Linking Clinical and Financial Data: The Key to Real Quality and Cost Outcomes

I have a book on my desk that tends to scare people, but its thesis is a great way to introduce the importance of linking clinical and financial data to improve healthcare. The book is calledShow Me the Moneyby Jack and Patricia Phillips.

当然，这本书并不是用来吓唬人的。因为我是一名财务人员，我喜欢这本书中关于实现高价值结果的讨论，因为它适用于当今新的医疗环境。

直到2010年问责制在医疗保健行业掀起一场风暴之前，卫生系统并不需要考虑实现高价值的医疗保健。这是因为卫生系统从“按服务收费”支付模式中获得了可预测的收入流，为了说明其收入，他们主要对从患者数量中获得的财务数据感兴趣。

The days of only tracking volume with the fee-for-service model, however, are now long gone. Nowadays health systems are tasked with providing high-value or value-based care along with a new focus on improving the quality of care based on clinical data.

New Clinical Quality and Operational Metrics Required for Value-based Purchasing

While theswitch to value-based purchasingwill ultimately improve both quality and cost outcomes, health systems now need the capability of tracking and analyzing many other metrics before they can comply with the government’s new mandates. These metrics include the following:

• Throughput.The time it takes to complete a process, such as shortening the average wait time in the ER or reducing the time between cases in the OR, now translates directly into money and greatly affects quality. Improving throughput will benefit the organization by reducing cost and increasing patient satisfaction.
• Quality.在基于价值的采购中，医院必须根据确定的基准评估和报告质量指标。病人得到出院指示了吗?护理经理安排随访了吗?在医院里摔了几次?有多少医院获得性感染?如果医院不报告他们的质量指标，他们将受到处罚，进一步影响他们的底线。
• Readmissions.Quality will also be assessed based on the rates of readmissions for all causes within a certain time period for specific patient populations. For example, what are therates of heart failure, pneumonia and AMI readmissions within a 30- and 90-day period?
• Mortality rates.What are the hospital’s mortality rates for pneumonia, heart failure and acute myocardial infarction (AMI) among its patient populations? High mortality rates in pneumonia, health failure and AMI will result in loss of incentives beginning in 2014.
• Patient satisfaction. Patient satisfaction is now tied directly to payment models. How satisfied are patients with their care experience? Was the room satisfactory? Was the family comfortable? Would they recommend the hospital?
• Cost per episode of care.由于以价值为基础的采购系统努力保持治疗的一致性以及支出的适当性和可预见性，控制成本现在比以往任何时候都更加重要。减少临床过程的变化将改善成本结构。

Clinical and Financial Data Challenges

As though health systems weren’t already dealing with enough concerns with all of the new metrics they need to capture and analyze, there’s one more challenge they’re dealing with — accessing linked clinical and financial data from within their systems to provide the right metrics in this new world of value-based reimbursement.

传统上，卫生系统将其财务和临床数据存放在不同的系统中。最初的系统是这样设计的，因为财务数据需要提供给负责成本和支付等特定功能的特定团队。临床数据保存在系统中，该系统允许临床团队专门关注再入院、医院获得性条件和临床过程的核心措施。但这两个数据系统没有集成，因为没有必要。

There is now, however, a need to access the data from both clinical and financial systems because the data can be leveraged to drive concrete, timelyquality improvements. The kind of quality improvements necessary to survive in this new world of accountable care,quality measures, shared savings, and bundled payments while also lowering costs.

Achieving High Value Results — A Winnable Challenge

Achieving high value results for health systems is a winnable challenge, provided the organization approaches the task with a thorough understanding of where it stands relative to clinical quality measures and the financial costs associated with delivering care. But the right tools and teams are necessary to liberate clinical and financial data to link it together to provide a full picture of trends and opportunities.

Enterprise data warehouse and Data Operating System

企业数据仓库(EDW)提供了从各种来源聚合数据的能力，如临床、财务、供应链和人力资源源系统，以这样一种方式，复杂的分析系统可以利用数据来推动具体的、及时的质量改进。

然而，传统的数据仓库解决了其中一些问题，已经不够好了。AsGartnerrecently reported, traditional data warehousing will be outdated and replaced by new architectures by the end of 2018. And current applications are no longer sufficient to manage these burgeoning healthcare issues. The technology is now available to change the digital trajectory of healthcare.

The Health Catalyst^®Data Operating System (DOS™) is a breakthrough engineering approach that combines the features of data warehousing, clinical data repositories, and health information exchanges in a single, common-sense technology platform.

Multi-disciplinary teams

In addition to the EDW and DOS, permanent multi-disciplinary teams of frontline staff (for example, clinicians, quality personnel, analysts, a financial representative, and technologists) can help drive sustainable improvement initiatives by analyzing the data to determine what to target and how best to realize improvement.

The team then sets goals that they constantly monitor to ensure they’re focused on sustaining quality andfinancial improvementsas well as clinical and operational outcomes. Once they discover an improvement based on the data and best practices, then they work to gain buy-in from the clinicians to adopt the improvement.

“啊哈!”Moment

It’s important to educate clinicians so they buy in to the improvement and understand the financial implications. In working with health systems for many years, I’ve discovered that if education and financial results are tied to real, demonstrable clinical improvements, clinical teams will become excited about the change. By using easy-to-use dashboards along with DOS, clinicians can visualize their own progress. The “Aha!” moment comes when they can see how the clinical decision they made two days ago affected the bottom line today.

A Health System Example of Linking Clinical and Financial Data to Improve Costs

这里有一个简短的例子，说明我的一个客户是如何从他们的一线团队获得支持而获益的。One of our client hospitals targeted length of stay following anappendectomy as a key opportunity for quality and financial improvement. The frontline team looked at the data in their EDW and discovered that clinicians were prescribing a wide range of antibiotics after an appendectomy.

Based on the outcomes data for each antibiotic, the team decided on a protocol for the entire facility and started encouraging clinicians to prescribe one particular antibiotic following surgery. The antibiotic turned out to be expensive, so any clinician who knew that the hospital was trying to cut costs might simply suggest using a lower-cost medication. But because we had linked the clinical and financial data in the data warehouse and made it available via dashboards, clinicians could see that while pharmacy costs rose, a parallel drop in length of stay (LOS) more than made up the difference. Once clinicians saw these results and caught the vision, they began requesting further refinements to the system. They began asking the team questions like, “Are we giving patients the antibiotic at the correct time after surgery?” Clearly, these clinicians became willing and proactive participants in the process. This is what data-drivenquality improvement的全部。

The Health Catalyst Data Operating System (DOS) — The Key to Linking Clinical and Financial Data

In short, quality and cost improvements require intelligent use of linked financial and clinical data coupled with education for multi-disciplinary teams who are driving process improvements. DOS offers the ideal type of analytics platform for healthcare because of its flexibility. DOS is a vendor-agnostic digital backbone for healthcare. Using DOS, teams will be able to populate workflow information systems with critical point-of-decision insights and give the organization access to the most recent clinical and financial data. This, in turn, provides the organization with the best way to identify quality and cost improvements and ultimately to achieve high-value results.

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