Coding • Retention/evaluation • Patient demographic clinical, insurance data • Patient medical records # • Deficiency types, DRGs • Coding indices and edits • Management reporting • Patient/payer billing • Provider deficiency profiling • QA 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

21. Identification of Key Data SourcesSocial Services/Mental HealthThese services support the integrated health care spectrum surrounding mental health and associated needs. Application Function Data Required Data Uses Scheduling • 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 Clinical Documentation, Care Pathways/Plans/ Protocols • 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 Management • 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

22. Identification of Key Data SourcesEnabling TechnologiesTechnologies have enabled providers to utilize new and more efficient methods of data communication. Category What They Enable 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. • Data warehouse; clinical data repository • Enterprise area networks • Community health networks • EDI Networking and Telecommunications Technologies Technologies that broaden the potential IT user base, through more visual, intuitive presentation and interpretation of data. • Clinical workstation • Data mining • #-D multimedia • Graphical user interfaces Networking and Telecommunications Technologies Work to integrate information - with associated improvement in care quality and efficiency, cost maintenance and control. • Scheduling • Case Management • Protocol management • Member health record • Uniform eligibility database Networking and Telecommunications Technologies Technology available to develo0p and support new applications. These technologies ease financial and risk barriers to new development and shorten application development timetables. • Relational databases • Interface tools,Query languages • Graphical interfaces • Open systems • Client/server

23. Identification of Key Data SourcesKey System Focuses and Applications System Focus Critical System Applications Patient Administration Applications Enterprisewide view; uniform; data accessible across the System; possibly uniform systems; support central business operations as required • Enterprise scheduling • Enterprise patient index • Enterprise capabilities for eligibility, benefit, utilization and protocols Medical Records Shift to single enterprise record; encounter-based longitudinal focus on patient/enrollee • Clinical data repository • Evolve toward electronic health record Decision Support Support multiple organisations and entities; used in pursuit of cost reduction, managed care contracting, clinical continuum • Contracting/profitability analysis • Clinical case management/analysis • Actuarial/risk-adjusted outcome analysis • Patient /enrollee satisfaction analysis • Budgeting and productivity m’gmt Clinical systems Managing efficacy of care within contract; support continuum of care • Common procedures, order protocols • Computerized protocols • Case management solutions • Integrated ambulatory acute care • Physician office result reporting

24. 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