Blog Post July 22, 2015 Value-Based Enterprise Conversation Series: Informed Authors Michelle Holmes As the healthcare industry continues shifting to value-based care delivery, nurturing and maintaining an informed health system is more important than ever. Organizations that expect to thrive in this evolving environment must demonstrate an awareness of what they need to know now as well as in the future and possess the infrastructure to acquire and manage the continuous flow of relevant data. But being informed involves more than just gathering data – converting that data into actionable information and leveraging it to make clinical, operational, financial, strategic, and technological decisions is critical. As part of our ongoing series of conversations about the value-based enterprise, Michelle Holmes, one of the leaders of ECG’s Healthcare IT practice, discusses the attributes of an informed healthcare organization and explores the technical and cultural barriers that often prevent organizations from making data-driven decisions. Quite simply, what does it mean for an organization to be “informed”?I think there are three aspects of being informed. One is having information that will enable you to identify problems or areas of opportunity. A lot of times something could be broken or not going well and you may not know it, because there’s no data or information to point that out to you. So part of it is just having the data and information so that you’re appropriately alerted when performance is trending downward or something isn’t working. Second, it’s having the data to be able to conduct monitoring, so that when you institute some type of improvement activity or initiative, you can tell if it’s working. Often organizations put initiatives and programs in place but don’t have a data-driven way to determine whether they were worth the time and effort. It’s being able to show an effect. That can be return on investment, but frequently it isn’t a dollar impact – it’s efficiency, quality, satisfaction, or productivity, where you may not be able to specifically attribute a dollar improvement to it but you still have to be able to measure and assess it. And then lastly, an informed organization makes data-driven decisions. Strategic, operational, tactical decisions; even clinical decisions at the point of care. Those decisions are based on accurate, complete, accessible, and easy-to-interpret information. That, in my mind, is probably the biggest definition of an informed organization. What systems have done this well?I think most people have a tremendous amount of data but very little information. So they’re collecting and accumulating data – financial, clinical, operational, and other data – but that hasn’t been turned into usable information. The organizations that are doing well, in my mind, have taken an incremental approach. So instead of saying “we’re going to take a mass of data and try to turn all of that into usable information,” they instead focus initially on one or two or three things and say “for this clinical improvement opportunity, or for this productivity improvement aspect, this is where we need information.” So they focus on the data that needs to be turned into information for those specific initiatives. When they do a good job on those couple of things, then they can build from there, as opposed to trying to tackle a mountain of data all at one time. I think that ends up being helpful for a number of reasons. One is, when you bite off what you can actually chew, then you can actually get it done. You’re not taking on so much that it ends up being a never-ending project where it’s hard to ever get to the point that you’re seeing value from all the efforts that you put in. And that’s when you start to change the culture of the organization so that it starts becoming more data-driven and informed, where people track the information they’re given and see the value of using it to improve quality, cost, productivity, satisfaction, and things like that. Then you have a much more engaged population that’s able to participate in the next activity or initiative, because you’ve developed that trust. Many organizations have a large base of users that are getting a lot of data, but they just don’t trust the numbers. They don’t have a culture of “we’re not willing to make this decision until we have the data to back it up,” because they don’t trust the data they’re given, and so they make decisions that aren’t necessarily informed. Of the clients you see or organizations you are aware of: on a scale of 1-10, (1 being poorly informed or suffering from data overload, 10 being sophisticated in terms of current and future knowledge), what is the average?It really is all over the board, so I’m hesitant to give a number. I think the organizations that, generally speaking, have been using technology in a meaningful way for a longer period of time tend to be further along with this. When we talk about being informed, we’re often talking about it in reference to a health system. Does this have application for a smaller enterprise? Say, a community hospital? A medical group?Absolutely. I think those organizations, so much of the time, just don’t use the systems and information they have at their fingertips. For example, small community hospitals and small practices usually have the systems and information they need, but they don’t know how to use them. There are features or functions of the technology that they already have that are simply underutilized. Why is that?I think that from the small physician practice to the large health system, often there’s the assumption that to even start doing something like this, you have to add systems and technologies and processes that don’t already exist. But if you take that incremental approach, usually there are features and functions of your existing technology that you can use to start down that path. And if you legitimately get to the point where you’ve outgrown that, and you know that you’re using the systems to their utmost capacity or capability, then it may very well justify the need to get something more advanced. But if you’re just starting out, if you’re a community hospital or a small practice, odds are there are things you can start doing tomorrow if you have a better understanding of what your systems can do right now. What are some of the common roadblocks that organizations might encounter when they’re looking to become more informed?I think one is that it can be very overwhelming. If you have literally years and years and terabytes of data, it can be daunting to figure out where you even want to start. The second thing is that usually it can be challenging to get to the point of having clean data. If you’re just starting down a road like this, you often encounter the “garbage in, garbage out” scenario where you realize, for example, that the data that’s being put into your system isn’t being done in a standard way – there’s duplication, there’s missing information, etc. So before you can start producing and distributing reports for people to react to, you do have to go through this data cleanup exercise. There’s also figuring out how you’re going to present information in a consumable way. How do you get people just what they need and not more than that? How do you give it to them so that they can trend and drill down so it really is usable? It’s kind of a translation process – how do you turn the data into actual information? And then beyond that, there’s just the cultural aspect. When people are used to making decisions because of gathering subjective input or following their gut, or just doing what’s always been done, etc., there’s a cultural challenge of getting them to the point where they’re comfortable relying on this information to inform their decision. They need to have the patience to wait for the information before they can make an informed decision. So there’s that cultural roadblock of getting people to the point where it never occurs to them to do anything until they have the information to back it up.What risks does a system encounter if it isn’t informed?I think there’s a significant risk of resource misallocation. You can spend a lot of time, money, and resources doing things that may not actually have an impact on your organization’s strategic goals and vision. If you point people in a certain direction because you think you discovered the root cause of a problem, and it turns out to be wrong, then you can spend a lot of time doing something that may not resolve the issues you identified. And then there are problems that don’t get identified, grow really quickly, and become out of control before you have a chance to do anything about them. So you’re not intervening until something has gotten really, really bad because you didn’t have any notice that something was starting to trend in the wrong direction. And then the other thing is just variability. If everybody’s doing things based on what they think is right and not because of what the information is telling them, then 10 different people could be doing things 10 different ways. So whether that’s 10 hospital department managers or 10 clinical managers or 10 doctors within the same specialty, if everybody’s doing something based on their personal bias, then you’re going to have a tremendous amount of variability that’s hard to manage and control. How does “Informed” relate to the other pillars of the VBE?I think a better question is whether “Informed” is a pillar or the foundational layer of the other four pillars. For example, how do you know if you’re truly integrated if you’re not measuring your stated goals for integration and tracking your progress? The same goes for the other elements – how do you know what you want to do and whether you’ve done it unless you have information that you’re measuring and tracking along the way? You need that information to tell you whether you’re realizing your goals, or to tell you when you’re not so you can intervene and make timely decisions. And if you do reach that point of actualization on each of the pillars, you need to be informed in order to maintain that performance. Michelle Holmes is a leader of ECG’s Healthcare IT practice and an industry expert on the application of IT strategies in physician practices and ambulatory care settings. She is known for leading focused engagements that create value for her clients, apply innovation to complex tasks, and ensure clarity at the task level so that action plans are successfully executed.