A CEO on a Mission

Ron Paulus has exemplified clinical performance improvement throughout his long health care career, so it's no surprise that the integrated delivery system that brought him in as CEO two years ago soon would reflect its leader.

Collecting and reporting quality metrics was but one of a slew of projects instituted at Mission Health, a five-hospital system based in Asheville, N.C., to achieve four aims: getting the desired outcome, without harm, without waste, and with an exceptional experience for patients and their families. Success at these objectives, says Paulus, played "no small part" in Mission Health's cracking the nation's top 15 health care systems this year in an annual analysis by Thomson Reuters.

Investments in performance improvement included identifying processes to repair and continually track to improve both the goals involving the usual industry core measures and other measures deemed a high priority for the health system's population, which is 75 percent Medicare and Medicaid. Patient satisfaction analysis was carried out to the nth degree; patient reps and top execs roamed the floors.

"It's some time and money, but the real value is what you can get out of it," says Paulus, who brought his experience as chief technology and innovation officer of Geisinger Health System, Danville, Pa. "It's altering the core product of our delivery, which is efficiency and outcomes of care. What we're seeing is we're moving these measures in a pretty significant way. I can show you before-and-after graphs of all these things that would knock your socks off."

Mission Health has mobilized a range of tools to find, lift and scrutinize clinical data. One of the systems deployed, which analyzes possible clinical shortcomings to zero in on, originally was developed in the 1990s by CareScience, a company he co-founded with David Brailer, who went on to become the first head of the Office of the National Coordinator for Health Information Technology.

A special project to detect and treat delirium called for "quasi-manual data collection," Paulus says. Some of that data was bundled into an EHR flow sheet and became part of nursing documentation. "Ultimately we get it concurrently and electronically, but it's still because somebody's capturing it."

There's a publicly displayed quality board in every unit of the health system. "On these boards are the most recent data for that unit as well as the overall hospital performance data. These are very prominent so that patients and their families and docs and nurses, everybody can see them."

Weekly leadership rounds take Paulus and other executives to individual hospital units to determine what works, what needs improvement and the goals to work toward. In addition, 100 patients are embedded into a facility-redesign and master-planning process, and a consultancy called ExperiaHealth follows patients around during their stay to discern how they see their care unfolding. Including patients "changes the dialogue. If you have a patient sitting there side by side with the doctor and the nurses and an administrator and the pharmacist and we're saying, 'How do we optimize this process?' nobody can say, 'That's really just too inconvenient' when the patient's sitting right there."

Capturing clinical information remains a chief challenge. Two prime targets for innovation are pharmacy data for medication reconciliation and turning unstructured data from notes into usable elements. Both use mid-level skilled staff to their fullest instead of roping in doctors to get basic data collected.

In the emergency department, pharmacy techs track documentation on medications. "It doesn't make sense for docs to be doing all this work. They should only do the stuff that's commensurate with their license, training and economic earning level," Paulus says. Mission Health is piloting a link to the e-prescribing exchange Surescripts "to provide 360-degree observation of true filled data as well as order data for med-rec in the ED." The feed will greatly cut into the manual work now necessary to get that information.

The missing link in converting unstructured notes into collectible data could be all the transcriptionists being phased out of their original job description by the rise of voice-recognition-to-text, says Paulus. "They're very familiar with medical terminology, they're familiar with rudimentary components of coding and abstracting. As we automate away that core transcription model, rather than saying we're just going to cut everybody and send them home and lose jobs, how can we transform their work into a more value-added component? They're naturally positioned to be able to take that automation-generated text and glean out of that some of these key data elements."

Taken from an article byJohn Morrissey on hhnmag.com