Analytics central to Anne Arundel Medical Center’s strategic vision
Learn how data, analytics and technology are helping Anne Arundel Medical Center and other health care organizations to improve performance and care.
About five years ago, Anne Arundel Medical Center (AAMC) in Annapolis, Md., decided to make a significant investment in data analytics, creating a team of about a dozen information technology (IT) specialists. The team's goal wasn't just to sit in a room and crunch numbers with nifty algorithms, but to use their skills to support the goals of clinical and administrative teams throughout the organization.
"The goal was to make information readily accessible to others," explains Executive Vice President and Chief Operating Officer Maulik Joshi, DrPH. The idea was to democratize the use of data so anyone in the hospital could use it to better understand their own area and to improve it. Hospital leaders believe analytics is central to improvement. "You can have analytics and no improvement but you can’t have improvement without analytics," he says.
One of the first things the team focused on was building a platform that would allow any user to query the organization's vast stores of information and get a useful answer. Led by David Lehr, chief information officer, the team built a system with an easy-to-use interface using Epic and various databases.
"Dave Lehr made it like Google," Joshi says, with a simple natural language query function. "You can type in emergency room wait times for patient satisfaction or length of stay in skilled nursing facilities. You get applications that allow you to analyze the data. It’s not last year's data but literally yesterday's data."
Making it work required some additional back-end focus on tagging, describing and organizing the content so it could be found. The IT team also spent time educating users about why analytics is important to their own jobs.
Lehr came from a career in software development, including co-founding a start-up and doing a stint at Epic, and recruited people from a variety of backgrounds for the team, including new graduates and developers with backgrounds in health care as well as other industries.
While the query engine was an important project for the analytics team with broad impact throughout the hospital, their work also underlies other high-profile projects pursued by AAMC. These include the Time is What Matters initiative, which measures time patients save from hospital improvement efforts, and a project that helped AAMC physicians reduce overprescribing.
Time is What Matters
AAMC developed a quality measure meant to be particularly meaningful to patients, calling it the Time is What Matters Measure. It aggregates the time patients have saved from hospital reductions in readmissions, length of stay and emergency department (ED) wait times. "Shifting the focus to patients' time encourages provider organizations to focus on what truly matters to patients, and provides an additional impetus for improvement," Joshi and coauthors from AAMC wrote in a recent New England Journal of Medicine Catalyst article about the initiative.
The measure was developed as part of the Age-Friendly Health System, an initiative created by the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA). Five health systems, including AAMC, are piloting the measure.
One of the main aims of the Age-Friendly Health System is looking at "what matters" to patients, and AAMC decided that time was a major concern. AAMC analyzed write-in comments on patient satisfaction data and found that 42 percent of ED patients’ negative comments were about time.
The strength of AAMC's analytics abilities made the measure possible. The composite score is updated each month and compared with the average for the previous fiscal year to gauge how much additional time the hospital is saving or costing its patients.
The composite measure combines three measures: readmissions, length of stay and ED wait time. The readmissions measure projects how many patients would have been readmitted if AAMC had maintained the readmissions rate average from the prior fiscal year and compares that with the actual readmission rate for the month. The length of stay (LOS) measure projects how many days patients would have spent in inpatient care if AAMC maintained the LOS average from the prior fiscal year and compares it with the actual number. The ED measure takes total ED visits to calculate how much additional time patients would have spent in the ED based on the average from the prior fiscal year.
AAMC is piloting use of the measure in its Acute Care for the Elderly unit to raise awareness among leadership and staff about the impact of improving performance on time-related metrics. The graphs are displayed on an internal huddle board and shared monthly with its leadership council. The data are also shared with patients who have an opportunity to comment on the measure. The hospital may add more components to the composite score in the future.
Analytics was also key to a project to reduce opioid overprescribing by physicians associated with AAMC. The study, whose results were published in JAMA Network Open in September, compared a six-month pre-intervention baseline with a 16-month post-intervention period. Physicians prescribing to patients in inpatient and outpatient settings were tracked. The initiative, led by physicians, gave medical directors information about physician prescribing practices compared with their peers and was accompanied by an educational campaign on opioid overprescribing.
AAMC also added new tools in the electronic medical record, such as patient education on opioid alternatives and safety, patient characteristics associated with elevated risk for dependence, and information on referral to substance abuse counseling and detoxification. AAMC also carried out a public information campaign for the community and for patients.
The monthly morphine milligram equivalents per encounter dropped 58 percent after the interventions, and the opioid prescriptions rate went down 38 percent. The researchers said physicians appreciated seeing a visual representation of their prescribing data in comparison to others and many were surprised to see where they ranked.
AAMC has used its analytics investment in many other ways, including projects to reduce ED waiting times and to produce a particularly robust health equity report using 35 different measures.
Joshi thinks the accomplishment is replicable with the right strategic investments. "Anybody can do it if you invest in the people, the time and the technology, and leverage your electronic health record," Joshi says. "Using data and information technology is a competency for great leadership in health care. It’s the fuel for what we do."
Case study: Sanford Health automates policy management
Sanford Health, the nations largest rural nonprofit health care system with 43 hospitals and 250 clinics, was looking for a more organized way to track the policies that ensured employees followed best practices to deliver excellent patient care. Each hospital was using its own separate system to write, update and distribute policies, which became increasingly disorganized. Smaller clinics relied on paper copies or electronically stored versions that were hard to find and often outdated. Sanford converted its entire policy management process to a centralized policy database from NAVEX Global. The project involved moving 27,000 documents to the new system. Once complete, Sanford was able to not only locate policies easily but also audit employee awareness of them and streamline its policy review and approval process.
"It's important for an organization our size to have standardized policies," Kathleen Mackeprang, RN, Sanford Health's special projects coordinator, said. It's essential that employees can quickly look up policies because it ensures they can effectively administer care to patients. NAVEX Global's Policy and Procedure Management Software & Services have earned the exclusive endorsement of the American Hospital Association.
Case study: Hospitals connect consumer needs with data and analytics
Data and analytic projects can easily lose sight of their ultimate purpose: to ensure a safe and high-quality experience for patients. Hospitals shared various methods to keep these goals connected during an executive dialogue sponsored by CareTech Solutions. At Ann & Robert H. Lurie Children's Hospital of Chicago, for instance, information technology staff are asked to walk to nursing and patient care units to help with a technical problem rather than doing it over the phone. That first-hand connection makes a difference in IT staff feeling engaged with the mission of their work. Hospitals can also hear patient perspectives through patient advisory councils or including a consumer/patient on a quality improvement team. Another hospital found success by adding a bedside-shift report, where the outgoing nurse and incoming nurse have a discussion in the patient’s room, something that substantially increased patient satisfaction; the project was bolstered by analyzing data before and after its implementation.
Case study: Foothill Community Health Center expands
When Foothill Community Health Center needed to expand to meet the growing health care needs for its northern California community, the center's leadership team sought help from First American Healthcare Finance. Because maintaining cash flow is so important to Foothill, it opted to fund new medical and dental equipment, software, construction costs, and even labor and licensing through First American, which gave it the ability to spread its payments over time. Along with providing funding, First American helped Foothill develop a growth strategy to continue expanding clinic sites to reach an underserved population, reduce wait times, and offer new services such as optometry and behavioral health. After expanding, the federally qualified health center was able to go from serving 400 patients per day to 1,000.
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