# Presentation: 051934

## Quality Data Managementat Partners HealthCare 

**Jonathan S. Einbinder, MD, MPH**
**Corporate Manager, Quality Data Management **
**Partners HealthCare System**
**June 22, 2007**
**jseinbinder@partners.org                                                                          **

*<footer>**Copyright 2007, Partners HealthCare, Inc.*

## Outline

- Quality Data Management overview
- Partners Quality Data Warehouse
- Observations about data aggregation, measurement, episodes
- Will touch on business functions, financial models, data aggregation methods and issues, longitudinal measurement (episodes)

- Copyright 2007, Partners HealthCare, Inc.

## Partners facts and figures

- 1.3 million patients per year
- $3.1 billion in patient service revenues, 2002
- 3.8 million outpatient visits per year
- 135,800 inpatient admissions per year
- 33,000 employees, providing more jobs than any other non-government employer in Massachusetts
- 18,000 are physicians, nurses and direct caregivers
- 13,000 are workers supporting the direct caregivers
-   5,000 are involved primarily in medical research
**  ****1,000 **build and maintain information systems

- Copyright 2007, Partners HealthCare, Inc.

## Lead by two academic medical centers

- Massachusetts GeneralHospital (MGH)
- 1,000 beds

- Brigham and Women’s/Faulkner Hospitals
- 770 beds

- Copyright 2007, Partners HealthCare, Inc.

## Organization & culture

- Partners is a complex, heterogeneous, federated, integrated delivery network
- Finance, Purchasing, IS centralized
- Heterogeneous IS- multiple vendors, solutions
- Entity-level budgeting
- Historically quality and operations are decentralized

- Copyright 2007, Partners HealthCare, Inc.

## Partners challenged by Dr. James Mongan...

- Dr. James Mongan, CEO of Partners HealthCare, created the High Performance Medicine Initiatives to demonstrate that the System provides “value-added care.”
- Grounded in the belief that Partners must distinguish itself on the basis of quality and effectiveness – the best possible patient outcomes and highest patient satisfaction, along with effective and efficient utilization of services.

- Copyright 2007, Partners HealthCare, Inc.

## High Performance Medicine Initiatives

_**Invest in quality and utilization infrastructure**_
**Information systems**
**Other resources**
- _Enhance patient safety_ by reducing medication errors system-wide
- _Enhance uniform high quality_ for select inpatient and outpatient conditions
- _Expand disease management programs_ for certain patients with chronic illnesses
- _Improve cost effectiveness_ by managing utilization trends and analysis of variance

- Copyright 2007, Partners HealthCare, Inc.

## Quality Data Management (QDM)

*QDM provides the infrastructure and systematic approach to manage data for reporting and analysis for clinical operations and quality.*
- Assumption: PHS clinical and administrative data has strategic value for understanding and improving practice, assessing performance, and driving improvement.
- Drivers:
- Pay-for-performance
- Public reporting of selected quality measures
- Partners High Performance Medicine Initiatives
- Ad hoc data requests
- LMR Report Central Project
- Emphasis on registries and population management tools
- (Research)

- Copyright 2007, Partners HealthCare, Inc.

## The Longitudinal Medical Record (LMR)

- Copyright 2007, Partners HealthCare, Inc.

## Quality Data Warehouse

- Externalize information from Partners ambulatory electronic health record
- Make that information available in a variety of ways

- Copyright 2007, Partners HealthCare, Inc.

## Why have a data warehouse?

- Transaction data is poorly suited for analysis.
- Running reports and queries in Production database may compromise system performance.
- Production databases not designed/intended to support aggregate queries.  May take many hours to run “simple” queries.
- Requires dedicated programmer resources, and no one programmer knows all relevant data.
- Data is incomplete, uncoded/miscoded.
- Lack of clear meta-data (explicit definitions and business rules) makes things harder.
- Hard to query across systems.
- e.g. ***Patients*** with ***diabetes*** and ***A1C>8***** **and ***no visit*** in past 12 months

- Copyright 2007, Partners HealthCare, Inc.

## Prescribed medications

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## Visits without notes

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## Pediatric body mass index (BMI)

- Copyright 2007, Partners HealthCare, Inc.

## Slide 15

- Copyright 2007, Partners HealthCare, Inc.

## Baby Steps: Longitudinal Data

- Goal: Follow cardiac surgery and cardiac intervention patients to understand what happens to them
- How: Combine patient level data
- Society for Thoracic Surgery (STS)
- American College of Cardiology (ACC)
- National Death Index
- Periodic follow-up (contact by nurse)

- Copyright 2007, Partners HealthCare, Inc.

## Chronic disease registries

- Compile lists of patients about patients with diabetes, heart failure, etc.
- Collect data about these patients into a database
- Create user tools or intervention modules
- Longitudinal, but not episode-based

- Copyright 2007, Partners HealthCare, Inc.

## Data integration challenge example:Understand utilization for joint replacement

- Goal
- Better understand utilization and costs for hip replacement.
- Challenge
- Currently no single data source provides a complete view of orthopedic care at Partners

- Copyright 2007, Partners HealthCare, Inc.

## Current analysis capability

- Copyright 2007, Partners HealthCare, Inc.

## Desired analysis capability

- Copyright 2007, Partners HealthCare, Inc.

## Slide 21

- Copyright 2007, Partners HealthCare, Inc.

## The challenge

*PATIENTS* have *DATA, PROVIDERS, VISITS, EPISODES*
*PROVIDERS *have* PATIENTS*
*VISITS *have* DATA, LOCATION*
*EPISODES *have *VISITS*
- What is a visit?
- How do you link patients and providers?
- Can you combine data sources by joining on patients, providers, visits, locations?
- How do you combine build episodes?

- Copyright 2007, Partners HealthCare, Inc.

## Data can be used for different purposes

- Externally focused (judgment)
- Get paid, hired/fired/promoted, publicly reported
- Inpatient focus, administrative data, manual abstraction
- Increasing ambulatory focus (pay-for-performance)
- Claims +/- lab results (and EHR)
- Internally focused (learning)
- Quality improvement, clinical understanding, efficiency
- Inpatient and outpatient, automated and manual abstraction
- More use of clinical data

- Copyright 2007, Partners HealthCare, Inc.

## Episodes desired but not emphasized

- Most measures of judgment and learning are aggregated at patient, provider, or visit level
- We are not ready to build clinical episodes
- Getting data
- Joining patients, providers, locations
- Defining patient-provider relationships
- Defining visits
- Joining claims and clinical data
- Improving coding, completeness of clinical data
- Users not asking for episodes
- Want actionable reports
- Episodes are used with claims data (ETGs)
- Predictive modeling initiative: working with IHCIS to use claims and lab data to identify high risk patients

- Copyright 2007, Partners HealthCare, Inc.

## What is the value of EHR data?

- Do reports and dashboards make a difference?
- Who will look at data and reports?
- What is the added value of grouping data into episodes?

- Copyright 2007, Partners HealthCare, Inc.

## Getting (and understanding) the data

- How is data extracted from transaction systems?
- Custom programs or tools on application side
- Integration engine
- Services
- Format: Flat files, XML, HL7
- Data integration for data warehousing poses unique set of challenges compared with clinical applications
- Mapping and normalizing disparate data sources
- Patients, Providers, Locations

- Copyright 2007, Partners HealthCare, Inc.

## Data Quality: problem and opportunity

- Multiple sources over many years
- Converted data
*Laissez-faire *management of concepts
- Voluntary use by clinicians

- Copyright 2007, Partners HealthCare, Inc.