Thursday, August 08, 2013

Big Data Moves To Improve Care and Reduce Costs. Looks To Be Working.

The Wall St Journal finds some very interesting data on big data use.
July 11, 2013, 10:43 p.m. ET

Hospitals Prescribe Big Data to Track Doctors at Work

Marnie Baker, a pediatrician whose job is to win over colleagues to data-tracking efforts, shows equipment to fellow doctor David Kim.
Marnie Baker, a pediatrician at California's MemorialCare Health System, has an easy manner and ready smile. Now, though, her job is to be the bearer of a serious and, for some of her colleagues, unwelcome message.
She's the voice of a program that digitally tracks their performance, informs them when they don't measure up—and cajoles them to improve.
MemorialCare is part of a movement by hospitals around the U.S. to change how doctors practice by monitoring their progress toward goals, such as giving recommended mammograms. It isn't always an easy sell. At one clinic earlier this year, physicians grilled Dr. Baker, who is director of performance improvement at a MemorialCare-affiliated physician group.
Cardiologist Venkat Warren said he worried that "some bean-counter will decide what performance is." He wondered whether doctors would be pushed to avoid older and sicker patients who might drag down their numbers.
"If it isn't cost-cutting, what is it?" Dr. Warren asked.
"It's providing better value," Dr. Baker responded.
Encounters like these are one result of the changes sweeping American health care. Technology is making it easier to monitor doctors' work as patients' details are compiled electronically instead of on paper charts. Software makers are selling new tools to crunch the data. Software called Crimson offered by the Advisory Board Co. now includes information on more than a half-million doctors, up from fewer than 50,000 in 2009.
At the same time, more physicians are going to work for hospital systems, which are under pressure to hit quality goals and cut costs. Many are striking deals with insurers that pull them away from traditional "fee-for-service" reimbursement, which pays for medical procedures individually.
Insurers—which themselves increasingly track physician results—are moving toward providing a set payment for the overall care of a patient. This system means that doctors who provide costlier-than-average care could break the budget.
The federal health law is speeding these trends. Under the law, hospital payments and penalties from the federal Medicare program will be linked to their performance on quality gauges, particularly rehospitalizations, which are costly. The law also created a new Medicare initiative for "accountable care organizations," providers that get extra rewards for efficiency and quality performance.
To succeed under the new health-care economics, hospital executives say, they must lean on doctors, who make nearly all the key decisions on what treatments, tests and drugs patients get. "The last frontier is the physicians," says Thomas Heleotis, vice president of clinical effectiveness at Monmouth Medical Center, part of New Jersey's seven-hospital Barnabas Health system.
Lots more with useful graphics here:
Note that this is all about assisting clinicians to do a better job - and at the same time deliver better more consistent care while reducing costs. Health system nirvana!
Note also the information on which this is based is the individual’s EMR and not some amorphous database somewhere.
A really well researched article. Enjoy!

1 comment:

Terry Hannan said...

David, institutions such as Regenstrief have being doing BIG data for years. Here is there data base and functionality for CDS from 2012.
Technology is NOT the problem. RMRS 2012
(est. 1976)
Regenstrief Institute: April 2012: 18 hospitals
>32 million physician orders entered by CPOE
Data base of 6 million patients
900 million on-line coded results
20 million reports-diagnostic studies, procedure results, operative notes and discharge summaries
65 million radiology images
CLINICAL DECISION SUPPORT- BLINK TIMES (CCDSS-through iterative Dbase analysis)
Also re the comment about the last frontier being physicians it is worthwhile readers looking at L.Leape: Five years after To Err Is Human. What have we learned?" He states essentially very little and one of the biggest barriers to progress is associated with the "culture of change" in clinicians/physicians. And in the last few weeks.
Tilburt JC, Wynia MK, Sheeler RD, Thorsteinsdottir B, James KM, Egginton JS, et al. Views of US physicians about controlling health care costs. JAMA. 2013;310(4):380-8. Epub 2013/08/07.
2. Emanuel EJ, Steinmetz A. Will physicians lead on controlling health care costs? JAMA. 2013;310(4):374-5. Epub 2013/08/07.