With hospitals, physicians, and all providers being told consistently now by the purchasers and payers of U.S. healthcare that they need to move systemically to improve patient outcomes, cut or curb costs, maximize efficiency, and enhance the patient/consumer/community experience, there’s simply no way around an intensive drive into clinical transformation. But how quickly are providers moving to do the core work involved in clinical transformation—to rework care delivery, optimize clinician workflow, provide robust clinical decision support, and leverage data and analytics to engage in the constant “blessed cycle” or “virtuous cycle” of data gathering, analysis, and sharing, clinical performance improvement and care process reform, and more data gathering, analysis and sharing?
Though just a few years ago, the executives and managers of most U.S. patient care organizations were still somewhat fumbling around in the dark for magic bullets and other clues, the good news is this: the leaders of pioneering patient care organizations are beginning to create templates that their peers can follow, in the journey that lies ahead. Take for example the folks at Allina Health in Minneapolis. Craig Strauss, M.D. and his fellow leaders at Allina have been leveraging data and analytics to transform cardiology care delivery processes, including completely reworking how they manage percutaneous coronary intervention, or PCI, also commonly known as coronary angioplasty. For their innovative work, they were named the number-one winning team in this year’s Healthcare Informatics Innovator Awards Program.
They key to the Allina breakthrough? A savvy combination of leadership, collaboration, mission- and vision-driven effort, and the strategic leveraging of data through analytics, tied closely to virtuous cycles of continuous performance improvement. It’s a combination that the leaders of more and more patient care organizations are clicking into all around the country.
Mark Werner, M.D.
Says Strauss, a practicing cardiologist and the medical director of Allina Health’s Minneapolis Heart Institute Center for Healthcare Delivery Innovation (MHI-HDI), “I think that clinical transformation is the identification of opportunities to improve quality and outcomes and reduce costs, and implement effective strategies from a process improvement standpoint, to effectively achieve those outcomes, with a strong foundation of data, including a retrospective outlook that informs efforts.” And, on the proverbial journey of 1,000 miles? “I think we’re at the beginning,” Strauss says. “We’ve begun to identify a potential shift from volume to value, and healthcare systems are working to develop systems of care that provide value over volume, but that’s a process that takes time and requires payer and provider transformation; but as much as we’ve talked about shifting from volume to value, we’re still in a very early phase of beginning to do it.”
On the plus side, Strauss says, “There’s no shortage of data available in healthcare. The challenge is identifying the subset of data that can drive change. To do that, we need to be able to look retrospectively at what has happened to populations we care for, and then develop the ability in a prospective manner to improve patient outcomes. So I think there will be a growing need for clinical analytics, a growing dependence on analytics, and a growing need for physicians and other clinician leaders to carry this out.”
“I do think that the pace of change in clinical care is faster than it has ever been, certainly during our respective careers,” says Mark Werner, M.D., national director of clinical consulting at The Chartis Group, a Minneapolis-based consulting firm. Werner, who has helped lead health systems and a health plan as a physician executive, says, “I think the pace is trying to accelerate, and is probably being driven by a few things, including technological advances that are changing how care is provided, as well as the growing ability to share information. In that sense, healthcare is becoming equally about information management as it is in the direct provision of services”—and that in itself is pushing clinical transformation forward.
Brian Patty, M.D.
Not surprisingly, some clinician and clinical informatics leaders working in the trenches right now see a strong link between the leveraging of core performance improvement methodologies like Lean management in patient care organizations, and clinical transformation specifically. Brian Patty, M.D., CMIO at Rush University Medical Center in Chicago emphasizes that “The organizations where I’ve seen clinical transformation efforts work well are using Lean methodologies,” he says. And, referring to his organization’s team of clinical informaticists, Patty says that “Where we come in, it has to work in and through the EHR [electronic health record]. And if we can make a care delivery process work through the EHR, we can hardwire it. And whether you’re using care pathways or workflow navigators, or all the tools in your EHR, you have to understand those tools.” CMIOs and others who are going to be working to execute on clinical transformation, he says, will necessarily have to do so using organized tools and methodologies—as many already are.
Dave Levin, M.D.
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