Rapid success in reducing unnecessary chest X-rays in asthma patients encourages use of advanced analytics technology for 'more important' outcomes
Internationally renowned Texas Children's Hospital reduced unnecessary chest X-rays in pediatric patients with asthma by 15 percent in just six weeks after rolling out an adaptive data warehouse platform and advanced analytics from Health Catalyst, the leader in healthcare data warehousing. This initial success has convinced the hospital to expand its deployment of the technology to include multiple medical and surgical programs and processes.
The hospital launched an overall quality and safety strategy several years ago, including implementation of an electronic health record (EHR) to collect raw clinical and financial data. The objective was to transform the data into meaningful information the facility could use in guiding its clinical quality interventions and waste reduction efforts.
Clinicians, however, still weren't able to effectively leverage the data they needed to improve quality of care for individual patients and specific patient populations. To meet clinicians' expectations, leaders of the hospital's quality, clinical and IT departments knew they needed to develop an enterprise data warehouse (EDW).
Implementation of the Health Catalyst Adaptive Data Warehouse was completed in a "phenomenally fast" three months, according to Margaret Holm, Ph.D., Director of Quality and Clinical Systems Integration at Texas Children's Hospital. At the same time, Health Catalyst conducted a data-driven financial and clinical assessment across the enterprise, looking at variability of care and resource consumption.
Armed with Actionable Data
After evaluating the results of the assessment, a multi-disciplinary team at the hospital decided to focus quality improvement efforts on asthma care. A cross-functional team was selected to assess and manage acute asthma in the hospital from the time of arrival in the emergency department (ED) to discharge. Within weeks, the team could identify a higher volume of chest X-rays being administered to asthma patients. The team also recognized that, according to the evidence, only 5 percent of chest X-rays were indicated.
Physicians were skeptical of the number of unnecessary chest X-rays, instead surmising that the data might be incorrect. "Unlike in the past, Health Catalyst enabled us to drill down into near real-time data to reveal patterns and convince [the physicians] they could help reduce the number of unnecessary chest X-rays," said Charles Macias, MD, MPH, Director of Evidence-based Outcomes at the hospital.
The asthma team addressed the issue by providing education and analytics dashboards for the clinical staff to monitor chest X-ray procedures. In six weeks, the team produced a 15 percent reduction in unnecessary chest X-rays.
"Our ability to very rapidly reduce unnecessary X-rays gave us confidence that we could use the Health Catalyst technology and process to change more important outcomes like length of stay," said Robert H. Moore, MD, a pediatric pulmonologist.
The technology makes it possible for the asthma team to analyze data on demand, rather than many months later. Armed with this near real-time data, the team is drilling down into specific interventions, such as the delay between the time a child arrives in the ED and the time he or she receives the appropriate medications.
"Those are the kinds of things that you want to see happen in short time frames, because they really make a difference in terms of length of stay or even whether a patient has to be admitted," said Dr. Moore. "If we can make that the most efficient it can possibly be, then we think we can reduce length of stays on the front end as well as reduce readmissions on the back end."
Expanding Use of the Technology
Holm said the hospital is working with Catalyst Health to add chronic asthma, cardiology and pneumonia, as well as other conditions and diseases. "The culture is changing, and it's all happening very fast," Holm noted, adding that the hospital's clinicians are now actively using the data to improve patient care by asking better questions about how care is delivered and uncovering the root causes of variation. In turn, rapid clinical feedback is reducing the development time required by technicians and analysts to build out the advanced analytics necessary to monitor and sustain improvements.
Myra Davis, MSE, Senior Vice President of Information Services at Texas Children's Hospital, applauds the direct involvement of clinicians in the analysis and transformation of data.
"Every time I hear how the adaptive data warehouse is referenced by clinicians and how the organization is using a rich repository of data to improve clinical outcomes, all I can do is smile and say, wow, mission accomplished," Davis said.
The hospital's goals for future quality improvement efforts include providing near real-time process and outcome metrics; standardizing the delivery of evidence-based care; enhancing gains in operational deficiencies and clinical effectiveness; increasing clinicians' use of the tools; and improving strategic alignment toward managing populations.
"Today, we have an adaptive data warehouse that integrates data management with evidence-based practice, operational data and financial metrics to allow us to understand the bigger scope of care delivery," said Dr. Macias. "We have never had the opportunity to do that before because so many silos of data existed. Now we can put patients first because we can see the data."
TCH Presentation at HIMSS13 in New Orleans Today
In a presentation entitled "Texas Children's Hospital Transforms Care with a Data-Driven Approach," Drs. Charles Macias and Margaret Holm will present these findings to attendees at the HIMSS13 conference and exhibition in New Orleans today.
The presentation will take place at 11 am CST in the Ernest N. Morial Convention Center, Room 294.
Visit Booth# 7721 at HIMSS13 to view a demo of Health Catalyst's adaptive data warehousing technology.
About Texas Children's Hospital
Texas Children's Hospital, a not-for-profit organization, is committed to creating a community of healthy children through excellence in patient care, education and research. Consistently ranked among the top children's hospitals in the nation, Texas Children's has recognized Centers of Excellence in multiple pediatric subspecialties including the Cancer and Heart Centers, and operates the largest primary pediatric care network in the country. Texas Children's has completed a $1.5B expansion, which includes the Jan and Dan Duncan Neurological Research Institute; Texas Children's Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; and Texas Children's Hospital West Campus, a community hospital in suburban West Houston. For more information, visit www.texaschildrens.org.
About Health Catalyst
Based in Salt Lake City, Health Catalyst (formerly Healthcare Quality Catalyst) delivers a proven, agile data warehouse platform that actually works in today's transforming healthcare environment. Currently 81 hospitals caring for 20 million patients utilize Health Catalyst's Adaptive Data Warehousing platform and solutions. Founded by healthcare veterans who developed their solution after struggling for years to try to make non-healthcare data warehousing solutions work, the Health Catalyst data warehouse utilizes an adaptive approach designed specifically to address the complex nature of healthcare data. Health Catalyst's platform combines technology solutions and clinical expertise borne out of repeated successful implementations that significantly improved quality of care and reduced healthcare costs. In addition to Texas Children's Hospital, Health Catalyst's proven solutions are deployed at leading health systems including Allina Health, Indiana University Health, MultiCare Health System, North Memorial Health Care, Providence Health & Services and Stanford Hospital and Clinics. For more information, visit www.healthcatalyst.com.