What does it look like to leverage data and IT at a very deep level and help to rework core clinical processes in order to improve clinical performance and patient outcomes and rethink costs? The leaders at Allina Health know, because they’re doing it. And they’re doing it particularly intensively in the cardiovascular services arena, where they have made groundbreaking progress in a number of areas, with documented results to show for it. For their pioneering work, the editors of Healthcare Informatics have named the Allina Health team the first place-winning team in our Innovator Awards Program this year.
At the highest level, says Penny Wheeler, M.D., the president and CEO of the 13-hospital, 61-clinic integrated health network in Minneapolis, “We at Allina are very much focused on how we create value for the individuals and the community we serve—which means the best outcomes in terms of quality, access, and experience, over dollars spent. That’s what value means. And when that’s your goal, you start to think about what kind of infrastructure you need to support it,” says Wheeler, who spent 22 years as a practicing obstetrician/gynecologist. Speaking of the data and IT infrastructure at Allina, as well as of the clinical leadership situation prior to the launching of the organization’s current initiatives, she says, “What we didn’t have was the right latticework to support certain things. Yes, we had Epic, and could connect that way, but couldn’t pull in all the information needed, nor did we have the clinical expertise next to that data, and the authority needed to drive us forward. So we built the right infrastructure to support this, and we had the right physician leadership to drive this, and we gave them the right authority to get it done.”
What “it” is, is a complex set of innovations focused initially on the cardiovascular services area (and which is now spreading to other areas in the organization). And it began when Allina leaders established the Minneapolis Heart Institute Center for Healthcare Delivery Innovation (MHI-HDI), to leverage existing data and analytics resources within the organization, including an enterprise data warehouse (EDW), developed by Salt Lake City-based Health Catalyst, with those resources being applied to cardiovascular care delivery under the aegis of the MHI-HDI.
A large number of initiatives are evolving forward under that umbrella. Among those that have documented dramatic improvements in outcomes of all kinds has been around the procedure known as percutaneous coronary intervention, or PCI, also commonly known as coronary angioplasty, a procedure used to open up blocked or narrowed arteries, during which a cardiologist feeds a deflated balloon or other device on a catheter from the inguinal femoral artery or radial artery up through blood vessels until they reach the site of blockage in the heart. There was a set of issues around PCI that Allina clinician leaders wanted to look at, to improve outcomes and also examine costs. That team was led by Craig Strauss, M.D., M.P.H., cardiologist and the medical director of the MHI-HDI, and Pam Rush, R.N., M.S., clinical program director of the Allina Health cardiovascular service line.
As Dr. Strauss notes, “The first step in improving outcomes is getting reliable data from across the system, and that was a big first step.” The next step, he continues, is “sharing that data, and bringing it together in an effective way, through our data warehouse.” And then following up on that step, the team found that it needed to create “the ability to develop condition-specific dashboards," he adds. “So we linked all of our cost and clinical record data, and our registry data—we have national registry data on PCI cases, because every PCI case is submitted to a national registry—and we put all that into a dashboard in our EDW, to allow us to look at and risk-stratify patients.” Indeed, data already existed in the cardiovascular literature suggesting that it was possible to risk-stratify patients coming into the cardiac cath lab, by three levels of risk—high, medium, or low. So Strauss, Rush, and their colleagues set about developing a questionnaire for each interventional cardiologist to complete about each patient about to receive PCI. As Strauss recounts it, “We brought all the interventional cardiologists together to develop a consensus approach to managing PCI complications, especially around bleeding.” And Rush adds, “Filling out the questionnaire requires the participation of the entire staff. When you implement a scoring tool like this and you’re counting on nurses to enter the data, it requires the whole team.”
Specifically, the clinicians looked at the use of what is called a closure device, which, as Strauss explains, “closes the hole made by the catheter when it goes into the femoral artery in the leg. We looked retrospectively to see for high, medium, and low risk patients, where the benefit was. And with closure devices, we found that the outcomes around bleeding complications did not different significantly among patients identified as being at low or medium risk for complications, in terms of whether the cardiologists used the closure device in their procedure or not; but for those determined to be high risk according to the scoring tool, there was a significant difference. Among the high-risk patients, bleeding within 72 hours occurred at a rate of 8 percent for those with no closure device, but only 3 percent if a closure device was used. What’s more, the red blood cell transfusion rate averaged 12.6 for those high-risk patients who had gone through the procedure without the use of a closure device, but only 5.9 for those whose cardiologists had used the device.”