1. Harnessing the Power of a Learning Health System to Change Systems of Care Delivery Margaret J. Holm, RN, PhD, FACHE Academy Health EDM Forum June 7, 2014 San Diego, CA

2. Organization Transformation "Every system is perfectly designed to achieve exactly the results that it achieves.” (P.Batalden)

3. Quality Education: At the Core

4. Metadata: EDW Atlas Security and Auditing Common, Linkable Vocabulary Financial Source Marts Administrative Source Marts Departmental Source Marts Patient Source Marts EMR Source Marts HR Source Mart FINANCIAL SOURCES (e.g. EPSi,) ADMINISTRATIVE SOURCES (e.g. API Time Tracking) ADMINISTRATIVE SOURCES (e.g. API Time Tracking) EMR SOURCE (e.g. Epic) EMR SOURCE (e.g. Epic) DEPARTMENTAL SOURCES (e.g. Sunquest Labs) PATIENT SATISFACTION SOURCES (e.g. NRC Picker, PATIENT SATISFACTION SOURCES (e.g. NRC Picker, Human Resources (e.g. PeopleSoft) Human Resources (e.g. PeopleSoft) Data: Generation and Access Copyright © HealthCatalyst 2013 Operations Labor productivity Radiology Practice Mgmt Financials Patient Satisfaction + others Clinical Asthma Appendectomy Deliveries Pneumonia Diabete s Surgery + others

5. DATA CAPTURE Acquire key data elements Assure data quality Integrate data capture into operational workflow Acquire key data elements Assure data quality Integrate data capture into operational workflow DATA ANALYSIS Interpret data Discover new information in the data Evaluate data quality Interpret data Discover new information in the data Evaluate data quality DATA PROVISIONING Move data from transactional systems into the EDW Build visualization Move data from transactional systems into the EDW Build visualization 5 Information Management: Roles Copyright © HealthCatalyst 2013

6. Collaborative Learning Interprofessional Teams Knowledge Management Use of Meaningful Data Integration of Evidence and Decision Support Tools Patient Engagement/Education PDSA Cycles Results Collaborative Learning Interprofessional Teams Knowledge Management Use of Meaningful Data Integration of Evidence and Decision Support Tools Patient Engagement/Education PDSA Cycles Results Transforming Care Delivery: Care Process Teams

7. Percentage of Asthma patients with order for chest X-ray (Emergency, Observation, Inpatient) Year & Month (Patient Count) Percentage of Asthma Patients with order for chest X-ray One Example of Results

8. Organization Programs: Clinical, Research & Operations Surgery Clinical Program Medicine Clinical Program Women’s Clinical Program Research Data Program Clinical Operations Program

9. CLINICAL PROGRAMS WORKGROUPS CLINICAL PROGRAM COUNCIL CLINICAL SYSTEMS INTEGRATION EXECUTIVE COMMITTEE EDW TEAM (Data Architects) Governance Structure: Integration of People, Data and Systems

10. Lessons Learned Shared vision, team learning and systems thinking guided the integration of care delivery creating opportunities for improvements, collaborative learning and meaningful data. New organization systems and governance structures were needed to manage improvements and electronic data. An iterative approach to data requests and utilization assures closer communication and more meaningful data. Senge P. The Fifth Discipline. 1990