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Welcome
Connecting Insights to Results: Healthcare analytics at SOC Telemed
# T C 1 8
Robyn Baek
VP of Analytics
Devdutta Bhosale
Director, Business Intelligence
Agenda
1. Background / Business Challenges
2. Analytics Strategy and Objectives
3. Systems Set up – Trial & Error
4. Key Lessons Learned
5. Use Case & Impact
6. Key Benefits
7. Next Steps with Self-Service Analytics
Background / Business Challenges
Our VISION as an organization is to transform healthcare by offering the highest quality telemedicine to healthcare systems and the patients they serve.
L A R G E S T P R O V I D E R
O F A C U T E C A R E
T E L E M E D I C I N E S E R V I C E S
F U L L - S E R V I C E
I N N O V A T I O N C E N T E R A N D
T E C H N O L O G Y T E A M
2 0 0 + P R O V I D E R
P H Y S I C I A N P R A C T I C E
S E R V I N G O V E R 5 0 0
H O S P I T A L S N A T I O N W I D E
F I R S T A N D L O N G E S T - S TA N D I N G
T E L E M E D I C I N E O R G A N I Z A T I O N
T O E A R N J O I N T C O M M I S S I O N
A C C R E D I T A T I O N ( 2 0 0 6 )
2 4 X 7 X 3 6 5 C O V E R A G E
V I R T U A L H O S P I T A L
Business Challenges
• Silo departments vs. new management team
• No data warehouse, business intelligence or analytics function
• Reports were produced in Excel through manual, labor intensive
processes
• Therefore,
Business decisions could not be supported by data or
analysis in a timely manner
Low client satisfaction
X 117..and growing
every month
Q3 Q4 Jan Feb Mar Apr Avg Arrival to Call 15.0
Total Consults 399 448 161 195 218 236 Avg Callback Time 3.0
Avg Hos Call to Order 33.2
93% 92% 98% 96% 97% 98% 18.5
Routine - Within SLA (Video) 100% 100% 100% 100% 100% 100% 66.7
Consults Within SLA (Phone) 100% 100% 100% 100% 100% 100%
Apr 2015 Apr 2015 Apr 2015
Client 55% 55% 22% 23% 232.3 222.4
SOC 37% 38% 30% 30% 86.1 87.0
*This report contains illustrative data.
Stroke % tPA Rate Avg Activation
2014 2015 2015 DTN Statistics
Emergency - Within SLA (Video) Avg Order to Delivery
Avg DTN Time
80
120
160
200
240
280
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
2014 2015
Consult Volume
93% 92% 98% 96% 97% 98%
7% 8% 2% 4% 3% 2%
0%
20%
40%
60%
80%
100%
Q3 Q4 Jan Feb Mar Apr
2014 2015
Video Time Review - Emergency ConsultsWithin SLA Outside SLA
62%
38%
Consult Priority Mix
Emergency Routine
55%
45%
Overall Stroke Volume
Stroke % Non-Stroke %
23%
77%
tPA Stroke Volume
tPA Stroke Non-tPA stroke
Additional Notes for Consideration: The consult volume for ABC Corporate has increased by 75 consults from January to April of 2015, a 32% increase. Further rese arch is warranted to improve overall SLA adherence rate. This may warrant additional physcian onboarding and/or scheduling in affected states to account for the incre ase in consults for the past 4 months and may require further consideration for the tiered-pricing structure. On average for the last 10 months, 38% of cases initiated at ABC were Routine cases, which indicates possible consideration for an addition of General Neurology Service Contract to account for non-time sensitive neurological cases to offset case loads for overall improvement in efficiency for time-sensitive emergent neurological cases.
Concluding Remarks/additional account analysis: Overall, ABC has seen an increase in consults from January of 2015 to April of 2015, an average of 32% increase. It is noted that the average arrival to call time is 15 minutes. Once a code stroke is identified we recommend contacting SOC to initiate a consult immediately. Additionally the hospital call to order time is 33 minutes. A review of current Stroke and CT protocols is recommend to help reduce this time in order to optimize the overall door to needle time. The average order to delivery time is 18.5 minutes and consideration should be given to reeducation opportunities for staff or a visit from a Genentech rep. which SOC can help facilitate. Facilities should consider mixing tPA bedside rather than in the pharmacy as this will reduce the time to delivery. For all consults, emergent and routine, the average activation time for 2015 for was 254.8 minutes. This is 2.5 times the average activation time for all other SOC clients. This could be due to specific outliers in certain cases. Nearly 2/3 of all consults called in from ABC were classified as emergent cases.
CBT Analysis: In Q3 of 2014, the adherence rate for Callback Time (CBT) SLA was 99%. In April of 2015, SOC was able to increase the adherence of CBT SLA to 99% within SLA (overall 1% increase in meeting SLA objectives for all consults). For the last 4 months, SOC was able to meet the initial call back time SLA objective for an average of 99% of all consults. This was achieved due to the addition of improved clinician case
management protocol, implemented in August 2014, allowing our clinicians to respond by phone for purposes of triage within the 15min. SLA objective.
VT Analysis: In Q3 of 2014, the adherence rate for Go to Video Time (VT) SLA was 92% for Emergent cases. In April of 2015, SOC was able to increase the adherence of VT SLA to 98% within SLA (overall 6% increase in meeting SLA objectives). Further research is warranted with an analysis of particular incidents for these consult delays. For the last 4 months, SOC has met VT SLA objective for an average of 100% of all
Routine cases . These improvements were achieved due to the addition of improved clinician case management protocol in August 2014, which enhanced the case triage process; for an overall improvement in efficiency by having patient information, triage information, necessary medical scans, and technical components tested to ensure readiness for our physicians prior to the examination of the patient via video.
Analytics Strategy and Objectives
Strategy and Objectives
Goal:Driving actions and results that transform healthcare industry by improving clinical outcomes and operational efficiency through fast, transparent, accurate, actionable data.
Tableau Server:A single point to access data. Single source of truth. An online portal accessible 24/7/365 for hospitals, physicians, clinicians, and internal employees.
What kind of actions and results?
• Operational improvement: SLA adherence, time to video, productivity
• Clinical improvement: Door-to-needle time, case mix, tPA administrations, discharge rates,
chart review
• Client satisfaction and retention: Utilization trend, health score
• Growth:
Demo dashboards
• Culture of transparency and data-driven business decisions
Systems Set Up
Telemed IQ Insights
Physicians- External- Internal
SOC Customers
SOC Employees
Biggest Challenge –Data security for different stakeholders.
BEFORE
AFTER
We had more than 600,000 excel files on our shared drive!!
Tableau Server(Production)
External Site
Public - Dept
Private - Dept
Private- Joe Smith
Users added to “Tableau Users” AD group with auto sync to Tableau
All Internal Users
Projects
Public Dept
CLP Summary
Exceptions
CSV Report
Demo
AD User Groups Projects
Real-time TV
Private - Dept Group
Joe Smith User
All External Users
Visual Analytics
Customer X
Demo User
Interactive Report
Workbooks Workbooks AD Groups
Drawbacks
Sites follow “share nothing” principle,
however, breaks the “DRY”
(do not repeat yourself)
approach for content
Internal Site
Content & Site Structure – Before – Multiple Sites
Base Reports/ Extracts
Visual Analytics
Customized
Demo
Interactive Report
Tableau Server(Production)
Public - Dept
Private - Dept
Private- Joe Smith
All Internal Users
Projects
Public DeptReport
CLP Summary
Exceptions
CSV Report
Demo
AD User Groups Projects
Real-time TV
Private - Dept
Joe Smith User
All External Users
Interactive Report
Workbooks Workbooks
Single Site
Content & Site Structure – After – Single Sites
Base Reports/ Extracts
Visual Analytics
Customized
Demo
Interactive Report
All external reports use a hybrid security approach based on list of authorized users in every row and/or user’s group membership.
Users are authenticated using SAML (Azure AD) and MFA
External users receive email summary reports which uses row-level security.
These reports give provide a quick-overview of different reports and encourages engagement.
Data Security – Key Takeaways
1. By setting Default permissions to “None,” users do not receive any permissions unless they are
explicitly granted.
2. All External users are in one parent AD group which is declined all permissions.
This sets the template for new projects only and minimizes the impact of human errors.
Key Learnings and Future Improvements• Setting up BI environment can benefit from applying software design principles – modularity,
encapsulation, component reuse, and “iteration” :-)• Row-level security can be easy to implement.• Multi-factor authentication is possible using Azure AD and SAML• Needs improvement on federated authentication and authorization for users from multiple
domains
Use Cases & Impact
Clinical Metrics Improvement – 1
Use Case
Partnered with a hospital to improve its
stroke program who was losing
neurologist coverage. Desired to meet
Joint Commission standard and continue
patient care.
Measurable Impact
Tableau dashboards provided insights
into operational workflow deficiency and
helped to improve door-to-needle time
from avg 57 minutes to 32 minutes which
decreases LOS and improved patient
outcome.
Clinical Metrics Improvement – 2
Use Case
Another hospital in jeopardy of losing
stroke certification due to lower than
required clinical metrics. Only 30% of
cases were meeting the goal (under 60
minutes door-to-needle).
Measurable Impact
Within a year, the hospital exceeded
goal (80+% under 60 minutes).
Feedback from the stroke coordinator
testifies that “easy to use” and “user
friendly” report was essential in
supporting her constant communication
and collaboration with her ED team.
Physician Performance Management
Use Case
Physicians work in silo and unaware of
their good/bad performance as well as
which metrics have bigger impact to
patient care.
Measurable Impact
• Physician productivity improved by
more than 200%
• Physicians themselves proactively
discuss ways to improve performance
Client Satisfaction and Retention
Use Case
Less than 20% of clients received
regular monthly reports, produced
manually in Excel. Unsatisfied with
operational performance. Client retention
was decreasing.
Measurable Impact
• NPS score improved by ~50 points
• Retention rate improved by ~600 bps.
• No terminations due to operational
performance since mid 2016.
• 100% clients receive standard
reporting package monthly. More than
half of clients have Telemed IQ
Insight account with increasing
engagement (260+ accounts).
Profit ImprovementUse Case
No visibility into future demand leading
to less than optimal scheduling of
physician hours. Poor SLA performance
due to difficulty in monitoring real-time
data.
Measurable Impact
• Profit margin improvement by more
than double (CAGR 24%)
• Demand & supply optimization drove
operational efficiency
• Physician productivity improved by
more than double (CAGR 20%)
• Profit and productivity improved while
improving quality (Current SLA
adherence = 98%)
Culture Shift from Silo to Radical Transparency
Use Case
Silo departments vs. new management
team. Business decisions could not be
supported by data or analysis in a timely
manner.
Measurable Impact
Culture of transparency and data-driven
business decisions.
May 2018
IVC Reversal Rate
Your Organization
80%
60%
40%
20%
5 10 15 20 25 30 35
IVC Reversal Rates by State
42%
Lessons Learned & Key Benefits
Lessons Learned & Tips
1. There is no such a thing as “user error.” Be user-centric.
2. Invite users to interact with data (self-service) through design and features
Action filters User-defined benchmarking
3. Build a culture of data. Top down approach helps.
Constant presence of data through multiple avenues
Obsess over sequential improvement in key metrics
Celebrate and quantify success (ROI)
Goal: Driving actions and results that transform healthcare industry
Key Benefits
• NPS score improved by ~50 points
• Retention rate improved by ~600 bps
• Profit margin improvement by more than double (CAGR 24%)
• Physician productivity improved by more than double (CAGR 20%)
• Profit and productivity improved while improving quality
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