With two hospitals, a physician group practice encompassing more than 2,200 billing providers, and a total of nearly 800,000 outpatient visits a year, the University of Texas Southwestern Medical Center health system (UT Southwestern) in Dallas is a very big patient care organization, with a lot of moving parts. And yet leaders there have succeeded in creating a clinical quality initiative that defies the odds: it has succeeded as a broad, deep, fast-moving, substantive, and agile, initiative, all at the same time. And the genius of this initiative is in how replicable it is. For all those reasons, the editors of Healthcare Informatics have named the team at UT-Southwestern the number-one winning team in the 2016 Innovator Awards program.
For it is at UT Southwestern that clinician, clinical informatics, IT, analytics, and administrative leaders have come together to create an Ambulatory Quality Outcomes (AQO) Project that is improving processes and outcomes across 40 medical specialties, and using rapid-cycle improvement processes to improve care delivery and care management, physician collaboration, and the capability to participate in meaningful quality outcomes benchmarking. All of this is being supported by intensive development work on the part of IT and analytics leaders at the organization.
(l. to r.: ) Jason Fish, M.D., Mark Rauschuber, Duwayne Willett, M.D.,
Jacqueline Mutz, Ki Lai, and Vaishnavi Kannan
Here are the key highlights of what’s been taking place at UT Southwestern:
- A few years ago, Daniel K. Podolsky, M.D., the president of the medical center, gave a clear directive that he wanted his colleagues in the health system to be able to prove demonstrable patient care quality outcomes. Out of that broad directive, the AQO Project was launched in January 2015.
- Early on, a collaboration that spanned four key areas of the health system—clinicians, IT, analytics, and operations—came together under a governance group known internally as the “Quadrad”—meaning a quadripartite collaborative leadership composed of representatives from those four broad operational areas—for the initiative. Under that governance, clinical informaticists, informaticists, clinician leaders, and data analysts launched a strategy that involved rapid-cycle improvement processes, with two-week iteration cycles for clinical performance improvement, leveraging the capabilities within the organization’s electronic health record (EHR—which is the core EHR from the Verona, Wis.-based Epic Systems Corporation), and combining EHR capabilities with the development of an expanded enterprise data warehouse (EDW).
- Also early on, two key decisions were made that helped shape everything that has happened since then. First, the decision was made to engage the physician leaders from as many outpatient specialties (referred to as clinics) as possible, meaning, ultimately, 40 different specialties, rather than simply start with one or a few and slowly roll out processes. And second, related to the first, the decision was made to force process standardization, by creating a standardized data architecture for the clinical decision support mechanism to be leveraged within the EHR, across all specialties, for the initiative’s analytics purpose. At the practical level, this meant literally requiring all physicians within a specialty to document things in the same way and in the same place within their documentation within the EHR, in order to facilitate analytics and data-sharing. Crucially, Quadrad leaders agreed that the only way to spread innovation quickly across the health system was to avoid a repeated “one-off” approach, and instead, to compel physician leaders in all the ambulatory specialties to work collaboratively on a standardized data and documentation approach to the initiative.
- One very broad specific goal of the initiative was to create robust patient registries in all the specific medical specialties. To date, the leaders of the initiative have built 58 specialty-specific patient registries, created 134 process and outcome measures covering 77 primary and 44 additional medical conditions, created 111 new clinical decision support tools within the EHR, and created 97 new workflows across 40 specialties. Very importantly, 58 patient registries have been created, with over 16,000 patients documented to date, in those registries.
From the start, a broad-based, standardized approach
So why did the UT Southwestern leaders focus on the outpatient sector rather than the inpatient sector? The answer is simple, says Duwayne Willett, M.D., UT Southwestern’s CMIO. “We made the decision to build an initiative that we felt had to cross all specialties. And this was an approach that has applied across specialties.”
The reality, says Mark Rauschuber, the organization’s associate vice president and CIO, is that “We’re a proud institution; we have six Nobel laureates on staff at the university. But we wanted to show the data to prove our quality of care.”