Analysis of the NEJM Catalyst Insights Council Survey on Care Redesign: Data, Analytics, and Outcomes. Qualified executives, clinical leaders, and clinicians may join the Insights Council and share their perspectives on health care delivery transformation.
By Amy Compton-Phillips and Namita Seth Mohta
Data and analytics are a key means for clinicians, clinical leaders, and executives to transform health care delivery. Yet health care organizations have work to do in getting measures right and much to learn about effective use of data, according to our most recent Insights Council survey.
Nearly two-thirds of Council members — a qualified group of U.S. clinicians, clinical leaders, and executives at organizations directly involved in health care delivery — say that the current emphasis on data and analytics among health care organizations serves to improve clinical care. Two-thirds of respondents say their organizations are effective in using data to guide business leadership, and 62% say they use data well to guide clinical leadership.
“Analytics fueled by genomics, big data, artificial intelligence, machine learning, and more allows us to see what was previously hidden. We can take observations and turn them into knowledge to make life better for our patients,” says Amy Compton-Phillips, MD, Chief Clinical Officer at Providence St. Joseph Health and NEJM Catalyst’s Care Redesign Theme Leader.
“How to best use analytics in health care is going to come to us in a different way than before,” says NEJM Catalyst Clinical Editor Namita Seth Mohta, MD. “Amazon, Apple, Google, and Microsoft — all with expertise in data aggregation and interpretation — are intensely looking at how they can leverage their data and apply their analytics capabilities to improve health outcomes. It is encouraging that they are partnering with health care providers so that there is more bidirectional collaboration, which will lead to more creative and innovative solutions.”
The majority of respondents (69%) see analytics as an opportunity to drive both improvement and accountability. Compton-Phillips warns against starting with the wrong goal, however. “If you start with accountability, you will stifle people’s willingness to use data to change behavior,” she says.
“You have to get the fundamentals of governance correct before data and analytics can be effectively used to realize improvement goals,” Mohta says. For instance, it is important for leaders and clinicians to be aligned on which outcomes are most important. Council members say that readmissions (76%) and patient experience (75%) are the two outcomes most often measured, with safety of care and mortality tied for third (each at 59%).
Physicians often bemoan the plethora of process measures, which sometimes come at the expense of outcome measures. Survey respondents are roughly split about how health care quality is currently measured: just over a third say their organizations emphasize process, a third say outcomes, and a just under a third say both. But a majority (60%) say that both process and outcomes should be measured. Compton-Phillips agrees. “Outcomes tell us if we are doing what we’re hired to do in health care, which is to make lives better. To drive outcomes usually takes measuring a few key process steps to get timely, actionable information along the way,” she says. For instance, reducing the outcome of deaths from heart disease requires tracking processes such as checking control rates for cholesterol and blood pressure.
In Mohta’s opinion, both process and outcome measures are necessary so that what is working can be “effectively spread and scaled.” She also emphasizes that different types of metrics — clinical, cost, and experience (patient and care team) — should be collectively measured.
Does success in using analytics depend on the visibility of the data? Insights Council members report that executives (84%) and clinical leaders (83%) far surpass frontline physicians (56%) in their ability to access an organization’s clinical data. Compton-Phillips says physicians, nurses, and other members of the care team should have access to analytics data, and patients as well. “Executive and clinical leaders have data that’s not always transparent to frontline caregivers. For doctors and nurses to know their performance, they need a mirror, a way to see the outcomes of their care. If we don’t give those creating the data access to the information, they won’t engage in driving change,” she says.
Where analytics efforts fall short, say survey respondents, is in organizational learning. Just under half (46%) say their organizations are very good or outstanding at creating data, half say they do well at storing data, but only 28% say their organizations are good at learning from data.
Overall, this Insights Council survey shows health care leaders and clinicians making good use of data and analytics, but there is more work to be done, particularly in guiding decisions for individual patients. Just over half (51%) say their organizations are effective in using data to support care decisions for individuals, but 47% of respondents say they do a poor job. Compton-Phillips is optimistic: “We’re not yet at the sharp end of where we need to be at the individual or population level, but we will get there soon.”
VERBATIM COMMENTS FROM SURVEY RESPONDENTS
Does the current emphasis on data and analytics in health care improve clinical care or detract from it? How and why? Respondents who say it detracts:
“Data analytics do not seem to be available to frontline physicians and individual patients.”
“Entire clinical staff is doing computer work 60-70% of the time. It is a means unto itself. Patient care is just a far, far secondary evil.”
VERBATIM COMMENTS FROM SURVEY RESPONDENTS
Does the current emphasis on data and analytics in health care improve clinical care or detract from it? How and why? Respondents who say it improves:
“Because we are at a place where US healthcare can no longer afford to have healthcare executives, consultants, and clinician leaders lead efforts in explaining data, especially outcome data. All stakeholders across the healthcare continuum should work off the same numbers, and transparency should be best policy. We see this working for population health, so why not for the entire US healthcare system?”
“Healthcare is an emotional endeavor by its nature. We provide healthcare with emotions. It’s hard, however, to improve healthcare with emotional thinking. Has to be data driven.”
VERBATIM COMMENTS FROM SURVEY RESPONDENTS
Does the current emphasis on data and analytics in health care improve clinical care or detract from it? How and why? Respondents who say it makes no difference:
“We don’t use the information to its maximum effect currently. We have some infrastructure around this but sometimes the data isn’t accessible.”
“We don’t have the right information, just lots of data.”
Download the full report for additional verbatim comments from Insights Council members.
Charts and Commentary
by NEJM Catalyst
We surveyed members of the NEJM Catalyst Insights Council — who comprise health care executives, clinical leaders, and clinicians — about data, analytics, and outcomes. The survey explores the goals and effectiveness of data analytics at Insights Council members’ organizations; their effectiveness at creating, storing, and learning from data; clinical decisions guided by analytics efforts; the visibility of clinical data at organizations; how health care quality is and should be measured; clinical outcomes measured at organizations; and the impact of data analytics on clinical care. Completed surveys from 566 respondents are included in the analysis.
NEJM Catalyst Insights Council members place guiding clinical leadership and guiding business leadership as the top goals of analytics efforts. Executives rated population health efforts a good bit higher than did clinicians — 50% of respondents versus 39%, respectively. Analytics efforts are weakest in supporting care decisions for individual patients. In a written comment, a clinical leader says, “We do not have the platform yet to best understand other important outcomes such as mortality and readmission. Thus, we are largely left with studying proxies such as HbA1C, etc.”
Moving from organizational goals to effectiveness in using data, Council members rate their abilities to guide business leadership highest and support care decisions for individual patients lowest. Respondents from the South (57%) choose the latter more often than people from other regions. According to one clinician respondent, effectiveness is difficult because “the data is not available in real time. Any attempt at gathering or collating info takes so long that it’s six months out of date by the time it gets to anyone who might make a difference.”
Download the full report to see the complete set of charts and commentary, data segmentation, the respondent profile, and survey methodology.
Join the NEJM Catalyst Insights Council and contribute to the conversation about health care delivery transformation. Qualified members participate in brief monthly surveys.