Data Analytics:Powering Clinical and Operational Excellence at the Cleveland Clinic

January 15, 2019

Craig Henderson

Manager, Business Intelligence

Agenda

• Introduction to Cleveland Clinic

• Analytics Strategy- Pillars of analytics

• Protocol Adherence & Effectiveness- Clinical Care Paths

• Emergency Services Case Study- Uncovering trends

• Patient Access Case Study

• Measuring success

• Founded in 1921

• 7.1 million patient visits

• 165,000 admissions

• 207,000 surgical cases

• 550,000 ED visits

• 4,435 inpatient beds

• 150 outpatient locations

• 51,000 Caregivers

• 3,000+ physicians and scientists

FHC

Elyria Family

Health CenterWestlake Family

Health Center

FHC

Lorain and Avon

Family Health

Centers

FHCLakewood

Family Health

Center

FHC

Strongsville Family Health

and Surgery Center

FHC

Brunswick Family

Health Center

FHC Wooster Family

Health Center

FHC

Independence Family

Health Center

FHC Solon Family

Health Center

FHC

Chagrin Falls Family

Health Center

FHC

Beachwood Family

Health and Surgery Center

FHC

Willoughby Hills

Family Health Center

FHC

HFairview Hospital

Avon Hospital

H

Lutheran Hospital

H

Ashtabula County Medical Center

H

Euclid Hospital

H

Hillcrest Hospital

H

South Pointe

Hospital

H

Marymount Hospital

H

Huron Health Center

FHC

Twinsburg Family Health Center

FHC

Cleveland

Clinic

Akron General Hospital

H Lodi Hospital

H

888 W Bonneville Ave, Las Vegas, NV

The Cleveland Clinic Lou Ruvo Center for

Brain Health, opened on July 13, 2009 in

Las Vegas, Nevada. It is operated by the

Cleveland Clinic and was designed by the

world-renowned architect Frank Gehry.

Cleveland Clinic Mission, Vision, Values

Our Mission:• To provide better care of the sick, investigation into their problems, and further

education of those who serve.

Our Vision:• Striving to be the world’s leader in patient experience, clinical outcomes,

research and education.

Cleveland Clinic – Strategic GoalsPatients

First Caregivers Affordability Growth Impact

Analytics Strategy

Enterprise AnalyticsBusiness Intelligence

• 70 caregivers responsible for clinical data warehousing and reporting

• Report through Medical Operations (not IT)

• Enterprise department; open to all 51k Caregivers

• Clinical reporting, research, web solutions, dashboard analytics

• 100+ data sources, 75TB

Commitment Flow Down

Enterprise Goals:

5 Pillars

Institute/Hospital

Department

Frontline

Performance Management

Monthly Executive Review/Strategic Initiative

Dashboards

Institute/Hospital Analytics

Center/Service Line

Frontline Management

Institutional Alignment

Enhance the value of CC data assets

Develop an analytically

capable organization

Promote standard processes and a culture that value

analytics over instinct

Create a modern analytics platform

DATA PEOPLE

PROCESS Technology

Comprehensive Analytics Strategy

Data Integration &

Quality

• Data Governance &

Stewardship Support

• Data Certification Capability

• Master Data Management

• Data Quality Capability

(Profile, Scorecard)

• Data Integration (ETL)

• Data Lineage and Meta-

data available

Data Aggregation &

Management

• Role-based Flexible

Security

• Efficient Storage of Large

Volumes of Data (structured

and unstructured)

• Quick Response Data

Retrieval

• Patient Entered Data

• Clinical Vocabulary

(Semantic) Support

Data Visualization,

Interrogation & Analytics

• Self-Service Capabilities

• Advanced Analytics &

Visualization Capabilities

• Data Exploration &

Discovery

• Support Structured and

Dashboard-style Reporting

• Geospatial Capability

• Simulation & Optimization

• Natural Language

Processing

How to meet the varying needs of our customers

Architecting the Platform

Analytics Challenges• Multiple audiences

- Executive, manager, analyst, statistician

• Internal and external sources

• 300+ analytics requests per month

• Accessibility to understandable information- Right accessibility for the right

person

- Summary vs detail

Sophis

tication

Ability to

Produce

Ability to

Consume

Maturity

Make analytics easier to consume

Increasing

understanding of

analytics

Analytics Platform

• Analytics quicker to market• Decrease visualization development

• Increase creators

• Executive usability complimented by deep drill

• Shift to self-service

• Empower overall data analytics

Enterprise Data

Sources

People

Any Data

Anywhere

Desktop Tools Analytics

Consumers

Business Objectives

Self-Service Capability

Protocol Adherence & Effectiveness

Creating a Path to Improved Patient Care

Process Management

Improvement for Healthcare• Optimize patient care

• Reduce practice variation

• Follow established guidelines

• Improve outcomes

• Use of the EMR

• Lower overall care costs

Patient Experience

Quality

Safety

High Reliability

Efficiency

Value

Care Path and EPIC

Care Path Dashboards

Summarized data

Detail

Flexibility

Trends

Comparisons

Measure impact• Why are we doing this?

• What is the impact?

Measureable Impact

60%35%

• Referral to physical therapy

• Imaging studies

• Use of opioids

Cost Savings Spine

• Less images ordered

Patient Care

• Less orders for opioids or tramadol

• Spine Care Path

• Cost variables in patient management

• Improved outcomes

• Total Hip/Total Knee Replacement• Elevated hemoglobin

• Diabetes, heart disease, anemia

• Appropriate antibiotics

46%

• 30 day readmissions

• 90 day reoperations

• Discharge to home

Patient Care

• More patients discharged to home

Cost Savings

• Less nursing home days

Measureable Impact

COPD Care PathAdherence & Effectiveness

Measure (Aug 2017) Care Path Non Care Path

Rate of LABD 86% 58%

Rate of follow up appointment 99% 78%

Rate of completed appointment 40% 32%

Cost per case reduction $1,285

“Clinical Care Pathways are one of the most powerful tools ensuring high quality, lower cost care.

Standardization and powerful visualizations provide insight into practice patterns and meaningful outcomes allowing us to make real change.”

• Dr. Timothy CroneMedical Director, Enterprise Business Intelligence & Enterprise Analytics

Break for Questions

Emergency ServicesCase Study

Driving Institute PerformanceProblem Statement:• 15 emergency departments using EPIC ASAP

• Accessibility to encounter information supplemented with ancillary services

Current Conditions:• Wealth of data

• Frequent flyer of analytic requests

Solution:• Partnered Governance

• Technology enablement

• Self service analytics

Emergency Services Data Model

ESI AnalyticsExternal

files

Decentralized data

Staging

Oracle

SQL Server

EPIC

ASAP Inpatient

ResultsDashboards that provide value:• Data replaces anecdotal evidence

• Visualizations highlight opportunities and drive performance improvement

• Transparency and comparative analysis – promotes friendly competition

Use Cases:• Monitoring of Call Back program

• Imaging and Medication Turnaround Time - Reducing ED LOS

Use Case: Call Back Program

Use Case:• Call patients post discharge to assess

wellbeing

• Address questions / follow-up

Current Conditions:• Captured in EPIC flow sheet

• Leadership can track call back performance

Measurable Impact:• Increased patient satisfaction

• 25% increase in call back rate

• 33% of ED’s surpass 75% target

Use Case: Imaging Turnaround TimeUse Case:• Turnaround time increases ED

LOS

Implications:• Lower patient satisfaction

• Higher rate of Left Before Treatment

• Increased “boarding”

Measureable Impact:• Dashboard used in Culture of

Improvement model areas

• ED’s reducing TAT in focused cohorts

• Identification of outliers

“Tableau dashboards have produced downstream benefits; we are able to more quickly and efficiently meet the demands of our customers.”

• McKinsey MuirSenior Operations Analyst, Emergency Services Institute

Patient Access

No Shows/Same Day CancelsOverall Impact

• Negatively Affected Patient Care

• Artificial Access Problems

• Office Productivity

• Lost Revenue

1%

DECREASE

Summary Dashboard

No Shows & Same Day Cancellations

Use Case: Lorain & TransportationUse Case:

•High percentage of chronic no shows/same day cancels

•Patients cancel due to transportation

38% in Lorain vs

19% overall

Use Case: Lorain & TransportationUse Case:

•74% live within 10 miles of the Lorain FHC

Implications:•Higher health costs

•Higher acuity health issues

•Low patient/provider satisfaction

•Lower productivity

Measurable Impact:•Pilot program initiation

Creative SolutionSame Day Cancel• Patient calls to cancel appointment

• Patient Service Representative asks for reason

• If reason is transportation offer ride program

Forecasting Future Access

• Forecast - Available

- Appointments scheduled

• Variables- Medical specialty

- Seasonality

- Day of week fluctuation

- Historical trends

Measuring Success

Implementation is a journey…

Divert ad hoc and project requests:• Analytics delivery up 146%, Distinct users up 54%

• 86% increase in projects of “High” complexity by enterprise resources

Continue self-service direction:• Increase data accessibility through Enterprise Data Vault

• Certify and publish data sources to Tableau Server

• Build Power User community for best practice sharing

• Implementation of Analyst University – increase Analyst acumen

Conclusion

Questions

henderc@ccf.org

https://www.linkedin.com/in/craig-henderson-0430907/