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Population Health Management in Real Time

January 19, 2012
by Gabriel Perna
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Marshfield Clinic has created a dashboard application that allows physicians to view real-time, usable data across their entire patient population

The benefits of the population health management dashboard application created by Marshfield Clinic, a 779-physician multi-specialty group based out of Marshfield, Wis., are obvious to Theodore A. Praxel, M.D., medical director of Marshfield’s Institute for Quality, Innovation, Patient and Safety (IQIPS). Dr. Praxel, whose team at the IQIPS had a major hand in creating the application, says it shows physicians the entirety of their patient populations, as well as allows them to view and use real-time specific data across all levels of care.

“Progressively, we’ve been building the ability to mine data and provide that data in the form of usable, actionable information to providers, not just at the point of care but in between care and in between visits, and [the dashboard] allows us to work on taking care of populations,” Praxel says. “At the touch of a button, I can see my entire patient panel, which is different than seeing my entire registry.  It’s not just limited to a disease…this shows me all the patients who are attributed to me who are in my population.”

Marshfield Chief Information Officer Ken Letkeman says the population health application can produce a wide assortment of metrics across a broad system in a timely manner. Not only does this kind of information make it easier for clinicians to make short-term changes, but according to Kate Konitzer, the solutions director responsible for clinical informatics at Marshfield, it can improve the healthcare quality and cost curve in the long-term by keeping more patients out of hospitals.

Kate Konitzer

Konitzer says the application has been seven years in the making, evolving from data on spreadsheets to a fully automated dashboard with automated feedback. What began as an initial desire to make evidence-based management of patient populations a priority, developed into a full-on collaborative effort between Marshfield’s information systems (IS) team and its data analytics and data warehouses groups, with Praxel and the staff from IQIPS providing a clinician perspective to the initiative.

The glue that held it all together was Konitzer, according to Letkeman. She worked closely with both the physician and technical sides of the operation. “She works with clinical sponsors and is responsible for ensuring the delivery and solutions to their group,” he says. “She has developed a great deal of domain expertise in population health management, but remains an IS resource.”

Ken Letkeman

Real-time data would be thorough as is, but the application also comes with physicians and certified nurse specialists from the IQIPS who work hand-in-hand with each department to better understand the results. The application itself works within the same data set as Marshfield’s electronic health record (EHR), Cattails M.D., an internally developed solution. It allows data that is collected at the point of care by physicians on their tablet devices to be sent to an enterprise data warehouse, where it’s stored and later sent back to the EHR for real-time analytic usage.

On the dashboard application, Konitzer notes there are four population views: summary of current information, trending information from back to 2004, a comparative view among peers, and monthly control charts that measure impact of a specific initiative. There’s also a part of the application that allows patients to chart their own progress.

The idea that physicians might not be willing to compare against each other was never an issue, says Letkeman. In fact, the comparison against other physicians had the opposite effect during the initial physician demonstration project.  “In some practices that might cause issue,” he says. “In ours, they were told, ‘It will be blind for a period of time then it will be unblinded.’ One of the revelations that we saw was that this was very effective in getting the tool more widely used.”  

Theodore Praxel, M.D.

Naturally, developing the application came with a number of challenges. Letkeman says creating the data set and figuring out the right metrics and benchmarks was a difficult task. Once those were determined, Konitzer says it wasn’t easy finding the technical tools within the application that could add efficiency while effectively looking at complex healthcare data.

Even before the application was ever created, Letkeman says there was difficulty in getting people on board with the population health management direction that Marshfield was taking. “That largely fell on Dr. Praxel, his predecessors and the physician leadership, who at the time made the bold decision to say, ‘This evidence-based medicine, this seems to be the way to go.’ They took to chronic-care disease management, I’d argue, before it became fashionable,” he says.

The team says that through a thorough collaborative effort, the application was not only developed, but has already become an early success, with 65 percent of Marshfield’s physicians and managers having already adopted it. Not only that, but because of the application, the Center for Medicare & Medicaid Services (CMS) has awarded Marshfield approximately $56 million for their shared savings of $118 million in its Physician Group Practice (PGP) Demonstration program.

“I don’t think the collaborative nature of this can be underestimated,” Praxel says. “There are times that Kate and I will be talking about something, and she’ll know where I want to go and say, ‘What if we do it a little differently?’ She’ll help me get the answer and display what I want in a way I wouldn’t have thought about because they understand the data better, but they also understand what we need to do to do the clinical job.”

 The work is far from done for those involved with Marshfield’s population health management dashboard application. Konitzer says one of the goals is to integrate the application into more point-of-care processes to create even more real-time feedback.

“Right now it’s pretty timely,” Konitzer says. “But we want to use the same data to facilitate the scheduling process more—to make sure patients are coming in and for instance, if they are diabetic, getting their A1C, LDL and microalbumins scheduled. That’s marrying population health with real clinical care, CPOE [computerized physician order entry], care plans and order sets.”

Praxel says the rise of accountable care organizations and working with managed populations will only create a “moving target.” Constant refinements, he says, will be necessary since there are always reasons to not treat a patient in the usual manner. “I think we’re just starting to scratch the surface of understanding how to turn data into actionable information and not just to make a piece of paper happy, but to benefit patients,” Praxel says.

For more on Marshfield's Population Health Management application, check out my podcast interview with Ken Letkeman.

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