Care management and team-based care delivery transformation are key factors for any population health strategy. Independent physician group Compass Medical has been using data-driven insights and dedicated care management teams to enable a 360-degree view of patient care.
"We went through a lot of organizational and growth challenges and, in recent years, as we started looking into the Big Data framework, the major challenge we had was we do not have the resources to start investing in massive infrastructure to then figure out what problems we are trying to solve," said Dhrumil Shah, CMIO and a family physician at Compass Medical. "We knew what we were good at and what we were not good at, but there was no science behind it. It was mostly anecdotal. As we started looking at analytics, we started creating data-driven insights around problems we knew we had to get better at."
Compass Medical made its core focus improving the patient experience by improving the provider experience.
"We used basic parameters around scheduling, the time it takes for providers to complete a visit, value stream analysis," Shah said. "For example, we did data-driven metrics around how much time caregivers spend in front of a computer screen in a 24-hour period. Caregivers see the EHR as a hurdle to patient care. So we started looking at their screen time, and then worked on interventions and used analytics to design some pilots. Some of those pilots gave us a huge ROI in just three weeks, some are 6- to 12-month pilots."
For instance, Compass Medical looked at things like hands-free dictation, any model that fits a provider workflow based on the analytics Compass used to highlight the problem it already knew it had.
Ultimately, Big Data played a big part in Compass Medical's work, and it was a journey to get to Big Data.
"Just like every other health system, we have multiple disparate information systems," Shah said. "Even though we use only one EHR, we have a system that does some of the financials, a system for care coordination, and so on. Multiple disparate systems created data siloes. We wanted to be a population health service organization. If you are looking at how you are affecting outcomes, Big Data plays a big role."
But as soon as Compass started looking at Big Data, it had to shift gears: Should the group invest in a Big Data platform, or, should it find a problem and build a platform around it, Shah explained. It did the latter.
"The main problem we found was care delivery, the way we were delivering care was becoming the problem," he said. "We had tried holistically to do a lot of care management activities for patients coming out of the hospital or going back into the hospital, but we did not have any insights into the patient's story. As we built out the EHR, we created the problem and multiplied it by three times because now we had more siloes. So how do we create a care delivery platform that works for multiple care providers, our diabetes educators, our physicians, our care managers and others; there is no one platform that is doing just that for all of them."
That's where Big Data came in to help with how Compass managed care delivery.
"One example, care management teams used to get census reports from the hospitals," Shah explained. "They had to actively get into the EHR system of each and every hospital, find the census reports, print them, map them to the patients in our EHR system, and make sure the patients were coming in for follow up. A lot of manual work to get to the standard of seeing every patient who is coming out of the hospital within three to seven business days. With Big Data, now we have centralized care management, which gets a lot of this data from the hospitals into our Big Data platform, then it sends messages to the appropriate facilities and the triage nurses can fill the gaps in care."
Shah will discuss population health issues at the HIMSS and Healthcare IT News Pop Health Forum, April 3-4, 2017, at the Westin Copley Place in Boston, Massachusetts, during a session entitled "Data-Driven Care Redesign from a Chronic Care Management Perspective." Register here.