Copyright © 2016 Health Catalyst 1

Insights

What Do You Get With a Clinical Improvement Application from Health Catalyst?

Health Catalyst’s improvement applications bring together the knowledge, people, processes, and tools to transform healthcare delivery.

Built on the foundation of the Health Catalyst Late-Binding™ Data Warehouse, we have thoughtfully developed a range of improvement applications to help organizations improve outcomes in several clinical and operational domains:

Population Health Management

Patient Injury Prevention

Shared Risk and Accountable Care

Operational Efficiency and Performance Monitoring

Financial Analytics

Translational Research

Health Catalyst has a mission to transform healthcare. And transforming healthcare takes more than data and dashboards. It takes a new way of doing things. We’ve been thinking about old problems—and some new problems—in creative ways, and have developed an approach that takes into consideration how healthcare is delivered. Our approach spans and supports three important systems that come together in our improvement applications:

Synthesis of evidence-based content helps organizations focus on best practices: What should we do?

Tailored analytics surface and communicate performance in key areas: How are we doing?

Improvement services help outcomes improvement teams drive adoption: How do we transform?

Together these systems enable organizations to achieve meaningful and sustainable outcomes improvement and truly transform care. In fact, we base our success on our clients’ ability to do this. Since our approach is unique, we are often asked to describe in detail what you get when you purchase an improvement application from Health Catalyst. This article answers that question using a specific clinical example (sepsis).

Copyright © 2016 Health Catalyst 2

Starter Content (Best Practices): Knowledge Concentrated

Improvement application starter content is meant to jumpstart an organization’s outcomes improvement work. It synthesizes both “best science” from the medical literature and “best efforts” of quality initiatives to help health systems plan and achieve more improvement, more quickly. The knowledge starter set may include one or more of the following, depending on the topic:

A Knowledge Brief: A summary of current evidence and trends in outcomes improvement.

A Care Process Improvement Map: A visual map of the overall care process across the continuum of care, including key best practices, “storm clouds” indicating areas of greatest improvement opportunity, potential metrics and data visualizations, and knowledge assets that health systems may need to adopt or develop to support best practice.

An Outcomes Improvement Packet: A distillation of technical, medical, and quality improvement knowledge related to the “storm clouds,” along with suggestions and examples to help health systems set aims and goals and begin to plan interventions for outcomes improvement.

Knowledge Brief

The Knowledge Brief is just that: a brief overview of background knowledge to support outcomes improvement opportunities for a specific care or workflow process. The Knowledge Brief includes:

A summary of why this is an important area of focus for quality improvement

Major guidelines that guide best practices in this domain

Trends or promising areas of focus for outcomes improvement

Selected supporting references

Improvement application starter content is meant to jumpstart an organization’s outcomes improvement work. It synthesizes both “best science” from the medical literature and “best efforts” of quality initiatives to help health systems plan and achieve more improvement, more quickly.

Copyright © 2016 Health Catalyst 3

Care Process Improvement Map

More than a high-level summary of clinical best practice, the Improvement Map orients team members to the scope of a care process, the major outcomes it affects, and the application metrics that support work in this area of care. We derive the map from our summary of the medical literature, the input of clinical and technical experts, and our experience with other healthcare systems.

The map shows the overall process across the continuum of care, with each of the action boxes representing a phase or site of care. The boxes contain key best practices (listed with evidence source and grade, where possible), and the yellow “storm clouds” indicate areas where, for most health systems, the opportunities are greatest. Finally, the map shows the metrics and data visualizations available in the application and identifies the knowledge assets—such as order sets and screening tools—that health systems may need to adopt or develop to support best practice.

Overlaying analytics, improvement opportunities, and clinical practice in a single, simple visual, the map communicates across disciplines—helping data experts, administrators, and clinicians get on the same page (literally). This accelerates quality improvement around the care process.

Overlaying analytics, improvement opportunities, and clinical practice in a single, simple visual, the map communicates across disciplines—helping data experts, administrators, and clinicians get on the same page (literally). This accelerates quality improvement around the care process.

Copyright © 2016 Health Catalyst 4

Outcomes Improvement Packet

The Outcomes Improvement Packet provides content tied to the “storm clouds” identified on the Care Process Improvement Map—those areas where the opportunities for outcomes improvement may be most promising. It distills clinical and quality improvement knowledge to help health system teams formulate goals and aims, plan interventions, and stay focused on meaningful and sustainable outcomes improvement.

While our health systems generally know accepted best practice, they may not know where their best improvement opportunities lay. The content in the packet anticipates the kinds of questions health systems often ask during implementation of our improvement applications. Specifically, they want to know:

Where should we focus in the care process? Why? What’s the support for the idea that practice change in this area can yield significant improvement in outcomes?

What’s the impact on key outcomes such as cost, patient experience, mortality, length of stay, and so on?

What’s been tried and proven effective by other healthcare systems and organizations? What interventions can we borrow and learn from?

What metrics might we use to gauge our progress and learn more quickly?

What aims and goals could we formulate and track with the support of the application?

The Outcomes Improvement Packet concisely addresses these concerns, providing suggestions and examples to help health systems set aims and goals and begin to plan interventions for outcomes improvement.

The Outcomes Improvement Packet distills clinical and quality improvement knowledge to help health system teams formulate goals and aims, plan interventions, and stay focused on meaningful and sustainable outcomes improvement.

Copyright © 2016 Health Catalyst 5

Analytics: Data Tailored

Based on starter content, the analytics included in an improvement application include precise patient registries, outcomes and process metrics, and visualizations—the “under the hood” engine parts that help teams use the application to drive outcomes improvement.

Precise Patient Registries (Cohorts)

Each improvement application comes with patient registry definitions that represent the patients who are affected by the clinical process. The patient registries in the starter set are flexible, designed to be molded around a health system’s specific environment, vetted by its clinical teams, and customized to support each health system aim. (If, for example, a system is aiming to improve sepsis screening in the ED, the cohort will be different than if it’s focusing on care for severe sepsis or septic shock.)

A care process-specific patient registry is delivered when the improvement application is installed. But unlike fixed cohorts based on administration codes, the starter set registries let teams refine patient registries using inclusion and exclusion criteria—such as clinical observations, laboratory findings, medications, and diagnostic tests—that may narrow or broaden the cohort based on goals and aims.

The graphic below shows an example of what a “starter” sepsis registry may include.

EXAMPLE SEPSIS “STARTER” COHORTS

1 Cohort related to aims focused on early recognition in the ED: All ED patients

2 Cohort related to aims focusing on 3-hour bundle: All coded sepsis + potential sepsis based on clinical observations, labs, medications, diagnostic tests. etc. at given points in time

3 Cohort related to septic shock: All coded septic shock + potential septic shock based on specific clinical findings

All emergency department patients

Potential sepsis

Sepsis

All inpatients

The patient registries in the starter set are flexible, designed to be molded around a health system’s specific environment, vetted by its clinical teams, and customized to support each health system aim.

Unlike fixed cohorts based on administration codes, the starter set registries let teams use inclusion and exclusion criteria to refine definitions until those definitions meet the specific needs of the organization.

1

2

3

Severe Sepsis

Septic Shock

Copyright © 2016 Health Catalyst 6

Metrics

Like the patient registries, the metrics contained in an improvement application are based on starter set content, but can be tailored to a health system’s specific aims and improvement projects. That’s because, although many of the Health Catalyst improvement applications do streamline surveillance (and so include metrics used for regulatory and accreditation purposes), they’re built to support outcomes improvement, not just reporting. Health systems will add, subtract, or modify metrics based on their needs to track process change, measure outcome improvements, and monitor balance metrics.

Visualizations

The visualizations delivered with an improvement application correspond to the “storm clouds” identified in the starter content; they use health system data to communicate current and historical performance in areas that evidence suggests have the greatest opportunity to improve outcomes. As with other elements of the starter analytics, the visualizations are:

Outcome-focused: Connected to the clinical, patient experience, and financial performance indicators the health system selects, and expressed in a way that matches the organization’s quality improvement vision (for example, in its sepsis dashboard, one of our clients has a visualization for number of “Lives Saved”).

Aim-directed: Tailored to specific aims (e.g., a process aim such as improved compliance with a bundled care protocol) intended to improve organizational outcomes.

Actionable: Granular data embedded in the architecture of an improvement application allow drill-down in every visualization, often to the order or patient level. This helps clinicians and administrators get to the “why” behind a piece of data—helping them adopt or refine interventions to improve performance against that metric. For example, one client has a view that reveals and guides the antibiotic choices for pneumonia treatment in patients with sepsis.

The following examples show the types of visualizations commonly used in the sepsis improvement application.

EXAMPLE OUTCOME METRICS

Support Sepsis System Goals

Mortality rate Length of stay (ICU, overall) Variable cost per case

EXAMPLE PROCESS METRICS

Support aims related to early recognition in the ed

Percentage compliance to the early recognition protocol in the ED

Time from triage to sepsis alert

Time from potential sepsis recognition to physican evaluation in ED

Time from triage/recognition to initiation of 3-hour bundle (standard sepsis order set)

Copyright © 2016 Health Catalyst 7

Sample sepsis dashboard: The following sepsis visualization displays outcome metrics such as mortality rate and length of stay in the top section, and related process metrics, like compliance to the sepsis 3-hour bundle, in the bottom section. Users can drill down into specific sepsis cohorts, care locations, and more.

Sample ED 3-hour bundle visualization: This example focuses on process aims around compliance to the sepsis 3-hour bundle, including overall compliance and compliance to each major component: lactate measurement, blood cultures, antibiotics, and fluid resuscitation. Users can drill down into specific cohorts and specific patient and provider details.

SAMPLE SEPSIS DASHBOARD

1 Outcome measures including mortality rate and length of stay (LOS)

2 Related process measures such as compliance to the 3-hour bundle

3 Various filters that allow you to explore by date, specific patient cohort, care location, and more.

SAMPLE SEPSIS 3-HOUR BUNDLE VISUALIZATION

1 Overall compliance2 Compliance to each major

component of the sepsis bundle

3 Related metrics such as minutes from arrival to order

4 Filters for date, specific patient cohort, and more

1

2

3

1 2

3

4

Copyright © 2016 Health Catalyst 8

Deployment Services: Driving Adoption

With the goal of helping organizations achieve more improvement, more quickly, Health Catalyst supports health system teams throughout implementation of the improvement application. The examples below are derived from our previous work at many healthcare organizations implementing the sepsis improvement application, suggesting how we work with health systems to facilitate outcomes improvement:

We provide health systems with additional perspective on their data. Do we interpret their performance data the same way they do? For example, one health system, concerned about a delay in implementing sepsis bundles, initially planned an intervention to solve a perceived problem with pharmacy dispensing. We worked with them and their data to reveal the real cause of the failure to meet time targets: a delay in nurse administration of the antibiotic.

We consult with organizations to identify key opportunities. For sepsis, we helped one health system re-focus improvement efforts “upstream” in the process, from laboratory processes to early identification of potential sepsis in the ED. Improvements here can affect the greatest number of patients—and enable timely, evidence-based care.

We share insights based on our work with varied health systems. Because of our deep experience, we can share practical lessons and tips—particularly with regard to leveraging technology to drive efficiency and quality. We know, for example, how an electronic sepsis alert system can work (or not) to accelerate best practice care—and have seen health systems realize its potential in their own systems.

We engage with internal health system teams at all levels and across clinical, technical, and business domains. Working with us to implement the sepsis improvement application, one health system thanked us for being able to “speak the language” of different leaders with different concerns—this helped her drive improvement work forward in the organization.

We support the health system’s ownership of outcomes improvement work. The culture, governance, and accountabilities must be aligned around the improvement work—not the engagement with Health Catalyst—and we support this transformative work. For example, after we

In addition to the technology, Health Catalyst provides support and services for the entire improvement program, including partner-mentors for leaders at all levels in the organization.

Copyright © 2016 Health Catalyst 9

assessed one health system’s improvement efforts, we were able to point out a lack of physician engagement, and suggested weekly meetings and other process changes in response. These changes helped their sepsis improvement work gain traction in their organization.

We celebrate with our health systems. In one particular week at a health system, two patients with sepsis were identified early and treated appropriately and promptly—thanks to the improvement team’s work supported by implementation of the sepsis improvement application. Both patients required ICU care and vasopressor support, but survived to return home to their families. We help health systems recognize and communicate success stories like these—and are grateful for the opportunity to help improve care one patient at a time.

So, What Do You Get with a Health Catalyst Improvement Application? The Start of Something Smarter

What we deliver with a Health Catalyst improvement application: the start of something smarter. More than evidence-based, an improvement application starter set is experience-based, founded on what we continually learn from our health systems and their successes in improving outcomes. Outcomes improvement teams, armed with best practices, analytics, and guidance from Health Catalyst, learn from their data and drive real changes that can be adopted by the organization, resulting in meaningful outcomes improvement.

Lives Saved

+ 2

What we deliver with a Health Catalyst improvement application: the start of something smarter. More than evidence-based—the starter set is experience-based, founded on what we continually learn from our health systems and their successes in improving outcomes.