Physicians need to understand data to provide better and safer care

Patients expect excellent care from their physicians.  Unfortunately, not all receive such care and most of us realize this.  Many who do understand the wide variation in patient care probably believe it is due to the clinical knowledge and attitude of the provider—a very knowledgeable physician or nurse who is passionate about his or her job will deliver the best care.  Although these ingredients are necessary for excellent patient care, today better care can be delivered with modern tools and methods, such as “smart” IV pumps, checklists, registries and EHR’s.  Many of these are digital and based upon data.  It is necessary for providers to understand data to provide better and safer care today.

Let me give you two examples of care, one assisted with data driven decision-making.

Dr. M is a primary care physician who has been practicing for over 20 years.  He still is passionate about the care that he gives his patients.  One of his focuses is on patients he has diagnosed with hypertension, as there seems to be an increase in patients with this chronic condition in the past few years.  Dr. M believes that he is providing excellent care.  He believes that most of his patients adhere to the drug regimen and diet that he has prescribed for them.  In a recent visit by his EHR vendor his office was shown how to find population level data on the EHR and registry.  The output on hypertension showed that only about 60% of his patients were adhering to their drug regimen and diet.  His patients were experiencing more coronary problems than expected.  There were a higher percentage of strokes among these patients than he realized too.  In other words, many of his patients were not achieving outcomes which would enable active and enjoyable life styles.

Dr. S is also a primary care physician.  She has been in practice for nearly 20 years.  She is still passionate about her work and is always looking for ways to improve the care that she and her staff renders.  She also focuses on patients she has diagnosed with hypertension.  Because she and her staff had their EHR vendor demonstrate how to view population level data when they were implementing the EHR, she has kept track of the outcomes for her hypertension patients.  Working from the baseline data that was available when the vendor demonstrated the software, she and her staff have continuously sought ways to improve the outcomes for her patients.  They have investigated patient-centered care more thoroughly.  One of the payers supplied them with information and contacts to help.  They contracted with a process improvement specialist to teach them how to use the plan-do-check-act cycle to improve outcomes.  The specialist also taught them how to use some other tools from Lean Healthcare to improve the quality and safety of care.  The result is that between 85% and 90% of her patients adhere to the plan that she and the patient create to take care of the chronic condition.  Her patients are much healthier and have fewer “healthcare crises”.  She has more time to spend with each patient and the income at her site has increased about 10%.

The two physicians are much alike in experience and attitude.  One of the main differences is that Dr. S uses data to understand the results of the care that she and her staff provide.  Using this data, they have learned “to work smarter, not harder”.  Using the baseline data, she and her staff sought out and adopted new methods and processes of providing patient care.  The results were very pleasing.

The world of healthcare is evolving and will require the kind of skills that Dr. S and her staff employ.  Recently, the American Medical Society issued a white paper, Pathways for Physician Success Under Healthcare Payment and Delivery Reforms, describing the new payment models that will likely be adopted by payers, both the government and private, and the skills that will be necessary for providers to successfully capitalize on them.  Among the list of skills in the paper were:

  • Having the skills/experience to efficiently/effectively implement a new/improved service
  • Having the ability to obtain and analyze data on the quality of services
  • Having the skills/experience to improve the quality of services
  • Having adequate resources to support high-quality service delivery
  • Having skills/experience in improving the efficiency of service delivery
  • Having the ability to obtain and analyze data on the quantity and cost of services delivered by other providers

As you can see, many of the necessary skills are based upon understanding data and processes and using them to improve the delivery of care.

This approach to providing quality in services and products has been used for many years outside of healthcare.  Toyota developed a unique approach based principally on plan-do-check-act (PDCA) and teamwork that resulted in a superior product that enabled them to be the standard of quality in production for many years.  Some healthcare providers are starting to adopt data driven models such as PDCA to improve care.  Advantage Health of west Michigan is having all of its primary care sites certified as medical homes.

With the advent of HIT products such as EHR’s, registries and “smart” hardware, it is now much easier to access data that can be used to drive improved outcomes.  Most EHR’s can provide population level data that can be used to view the level of care presently rendered and to track changes in outcomes as new processes and hardware are adopted.

It will be necessary in the near future for providers to develop their skills in using data to modify processes at their site so that the patient outcomes are significantly better.  New payment models based upon quality of care will require this.  Successful employment of these techniques will be rewarding for all involved—patients, providers and payers.

Donald Tex Bryant is a consultant who helps healthcare providers meet their challenges. He can be reached at Bryant’s Healthcare Solutions.

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  • Anonymous

    So let me get this straight.

    Dr. S spends lots of time doing population management, for which she is paid nothing, and somehow, this allows her to spend more time with each patient, which reduces her charges, so she raises her overhead by hiring consultants and requiring more support staff, and this increases her income by 10%? And she accomplishes this miracle because she “understands data”?

    Well, I understand that 1+1=2, and the only way to boost income is to increase charges and/or reduce overhead.

    I ain’t buying it.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I don’t know why Toyota always gets credit for everything….

    Most docs I know have been practicing PDCA since pretty much forever. Patient comes in, tells a story. is examined and diagnosed, a Plan is created; patient goes home and engages in the Do part as best he can or is willing to; patient comes in for the scheduled Check up; plan is Adjusted accordingly; and repeat until patient is satisfied.

    Perhaps the patient-centered part comes from the famous Toyota car-centered approach to production lines…..

  • http://www.bryantsstatisticalconsulting.com Donald Tex Bryant

    As author of this article I have come across many resources which illustrate the achievement of Dr. S.  A very good site with tons of resources and descriptions of outcomes is the TransforMEd web site.  To see the financial impact of such practice transformations, you can visit http://www.transformed.com/CEOReports/FinancialImpact.cfm.

     

  • Mark Novotny

    Donald is right. Unfortunately many physicians believe that their training in looking at data from randomized controlled trials prepares them for looking at data about processes and process improvement. Without formal training, physicians fall into the same traps that others do: attributing causality when there is none, or  believing there has been a change when they are viewing random variation. obtaining formal training, or bringing that expertise into their professional lives through skilled process improvement partners, is absolutely critical for achieving the kinds of results described in this post. see http://www.cooley-dickinson.org/node/728 for an example of why this is so important.
     
     

  • Anonymous

    TransforMEd has been widely criticized for refusing to provide anything beyond anecdotal reports of improved finances in practices that buy their services. 

    The objective Final Evaluator’s Report of the National Demonstration Project reported that the participating practices (even with very large helpings of free consultants and subsidies for IT) experienced “significant financial stress,” and concluded that the PCMH model is probably not viable without large financial support from outside sources. 

    If someone is paying Dr. S for patient management and for seeing fewer patients, you should have reported that.

  • Anonymous

    Not sure exactly what you’re saying, but I think the formula income = receipts – expenses remains valid. I can see nothing in the information about Dr. S’s practice that would alter that equation favorably, unless she is receiving large subsidies that aren’t mentioned.