2008 OACHC Annual Conference“United for a Healthy Ohio”
Healthcare GIS and Lean Thinkingg
Edward [email protected]
(513) 322-5141(513) 322-5141
Mark Carrozzamcarrozza@healthfoundation [email protected]
(513) 458-6722
2008 OACHC Annual Conference“United for a Healthy Ohio”
Cincinnati, Ohiowww healthlandscape orgwww.healthlandscape.org
2008 OACHC Annual Conference“United for a Healthy Ohio”
About HealthLandscape• Powered by ESRIPowered by ESRI• Developed at Univ of Cincinnati• Sponsored by The Health Foundation of Greater Cincinnati and the
American Academy of Family PhysiciansAmerican Academy of Family Physicians• Conceived: May, 2004• Launched: Dec, 2008
• Web based mapping of public health data at www.healthlandscape.orgprovided compliments of the sponsoring organizations (free)p p p g g ( )
• Web based mapping of private enterprise data (subscription)
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2008 OACHC Annual Conference“United for a Healthy Ohio”
What is HealthLandscape?
l hL d i i t ti b tl th t ll h lth• HealthLandscape is an interactive web atlas that allows health professionals, policy makers, researchers, and planners to combine, analyze, and display information in ways that promote better understanding of health and the forces that affect it sing geospatial mapsof health and the forces that affect it using geospatial maps.
H1N1 Swine Flu
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H1N1 Swine Flu
2008 OACHC Annual Conference“United for a Healthy Ohio”
Datasets Built-In to HealthLandscapeCommunity DataEconomics
Substance Abuse and PreventionAll Substance Abuse Arrests, Uniform Crime Reports, 2005 SAMHSA F iliti 2007Appalachian Counties Economic Status
Area-Based Socioeconomic Measures, 2000 BEA County Income & Employment Summary, 2007 BEA Economic Profile, 2006 BEA Economic Profile, 2007 BEA Farm Income & Expenses, 2007 BEA Personal Current Transfer Receipts 2007
SAMHSA Facilities, 2007
United States2000 Health Workforce for Counties Larger than 100,000 Population Active Physicians and Doctors of Medicine in Patient Care AHRQ State Healthcare Quality Ranks 2007 AHRQ State Healthcare Quality Rates 2007 Assisted Housing ProfileBEA Personal Current Transfer Receipts, 2007
County Poverty, 2005 (US Census, SAIPE) HUD Fair Market Rents, 2008 Labor Force Size and Unemployment by County, 2007 Labor Force Size and Unemployment By County, 2008 Small Area Income & Poverty Estimates, 2006 Small Area Income & Poverty Estimates, 2007
Assisted Housing Profile BRFSS (Age 40-64), 2006 BRFSS (Ages 18-39), 2006 BRFSS (Ages 65+), 2006 BRFSS (Men Only), 2006 BRFSS (Women Only), 2006 BRFSS, 2004
Health EconomicsHealth Insurance Coverage by County, 2000 Health Insurance Coverage by County, 2005 Health Insurance Coverage by State, 2006 Health Insurance Coverage by State, 2007 Hospital Employment & Payroll Data by State, 2007 Medicaid Recipients Recipients in Managed Care Payments Per Recipient Recipients Per 100
BRFSS, 2006 Commonwealth State Health System Performance Ranks, 2007 County Age-Adjusted Death Rates, by Race, 1999-2005 Health Access Deprivation Index (ADI) Infant Mortality by Race, by County, 2003-2004 Local Government Health Employment & Payroll Data, by State, 2007 Medically Disenfranchised/County Medicaid Recipients, Recipients in Managed Care, Payments Per Recipient, Recipients Per 100
Persons Below Poverty Level, 1989-2004 Medicare Enrollees, Percent in Managed Care, Payment Per Enrollee, Short-stay Hospital
Utilization, 1994-2004 Persons Enrolled in Health Maintenance Organizations (HMOs) per State, 1980-2006 Persons Without Health Insurance Coverage by State, 1995-2005 State Mental Health Agency Per Capita Expenditures, 1983-2004
H lth Q lit I di t
y yMortality by County, 1979-1998 Mortality by County, 1999-2004 Mortality By Underlying Cause Among Children, 1990-2005 Natality and Prenatal Care by County, 2005 Nursing Homes, Beds, Occupancy Rates and Residents Rates by State, 1995-2006 Physician per Population by County Physicians and Spending by StateHealthcare Quality Indicators
AHRQ 2007 Cancer Measures of Healthcare Quality AHRQ 2007 Diabetes Measures of Healthcare Quality AHRQ 2007 End Stage Renal Disease Measures of Healthcare Quality AHRQ 2007 Heart Disease Measures of Healthcare Quality AHRQ 2007 Respiratory Diseases Measures of Healthcare Quality
HRSA Geospatial Datawarehouse
Physicians and Spending by State State and County Mortality per 100,000 State Health Systems Performance, Ranked Vaccination Coverage Among Children 19-35 Months, 2002-2006 Virginia County Mortality Data
Health Workforce DataUS Medical Schools 2007HRSA Geospatial Datawarehouse
Ambulatory Surgical Centers Critical Access Hospitals Federally Qualified Health Centers Hospices Hospitals Nursing Facilities (NF)
US Medical Schools, 2007 Medically Underserved Areas/Populations Physician Scarcity Areas (ZIP), 2005 Health Professional Shortage Areas, 2004 Health Center Locations
Population & EconomyNursing Facilities (NF) Skilled Nursing Facilities
Poverty & Income Age & Gender PopulationFamily Characteristics Race & EthnicityHousehold Characteristics Social Characteristics
www.HealthLandscape.org
Who is Using Who is Using HealthHealthLandscapeLandscape??• Over 2,400 registered users since the beta release in July 2007• Great for Non-Profits and Community Health CentersGreat for Non Profits and Community Health Centers• Sponsored by The Health Foundation and American Academy of
Family Physicians/Robert Graham Center
Top User Categories are:– Academic Researchers (33%)– Residency Programs (20%)– Physicians (16%)– Other Medical Professionals (15%)– Foundations (10%)– General Public (4%)– Other/Unknown (2%)( )
2008 OACHC Annual Conference“United for a Healthy Ohio”
H lth GIS d L Thi kiHealthcare GIS and Lean Thinking
2008 OACHC Annual Conference“United for a Healthy Ohio”
Healthcare Roundtable 5/21/09
The Traditional GIS Approach
F th ti– Frame the question– Select your data– Choose your analytic approachy y pp– Process the data– Read the results
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2008 OACHC Annual Conference“United for a Healthy Ohio”
What is special about GIS for Healthcare?
• Layering of co-dependent health factors• “Worth a million words”• Predictive vs Prescriptive• Real time “command & control”• It’s all about Outcomes
2008 OACHC Annual Conference“United for a Healthy Ohio”
Healthcare Roundtable 5/21/09
An Alternative Approach
Th T di i l GIS A h G l C i A hThe Traditional GIS Approach– Frame the question– Select your data
Goal Centric Approach– Define the problem– Show the problemy
– Choose your analytic approach
– Process the data
p– See the problem– Solve the problem
Sustain the Solution– Process the data– Look at the results
– Sustain the Solution
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2008 OACHC Annual Conference“United for a Healthy Ohio”
Goals Centric Approach
EnvironmentMaps
Co-Dependencies
TrackingTrackingMaps
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2008 OACHC Annual Conference“United for a Healthy Ohio”
Sample ProblemsSample ProblemsHealth Mapping for Urology
Problems:– Location of Practice Sites– Patient Retention– Patient Growth– High Cost of Health Procedures– Profitability– Quality of Care (Patient Perceived)– Underutilized Resources– Equipment Placement– Others?
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2008 OACHC Annual Conference“United for a Healthy Ohio”
Patient Population MapsWh t d k b t ti t t t fit bilit t ti f ti h t ?What do we know about our patients e.g. count, cost, profitability, outcomes, satisfaction, churn, etc?
All Patients Top 1-5 ICD9 Re-Admits <30 Days Repeat Visits
AnalysisPatient Profile – Count, Density, Cost, Profitability, Diagnosis Dispersion
Hot Spot AnalysisLocation/Allocation Model
Kernel DensitySpider Diagram
Spatial Interaction ModelsGravity Models
Population DistributionMean or Weighted Mean Center
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2008 OACHC Annual Conference“United for a Healthy Ohio”
Environmental MapsWhat factors impact the quality, cost, delivery of care to our patients?
Proximity to Care Quality of Care ??? ???(Patient Perception)
•Income Level•Age Distribution•Sex Distribution•Insurance Coverage•etc
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2008 OACHC Annual Conference“United for a Healthy Ohio”
Intervention MapsWhat can we do about it?
Move Locations Quality of CareHome Visitation ???(Patient Perception)
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2008 OACHC Annual Conference“United for a Healthy Ohio”
Tracking MapsHow can we maintain and improve the current condition?
Proximity to Care Re-Admits Quality ???y(patient perceivwd)
???
Red Zone AnalysisRed Zone Analysis
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2008 OACHC Annual Conference“United for a Healthy Ohio”
Next Steps?
• Clarify the problems?• Extract the data• Generate Maps
• Populationp• Environment• Intervention• Tracking
• “Read” the Maps
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2008 OACHC Annual Conference“United for a Healthy Ohio”
Lean ThinkingLean Thinking
2008 OACHC Annual Conference“United for a Healthy Ohio”
Lean Six Sigma
• Process methodology for improving quality and eliminating waste & “defects”
• Initially used in manufacturing industries• Introduced by Toyota, Motorola, General ElectricIntroduced by Toyota, Motorola, General Electric• Data Driven
Begins by capturing the “Voice of the Customer”• Begins by capturing the “Voice of the Customer”
2008 OACHC Annual Conference“United for a Healthy Ohio”
What is special about Lean Six Sigma in Healthcare?
• Methodology to eliminate waste, minimize errors, improve quality reduce costimprove quality, reduce cost
• Data Driven…understanding the customer/patient populationpopulation
• Process…not an event• Addresses the complete problem many questionsAddresses the complete problem…many questions
2008 OACHC Annual Conference“United for a Healthy Ohio”
Healthcare Roundtable 5/21/09
The Lean Process
22Source: John Shook Lean Enterprise Institute “Managing To Learn”
2008 OACHC Annual Conference“United for a Healthy Ohio”
Health Mapping Process…A Lean Approach
P l ti M D fi th blPopulation Maps Define the problemUnderstand the current conditionSet a target condition
Environmental Maps Root Cause Analysis
Intervention Maps Potential CountermeasuresPlan
Tracking Maps Follow-up
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2008 OACHC Annual Conference“United for a Healthy Ohio”
Lean Lexicon
T P d i S M d M M i• Toyota Production System• Six Sigma• Value Stream Mapping
• Muda, Mura, Muri• Andon• Balance ScorecardValue Stream Mapping
• Statistical Process Control• Just In Time
Balance Scorecard• Root Cause Analysis• FMEA
• Kaizen• Kanban
5S
• Theory of Constraints• QFD
14 P i t• 5S• 5 Whys• Gemba
• 14 Points• Deming• SCRUMGemba
• TQMSCRUM
2008 OACHC Annual Conference“United for a Healthy Ohio”
Lean Bibliography
• “The Machine That Changed The World”• “Lean Thinking in Healthcare…Doing More With Less”• “Lean Hospitals”• “Making Hospitals Work”• “The Nun and the Bureaucrat…How they found a cure
for the sick hospital”
2008 OACHC Annual Conference“United for a Healthy Ohio”Healthcare Roundtable 5/21/09Healthcare Roundtable
5/21/09
Sample Case
Wh f l iMayfield Clinic
• Where are my referrals coming from and are my offices located appropriately? Has this changed over time?
• Have I lost revenue because of my office locations or those of myoffice locations, or those of my competitors?
• Which geographic areas of the k t id th b tmarket provide the best
opportunities for growth?
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2008 OACHC Annual Conference“United for a Healthy Ohio”
For a copy of this presentation and sample case
513.322.5141
2008 OACHC Annual Conference“United for a Healthy Ohio”
2008 OACHC Annual Conference“United for a Healthy Ohio”
In Summary
• Healthcare delivery must do more with less by elliminating waste and errors…which will improve quality and reduce costand reduce cost
• Mapping for healthcare is a process, not an event• Lean GIS starts with problem definition from which many• Lean GIS starts with problem definition from which many
questions/maps are derived