Welcome

It’s Gonna be Epic – Lehigh Valley Health Network and Tableau

Walter J. Chesla

Senior Clinical Business Intelligence Analyst

Lehigh Valley Health Network

# T C 1 8

Donna L. Wendling

Senior Clinical Business Intelligence Analyst

Lehigh Valley Health Network

Agenda

▪ About Lehigh Valley Health Network

▪ In the Beginning…

▪ Challenges

▪ Clinical Data Platform

▪ Clinical Care Pathways

▪ Protected Health Information (PHI)

▪ Distribution & Tableau Server

▪ What’s Next?

About Lehigh ValleyHealth Network

Who We Are…

• 8 Campuses

• 3 Institutes

• 1 Children’s Hospital

• 160+ Physician Practices

• 17 Community Clinics

• 22 Health Centers

• 18 ExpressCARE Locations

• 1 Children’s ExpressCARE

• 45 Rehab Locations

• 81 Testing and Imaging Locations

• 18,000+ Employees

• 2,005 Physicians

• 834 Advanced Practice Clinicians

• 4,208 Registered Nurses

• 69,346 Admissions

• 274,879 ED Visits

• 1,838 Acute Care Beds

Health Information Awards Grand Slam

• HIMSS EMR Adoption Model Stage 7 designation

• Inpatient & Ambulatory, May 2017

• Three Most Wired Awards• Including Innovator and Advanced, June 2017

• HIMSS Davies Award• August 2017

Lehigh Valley Hospital – Cedar Crest

In the Beginning…

Epic Reporting

Workbench• Operational Real-time Reporting tool available

only within Epic Hyperspace

Slicer Dicer• Only available within Epic Hyperspace• Self-service reporting and visualizations

SAP Crystal Reports• Available within Epic• Static reports, slow to develop and deploy

SAP BOE, Webi, Lumira• Web interface, available outside of Epic• Allows users to run Crystals without Epic access• Webi provides self service reporting with basic

visualizations

Challenges

Data!

• So many data points in Epic…and finding the correct ones.

Protecting PHI

• Ensure only appropriate end users have access.

Time Consuming Report Development

• Traditional Waterfall Dev Cycle for Static Reports – Spec, Dev, Test/Review, Release

Large Backlog of Request

• Too much work, too few resources

Difficult to Identify Trends and Outliers in a Timely Manner

• Delay in taking corrective action

Finding Reports to Meet the Business Needs

• Large library existing only in Epic Hyperspace

Limited Self Service

• Webi

• Slicer Dicer (limited to Hyperspace)

Why Tableau?

Faster Development, Faster Insights• Encourage discovery through filters and actions

• More easily identify trends

Minimal End User Training• Intuitive interactions

Encourage Discovery• Answer questions through filters and actions

Easier distribution through Tableau Server• Free the data! No longer locked into Epic Hyperspace.

Drive transparency and culture change• We are becoming a data driven organization• Support process improvement efforts

Data Platform

Data Platform

Epic Chronicles(Operational Database)

Epic Clarity(Reporting Database)

Tableau Server

Tableau Server Users

Tableau Desktop

Developers

Other Data Sources – Non-Clinical(Excel, Text/CSV Files, HP Cloud, Oracle)

Clinical Care Pathways

Dumb boldness is the best way to approach a new challenge.

Jerry Seinfeld

Comedian

Clinical Care Pathways

▪Define a standard of care for common procedures and illnesses.

▪What questions are providers and clinicians trying to answer? What insights can we find?

▪How is success measured? What are the key metrics?

Clinical Care Pathways – Length of Stay

Length of Stay is a high level indicator for quality of care and cost.

A lower length of stay equates to lower cost for the network and patient, and indicates we are caring for our patients in a timely manner.

Ileostomy Length of Stay

Impact

• Overall Length of Stay Reduced from 26.4 hours to 10.9 days (15.5 day reduction)

• Post Op Length of Stay Reduced from 20.5 days to 8.7 days (11.8 day reduction)

Clinical Care Pathways – CMI (Case Mix Index)

A measure of the diagnosis grouper

used in coding a hospital encounter.

Target CMI = 1

Above 1 is ideal; Below 1 indicates

less than optimal coding.

Impact• Every tenth of a point below 1.0 is $800k in potential lost revenue; above 1.0 is an $800k gain.

Clinical Care Pathways – Readmissions

If we’re doing our job correctly……you won’t see us again.

Impact• Insurance won’t reimburse for readmissions related to the original diagnosis or procedure.

• A lower readmission rate equates to less lost revenue.

Clinical Care Pathways – Order Sets

Order sets define a standard protocol for procedures and illnesses.

Tableau helps us measure and improve usage.

Impact• Order set usage ensures consistent and proper care for similar diagnoses and procedures.

• Prevents extraneous orders that may drive up costs (and may not be reimbursable).

Clinical Care Pathways – Order Sets

But sometimes improvement is elusive.

Impact• With order set usage trending down, an optimal standard of care may not be met.

• Education should be provided to ensure the correct orders are used.

• Protocol should be revisited to verify the correct orders are included.

Clinical Care Pathways – Pregnancy Episodes

▪Pathway focused on improving pregnancy outcomes

▪Knew what we should do – needed to discover where to improve

▪Chose key metrics to track

▪Use workbooks to implement change and monitor effectiveness

Clinical Care Pathways – Pregnancy Episodes

▪ Key tests and vaccines measured at specific points of the pregnancyRubella: 10-18 Weeks GBS: 38 – 40 Weeks

Tdap: 27-36 Weeks Flu: Seasonal

▪ Measured percentage at pathway implementation (orange line).

▪ Continued to monitor weekly to measure improvement.

Clinical Care Pathways – Pregnancy Episodes

▪ Educated providers and clinicians on pathway processes and measured results.

▪ December 2017: Noticed a downward trend, and identified a problem.▪ New Prenatal Package was added to Epic, but not to the workbook metrics.

▪ New practices (offices) using Epic, but pathway was not yet implemented.

▪ Added new Prenatal Package and removed practices not yet utilizing pathway.

▪ Metrics immediately rebound.

Clinical Care Pathways – Pregnancy Episodes

A Patient Details Dashboard helps providers and clinicians identify patients to target for care, including those at high risk.

Not Shown: Patient MRN Column

Impact

• Identify patients requiring attention.

• Patients meeting all key metrics have better outcomes for mother and baby.

Clinical Care Pathways – Pregnancy Episodes

Pathway ImplementationNovember 2016

Pathway ContinuationAugust 2018

Rubella 80% 92%

Tdap 47% 78%

GBS 70% 83%

Flu 2% 36%

▪ Key metrics measured throughout an active pregnancy result in better outcomes for mother and baby.

▪ Flu is affected by seasonality – December through March seeing 60% acceptance of flu vaccine.

Clinical Care Pathways – Acute Coronary Syndrome (ACS)

• The Pathway Overview provides the most pertinent high level metrics and trends at a glance.

Clinical Care Pathways – Acute Coronary Syndrome (ACS)

▪ Improve patient safety and decrease complications related to morbidity and mortality in STEMI and NSTE ACS patients

▪ Increase clinical standardization

▪ Reduce LOS for patients with low to intermediate risk

▪ Reduce unplanned readmissions within 30 days

▪ Maximize quality, and lower costs for patients admitted with AMI

Clinical Care Pathways – Acute Coronary Syndrome (ACS)

Medication on Arrival and Discharge

• Medications such as aspirin on arrival are best practice guidelines from the ACC/AHA.

Impact• While we show a 4.4% increase (86.7% to 91.1%), aspirin is still not given on arrival for 8.9% of encounters.• The patient should receive required medication every time when not contraindicated.• As we are not at 100%, an opportunity for improvement remains.

Clinical Care Pathways – Acute Coronary Syndrome (ACS)

Cardiac Rehab Referral

• Cardiac rehab is recommended by the ACC/AHA and monitored by many of the registries we participate in.

• Real time monitoring ensures patients are getting the order.

Impact• An 11.7% increase year over year indicates

more patients have a continuation of care.

• Even with an 11.7% increase, the overall 42.2% indicates continued opportunity for improvement.

20192018

Clinical Care Pathways – Acute Coronary Syndrome (ACS)

Heart Score

• The heart score is a tool that helps assess risk for a major cardiac event. • User education has led to improved documentation.

Impact• While modest, documentation has improved 6.8% since 2017.• As users are educated, documentation should continue to improve.

Clinical Care Pathways

By the end of 2019, approximately 90% of Inpatient services will be included in a Pathway

29 Pathways Exist Currently

17 – 25 New Pathways will be added by July 2019

We really wanted to show how we handle Protected Health Information…

Protected Health Information (PHI)

…but you don’t have access.

PHI Security

Create a Calculated Field: PHI Filter

ISMEMBEROF(‘COPD_PHI')

Add the PHI Filter to the Worksheet containing PHI

Set Filter to True

This will display details if the user is a member of the Active Directory Group.

PHI Security

▪ Create a worksheet for PHI Message

▪ Create calculated field PHI Text

PHI Security

• Create a new PHI Message Worksheet

• Use previously created PHI Filter calculated field as a filter, set to False

• On PHI Message Worksheet, drag PHI Text to Text Mark - Format as large red text.

• To test, select a user who should NOT have access to PHI. If successful, the message will appear.

PHI Security

Combined the Details and PHI worksheets onto one dashboard, and test!

Distribution & Tableau Server

Distribution & Tableau Server

• Repository for all things reporting

• Empowers self service – users are trained to upload their own Tableau workbooks and PDFs

• All Tableau workbooks on the Analytics Portal are published to Tableau Server

Lehigh Valley Health Network Analytics Portal

Key Benefits and Measureable Impact

Key Benefits and Measureable Impact

Length of Stay• Shorter lengths of stay lead to lower costs for network and patient.

• 15.5 day reduction in overall length of stay for Ileostomy.

Readmissions• Insurance does not reimburse for readmissions related to the original procedure.

CMI• Ensure procedures are coded correctly.

• One Tenth of a point can equal $800,000.

OB• Improved overall care: Rubella by 12%, Tdap by 31%, GBS by 13%, Flu vaccine by 34%

Order Set Usage• Maintain a standard of care for procedures.

Access to Data• Availability of metrics outside of Epic Hyperspace for executive team.

What’s next?

What’s next?

More Self-Service Analytics• We have more developers than ever, in departments all over the network!

New Data Sources (and Certified Data Sources)• Leverage Caboodle – the Epic Clinical Data Warehouse – to create new data sources.

Integration of Non-Epic Clinical Data• Create a one-stop shop for all clinical data!

Evolving Standards• We keep learning! But when do we refactor older projects?

New Developers• Inside our team and across the network – how do we support and train them?

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