Joe Kimura's dad was a professor of computer science, and Joe grew up taking computers for granted-until he got to his internal medicine residency and found patient hand-offs being handled via a batch of index cards held together by a ring.

"We would cross over 70 or 80 patients that way," he says, with no nostalgia whatsoever. His frustration eventually helped steer him into a health services research fellowship at Harvard, exploring the general question of how to use data to drive changes in care. "Physicians and nurses are data hungry, and they change when they believe the data they see," he says. "But you need a heck of a lot of data to make a case for change, and you have to make it easy for the practice to use."

Atrius Health, a multispecialty group practice serving 675,000 patients in eastern Massachusetts, is a Medicare Pioneer Accountable Care Organization and also holds risk-based contracts with Medicaid and several commercial insurers. In a recent interview, Kimura says he's figuring out how to use data to change clinician and organizational behavior.

On tracking costs

We have a tremendous understanding of how to integrate claims data with clinical information, but to get to true value-based analytics, you have to go beyond that. We are pushing for an activity-based cost-accounting structure. We need to know the cost of producing a service, as risk-based payments shrink and shrink. We used to do all of our budgeting based on what was reimbursed, and it had nothing to do with the cost of producing the services. All the vendors are trying to do activity cost modeling, but the pipeline of supply chain information isn't there. We understand more now than we did. We know when we're using more nurse overtime, for example. But it's not at the point where I can say that a surgeon using these tools and hardware is increasing or decreasing the cost of a hip replacement. We need to invest to get that information.

On integration

We created a dashboard for pediatric asthma care with all the metrics the physicians wanted, pulled from the EHR and other systems. Six months into using it, they gave us feedback that they were spending a lot of time flipping back and forth between systems. Couldn't we put it all into the EHR? And also put in the algorithms so we can calculate risk scores and rank all our patients? It took two days of work. Then later we went to a single sign-on and automated hotlinks, so the end users don't know which system they're in, and just go where they need to by touching icons. It's one of our most well used reports-it gets 60 users a month, and we only have 110 pediatricians in all. And the patients are being taken care of much better.

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