It takes a village to raise a child or so the saying goes. At Texas Children’s Hospital, located in Houston, they take that phrase to heart.
One of the largest pediatric hospitals in the country, Texas Children’s has a main campus with more than 600 beds, as well as several satellite health centers, a large primary care medical group, a number of specialized primary care facilities for underserved populations, and an HMO to boot. Beyond that, the hospital caters to countless types of patients, providing numerous specialties.
Quite simply, as Kathy Carberry, R.N., the directorof outcomes and impact service at the hospital, says, “When you think about data, there is a lot.”
While the data doesn’t raise or treat the child, it certainly provides a great deal of assistance to the practitioners and caregivers who do. Carberry leads a multidisciplinary team of doctors, surgeons, outcomes nurses, computer programmers, data architects and specialists, and others on both the clinical and IT side who measure and analyze outcomes data for patients. That data is used to measure what happens after a patient undergoes an operation, the long-term implications of those operations, and where the hospital can improve its care.
“We pull together a team of experts that represent [for example] endocrinologists, radiologists, surgeons. It’s important that we not only deliver this care, but to ensure we are doing it in the best way possible with the best evidence. All the while, we should account for all that we do for patients and their families,” Carberry says.
Kathy Carberry, R.N.
Power from Data Visibility
Texas Children’s pulls data from disparate clinical, financial, and operational sources, stores all of the information in a data warehouse (from the Salt Lake City-based Health Catalyst), and uses applications (from the Radnor, Penn.-based QlikView) to spit out interactive, nuanced outcomes reports. The reports can detail different populations, locations within the hospital’s enterprise, and help the hospital track outcomes all the way down to the patient level.
“It’s getting data out of systems which have a ton of data but you can’t get anything out of them,” Carberry says. The data is essentially real-time, she adds, and has increased transparency. “These technologies gave us visibility to this data. When you have visibility into data, it’s powerful.”
Originally, Texas Children’s used the data analysis initiative to improve upon high-volume, costly procedures that the hospital knew were a problem. From that effort, two years have gone by and the effort has blossomed into assisting every possible venue that could use the help. Needless to say, Carberry and others have seen positive results across the enterprise.
For appendectomy patients, the area where Carberry worked specifically, the team saw increased compliance with the appropriate antibiotic treatment after surgery. They had discovered that a lot of the bugs they were finding were resistant to the antibiotic being prescribed, which wasn’t the standard. Thus, they implemented the single antibiotic, and 95 percent are compliant with that. Also, with those appendectomy patients they implemented a fast-track discharge program.
Keeping up with Demand
The data transparency has initiated a culture shift at Texas Children’s, and the doctors are jumping on board. Carberry says when you show them the reports and the capabilities of the applications, they are usually “drooling.” The challenge lies in keeping up with the demand.
“There is a knowledge gap in how hard it is to get the data to point where you are willing to show it (to the physicians) and where it’s cleaned up enough,” says Carberry. First and foremost, this means the data has to be accurate. “Physicians will immediately find the data that’s not right. Their eyes will gravitate towards it.”
To bridge the gap between physicians and IT people, Texas Children’s has intermediaries that translate between the two "languages." Carberry says it’s rare to get physicians and applications architects to talk for hours on end. “You need someone that can provide that feedback in the interim,” she adds.
Importance in Governance
Carberry says that the next step with this data is to tap into patient-facing applications and patient-reported data. This means integrating the patient portal into the data warehouse. The functionality, from the portal side though, isn’t quite there yet, she says.
Getting this patient information plays into the larger goal at Texas Children of create more continuity and better understanding of what’s happening to its patient population. There is more data to be had, Carberry says, and ultimately, the hospital hopes to turn it all around to create risk-adjusted calculators. These calculators can educate patients and families better on the complications of surgeries.
To Carberry, data governance will be the important element in achieving these long-term goals. Throughout the initiative, she says they have been constantly developing structure and governance to adapt as the efforts shift.
“We have to transform the relationship between IT and clinicians if this is going to work in a meaningful way. You need more and more knowledge workers. You need teams of people, auditing, mining and reporting data, and not just have it be siloed in IT, but integrated across the enterprise,” Carberry says.
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