Healthcare Analytics for Quality and Performance Improvement

Trevor L. Strome

• Publisher: Wiley
• Year: 2013
• ISBN:
  9781118760154
• Edition: 1
• Topic: Business
• Subtopic: Business Strategy
• Index: Business

Improve patient outcomes, lower costs, reduce fraud—all with healthcare analytics

Healthcare Analytics for Quality and Performance Improvement walks your healthcare organization from relying on generic reports and dashboards to developing powerful analytic applications that drive effective decision-making throughout your organization. Renowned healthcare analytics leader Trevor Strome reveals in this groundbreaking volume the true potential of analytics to harness the vast amounts of data being generated in order to improve the decision-making ability of healthcare managers and improvement teams.

• Examines how technology has impacted healthcare delivery
• Discusses the challenge facing healthcare organizations: to leverage advances in both clinical and information technology to improve quality and performance while containing costs
• Explores the tools and techniques to analyze and extract value from healthcare data
• Demonstrates how the clinical, business, and technology components of healthcare organizations (HCOs) must work together to leverage analytics

Other industries are already taking advantage of big data. Healthcare Analytics for Quality and Performance Improvement helps the healthcare industry make the most of the precious data already at its fingertips for long-overdue quality and performance improvement.

CHAPTER 1
Toward Healthcare Improvement Using Analytics

Innovation is anything but business as usual.

—Anonymous

How sustainable is healthcare in its current state? Most healthcare organizations (HCOs) claim to be undertaking quality improvement (QI) initiatives, but only a few are consistently improving the quality of healthcare in a sustainable fashion. Despite increased spending on healthcare in the United States, there is little evidence that the quality of healthcare can be improved by increasing spending alone. Health information systems is one technology with the potential to transform healthcare because, among its many capabilities, it can deliver the best evidence to the point of care, employs intelligent algorithms to reduce and prevent medical mistakes, and collects detailed information about every patient encounter. Even with growing volumes of data to analyze resulting from the continuing proliferation of computer systems, HCOs are struggling to become or remain competitive, highly functioning enterprises. This chapter will highlight current challenges and pressures facing the healthcare system, identify opportunities for transformation, and discuss the important role that analytics has in driving innovation and achieving healthcare transformation goals.

Healthcare Transformation—Challenges and Opportunities

Healthcare delivery is undergoing a radical transformation. This is occurring as the result of both necessity and opportunity. Change is necessary because, in many ways, the provision of healthcare is less efficient, less safe, and less sustainable than in the past. The opportunity, however, arises from the advancement of technology and its impact on healthcare delivery. Technology now allows increasingly intelligent medical devices and information systems to aid in clinical decision making, healthcare management, and administration. The challenge facing HCOs is to leverage advances in both clinical device technology and information technology (IT) to create and sustain improvements in quality, performance, safety, and efficiency.

Data generated via healthcare information technology (HIT) can help organizations gain significantly deeper insight into their performance than previous technologies (or lack of technology) allowed. HCOs, however, face the very real risk of information overload as nearly every aspect of healthcare becomes in some way computerized and subsequently data-generating. For example, radio frequency identification (RFID) devices can report the location of every patient, staff member, and piece of equipment within a facility; sampled every second, the location data captured from these devices accumulates quickly. Portable diagnostic equipment now captures and stores important patient clinical data, such as vital signs, and can forward that data to electronic medical records (EMRs) or other computerized data stores. Similarly, devices with embedded “labs on a chip” can now perform point-of-care testing for many blood-detectable diseases, and generate enormous volumes of data while doing so.

HCOs must find a way to harness the data at their disposal and take advantage of it to improve clinical and organizational performance. Data analytics is critical to gaining knowledge, insight, and actionable information from these organizations’ health data repositories. Analytics consists of the tools and techniques to explore, analyze, and extract value and insight from healthcare data. Without analytics, the information and insight potentially contained within HCOs’ databases would be exceedingly difficult to obtain, share, and apply.

But insight without action does not lead to change; data overload can risk impeding, not improving, the decision-making ability of healthcare leaders, managers, and QI teams. In my experience, the true potential of analytics is realized only when analytics tools and techniques are combined with and integrated into a rigorous, structured QI framework. This powerful combination helps to maintain the focus of QI and management teams on achieving the quality and business goals of an organization. Analytics can also be used to explore the available data and possibly identify new opportunities for improvement or suggest innovative ways to address old challenges. When an HCO uses analytics to focus improvement efforts on existing goals and to identify new improvement opportunities, healthcare can become more effective, efficient, safe, and sustainable.

The Current State of Healthcare Costs and Quality

A discussion on the topic of healthcare analytics must first begin with a discussion of healthcare quality. This is because analytics in healthcare exists for the purpose of improving the safety, efficiency, and effectiveness of healthcare delivery. Looking at the current and emerging challenges facing healthcare the way we looked at problems in the past can and will only result in more of the same. And it seems that many people, from healthcare providers who are overworked to patients who must endure unacceptably long waiting lists for relatively common procedures, are extremely dissatisfied with the way things are now.

Despite the seemingly miraculous capabilities of the healthcare system to maintain the health of, and in many cases save the lives of, patients, the system itself is far from infallible. The question of how safe is healthcare delivery must continually be asked. The often-cited Institute of Medicine (IoM) report To Err Is Human: Building a Safer Health System declares that a “substantial body of evidence points to medical errors as a leading cause of death and injury.”¹ The report cites two studies that estimate between 44, 000 and 98, 000 patients die every year in hospitals because of medical errors that could have been prevented. These are people who expected the healthcare system to make them well again or keep them healthy and were horribly let down.

According to the IoM report, the types of errors that commonly occur in hospitals include “adverse drug events and improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities.” Not surprisingly, emergency departments, operating rooms, and intensive care units experience the highest error rates and those with the most serious consequences.

Not only do hospital errors result in a staggering yet largely preventable human toll, but they result in a tremendous financial burden as well. It is estimated that the cost to society of these preventable errors ranges between $17 billion and $29 billon in both direct and indirect financial costs. Of course, the majority of these errors are not caused by deliberate malpractice, recklessness, or negligence on the part of healthcare providers. Rather, according to the IoM report, the most common causes of healthcare errors are “due to the convergence of multiple contributing factors” and that “the problem is the system needs to be made safer.”²

In the near decade and a half that has passed since the release of the 1999 Institute of Medicine report, most of its findings are as relevant today as they were in 1999. Despite dramatic innovations in biomedicine and healthcare technology since the IoM report, many HCOs today still find themselves under immense pressures, some of which include:

• Improving quality and patient safety
• Ensuring patient satisfaction
• Adapting to changes in legislation and regulations
• Adopting new technologies
• Demonstrating improved patient outcomes
• Remaining sustainable and competitive

The challenge facing HCOs today is to balance the need to innovate by adopting new technologies and improving processes while providing the essentials of safe, efficient, and effective patient care. While these two needs are complementary, with improved patient care as the ultimate goal, they both require financial, human, and technical resources that are drawn from a limited, and in some cases shrinking, resource pool.

The Cost of Healthcare

HCOs must endeavor to reduce unnecessary deaths, injuries, and other hardships related to medical errors and other issues stemming from substandard quality. But given that the cost of healthcare delivery seems to be increasing unabatedly, could healthcare be at risk of becoming unsustainable in its current form? Direct and indirect costs attributed to healthcare represent a significant and increasing burden on the economies of countries providing modern healthcare, and may not be sustainable at current growth rates.

Figure 1.1 illustrates the immense cost of healthcare by showing the percentage of healthcare expenditures as a proportion of the gross domestic product (GDP) of selected countries.³ Of the countries in F...