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.
And, more specifically, says Dave Levin, M.D., the former CMIO of Cleveland Clinic and a partner in the Suffolk, Va.-based Amati Health consulting firm, using data specifically to change care processes “has always been about actionable knowledge: you’ve got to deliver it to the right place at the right time in a way that I can make it actionable as a patient or caregiver.”
It’s exactly that kind of thinking that has helped to propel clinical transformation action forward at UT-Southwestern Healthcare in Dallas, where leaders there have been propelling forward their Ambulatory Quality Outcomes (AQO) Project, an initiative that is improving processes and outcomes across 40 medical specialties, through the use of data-driven rapid-cycle improvement processes to improve care delivery and care management. It’s for that initiative that UT-Southwestern’s team was named the first-place winning team in 2016 in Healthcare Informatics’ Innovator Awards Program. With regard to their awareness of the need to move quickly and also systemically across their organization with their clinical transformation work, Jason Fish, M.D., assistant vice president for ambulatory quality, and associate CMIO, for the organization, told Healthcare Informatics last year at this time, “From an analytics and IT standpoint, our culture had been one where we were struggling along, giving people some really cool one-off projects, but we shifted towards broad building of quality,” Fish says. “So we had a lot of learning around that, to build things in a way that fit within this framework.”
Physicians in Practice: Becoming Overwhelmed by Mandates?
Given recent, rapid policy and regulatory changes at the federal level, some industry leaders believe that physicians in practice, in particular, may be finding the current moment overwhelming in terms of mandates for change. “We are starting to see the needle move” on clinical transformation, “and instead of talking about implementing and adopting EHRs, we’re talking about how we leverage these tools to impact patient care delivery and provider behavior, and so on,” says George Reynolds, M.D., the former CIO and CMIO of Children’s Hospital Medical Center in Omaha, and an independent consultant. “And yet the pace of regulatory and other change,” he cautions, “which already was challenging under meaningful use, is becoming even harder under MACRA”—the Medicare Access and CHIP Reauthorization Act of 2015—he cautions. “We keep using the word ‘overwhelming,’” he says, “and I keep thinking of the guy in ‘Princess Bride’ who uses the word ‘inconceivable’ over and over. I think it’s hard for doctors to understand the context and meaning of what they’re doing,” he says. “We’ve managed to disconnect our profession, the practice of medicine, from meaningful connection with our patients, as these regulations and these tools have served to separate them. And there are ways this could be reversed. So part of clinical transformation has to start with that physician-patient interaction. Think about Facebook, and how Facebook allows you meaningful connection with people with whom you might just have exchanged Christmas cards with. So what the EHR needs to become is a shared platform for communication between patients and providers.”
Reynolds cautions about physicians becoming overwhelmed speak to some of the core challenges in the path forward around clinical transformation. In this, CIOs and especially CMIOs, along with CMOs, CNOs, and other leaders of patient care organizations, will surely be the collective glue that will hold this industry-wide venture together, as providers move forward to rework patient care itself. Only time will tell as to how rapidly success can be achieved in an enterprise that simply cannot afford to fail.