9/18/2012
 

Office of Analytics Analytics and Business Business Intelligence Intelligence

Stephan Fihn, MD MPH

Director

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9/18/2012
 

Supporting Secretary Shinseki’s 

Priority to be Data Driven 

• Enhancing analytic capacity

• Standardizing approaches to data capture, analysis

and reporting

• Improving efficiency

• Consolidated numerous programs and offices

• Working to improve data quality

Our Goal: The Right Information to the Right 

VETERANS HEALTH ADMINISTRATION 2

Our Goal: The Right Information to the Right 

Person at the Right Time 

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9/18/2012
 

OIA Structure 

Office of

Informatics

and Analytics

Health

Informatics

Analytics and

Business

Intelligence

Health

Information

Governance

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VETERANS HEALTH ADMINISTRATION

   

     

   

     

9/18/2012
 

Our Services 

Analytics & Business Intelligence Health Informatics Health Information Governance

Performance Measurement Applied Informatics Service Health Information Management

Operational Metrics Bar Code Resource Office Data Quality Program

VHA Support Service Center Health Informatics Initiative Health Care Security Requirements

ADUSH For Health Informatics and Analytics

VHA Support Service Center Health Informatics Initiative Health Care Security Requirements

Analytic Support Human Factors National Data Systems

Web Solutions/CDW Governance /Mobile

Apps

Informatics Patient Safety

Information Access & Privacy

Clinical Assessment Reporting & Tracking integrated Electronic Health Record Library Network Office

Knowledge Based Systems VACO Library

Standards & Interoperability

Veteran/Consumer Health Informatics Office

Support Operations

Training and Education

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OABI Organizational Structure 

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Current and Proposed Products 

For Management:

• Context based, relevant information

• Process improvement support

• Analytics training

• Innovative collaboration tools

For Clinicians

• Context based decision support

VETERANS HEALTH ADMINISTRATION 

• Context based decision support

• Population management

• Real‐time data collection

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9/18/2012
 

Products (cont.) 

For VHA leadership

• Detailed analysis of programs and issues

For Patients

• Web‐based and mobile applications

For Research

• Validated, relevant data

• Analytic tools

VETERANS HEALTH ADMINISTRATION 

• Analytic tools

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9/18/2012
 

Products (cont.) 

For other health care partners

• Benchmarking

• Leading measures

For public/consumers

• Recognition as leader in public reporting

VETERANS HEALTH ADMINISTRATION 

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9/18/2012
 

Homeless Veteran Products 

VETERANS HEALTH ADMINISTRATION 

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VETERANS HEALTH ADMINISTRATION

9/18/2012
 

Homeless 

Homeless Services Cube 

•Consolidates VHA workload, 

VBA claim, Homeless and at 

risk legacy system, HOMES 

application to identify and track 

homeless and at risk Veterans 

•Includes over 400 metrics 

related to homeless and at risk related to homeless and at risk 

Veterans, homeless/housed 

indications, services, outcomes, 

benefits 

•Provides patient level detail; in 

User Acceptance testing on 

VSSC website 

•For homeless and at risk 

coordinators, management & 

leadership 

•Developed and supported by 

Butch Fort and Betsy Lancaster 

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9/18/2012
 

Homeless 

Homeless Veteran Profile 

•Profiles homeless and at risk 

Veterans including Mental 

Health, VBA Claim, Primary 

Care and Homeless service 

history 

•Provides demographics 

address, PC & homeless 

provider and diagnostic hx 

•Will include Veteran VIC 

Image 

•Provides patient level detail; 

in User Acceptance Testing on 

VSSC website 

VETERANS HEALTH ADMINISTRATION 

•For homeless and at risk 

coordinators, management & 

leadership 

•Developed and supported by 

Butch Fort and Betsy 

Lancaster 

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9/18/2012
 

Homeless 

HOMES Application 

•Homeless Operations, 

management and Evaluation 

System (HOMES) allows for the 

recording of intakes 

assessment forms and the 

tracking of intake forms 

•Integrated several stand-alone 

homeless program legacy 

processes and applications 

•Feeds data daily into 

Homeless Registry 

•Provides patient level detail 

VETERANS HEALTH ADMINISTRATION 

•For homeless and at risk 

coordinators, management & 

leadership 

•Developed and supported by 

Sp Thakur, Tom Bricker and 

Jeanne Weishar 

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9/18/2012
 

Homeless 

Other Projects and Efforts 

•	 VIC Images ‐ incorporation of Veteran Identification Card images into
 

homeless reporting for homeless coordinators
 

•	 HUD/HMIS Data Sharing – as the homeless client served in the community

are sometimes the same veterans served in VA, the goal of this project is to

exchange data between the VA Homeless Registry and HMIS in a controlled,

secure environment.

•	 VBA Claims and Benefits ‐ expansion of the VBA claim and benefits data

into the Homeless Registry beyond those Veterans with a VBA Homeless

Flash applied.

•	 Homeless Service Monthly Dashboard – automation of a monthly dashboard

of homeless programs niq es and o tcomes c rrentl in e cel

VETERANS HEALTH ADMINISTRATION 

of homeless programs, uniques and outcomes ‐ currently in excel

• HOMES Application version 1.6 – expansion of HOMES application to

coordinate the care of homeless and at risk Veterans

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Mental Health Products 

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Mental Health 

Mental Health Summary Report 

•Consolidated and detail 

view of Mental Health 

performance measures & 

monitors 

•Includes MHICM, SUD, 

OEF/OEF Psychotherapy, 

MDD, 14 Day Follow-up, 7 

Day Follow-up After Inpatient 

Stay and High Risk Suicide 

Follow-up 

•Provides patient level detail 

•Accessible through VSSC 

website 

VETERANS HEALTH ADMINISTRATION 

•For MH providers, 

management & leadership 

•Developed and supported 

by June Oliver 

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9/18/2012
 

Mental Health 

Mental Health Uniform Services Handbook Survey 

•Combines repeated USH Survey 

with MH workload and other 

clinical data to track compliance 

with MH directives 

•Includes metric domains: 

General, Emergency Services, 

Seriously Mentally Ill, SUD, 

PCMHI G i i P PCMHI, Geriatric Programs, 

Homeless, Integration, PTSD, 

OEFOIF, MST, Telehealth 

•Accessible through VSSC 

website 

•For MH providers, management 

& l d hi & leadership 

•Developed and supported by 

June Oliver 

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Mental Health 

Mental Health Information System 

•Consolidates MH Evaluation 

Center (NPECEC, SMITREC 

and PERC) and performance 

measure and monitor data and 

compares to targets 

•Domains include Uniform MH 

Services Survey Scores T21 Services Survey Scores, T21 -

Business Results and Global 

Domain Scores 

•Accessible through User 

Acceptance testing on VSSC 

website 

•For MH providers For MH providers, 

management & leadership 

•Developed and supported by 

June Oliver 

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Primary Care 

Primary Care Almanac 

•Almanac combines Primary 

Care panel assignments 

(PCMM) w/ clinical data 

including lab, pharmacy, 

clinical cohorts, pt. demographics, care coordination 

program enrollment 

•Provides detail clinical 

support for diabetes & htn 

•Provides pt & provider level 

detail 

•Accessible through VSSC 

website & CPRS tools menu 

VETERANS HEALTH ADMINISTRATION 

•For primary care providers, 

team members & mgmnt 

•Developed by Fred Kirkland 

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Primary Care 

Care Assessment Need (CAN) Report 

•CAN provides estimated 

probability of death/hospital 

admission w/in specified time 

frame (90d or 1 yr). 

•Score expressed as a 

percentile 0-99; higher score 

indicate follow indicate follow-up assessment up assessment 

•Provides patient level detail 

•Accessible through VSSC 

website & CPRS tools menu 

•For primary care providers, 

and/or nurse care manager and/or nurse care manager 

•Model developed in 

collaboration with PCS 

•Report developed by Freddy 

Kirkland 

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9/18/2012
 

Primary Care 

Patient Aligned Care Team (PACT) Compass 

•PACT Compass enables 

management & field to track 

compliance to PACT 

operational directives & goals 

•Metric Domains include 

Panel Management, Access, 

Continuity Coordination or Continuity, Coordination or 

Care, Medical Home Builder 

Survey, AES 

•Perf. measures & monitors 

•Provides provider and some 

patient level detail 

VETERANS HEALTH ADMINISTRATION 

•Accessible through VSSC 

website & CPRS tools menu 

•Developed by Teresa 

Stevens 

•Supported by Fred Kirkland 

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9/18/2012
 

Primary Care 

Primary Care Provider Panel Cube 

•PCP Panel cube provides a 

weekly snapshot of PCMM 

panels, patients, providers, 

teams, capacity, FTE, patient 

demographics, workload, 

rooms & staffing, Medical 

Home Builder Survey 

•Provides patient and 

provider level detail 

•Accessible through VSSC 

website 

•For primary care providers, 

manag ement & leadership 

•Developed and supported 

by Betsy Lancaster 

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9/18/2012
 

Primary Care 

Primary Care Staffing and Room Application & Reporting 

•Entry of room and staff data 

for use in the modeled 

capacity calculations and 

staffing ratio monitor 

•Provides division and above 

level 

•Accessible through VSSC 

website; application access 

limited to selected visn staff 

•For primary care 

management & leadership 

•Developed and supported 

by SP Thakur, Teresa 

Stevens and Fred Kirkland 

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9/18/2012
 

Primary Care 

Dual Assignment Application & Reporting 

•Entry and reporting of 

primary care dual 

assignment approvals 

across facilities 

•Provides patient level detail 

•Accessible in User 

Acceptance Testing through 

VSSC website; application 

access limited to selected 

visn staff 

•For primary care 

management module 

( ) PCMMcoordinators and 

providers 

•Developed and supported 

by SP Thakur, Steve Krysiak 

and Fred Kirkland 

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9/18/2012
 

Primary Care/Mental Health 

Primary Care Mental Health Integration Dashboard 

•PCMHI program is integrated 

care for Veteran physical and 

mental health conditions 

• Shared program of the Office of 

Mental Health Services and the 

National Primary Care Program. 

•Dashboard includes 

•Service Utilization, including 

patients served and 

encounters 

•Operations, including 

program components and 

staffing 

•Performance measures 

VETERANS HEALTH ADMINISTRATION 

•Developed by Teresa Stevens 

•Supported by June Oliver 

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Patient Aligned Care Team (PACT) Compass 

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Primary Care 

Other Projects and Efforts 

• PCMM Rehost – effort to rewrite Vista PCMM application to

decrease complexity and increase functionality. HP has been

engaged as contractors

• Primary Care Panel and Model Capacity Update – detailed

analysis analysis to update primary primary care panel size and modeled modeled capacity capacity

guidelines as driven by direct care and support staff FTE, visit

intensity, available rooms and other factors

• PACT Team Certification – analysis of PACT teams and providers

in an effort to identify best practices and compliance to PACT

VETERANS HEALTH ADMINISTRATION 

y p p

Concepts and directives

• PACT Metric Study – in‐depth, statistical analysis of foundation

metrics such as PACT continuity and same‐day access

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Other Products 

Capital Asset Inventory

EEO/Alternative Dispute

Resolution Dashboard

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Sexual Assault Database 

Data from Issue

Brief on left

Data from IOC on

right

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9/18/2012
 

Geriatrics 

Community Living Center QMQI Cube 

•CLC QMQI cube tracks 

required assessments of 

patients in Community Living 

Centers 

•Includes 34 indicators 

across 11 domains 

•Provides patient and 

provider level detail 

•Accessible through VSSC 

website 

•For primary care providers, 

manag ement & leadership 

•Developed and supported 

by Betsy Lancaster 

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Other Products 

Enrollment, Eligibility, Revenue,

and Non‐VA Care (EERN) Data Cube

Consults Cube

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Products — Issue Brief Database 

• Provides improved access to issue briefs plus aggregation and trending

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Products 

Capital Asset Inventory

EEO/Alternative Dispute

Resolution Dashboard

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Products 

Rehabilitation Services Dashboard

Secure Messaging Reports

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Other Recent OABI Products 

•	 VHA Operation Enduring Freedom/Operation Iraqi Freedom

(OEF/OIF) Outreach Reporting System (VORS) Leadership Report

• Palliative Care Bereavement Survey

• Women Veterans Profile

• Nursing Dashboard

• Patient Aligned Care Team (PACT) Compass

• Executive Career Field Plan/ T21 2011 Measure Report

• Non‐VA Care Top 100 Vendors & Non‐VA Care Interest Payments

VETERANS HEALTH ADMINISTRATION 

• Non VA Care Top 100 Vendors & Non VA Care Interest Payments

• Mental Health Uniform Survey Handbook Survey

• Appointment Cancellation and Reschedule Rates

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Clinical and Operational Metrics 

Office of Productivity, Efficiency and Staffing 

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New and Improved Reporting Tools for 

Accountability and Improvement 

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New Operational Reports Being Developed 

• Comp and Pen – Prior reports provided only visit counts. Collaborating with Chief

Business Office to provide Social Security Number level appointment data.

Timeframe: 2‐3 months

• Non VA Care ‐ Derived from Field‐Based Analytics Program, reports linking Fee Basis

Claims to authorizations for treatment, payment, and ord i er ng service. Plan to

extract of ALL Fee Basis Claims System data Æ detailed national reports

• EDIS – Detailed reports of key Emergency Department (ED) metrics, e.g., mean/

median time through ED, time to triage, times to admit decision and in bed,

patients leaving against medical advice, etc. Timeframe: 2‐3 months

VETERANS HEALTH ADMINISTRATION 

• Integrated Billing/Revenue Operations ‐ Detailed reports on Reason Not Billed and

3rd party revenue by stop code (derived from manual reports created for ED at

Madison as part of Field Analytics Program). In development

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CDW-Based Enterprise Applications 

Primary Care Almanac

Care Assessment Need (CAN) Report

PACT Compass

Homeless Services Cube

Homeless Homeless Veteran Veteran Profile Profile

MH Summary Report

MH Uniform Services Handbook 

Dashboard

PC Mental Health Integration

Dashboard

Virtual Care Modality Dashboard

Telehealth Cube

Amputation Cube

VETERANS HEALTH ADMINISTRATION 

MOVE Outcomes Report

Palliative Care

Consult Cube

On‐Time Surgeries

Outpatient Outpatient Encounter Encounter Timeliness Timeliness

Comp and Pen

Non‐VA Care

Beneficiary Travel

Outpatient Encounters

Integrated Billing/Revenue

Operations

Emergency Dept. Info. System

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9/18/2012
 

Patient Care Assessment System Patient Care Assessment System 

CAN Risk Level (1-99) 

Select CAN Timeframe 

Clinical Priority

Statistical High Risk

High Intensity Medical Management

Suicide Risk

Homeless

Frequent ER User

Polypharmacy

Frequent PCP Visits

Frequent Admissions

VETERANS HEAL 

Medication Non‐Adherence (MUET)

OID/OIF/OND High Risk

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Products - RAMP – Enterprise Wide Portal 

VETERANS HEALTH ADMINISTRATION 

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Performance Measurement 

External Peer Review Program 

Clinical Metrics, e.g., HEDIS and ORYX 

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Survey of Health Experiences of Patients (SHEP) 

Patient satisfaction and health status for a representative sample of 600,000 

Veterans 

Inpatient Care: Overall Rating of This Hospital Stay - National 

Number 

Answering 

Attribute 

Question 

(Weighted) 

% of Total 

Respondents 

Answering 

Attribute 

Question 

Overall 

Rating of 

Hospital 

% Satisfied with 

Attribute 

Composite 

Component* 

Loss Potential 

214,191 54.9% 62.5% 48.2% CommRx 27.6 Q17 Side Effects 49.5 

294,612 75.6% 62.1% 55.6% HospStaff 34.2 Q4 Call Button 44.8 

256,564 65.8% 62.3% 52.1% PainMgt 29.1 Q13 Pain Control 44.3 

388,433 99.6% 64.0% 67.1% 50.1 Q25 Nurse Care About You 43.6 

388,928 99.8% 64.0% 66.0% CommRn 46.6 Q2 Nurse Listen 42.6 

370,568 95.1% 63.8% 56.4% Noise 30.7 Q47c Noise 41.8 

388,441 99.6% 64.0% 67.9% 49.4 Q24 Nurse Resepct 41.5 

131,205 33.7% 62.9% 57.9% HospStaff 33.2 Q11 Bathroom Help 40.9 

389,807 100.0% 64.0% 65.0% CommRn 42.2 Q3 Nurse Explain 40.4 

388,834 99.8% 64.0% 69.2% 49.6 Q27 Dr Care About You 39.3 

256,388 65.8% 62.3% 67.6% PainMgt 49.4 Q14 Help Pain 39.2 

368,181 94.5% 63.7% 62.5% Privacy 36.6 Q47b Privacy 38.7 

388,813 99.7% 64.0% 68.6% 46.6 Q26 Dr Respect 38.0 

386,161 99.1% 64.0% 62.7% 34.9 Q34 Know Who to Ask 36.9 

383,015 98.3% 64.1% 48.0% Quiet 18.9 Q9 Quiet 36.5 

389,300 99.9% 64.0% 66.5% CommDr 39.1 Q7 Dr Explain 35.0 

387,684 99.5% 64.1% 70.8% CommDr 46.4 Q6 Dr Listen 34.2 

379,684 97.4% 64.0% 74.5% 54.0 Q47a Cleanliness 32.9 

388,112 99.6% 64.0% 69.7% Clean 41.9 Q8 Cleanliness 32.3 

389,428 99.9% 64.0% 79.0% CommRn 65.7 Q1 Nurse Courtesy Respect 31.1 

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Updated Public Reporting Site 

• New website incorporates the

content of ASPIRE in a user‐

friendly, 508‐compliant format.

• Format and content tested with

a panel of Veterans representing

different different eras and service service and

many levels of internet

sophistication.

• Content oversight board includes

VHA Offices of Communication,

Quality, Safety and Value, Policy

and Services Patient Centered

VETERANS HEALTH ADMINISTRATION 

and Services, Patient Centered

Care, and Operations.

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High Level Predictive Analytics 

• Care Assessment Need (CAN) Score

– Complex predictive equation (~150 data elements

extracted from numerous domains in CDW)

• Est. likelihood of admission or death w/in 90 d or 1 yr

• Computed weekly for ~5 million primary care pts

– Integration into new web application: Patient Care 

Assessment System (PCAS) 

• Other Predictive models in development:  acute

VETERANS HEALTH ADMINISTRATION 

kidney injury, methicillin‐resistant Staphylococcus 

aureus (MRSA) on admission, C. difficele, 

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Care Assessment Need (CAN) Report 

VETERANS HEALTH ADMINISTRATION 

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Clinical Assessment, Reporting and Tracking System– 

Cardiac Catheterization Labs 

• Performance

benchmarking

• National peer

review program

• Device safety

surveillance in

partnership with

FDA

• Asset

management with

real‐time locator

system (RTLS)

VETERANS HEALTH ADMINISTRATION 

• Partnership with

DoD

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Use of High Level Analytic Data for Population 

Management and Resource Planning 

1-yr likelihood of 

admission or death 

2.37% - 9.03% 

9.04% - 10.01% 

10.02% - 10.96% 

10.97% - 12.18% 

12.19% - 19.34% 

Dynamic 

1-yr likelihood 

of admission 

1.86% - 5.93% 

5.94% - 7.00% 

7.01% - 7.97% 

VETERANS HEALTH ADMINISTRATION 

Dynamic 

Geospatial 

Mapping 

7.98% - 9.21% 

9.22% - 16.99% 

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Field 

Analytics 

Training 

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Clinical and Operational Metrics — Inpatient 

Evaluation Center (IPEC) 

• Risk adjusted outcomes and metrics, e.g., mortality, hospital‐

associated infections (including MRSA), length of stay

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Analytics — National Evaluation of PACT / 

Demonstration Labs 

PACT Demonstration Lab Initiative

Progress Report – FY 2012, Quarter 1

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Mobile Applications for Patients 

VETERANS HEALTH ADMINISTRATION 

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Summary 

• Many other products not described

• In process of integration to achieve greater efficiencies

• Collaboration throughout VHA and Veterans Benefits

Administration

• Moving from retrospective to real‐time reporting and

prediction

• Enhancing analytic capacity within VHA

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