The Best Way to Optimize Physician Workflow

The Best Way to Optimize
Physician Workflow ̶ Dr. Ed Corbett

© 2016 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The Present State of Physician Workflow
The present state of the union, when it
comes to physician workflow, doesn’t
allow a good connection between what a
physician sees while using an EHR on a
daily basis and the analytic data needed
to improve patient care.
Physicians must have access to the data
that allows them to make better clinical
decisions presented to them in their
regular daily workflow within the EHR.

The Present State of Physician Workflow
EHRs were developed as repositories of
information that replaced the old paper
charting systems.
Many EHRs mimicked the structure of
old paper charting systems to help
physicians feel more comfortable as they
transitioned from the old to the new.
However, these days, that model doesn’t
lend itself to improving patient care with
the use of data.

Time Is Ticking to Create Physician Satisfaction
For physicians, time is a precious
commodity. We have very little of it to
spend with patients and document.
Anything adder creates physician angst.
We are inundated with alerts and popups,
whatever the EHR vendor has developed
to remind us of important details.
We get to the point where there’s too
much going on. There simply isn’t enough
time in the day.

We get inundated with quality metrics and
then must decide how much time and effort
to spend on them.
We are so busy taking care of everyone day
to day: patient appointments, ordering tests,
documenting encounters, reviewing test
results, communicating feedback to patients,
following up on orders, and then making
sure none of this falls through the cracks.
Patient care is the preferred, although major,
time consumer.

Whenever we talk about adding something to
the existing workflow, we have to think in
terms of how we will accept and implement it.
• What kind of impact is it going to have on our
workflow and satisfaction?
• How will it help us be more efficient so we can
spend time in the ways that we prefer, i.e.,
extra minutes with our patients?
Improved physician satisfaction translates to
improved patient satisfaction.

Data Is the Workflow Fuel of the Future
We are moving into an era of the empowered
patient, where software and analytics are used
to influence patient/physician decision making.
This is partly due to population shifting. The
older generation hasn’t been as technically
savvy as the younger generation.
They are impatient for information, they are
well connected, and they seek value from their
healthcare services.
Their expectations of being a patient are
different and how they access care is different.

Improving Workflow across the Continuum of Care
As payment models are shifting to paying
physicians for taking care of populations of
patients, physicians need to have a broader
view of their patient panels.
It’s one thing to use data and analytics to
improve physician workflow in a single
setting like a hospital, but the tendency is to
think that it won’t carry over into an
outpatient clinic or other setting.

MultiCare Health System, an integrated delivery
system in Washington State, undertook an
initiative in February of 2014 to find the best
practices for identifying and treating pneumonia.
They organized and got feedback across
multiple care settings: emergency department,
inpatient and outpatient units, transitional care
and nursing home providers, community
physicians, nursing, respiratory, pharmacy,
operations, information technology,
organizational effectiveness, and
physical therapy.

They were able to build a consensus using
clinical best practice guidelines combined with
local disease patterns, and produced protocols
and guidelines that were integrated into the
decision-making process across the continuum
of care in their area.
Then they tracked their progress with their
data warehouse and analytics to see progress.
Among other significant improvements, they
reduced their pneumonia mortality rate by 28%
and their pneumonia readmissions by 23%.

Having the right data was absolutely
critical to improving patient care.
This type of evidence-based workflow with
data driven protocols and guidelines
helped to eliminate care variation and
improved patient outcomes.

Data to Improve Care for the Individual
The use of data to improve population care is
vitally important, but the future vision may include
much more. How are we going to use data to
really impact the care of patients on a more
precise personal level?
To try and answer this question, Health Catalyst is
changing the delivery of our services.
We are evolving from an offline, data aggregator and
analytics company, to a real-time data production and
decision support company, integrating the knowledge
derived from analytics into the workflow of our clients,
wherever that workflow occurs.”
- Dale Sanders
Executive VP Health Catalyst

Data and Analytics Alone Aren’t Enough
We have the ability to get all this great data
that tells us everything we need to know
about a patient’s medical condition.
But then we have to get this to the point of
care, closing the analytics loop, so doctors
can use it to actually take of patients.
Most of the time, data sits abandoned and
isn’t used to inform or personalize care.
We must take the data and its analysis back
through the enterprise data warehouse
(EDW) and link it into the EHR.

Closed-loop analytics for individual patients
begins with external evidence.
The data governance body in an organization
sets and monitors improvement priorities that
shape the evidence for the local EHR, clinical,
and analytics teams, which personalize care
using evidence-based practice standards.
Working with EHR data, the Clinical Decision
Support team highlights individual health
status and care plans; and Clinical Quality
Analytics, working with the EDW, supports
personalized health and care of the patient.

Closing the loop is a matter of getting the right
data to the right people, but healthcare doesn’t
do a good job of this right now.
We’re able to view the universe of data from the
EDW and analytics applications, aggregate it,
and get an understanding of care delivery,
variation of care, and variation of cost of care.
But then we have a hard time getting this back to
the people who need it in order to affect change.

One Application in Progress
Health Catalyst has a Clinical
Analytics and Decision Support
application called Patient Flight
Path – Diabetes.
It’s an app for delivering more
efficient diabetes care and it’s
currently in testing with one of our
healthcare systems.
Patient Flight Path delivers
diabetes disease specific metrics,
labs, demographics, complications,
and associated costs.

Patient Flight Path provides a population view
for clinicians to summarize all patients under
their care and a patient view with projected
costs and next likely complications to avoid.
The app recommends treatments in various
categories (lifestyle, medications, checkups,
etc.) and it gives physicians the ability to view
population risk and patient risk over time.

The next step is for the physician to meet
with individual patients to review their
current “flight path.”
This means showing the patient in real
time what their current state of care is,
and what the predicted outcomes would
be with no change in care.
And then showing the patient the
potential impact to their health outcomes
and cost outcomes, if positive evidence-
based changes were made to their care.

For example, we can present multiple
scenarios to the patient: maintain current
glucose control, add a new medication, or
implement a weight-loss program. Then the
program will predict the various outcomes.
For example, lose ten pounds and it will result
in improved blood sugar and the long-term
chances of having a complication, like
retinopathy or heart attack, or nephropathy will
decrease by 10 percent. In addition, expected
medical costs will be reduced by 5 percent.

Using data at the point of care, where the
physician is showing the patient potential
outcomes based on predictive analytics, has
the potential to better include patients in their
care decisions and foster more patient
engagement in their own care.
This type of application with aggregated data
from an EDW can close the loop, so the
physician can have data, analytics,
decisions, visualizations, and a treatment
plan right at her fingertips without having to
change any of her normal workflow.

We Can Improve Physician Workflow through Analytics
We can overcome most of the limitations
discussed here with better use of data.
Going forward, we have to supplement the
retained human knowledge of physicians
with the abundance of other medical
knowledge that is continuously evolving.
We haven’t found the holy grail of how to
do this yet, but a lot of what Health Catalyst
does is to aggregate data and show people
what they are currently doing.

We Can Improve Physician Workflow through Analytics
Then we create this knowledgebase of
clinical evidence and best practices.
We use analytics to inform the health
system about where they are currently,
and what they should be doing according
to the latest evidence.
Then we try to help them change what
they’re doing to get to the better state.
Imagine the future of medicine driven by
data and analytics informing all aspects
of patient care.

For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

More about this topic
How To Unlock theAnalytic Value of Your EHR
Dan Burton, Chief Executive Officer
Patient Flight Path Analytics: From Airline Operations to Healthcare Outcomes
Dale Sanders, Executive VP of Software; Justin Gressel, Senior Data Scientist
David Crockett, Ph.D., Research & Predictive Analytics, Sr. Director
Improving Clinical Workflow: An Example from the Emergency Department
Jennie Welch, Sales, VP
Analytics in Medical Practice: How to Get Physicians On Board and Engaged
Dr. Bryan Oshiro, Chief Medical Officer, Senior Vice President
The Real Opportunity of Precision Medicine and How to Not Miss Out
David Crockett, Ph.D., Research & Predictive Analytics, Sr. Director
Link to original article for a more in-depth discussion.
The Best Way to Optimize Physician Workflow

David K. Crockett, Ph.D. is the Senior Director of Research and Predictive Analytics.
He brings nearly 20 years of translational research experience in pathology, laboratory
and clinical diagnostics. His recent work includes patents in computer prediction models
for phenotype effect of uncertain gene variants. Dr. Crockett has published more than 50
peer-reviewed journal articles in areas such as bioinformatics, biomarker discovery,
immunology, molecular oncology, genomics and proteomics. He holds a BA in molecular
biology from Brigham Young University, and a Ph.D. in biomedical informatics from the University of
Utah, recognized as one of the top training programs for informatics in the world. Dr. Crockett builds
on Health Catalyst’s ability to predict patient health outcomes and enable the next level of
prescriptive analytics – the science of determining the most effective interventions to maintain health.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com

The Best Way to Optimize Physician Workflow

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