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The 2017 Healthcare Informatics Innovator Awards: Co-Second-Place Winning Team—Mercy Health

January 25, 2017
by Heather Landi
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Leveraging data on a grand scale to support health risk assessment and population health

As healthcare providers across the country seek to transition from fee-for-service to value-based care delivery and payment, many are trying to tackle the complexities involved in transforming from the traditional siloed care model into a network care model, which enables increased care coordination and effective population health management, both of which are foundational to value-based care. The majority of healthcare providers undertaking this work are facing monumental challenges related to combining clinical data from multiple health information systems with paid claims data, analyzing the data and then delivering actionable information back to clinicians at the point of care. It’s a capability that few provider organizations, thus far, have achieved, which makes the Cincinnati-based Mercy Health’s groundbreaking work in this area all the more impressive.

Clinical and IT executive leaders at Mercy Health are now successfully integrating population health analytics into the clinical workflow as part of an overall effort to achieve meaningful population health management. For their trailblazing work, the editors of Healthcare Informatics have named the Mercy Health team the co-second-place winning team in our Innovator Awards Program this year.

Essentially, this population health informatics project has been the result of a strategy to combine the technological capabilities of Mercy Health’s enterprise Epic electronic health record (EHR) and IBM Watson Health Explorys’s analytics platform, along with a generous amount of good old-fashioned elbow grease by the Mercy Health project team.

Mercy Health, the largest health system in Ohio and one of the largest health systems in the United States, operates about 450 health facilities, including 23 hospitals, eight senior living communities, five hospice programs and seven home health agencies in Ohio and Kentucky. J.D. Whitlock, vice president of enterprise intelligence, says the health system started its population health journey in 2011 when it’s clinically integrated network, Mercy Health Select, was selected to participate in the Centers for Medicare & Medicaid Services’ (CMS) Medicare Shared Savings Program (MSSP) accountable care organization (ACO) model. According to Mercy Health executive leaders, Mercy Health Select generated more than $15 million in savings in 2014. Today, Mercy Health’s value-based contracting programs include the MSSP ACO, which now covers close to 70,000 beneficiaries, as well as four Medicare Advantage programs and the employee health plan, for a total of 130,000 lives covered.

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Essentially, as the result of the project team’s work to integrate its Epic EHR and Watson Health analytics, project leaders are using paid claims and clinical data to define populations, generate advanced risk scores and integrate them back into the Epic workflow. As a result, ambulatory care coordinators and primary care providers are able to leverage advanced and prospective risk scores within the EHR workflow, which significantly facilitates the work of identifying high-risk patients and improving care coordination.

An Evolving Technology Strategy

Whitlock credits the health system’s executive leadership, in particular CIO Becky Sykes, with making key, forward-leaning decisions back when Mercy Health began its ACO work that has helped to propel its population health management informatics work forward. As the executive sponsor for this project, Sykes drove the vision and execution of Mercy’s large single-instance Epic deployment with collaborative build and clinician-led optimization. Of the 650 primary care providers that participate in the Mercy Health Select MSSP ACO, 96 percent are on the health system’s single-instance of Epic, including both employed primary care providers as well as affiliate PCPs. “That makes all the difference in the world to be able to do these things efficiently,” Whitlock says.

Recognizing the need for a population health platform, Mercy Health also partnered with Cleveland-based Explorys back in 2011 to implement its population health strategy. [IBM acquired Explorys in 2015 and it is now a part of IBM’s Watson Health unit.] “When we kicked off our ACO work, back at the end of 2011, [Sykes] recognized some of [Explorys/Watson Health’s] capabilities very early. She also had resourced this work, so that everyone on the team had time to work on this project, understanding that it’s complex and it takes longer than you think it will,” Whitlock says.

JD Whitlock

According to Mark Binstock, M.D., associate medical information officer at Mercy Health, two years ago, when the health system really pushed forward into population health management, the capability to integrate paid claims data and clinical data was not a strength or functionality of the Epic platform. And so, Mercy Health physician and IT leaders saw an opportunity to leverage the strengths of Epic’s Healthy Planet platform—workflow integration, clinical decision support, the patient portal and patient outreach—with the strengths of Watson Health, namely, data aggregation from multiple EHRs and paid claims from multiple payers, as well as advanced risk scores and machine learning.

The project team was comprised of IT and clinical leaders, including Sykes, as the executive sponsor, Whitlock, as the solutions architect for the project, Binstock, Aaron Thomas, CarePATH team lead, population health, and Gary Grazak, population health IT senior director.

Binstock served as the clinical subject matter expert on the project team, and as Whitlock notes, “told us exactly what we need to build so that a doctor will use it.”

“As hard as the technical challenges were with this project, and they were hard and took a lot of effort, the cultural element is even harder and is still an evolution,” Binstock notes. “For many doctors, the most customary practice that the y’re used to dealing with is a patient who is coming in with a complaint or problem and the doctor is addressing that problem at that visit. What we’re trying to do is change that to think of that visit as a vehicle for extending care for the patients’ entire health, the chronic conditions and the preventive services gaps. So that’s what we’re up against—how, at that point of care, to make that doctor aware of care gaps as its related to chronic conditions and the preventative services gap, such as a mammogram or pap smear, and make it easy to close those gaps.”

Mark Binstock, M.D.

He continues, “And the reality is, it’s actually very hard, perhaps impossible, to expect a doctor to not only take care of the problem at hand, but all these other gaps in care. So, therefore, we need additional tools that occur at other points in time when the patient is not physically present in the doctor’s office, where the care team, and extensions of population care, can assist in the identification and closure of those care gaps.”

Foundational to this initiative has been some very complex and challenging IT work that has involved the building of data and reporting structures inside the Epic application in order to present the end result to clinicians, as well as building a patient context-sensitive single sign-on solution that presents the Watson Health patient summary, including risk scores and care gaps calculated from multiple EHRs and paid claims data, within the Epic clinical workflow. Regarding the patient context-sensitive single sign-on solution, Thomas says, “Rather than asking the provider to jump out to a web browser to sign in external to the EHR, we’re imbedding a link within the patients’ plan of care, and that’s happening behind the scenes.”

To accomplish this, the project team worked collaboratively with IBM Explorys and Epic. “We had multiple calls between engineers from Explorys, engineers with Epic and engineers from our Mercy Health Epic team to make sure everything was talking as it needed to in order to do that patient context sensitive single sign on,” Binstock says.

Thomas adds, “From a technical perspective, it required extensive testing and also development on our side. It was the challenge of speaking two different languages, one on the technical side of Explorys and one within the ecosystem of Epic.”

The work also involved leveraging Watson Health advanced risk scores and building on those capabilities to develop three advanced risk scores—an overall utilization risk, a mortality risk score and a risk of emergency department visit utilization. “You need both paid claims data from the payers to give you the breadth of what’s going on with the patient where it’s not happening inside your EHR and then the low latency of what happens with your patient inside your health system that’s in your EHR," Binstock says. He notes that Mercy Health's development of utilization scores is not particularly unique, yet "the combination of paid claims and the EHR data together into this score, I don’t think a lot of people are doing that,” he says.

That resource utilization tool enables providers and care coordinators to “slice and dice the population into cohorts to assign different modalities of intervention to,” Binstock says.

Additionally, the Mercy Health project team wanted a mortality risk score to indicate when a patient is in need of hospice care rather than intensive care coordination. Binstock has been guiding the development of some of the Watson Health risk scores, as well as the decision support tools inside Epic that utilize these risk scores. For example, Binstock decided to base the mortality risk score on the Gagne Index, which calculates the risk of mortality in the upcoming 12 months for patients 65 years and older. “It enables triage and care coordination, in a slightly different way. For patients who have a high risk of death within the next 12 months, it shifts the focus of care coordination towards end-of-life care, potentially hospice care and palliative care, to make sure things like advanced directives are in order,” Binstock says.

The third score presents a patient‘s risk of ED visit utilization within the next 30 days. “Because those types of resources tend to be very expensive, tend to  be episodic and tend to not lead to good continuity of care, we’re trying to use those scores to predict who will likely end up in the emergency room and provide interventions to mitigate that,” he says.

According to Thomas, the project leaders went one step further in their innovative work, to provide the end-users of the tools additional information about what the risk scores mean. “We determined that some folks don’t understand the full extent of what the value, the risk score, means. And that’s one example of the technical piece, the IT, and trying to converge that with the cultural piece. For them it’s, what does this mean? What does this represent to me? And, the IT piece is us trying to help facilitate that within the EHRs or whatever tool we’re looking at to provide that additional information and why it’s valuable to them,” he says.

Aaron Thomas

With that solution in place, Mercy Health Select primary care providers on Epic have population health clinical decision support baked into the EHR workflow, which provides a more complete picture of the patient. “It provides initial identification of all the patients, in a primary care providers’ panel, who should be considered for care coordination,” Whitlock says.

Next Steps and Ongoing Progress

Phase one of the project was to enable providers and care managers to see the risk scores and receive reports on patients with high risk scores in order to manage them effectively. Moving forward, the Mercy Health project team is working to create best-practice alerts to signal when a patient has a high mortality risk score. “We’re trying to bring this to the surface to alert providers and the care team that the patient has this unique calculated risk of death and they need to take that into consideration when planning other aspects of the patient’s healthcare. That’s a novel approach of displaying the information as a number but also urging providers to act on it,” Binstock says.

The population health management work that Mercy Health has accomplished, to date, strategically prepares the health system for the ongoing and accelerating movement toward value-based payment models, the executive leaders say.

“With the portion of the population that’s considered to be at-risk and the lining up of incentives, compensation and structures for the providers to do these tasks that are expected them, that is all rapidly changing, and we are giving the providers the right tools we think they will need to be successful in the newer markets,” Binstock says.

“Because this work is so difficult, it’s sometimes portrayed as having a foot in two different canoes—the fee-for-service world and the value-based care world. You’ve got your foot in the value-based care canoe so when the economics really change, you can hop into that canoe, and how you deal with the complexity of that is very challenging, “Whitlock says. “To give ourselves a little bit of credit, because we are a religious non-profit, we have stepped out into population health before it was a financially rewarding thing to do, and we decided to do that because better care coordination of the patients is the right thing to do for our patients.”

Thomas adds, “I give credit to the wisdom of our organization’s leadership for strategic timing. I think you can look back and see how we’ve evolved with doing things in different ways strategically as the systems mature and the technology matures.”


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The Modern Healthcare CIO, CMO, and CTO

December 10, 2018
by Lori Williams, Industry Voice, vice president of fulfillment, Gigster
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Disruption in the healthcare space comes primarily from the expansion of data’s role in the industry, and the healthcare C-suite’s familiarity with that expansion will help drive company and industry success

For the healthcare C-suite executive, the industry has never been more complex—nor has it ever contained so much potential. Emerging technologies mixed with political uncertainty has created an environment where incredible amounts of healthcare data are revolutionizing how patient care is handled, but patients remain uncertain about the future of their own health. With better data and the means to draw insights from it, healthcare CIOs, CMOs and CTOs are in a position to help address patients’ uncertainties and make hospitals and clinics more accessible and effective than ever before.

Here’s a look at how the role of the modern healthcare CIO, CMO and CTO is changing:

The Modern Healthcare CIO
The modern healthcare CIO’s role has evolved to become more innovative. No longer a title reserved strictly for engineers and IT professionals, today’s healthcare CIOs are focused on information science instead of simply setting up network infrastructure or providing back-end support. The trend towards a more data-centric role began as hospitals rolled out electronic health records, equipping individuals with better access to healthcare provider data. Through enterprise data warehousing, CIOs are becoming masters of data management, governance and predictive analytics, and passing along the many benefits of those knowledge bases to patients.

The Modern Healthcare CMO
The confusing healthcare landscape makes the role of a healthcare CMO more necessary than ever before. Thanks to ongoing regulatory changes, uncertainty surrounding the Affordable Care Act, and shifting consumer expectations for on-demand services, healthcare CMOs are responsible for helping patients navigate their way through a complex and opaque industry. As patients continue to assume the role of consumers, carrying out comparison shopping as they would for any other industry, CMOs must be adept in crafting a healthcare provider’s brand and messaging.

At the same time, CMOs must also ensure that healthcare providers offer a modern online experience, ensuring websites are mobile-optimized and social media accounts are generating engagement. This also means CMOs need to help move marketing efforts into the 21st century, transitioning away from direct mail or billboards towards digital marketing and CRM tools. Because if they don’t, there are plenty of med tech startups that will promptly eat into their market share.

The Modern Healthcare CTO
Unlike healthcare CTOs of the past who remained siloed off from the rest of the organization, today’s modern healthcare CTO is fully engaged with healthcare providers and their technology stacks, utilizing new software and hardware to improve daily workflows. The CTO is enabling the transition to patient-oriented self-service operations, enabling patients to carry out administrative tasks like scheduling appointments or refilling prescriptions over the internet. Because medical data is often stored in a variety of different sources, it’s critical for the CTO to be able to keep these systems interoperable with one another. For hospitals riddled with legacy software, CTOs should expect to continue employing middleware solutions to bridge the gap between old and new.

Members of the healthcare industry C-suite have the power to transform lives, and the CIO, CMO and CTO have roles that directly affect a provider’s ability to carry out positive change. With better data from the CTO’s tech stack, the CIO can use better analytics to help providers determine the best solutions for their patients, marketed to consumers by the CMO through modern platforms in clear, easy-to-understand language.

Lori Williams currently serves as Gigster’s vice president of fulfillment. Prior to joining Gigster, Lori was the general manager for Appririo.


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What Does Your Magnum Opus Look Like? A Few Operatic Thoughts

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I was given the privilege and pleasure recently of presenting, for the second year in a row, a lecture on Richard Wagner’s “Ring” cycle, as the leading opera company in my city, a world-class opera house, has been putting on, in yearly succession, the four operas of the “Ring of the Nibelung” cycle by German composer Richard Wagner (1813-1883). Last year, the second opera in the tetratology, “Die Walküre,” was performed; this year, the third opera, “Siegfried.” After the concluding opera, “Götterdämmerung,” is performed, the entire cycle will be presented in festival format, always a major cultural event. I spoke on “Siegfried.”

I’ve been fortunate to have seen six complete “Ring” cycles in live opera houses in different cities, and I can tell you, it’s a life-changing experience, as this four-opera work (16 hours of music altogether), sits at the absolute summit of western art. Richard Wagner was a hideous human being himself, but spent numerous years working on something that changed the course of classical music and redefined opera.

What’s more, from the summer of 1848, when Wagner wrote a first sketch of the libretti, or texts, of the operas, until their true compositional completion in 1871, more than 23 years were to pass; and it would be another five years before the tetralogy was fully presented, in a purpose-built new opera house in the Bavarian town of Bayreuth. It was a herculean feat to create the entire text of these four long operas, and compose 16 hours of music that would completely redefine the concept of opera. Indeed, when the crowned heads of Europe, the great living composers, and the 19th-century European intelligentsia and glitterati, gathered at the new Festspielhaus in Bayreuth in 1876, many were so overwhelmed by what they saw and heard, that they were rendered speechless. Even now, 142 years later, first time Ring-goers are overwhelmed by the breadth and sweep, the musical and dramatic audacity, and uniqueness of the “Ring” operas, with their story of gods, giants, dwarves, flying Valkyries, Rhinemaidens, one huge dragon, humans, gold mined from a river, magic swords and spears, and of course, a gold ring whose possessor can control the world and its fate.

Even just looking at the third opera, “Siegfried,” Wagner struggled mightily. For one thing, being essentially a grifter and a cad, Wagner borrowed/took money from everyone who would lend/give it, and often had affairs with the wives of the patrons bankrolling his compositional work, leaving his life in constant chaos, as he fled from one city to the next. One such wife, Mathilde Wesendonck, inspired the opera “Tristan und Isolde,” groundbreaking operas that Wagner wrote during a 12-year hiatus in his composition of “Siegfried.” And “Tristan” itself changed the entirety of classical music, its tonality-challenging chromaticism.

Well, no one is expecting anyone to match the unique creativity of Wagner’s “Ring” cycle. But the leaders of U.S. patient care organizations are doing a lot of important things these days, including using formal continuous improvement methodologies to rework core patient care delivery processes in order to transition into value-based healthcare. What’s more, as our Special Report on Leadership outlines, the entire role of the CIO is being rethought now, as the demands for leadership and strategic capabilities are catapulting that role forward; and patient care organizations are beginning to make real headway in advancing equality for women and people of color among the ranks of healthcare IT leaders and managers.

So while no one is expecting anyone to create an operatic tetralogy that will change the face of music, there are plenty of heroic endeavors open to anyone willing to envision the healthcare system of the future. The opportunities are as limitless as the imagination.

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Using Performance Management to Scale

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Performance management is so much more than just a year-end performance review
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Performance management and goal setting have always been part of my DNA. It’s like a compass that tells us we are steering the ship in the right direction or gives us a chance to course correct if we wander off track. It’s hard for any organization to determine how they are doing unless there are clear measurable objectives. CIOs and their leaders need monthly, quarterly and annual goals to measure how you and your team are doing against the plan. I also firmly believe they should be S.M.A.R.T. goals: Specific, Measurable, Achievable, Relevant and Time-based.

Once the goals have been established, you need a written plan. I like three-year rolling plans so you can look into the future and describe your vision of what your organization will look like 36 months out. Then you can work back to the second year, and eventually the first year, to give you the framework for what you need to accomplish in the next 12 months. I suggest you do it with your managers. It makes them accountable to the organization since they are involved in the formation of the plan.

Your plan must be a living document to be used frequently during team meetings throughout the year to see how you are performing as a team and individually. This is not a process you invest in to review at year-end to see how you performed. By then it’s too late. It must be reviewed on a consistent basis to make sure everyone is on track. Performance management is so much more than just a year-end performance review. If there are individuals who are not performing against the plan, you can use the plan as a tool to performance manage them to re-engage as an important member of the team. 

I just returned from the Scale-up Conference in Denver and learned so much about taking goal setting and performance management to a whole new level by adopting the "Rockefeller Habits," as written by Verne Harnish. After reading the book, everything changed for me in the way we will be doing our planning, goal setting and performance management forever. It’s so brilliant and easy to understand. Here they are:

Rockefeller Habit #1: The executive team is healthy and aligned

Rockefeller Habit #2: Everyone is aligned with the #1 thing that needs to be accomplished this quarter to move the organization forward

Rockefeller Habit #3: Communication rhythm is established and information moves through the organization accurately and quickly

Rockefeller Habit #4: Every facet of the organization has a person assigned with accountability for ensuring goals are met

Rockefeller Habit #5: Ongoing employee input is collected to identify obstacles and opportunities

Rockefeller Habit #6: Reporting and analysis of customer feedback data is as frequent and accurate as financial data

Rockefeller Habit #7: Core values and purpose are “alive” in the organization

Rockefeller Habit #8: Employees can articulate the key components of the company’s strategy accurately

Rockefeller Habit #9: All employees can answer quantitatively whether they had a good day or week

Rockefeller Habit #10: The company’s plans and performance are visible to everyone

Accountability is no longer hard to measure since the entire plan is visible to everyone throughout the organization. Each part of your team should have key people accountable for every functional part of your organization. No more guessing is required. I’ve read countless books about leadership, performance management and goal setting, as I’ve been an avid student on the subject for decades.

These ten habits, once adopted and measured regularly, can change any organization that wants to grow and scale, and keep everyone accountable along the way.

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