Things continue to move forward at the University of Texas Southwestern Medical Center health system (UT Southwestern) in Dallas, where that organization’s Ambulatory Quality Outcomes (AQO) initiative has been pathbreaking in many ways—so much so that it led the editors of Healthcare Informatics to name the UT Southwestern team as the first-place-winning team in our 2016 Innovator Awards Program.
As we reported in our January/February 2016 issue, UT Southwestern leaders there have succeeded in creating a clinical quality initiative that has been broad, deep, fast-moving, substantive, and agile—and replicable. Indeed, at UT Southwestern, clinician, clinical informatics, IT, analytics, and administrative leaders have come together to create the AQO Project, which is improving processes and outcomes across 40 medical specialties, and using rapid-cycle improvement processes to improve care delivery and care management, physician collaboration, and the capability to participate in meaningful quality outcomes benchmarking. And all of this work continues to be supported by intensive development work on the part of IT and analytics leaders at the organization.
And, as part of our report on the AQO initiative in our January/February 2016 cover story package, we noted, “One very broad specific goal of the initiative was to create robust patient registries in all the specific medical specialties. To date, the leaders of the initiative have built 58 specialty-specific patient registries, created 134 process and outcome measures covering 77 primary and 44 additional medical conditions, created 111 new clinical decision support tools within the EHR, and created 97 new workflows across 40 specialties. Very importantly, 58 patient registries have been created, with over 16,000 patients documented to date, in those registries.”
Among the several leaders of the initiative have been Duwayne Willett, M.D., UT Southwestern’s CMIO; Jason Fish, M.D., the health system’s assistant vice president for ambulatory quality and associate CMIO; Mark Rauschuber, UT Southwestern’s CIO; Jacqueline Mutz, R.N., assistant director of ambulatory quality; and data analysts Ki Lai, assistant vice president for enterprise data services; and Vasihnavi Kaanan EHR [electronic health record] and clinical decision support specialist.
Recently, Healthcare Informatics Editor-in-Chief Mark Hagland reconnected with Dr. Willett to get an update on the AQO initiative. Below are excerpts from that interview.
Dr. Willett, it’s great to reconnect with you regarding the evolution of your team’s work at UT Southwestern. How has the AQO Initiative evolved forward since we spoke at the end of 2015
It’s continued to move progressively forward. Obviously, we’ve been learning lessons as we’ve progressed, and have been able to apply those. We initially did a single registry, and they’ve gotten an appetite for more. We had initially started out with 43 registries; we currently have 81. And 52 of the registries have quality measures associated with them. Sometimes, we’ve just wanted to identify populations for care-gap closure. As a project at first, it’s turned into an ongoing program, and leadership-driven, tied to incentive programs for physicians. And a big push into patient-reported outcomes. We just did an update yesterday, actually. We had representatives of MD Anderson Cancer Center visiting us. And we noted for them that we’ve had 3,200 patients who have completed one or more questionnaires, so something like 225,000 questions have been answered. Over 80,000 of our patients have been put onto registries. In fact, most patients in practices are on at least one registry.
How has the standardization of process and documentation, which were key elements in the initiative at its outset, played out, over the past two years?
We’ve been very thankful we’ve done things in that standardized way. We now have fewer FTEs connected to [the day-to-day management and operations of] the program, but have continued to expand outwards in terms of activity. And we know the set of tools in the toolbox to use. What’s more, the code to calculate the quality measures has been templated out, so they literally now do a “save as,” and so we have a single power-BI [business intelligence] dashboard that can look at all the registries, all from a single data set. So that’s been very helpful.
What kinds of lessons have you learned, as a CMIO, broadly, in the past two years?
One lesson is that there is always this presumption that if you feed people data, esp. physicians, that it will stimulate action. And it’s been very confirmatory of that, that doctors like data, use data, and are willing to take action when they receive data they believe in. And because physicians have been involved in selecting the conditions for the registries, and designing the tool, they’ve been very supportive. One example was in our rheumatology department. The guidelines for care are that they’d like to have them on a disease-modifying rheumatic drug. And it turns out they were actually doing a very good job of that already; were not doing such a good job of assessing patients’ symptom burden—how the patients rated their levels of symptoms. So they set up two measures—one was a process measure. They wanted to know, were they prescribing the right medications?