Audio Transcript

Introduction to Health Care

Data Analytics
Module 1: Introduction to
Quality Improvement and
Data Analytics
Lecture a
Version 1.0/Fall 2016

This material was developed through a collaboration of Bellevue College and the Veterans Health
Administration, with Bellevue College funded by the Department of Health and Human Services, Office of
the National Coordinator for Health Information Technology under Award Number 90WT0002.

Except where otherwise noted, this work is licensed under the Creative Commons Attribution-
NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit
http://creativecommons.org/licenses/by-nc-sa/4.0/.
Slide 1
Welcome to the Introduction to Health Care Data Analytics, Module 1, An Introduction to
Health Care Quality Improvement and Data Analytics, lecture a.

Slide 2
The learning objectives for this module include
Discuss drivers for health care transformation
Identify quality initiatives that have shaped the national health care landscape
Define health care quality and value
Describe the background and evolution of quality and performance improvement
Discuss the quality improvement (QI) [Q-I] frameworks that utilize analytics
Define health care data analytics
Discuss how analytics can help transform health care

Slide 3
The landscape of health care is changing rapidly. Health care organizations are under
pressure to increase the quality and safety of care, reduce costs, and meet changing
regulatory requirements. In response, the health care delivery system is undergoing a
transformation to a more integrated, patient-centered model, focused on improving
health outcomes.
In this lecture, well describe
The current health care landscape,
The growth of technology in health care, and
The health care cost and quality crisis.
Well also introduce the role of data analytics in supporting quality improvement.

Slide 4
In 1999, the Institute of Medicine (IOM) shocked the nation when it reported that as
many as 98,000 deaths occur each year due to preventable medical errors. This
occurs despite the fact that the United States spends significantly more money than any
other country on health care. The same year, the US was spending over 13% of the
nations Gross Domestic Product (GDP) on health care3% more than the next highest
country. Since that time, costs have continued to escalate.

Slide 5
Without a doubt, the pace at which technology is impacting our everyday lives is
increasing at lightning speeds. Currently, 29% of Americans say their phone is the first
thing and last thing they look at every day, which is a telling sign of how connected we
are with technology.
The use of health information technology (health IT), including electronic health records
(EHRs), is expected to improve efficiency of health care delivery, decrease overall costs
for services, and improve the quality of patient care. However, the health care industry

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hasnt been as quick as others to adopt technology. The 1996 Health Insurance
Portability and Accountability Act (HIPAA) moved the industry toward increased use of
technology, requiring providers and large health plans to transmit claims and health plan
benefit transactions electronically while maintaining privacy and confidentiality of
personal health information.

Slide 6
To advance the use of EHRs and health IT to improve the delivery of health care in the
United States, the American Recovery and Reinvestment Act (ARRA) was passed in
2009. It included the Health Information Technology for Economic and Clinical Health
Act, also known as HITECH, which provided financial incentives for the implementation
and meaningful use of EHRs. The incentives, administered by the Centers for Medicare
& Medicaid Services (CMS), encouraged providers not only to transition to EHRs but
also to implement computerized provider order entry (CPOE) and clinical decision
support (CDS) systems. Implementing these systems enables providers to demonstrate
improved quality and safety, better care coordination, and increased patient
engagement.
Widespread adoption and meaningful use of EHRs was intended to produce
Better clinical outcomes,
Improved population health outcomes,
Increased transparency and efficiency,
Empowered individuals, and
More robust research data on health systems.

Slide 7
Since ARRA was passed, the use of EHRs and health IT applications has increased
dramatically, even doubling during a recent three-year period. The result has been an
exponential growth in the amount of patient data available. Personal health records
(PHRs) and nontraditional sources of health and wellness informationsuch as
environmental data, social media, and wearable technologiesalso generate vast
amounts of information. The massive amount of data, known as big data, has the
potential to support a wide range of medical and health care functions, including clinical
decision support, disease surveillance, and population health management. Authors
Shah and Pathak note that trends and patterns revealed in the data can provide [quote]
evidence of safety and effectiveness of different treatments, comparative outcomes
achieved with different delivery models, and predictive models for diagnosing, treating,
and delivering care. [end quote]

Slide 8
The health care industry has made a tremendous investment (estimated at $25 billion in
a five-year period) in using health IT in hopes of reducing medical errors, decreasing
health care costs, and improving health outcomes. By many accounts, results have
been disappointing, perhaps in part due to the sheer complexity of health care.

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In 2002, Peter Drucker stated in his book Managing in the Next Society that [quote]
health care is the most difficult, chaotic, and complex industry to manage today [end
quote] and that the hospital is [quote] altogether the most complex human organization
ever devised [end quote].
The IOM study referenced earlier, To Err Is Human, highlights how complex and
inherently risky health care is and provides a strong impetus for performance
improvement.

Slide 9
The Institute for Healthcare Improvement (IHI) [I-H-I] advocates a systematic approach
to optimizing health system performance described in a framework called the Triple
Aim.
The three aims are
Improving the patients experiencespecifically, their satisfaction with the care
provided, as measured by satisfaction surveys, and the quality, safety, and
outcome with respect to their health status;
Improving the health of populations, based on prevalence and incidence of
chronic diseases, mortality rates, and life expectancy; and
Reducing the average cost per person for health care and hospital and
emergency services utilization rates.
To translate the Triple Aim concept into specific actions for change, IHI recommends
that health care organizations use a systematic approach that includes five
components:
Focus on individuals and families,
Redesign of primary care services and structures,
Population health management,
Cost control platform, and
System integration and execution.

Slide 10
Although it may seem that the patients experience and successful outcome should
have always been the focus of health care, this paradigm shift is emerging only recently.
Historically, the providerpatient relationship was paternalistic. The physician
determined the appropriate course of treatment based on his or her knowledge and
experience, and the patient was a passive participant in the interactions. The provider
patient relationship has been evolving into a partnership in which the patient has more
autonomy and takes a more active role in decisions regarding treatment options. The
culture has also changed. Health care is becoming less about curing acute illness and
more about prevention and management of chronic conditions. Patients are generally
more educated and have access to considerably more information and support
networks via the Internet than ever before. Consumer expectations have also changed.
Patients expect to be able to schedule appointments, communicate with providers, and
access their health information online.

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Slide 11
Changes in reimbursement models are also incentivizing health care organizations to
focus on improving patient outcomes and transitioning to patient-centered care.
Traditional reimbursement models were based on a fee-for-service model in which
health care providers were paid for each service provided, such as an office visit,
diagnostic test, or medical procedure. Fee-for-service is a volume-based model. Health
care providers earn more by doing more, regardless of the outcome.
In a value-based reimbursement model, providers are reimbursed on the basis of
achieving health care quality measures and positive patient outcomes.

Slide 12
But how do we determine if the care provided is a good value? Value in health care is
defined in relation to the customers, or patients, needs and expectations. The key
indicators of the value of health care delivery are whether the patients health was
improved, whether the patient felt good about the experience, and whether the care
provided resulted in a positive outcome. If so, the care added value for the patient.
Value can be quantified by the ratio of desired outcomes relative to cost.

Slide 13
We also need to define health care quality.
The IOM defines it as
[quote] the degree to which health services for individuals and populations increase the
likelihood of desired health outcomes and are consistent with current professional
knowledge [end quote].
Quality also needs to be defined in quantifiable terms to enable measurement, analysis,
decision making, and action.

Slide 14
In a follow-up report to the earlier To Err Is Human, IOM published Crossing the
Quality Chasm: A New Health System for the 21st Century. In this study, the IOM
examined the divide, or chasm, between what is considered quality care and the health
care that people actually receive. The report identified six domains of quality that health
care organizations should aim to improve.
1. Safety: Avoiding harm to patients
2. Effectiveness: Providing services based on scientific knowledge
3. Patient-centeredness: Providing care that is respectful of and responsive to
individual patient preferences, needs, and values
4. Timeliness: Reducing waits and delays
5. Efficiency: Avoiding waste, including waste of equipment, supplies, ideas, and
energy
6. Equity: Providing care that doesnt vary in quality because of personal
characteristics

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Slide 15
Measuring performance in health care isnt a new practice. Most health care
organizations have long recognized the need to evaluate their performance, yet many
struggle with what to measure and how to effectively use the results of those measures
to improve and maintain sustainable improvements.
More than 50 years ago, a physician named Avedis [uh vay dees] Donabedian [Do na
bay dian] proposed a conceptual model for evaluating health care quality based on
three categories: structure, process, and outcomes.
He defined structure as the environment in which health care is provided.
Structure measures include the context of care, such as the physical
environment in which health care is delivered; the resources available, such as
staff and equipment; and organizational policies that direct how staff behave.
Process is the way care is delivered and includes all the activities and
interactions around the health delivery system. Examples include services
provided such as registration times, labs ordered, labs performed, and so on.
Often, these data are available in the EHRs.
Outcome measures are the resultsor endpointsof a treatment or other
process. Outcome indicators could be length of stay, readmission, mortality, and
so on.
Donabedians approach utilized graphical presentations of statistical data and evidence-
based medicine practices.
According to his model, the context (or structure) in which care is delivered affects
processes and outcomes. Outcomes indicate the combined effects of structure and
process. Many health care organizations focus on managing process and fail to address
structure, which results in limited and often temporary improvements in outcomes.

Slide 16
Industry has been addressing quality and performance improvement for quite some
time. As far back as the 1920s, quality improvement pioneers, such as Walter
Shewhart, W. Edwards Deming, and Joseph M. Juran, worked to increase the efficiency
of American industry. Shewhart and Deming, both physicists, and Juran, an engineer,
applied a scientific approach to improving quality and efficiency. They did this by
streamlining and standardizing processes, minimizing human error, and collecting data
to support effective decision making. Over the years, industry has produced several
quality improvement methodologies that provide a framework that can be adapted for
use in health care. In the next few slides, well review three quality improvement
frameworks that have made their way into health care: Lean, Total Quality
Management, and Six Sigma.
Lean is an approach focused on improving efficiency by reducing waste. It was
initially introduced in Japan in the car manufacturing industry around 1948 and
gained significant popularity by the 1970s.
Total Quality Management (TQM) [T-Q-M], also called Total Quality Improvement
(TQI) [T-Q-I], was introduced by the US Navy in the 1980s. The Navy utilized the
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 work of Deming, a quality thought leader, to design an organization-wide quality
improvement process that was then adopted by other organizations.
Six Sigma, which also gained popularity during the 1980s, was developed by the
Motorola Corporation and focuses on improving quality by reducing defects and
variation.

Slide 17
The term lean was coined during the late 1980s by a research team headed by James
P. Womack, Ph.D., at MITs International Motor Vehicle Program, to describe Toyotas
business methods. Lean focuses on maximizing customer value while minimizing
waste. Lean thinking starts with eliminating waste so that all work adds value and
serves the customers needs. Although Lean was developed in the automotive industry,
its application as a quality improvement methodology in other industries, including
health care, has been gaining popularity. In health care, according to data analytics
expert Trevor Strome, [quote] Lean thinking helps to identify the least wasteful way to
provide better, safer health care to patients with minimal delays [end quote].
Lean uses value stream maps (also called material and information flow mapping) to
illustrate process steps and identify the time required to complete each step as well as
time spent waiting for the next step to occur.

Slide 18
TQM is a process-oriented approach to continuous improvement of products and
services. The TQM or TQI framework incorporates the idea that quality improvement is
an ongoing effort. Involvement of the entire organization is required to adopt and
maintain a climate in which an organization improves its ability to deliver high-quality
products and services to customers. TQM considers quality to be defined by customer
requirements and expectations. The approach also assigns top management direct
responsibility for quality improvement efforts and for creating an organizational climate
dedicated to continuous quality improvement. It focuses on optimizing processes and
systems and uses chartered performance improvement projects assigned to a project
team. It relies heavily on systematic analysis of work processes. A variety of process
mapping techniques, graphic display of data, and the Plan, Do, Study, Act (PDSA) [P-D-
S-A] cycle are used to gain valuable learning and knowledge for the continual
improvement of a product or process.
Following are the steps in the PDSA cycle:
Step 1: PlanPlan the test or observation, including a plan for collecting data.
Step 2: DoTry out the test on a small scale.
Step 3: StudySet aside time to analyze the data and study the results.
Step 4: ActRefine the change based on what was learned from the test.

Slide 19
Six Sigma is a management philosophy and a structured, data-driven approach for
eliminating defects. [quote] Six Sigma projects involve increasing quality and yield
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while reducing defects and variation. [end quote] Its a system and tool set that applies
statistical analysis to measure and improve performance. The approach enhances
quality by supporting decision making based on statistics and facts. Six Sigma is highly
measurement and data driven. In fact, the name Six Sigma relates to driving toward six
standard deviations between the mean and the nearest specification limit. Six Sigma
assesses defects per million opportunities and aims for fewer than 3.4 defective parts
per million opportunities.
Although the Six Sigma deviations may not be relevant in all applications, data has to
be obtained to determine the baseline performance of a process in order to validate that
an improvement has been made. The problem-solving approach DMAIC [duh may ick]
(Define, Measure, Analyze, Improve, and Control) is used in Six Sigma. Well discuss
the DMAIC framework in more detail in a future module. Briefly, the framework has five
phases:
Define the problem, project goals, and project plan.
Measure and map the current process to establish a baseline and determine the
magnitude of the problem.
Analyze the value-added/non-value-added process steps, the sources of
variation, and the root causes.
Improve the process by devising a strategy, then testing and tweaking that
strategy to achieve desired results.
Control the process to ensure improved performance level is maintained.

Slide 20
According to the National Quality Forum (NQF), the ability to extract meaningful,
actionable insights from the wealth of raw information captured across the health care
industry will be the key to improving quality and patient outcomes. This data is the
cornerstone of quality improvement. Data analytics describes how well current systems
are working and what happens when changes are applied.
Value-based care relies heavily on patient data. Health care analytics is a prerequisite
for performance improvement initiatives addressing value-based care in an automated,
cost-effective, and efficient manner. Use cases for data analytics projects can and have
led to quality improvements. These initiatives include such topics as identification and
management of high-risk patients; development of evidence-based protocols and best
practices to reduce hospital readmissions, infections, and other adverse events; and
tracking disease outbreaks and health disparities. These applications of data analytics
are vital for successful performance improvement efforts, which can result in improved
patient outcomes consistent with value-based, patient-centered care. In the next lecture,
well define data analytics and discuss several types of analytics and their use in health
care.

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