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

2 Scenario Planning for PCTs The 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: Dont use more than three scenarios. Develop scenarios with equal probability of success based on what you know. Carefully name each scenario.

4 Scenario Planning From 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 Planning From 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 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

12 Identification of Key PCT Data Sources Source: DeLuca, Joseph, M., Enmark, Rebecca, The CEOs Guide to Health Care Information Systems, 2nd edition, Jossey-Bass, (ISBN : x)

13 Identification of Key Data Sources Patient 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 services QI, 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 mgmt 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. Mgmt /physicain reporting Provider profiling QA Patient trending Medical Records

14 Identification of Key Data Sources Patient Financial & Administrative Systems - cont 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 mgmt Physician profiling Outcomes studies Mgmt 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

15 Identification of Key Data Sources Decision Support Systems These systems are obtained through a specialty group of HIS vendors. Application Function Data Required Data Uses BudgetingRevenue/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 mgmt Cost Accounting Reimbursement Modeling Project revenue expenses Compare actual/expected reimbursement Predict financial impact of changes

16 Identification of Key Data Sources Decision Support Systems - cont 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 depts and point of service Patient accounting and administrative data Population analysis UR Contract negotiation and mgmt Physician staffing & recruiting Budget requirements by service line Management of labor hoursLabor 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

17 Identification of Key Data Sources Clinical 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

18 Identification of Key Data Sources Clinical Systems - cont 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

19 Identification of Key Data Sources Ancillary Department Clinical Systems Ancillary systems support the internal activities of a health care organisations 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 RoomtScheduling, OR prep Inventory control Staffing, costs Surgical supply preference Productivity Cost identification and control

20 Identification of Key Data Sources Practice 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

21 Identification of Key Data Sources Social 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

22 Identification of Key Data Sources Enabling 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 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.

23 Identification of Key Data Sources Key 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 mgmt 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

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