By Jennifer J. Salopek
Utah’s Intermountain Health has been using sophisticated information technology systems to track patient outcomes and prompt best practices for 15 years, and has had electronic health records for 40 years, says Stanley M. Huff, MD, Chief Medical Informatics Officer. Huff shared many of Intermountain’s challenges and successes in a session at the AAMC annual meeting in Chicago in November. Huff is also a clinical professor at the University of Utah, where he teaches a course in medical information standards, which he describes as “a big help to analytics.” A key challenge in data-driven medicine, according to Huff, is “getting good, standard, structured, coded data to the people who do the analytics.”
Inspired by Senior Vice President David Burton, whom Huff describes as an “organizational visionary,” Intermountain adopted the stance that the practice of medicine should revolve around common clinical processes and the improvement of those processes. Their efforts began with well-baby deliveries, and have since evolved to nine clinical programs including cardiovascular disease. Each is headed by a practicing physician who spends 25 percent of his or her time on initiatives that improve quality.
“There is no top-down direction; decisions are made within the programs,” says Huff, who notes that those decisions are informed by data analytics. Data leads to insights, which are validated with research, which are then applied “with confidence” to improve patient care.
“The electronic data warehouse is key in spinning this cycle faster to gain the insight necessary to act decisively, so we can improve the quality of care for our patients,” Huff says.
In the case of elective inductions, for example, research showed that ventilator usage decreased dramatically in babies who were delivered without complications at 39 gestational weeks. Elective inductions can be convenient for doctors and expectant families, and can spare mothers some of the discomfort of the final weeks of pregnancy. But since 1999, the American College of Obstetricians and Gynecologists has recommended that, for the sake of the baby’s health, no elective inductions be done before the 39th week of pregnancy. The dating of pregnancy is sufficiently uncertain that what is thought to be the 38th week may really be the 36th week, and a baby born in the 36th week is more likely to have underdeveloped lungs or other problems. Early elective inductions also lead to longer labors and more C-sections.
Despite the recommendation, though, about 30 percent of elective inductions at Intermountain in 2001 were done before 39 weeks, roughly the national average. That year Intermountain adopted a protocol urging doctors to avoid most early inductions, and only then did the rate begin to fall. By 2004, the share of elective inductions done before the 39th week at Intermountain fell to 5 percent, and it is now less than 2 percent. The number of newborns with respiratory problems has also dropped.
“Analytics are used to understand a current problem, assess the current state, measure progress, and drive outcomes,” Huff explains.
Although many health care organizations have implemented or are planning to implement electronic health records, many still find big data daunting.
“It’s mostly a matter of scale,” says Huff, who notes that there are fewer resources available in smaller organizations to have data analytics specialists on staff. By contrast, 40 FTEs are employed in the design and management of Intermountain’s electronic data warehouse, which contains 15 terabytes of data in approximately 95 billion rows. There is tight coordination with the clinical and business areas, including a shared physical location.
Issues around data ownership are a common challenge in health care and constitute a barrier in some institutions. “People want to control their data rather than contributing it to the electronic data warehouse,” says Huff. “Data is not supposed to be the property of a particular specialty or profit center.”
Intermountain’s culture has long been one of sharing, says Huff, who has been with the organization for 27 years. The father of that culture was Homer Warner, MD, founder of the medical informatics effort at Intermountain.
“From the start, we have used computers to improve clinical care rather than primarily for administrative or billing purposes,” says Huff. “Dr. Warner left a legacy that makes it easier for us to do things.”