Strategies Using Data From Clinical Information Systems to Perform Research And Improve Patient Care
My job as the director of Internal Process Control at Intermountain Healthcare is to ensure that our caregivers use data and measure processes in just about everything they do. Examples include clinical processes where we measure caregiver adherence, patient reported outcomes and visit utilization. We are also looking at downstream cost savings where possible. Another example is how we request and use continuing education resources. This case study centers around the use of health informatics, which is the practice of acquiring, studying, and managing health data and applying it to improve the health of the patient. This aligns with Intermountain’s mission “Helping people live their healthiest life possible.” At Intermountain Healthcare, data is used to assist caregivers to improve patient care and inform quality improvement. Standards for care are determined from evidence-based care processes. Many care processes have been published, others have been developed and tested at Intermountain Healthcare (See LeaRRn case study by Gerard Brennan) Patient/client data from self-report and performance-based measures are critical to our process. When we started, there was no central outcomes repository, so we developed the Rehabilitation Outcomes Management System (ROMS). This is a web-based analytic platform that is used to manage patient’ data for clinical research and quality improvement to standardize care at Intermountain. Intermountain‘s Enterprise Data Warehouse (EDW) contains standardized outcome data from over 4 million patient visits collected from ROMS and integrates with other data sources, such as financial data, utilization data, co-morbidities, and social determinants of health data. These data used in combination with a patient classification system helps us place patients in homogeneous groups so we can more accurately compare patient outcomes. The EDW is also used for data mining and analysis enabling us to convert data to trusted, actionable information. We make data reports actionable and accessible for all clinicians and managers by creating dashboards that display key metrics that update daily. Analyzing data from multiple sources and converting it through dashboards leads to translating data to practice, reducing unwanted variation, and the continual
improvement of care. We also conduct health services research using the same data and have published peer reviewed manuscripts adding to the body of knowledge available to rehabilitation providers.
Rehabilitation services faces several challenges in collecting obtain accurate data including: 1) collecting data from a representative sample to reflect the patients in the entire health system, 2) obtaining adequate (80% of patients with both initial and discharge measures) follow up data, 3) severity adjusting, 4) providing longitudinal data over multiple years to reflect changes in treatment processes and 5) collecting data on the entire rehabilitation spectrum of services. For example, neurologic, vestibular and acute care patients provide unique challenges based on length of stay and lack of published care processes.
The future of advancing practice through informatics in the area of rehabilitation is bright. Some areas with especially great potential include: making data available to patients through portals to enhance engagement in their own care; advancing use of telehealth as a delivery process that can use data and technology from many sources to provide more effective care; integrating provider decision assist using artificial intelligence that combines data from care processes, outcomes, predictive analysis and the EMR to nudge providers make more accurate clinical decisions.
Applied LeaRRning Case
Stephen Hunter, PT, DPT, Is Director of Internal Process Control for rehabilitation services at Intermountain Healthcare. This team is responsible for standardizing and disseminating research and best practice to the 1500 rehabilitation caregivers at Intermountain. This case study describes how Intermountain Healthcare has used data to perform research and improve care. The case presentation includes specific examples combined with visualization dashboards.
“When processes are established and data provided to caregivers in a way they can easily understand, the result is improved patient care and reduced unwarranted variation.”
Stephen Hunter, PT, DPT