Using data in a transparent manner has enabled Kaiser Permanente to create a culture of high performance, according to Bernadette Loftus, M.D., associate executive director in the Mid-Atlantic States for Permanente Medical Group.
Analyzing performance data and making it available to all physicians--a competitive bunch--lets each physician and their peers know how they are doing in achieving specific quality measures. “People change their ways when they walk down a hallway, see scores on the wall, and someone they know is doing better than them,” Loftus told attendees of Health Data Management’s Healthcare Data Analytics Symposium in Chicago.
While physicians scoring lower than peers will always argue that the data is wrong, they invariably change their ways, she added.
Kaiser, with the largest non-military electronic health records deployment in the nation, uses its data in a “relentless” matter, she said. “Some people call it obsessive, compulsive behavior.” And it works. The 2011 Hewitt Health Value Initiative ranks Kaiser as 15 percent more cost-effective than all other plans in the regions it serves, and 126 percent better at clinical outcomes.
When a patient registers at a Kaiser hospital or physician office, care recommendations for the patient, such as being due for a mammogram or a notification that the patient has not picked up prescriptions, are displayed on the screen. The system also automatically gives physicians and staff specific quality indicators, such as what percentage of cardiovascular or diabetic patients are not at the target level for lipid control.
With so much data available, Kaiser takes steps to make sure it is used. A “backsweep” report identifies recommended care not provided, tags it back to the specific physician and assistant, and asks that follow-up with the patient be done. Then a “re-sweep” report 30 days later is performed to make sure the care was provided. A “forward sweep” report makes it easier to tack on preventive care to an upcoming appointment. Six weeks before a patient’s optometry appointment, for instance, the office could call the patient and suggest getting their mammography out of the way the same day.
Information is the fuel that powers change, Loftus emphasized. But at the same time, “we are simultaneously awash in information and bereft of it.” Effectively using data without overwhelming people is a matter of leadership defining what to measure, not how, and asking the right questions.
For instance, providers almost always believe the more accurate measure of patient wait times for an appointment is the length of interval to the first available appointment--but each measurement is just one patient’s experience, Loftus said. The more accurate measure is the percentage of patients seen in a defined interval. Kaiser’s measure is 90 percent seen within 10 days, “and that’s not as lofty as it seems.”
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