Tip Bisnis

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Clinical pathway & cot selasa
1. C linical Pathway & Cost of Treatment(Conceptual Thinking & Application) Ronnie Rivany ® Health &
Hospital Economics Pusat Kajian Ekonomi & Kebijakan Kesehatan FKMUI
2. JASTIFIKASI• Standarisasi tarif RS ?• Belum ada Clinical Pathway sebagai penjaga mutu & sebagai
basis layanan MUTU dan basis perencanaan/perhitungan biaya• Sistem, Kebijakan dan Prosedur yang
tidak jelas dan tidak konsisten serta belum terintegrasi• Buku Tarif Departemen Kesehatan 2007 (?)
3. Major Diagnostic Categories (AR-DRG v 5,2, 2006)1 Diseases and disorders of the nervous system2
Disease and disorders of the eye3 Disease and disorders of the ear, nose, and throat4 Disease and
disorders of the respiratory system5 Disease and disorders of the circulatory system6 Disease and
disorders of the digestive system7 Disease and disorders of the hepatobiliiary system and pancreas8
Disease and disorders of the musculoskeletal system and connective tissue9 Disease and disorders of
the skin, subcutaneous tissue, and breast10 Endocrine, nutritional, and metabolic diseases and
disorders11 Disease and disorders of the kidney and the urinary tract12 Disease and disorders of the
male reproductive13 Disease and disorders of the female reproductive system14 Pregnancy, childbirth,
and the purperium15 Newborn and other neonates with conditions originating in the perinatal period16
Disease and disorders of blood and blood forming organs and immunological disorders17
Myeloproliferative disease and disorder, and poorly differentiated neoplasm18 Infectious and parasitic
disease (systemic or unspecified sites)19 Mental diseases and disorders20 Alcohol/drug use and
alcohol/drug- induced organic mental disorders21 Injuries, poisoning, and toxic effects of drugs22
Burns23 Factors influencing health status and other contact with health services
4. DRG Numbering• The format = A DD S• A = Pre MDC DRG’s ; B = nervous system DRG; O =
Reproductive System; Z = DRG’s relating to other health factors; 9 = the error DRG’s• DD = DRG’s
partition; – Range 01 – 39 Surgical Partition – Range 40 – 59 Other Partition – Range 60 – 99 Medical
Partition• S = split indicator – A = highest resources DRG – B = second highest resources
5. General Logic, All acute admited patien Diagnosis Related Group’s Principal diagnosisMajor
diagnostic category # 1 MDC # 2 MDC # 3 MDc # 4 Yes No Surgical Partition of MDC # 1 Medical Partition
of MDC # 1 What procedure Procedure Procedure Procedure Procedure Custer A Cluster B Cluster C
Cluster D What age group’s Over Under XProcedure cluster A over age X Procedure cluster A under age
XSignificant secondary condition ? Yes No Procedure cluster A Procedure cluster A Over Age X, with CC
Over Age X, without CC
6. INDONESIAN DRG’s
7. INDONESIAN DRG’s• Pola pikir – ICD tetap – MDC untuk sementara tetap – Clinical Pathway bisa
dibuat – DRG di konfirmasi + bisa dibuat – Casemix di konfirmasi + bisa dibuat – Costing dilakukan
dengan pendekatan Activity Based Costing + Simple Distribution
8. POLA PIKIR INDONESIAN DRG’s (1) INA - DRG 1.Konfirmasi DRG 2.Hitung Cost/DRG Clinical Pathway
& Casemix Activity Based Costing
9. POLA PIKIR INDONESIAN DRG’s (2) ICD MDC 1 DRG DRG DRG 2 COST CASEMIX TARIF COST TARIF
10. Clinical Pathway• Anticipated Recovery Pathway (ARPs)• Multidisciplinary Pathways of Care
(MPCs)• Care Protocols• Integrated Care Pathways• Pathways of Care• Care Packages• Collaborative
Care Pathways• Care Maps• Care Profiles
11. Konsep perencanaan pelayanan terpadu yang merangkum setiaplangkah yg diberikan kepada
pasien berdasarkan standar yanmed, standar asuhan keperawatan&standar pelayanan tenaga
kesehatan lainnya , yg berbasis bukti dng hasil yg dpt diukur dan dalam jangkawaktu tertentu selama di
rumah sakit
12. Major Diagnostic Categories (Pedoman Tarif ?? DEPKES,2007)1 Diseases and disorders of the
nervous system2 Disease and disorders of the eye3 Disease and disorders of the ear, nose, and throat4
Disease and disorders of the respiratory system5 Disease and disorders of the circulatory system6
Disease and disorders of the digestive system7 Disease and disorders of the hepatobiliiary system and
pancreas8 Disease and disorders of the musculoskeletal system and connective tissue9 Disease and
disorders of the skin, subcutaneous tissue, and breast10 Endocrine, nutritional, and metabolic diseases
and disorders11 Disease and disorders of the kidney and the urinary tract12 Disease and disorders of
the male reproductive13 Disease and disorders of the female reproductive system14 Pregnancy,
childbirth, and the purperium15 Newborn and other neonates with conditions originating in the
perinatal period16 Disease and disorders of blood and blood forming organs and immunological
disorders17 Myeloproliferative disease and disorder, and poorly differentiated neoplasm18 Infectious
and parasitic disease (systemic or unspecified sites)19 Mental diseases and disorders20 Alcohol/drug
use and alcohol/drug- induced organic mental disorders21 Injuries, poisoning, and toxic effects of
drugs22 Factors influencing health status and other contact with health services23 Medical Outpatient
Visit
13. HUBUNGAN C.P & DRG/CASEMIX ICD MDC Clinical PathwayDRG DRG DRG COST CASEMIX TARIF
COST TARIF
14. Clinical Pathway in Hospital
15. Pengembangan Konsep Clinical Pathway International Classification of Disease (ICD) Major
Diagnostic Categories (MDC)ClinicalPathway Surgical / Other / Medical Diagnosis Related Groups (DRG’s)
Casemix
16. Format dasar Clinical PathwayAktivitas pelayanan Pra R.I Rawat Inap (R.I) (Poliklinik/ Hari I Hari 2
Komplikasi UGD) Tgl Tgl / Co- morbidity 1 2 3 4 5PendaftaranPenetapan DiagnosePra-
PerawatanPerawatanTindak Lanjut
17. CLINICAL PATHWAY DALAM TAHAPAN PRA PERAWATAN & PERAWATAN Aktivitas pelayanan Pra
R.I Rawat Inap (R.I) (Poliklinik/ UGD) Hari I Hari 2 Komplikas Tgl Tgl i/ Co- morbidity 1 2 3 4 5Pra-
PerawatanAssessment klinis• pemeriksaan/visite dokter• konsultasiPemeriksaan penunjang•
laboratorium• Radiologi• Dst sesuai SPM, SAK & SPOPerawatan• Tindakan medis• Pemberian
obatDst-nya, sesuai SPM,SAK & SPO
18. DUMMY TABLE (1) Clinical Pathway UtilisasiNo SOP Hari.1 Diag.Utama + Serta + Sulit + Serta +
Sulit1 Admission2 Diagnostic3 Pra Therapy4 Therapy5 Follow Up6 Discharge
19. DUMMY TABLE (2) Clinical Pathway UtilisasiNo Aktivitas SDM OBAT OVERHEAD1 Admission2
Diagnostic3 Pra Therapy4 Therapy5 Follow Up6 Discharge
20. DUMMY TABLE (3) Clinical Pathway UtilisasiNo Aktivitas Min Max Mean / Utilisasi Utilisasi Median
Utilisasi1 Admission2 Diagnostic3 Pra Therapy4 Therapy5 Follow Up6 Discharge
21. CLINICAL PATHWAYSYMPTOM DIAGNOSIS THERAPY FOLLOW UP 1 2 3 4 5Admission Diagnosis Pre

Therapy Therapy Follow upActivities Activities Activities Activities Activities ABC ABC ABC ABC ABC
22. PEMBUATAN CLINICAL PATHWAY (1)• Diawali dengan membuat template untuk mendapatkan
clinical pathway. Langkah- langkah dalam membuat clinical pathway adalah sebagai berikut :• Membuat
koding untuk memudahkan entry data.• Entry data karakteristik, identitas, tanggal masuk dan keluar
rumah sakit, lama hari rawat, jenis pembayaran, diagnosa utama, penyakit penyerta, penyakit penyulit,
cara masuk, status keluar dan kelas rawatan dari masing-masing pasien. Entry data dilakukan
berdasarkan kelompok AR-DRG.
23. PEMBUATAN CLINICAL PATHWAY (2)• Entry semua aktivitas yang diterima pasien dari masuk
sampai pulang dan pada waktu rawat jalan. Semua aktivitas dekelompokkan berdasarkan tahap clinical
pathway.• Konfirmasi tahap clinical pathway dan variabel kegiatan dengan SPM IDI, SPM Profesi dan
para dokter dan paramedis di Rumah Sakit .• Draft clinical pathway diisi berdasarkan frekuensi masing-
masing kasus.• Berdasarkan nilai mean atau median didapatkan nilai rata-rata masing-masing variabel
dalam clinical pathway perhari rawatan berdasarkan kelompok AR- DRG.• Cleaning dan pengecekan
ulang terhadap nilai utilisasi berdasarkan tahap dalam clinical pathway masing-masing kelompok AR-
DRG sehingga didapatkan nilai utilisasi kelompok AR-DRG berdasarkan clinical pathway.
24. PEMBUATAN CLINICAL PATHWAY (3) Draft & Finalisasi Clinical Pathway• Setelah draft Clinical
Pathway yang berbasis evidence tadi telah dibuat, maka tahapan akhir dari penyusunan Clinical Pathway
ini adalah Focus Group Discussion dengan Panel Expert ( para spesialis ) dan Ikatan Profesi , untuk
bersama-sama menyepakati jenis dan jumlah tindakan/FORMULARIUM yang akan dipergunakan dalam
Clinical Pathway
25. DUMMY TABLE (1)Clinical Pathway Cost of TreatmentActivities Day.1 Day.2 Day.3 Day
…..Admission + + + +Diagnosis + + + +Pre Therapy + +Therapy + + + +Follow UpDischarge
26. DUMMY TABLE (2) Clinical Pathway Cost of TreatmentNo Activities Day.1 Principal Penyulit
Penyerta PP Diagnosis1 Nursing2 Consultation3 Doctor visits4 Medical Procedures5 Nursing6 Medical
/DRUGS Treatment7 Supporting exams8 Nutrition9 Physiotherapy10 Etc
27. DUMMY TABLE (3)Clinical Pathway Cost of TreatmentNo Activities U DC IC TC UC U x UC1

Admission2 Diagnosis3 Pre Therapy4 Therapy5 Follow Up6 Discharge TOTAL C/DRG
28. Cost of Treatment (Cost DRG/Casemix)No Cost of Treatment / Direct Cost IndirectCost Activity
Based Investasi Operasional Pemeliharaan INDEX Costing1 Admission %2 Diagnostic %3 Pra Therapy %4
Therapy %5 Follow up %6. Discharge
29. APLIKASI COST/DRG/Casemix dalam PK BLU(1)Cost of Treatment Rawat Inap dan Rawat JalanNo
AR-DRG KLS. III KLS. II KLS.I UTAMA VIP RAJAL 1 B70A 5181485 5281384 5339924 5778045 5805053
803121 2 B70B 4075179 4153671 4199667 4543904 4565126 995167 3 B70C 1905273 1976629
2018443 2331386 2350678 987047 4 B70D 1848767 1863038 1871401 1933989 1937848Perbandingan
Biaya Rawat Inap KLS.IIINo AR-DRG KLS. III Tanpa Gaji Tanpa Obat Tanpa Gaji Dan Obat 1 B70A 5181485
4250350 2972007 2040872 2 B70B 4075179 3476706 2250808 1652334 3 B70C 1905273 1489521
1438879 1023127 4 B70D 1848767 1624600 1030735 806568
30. CLINICAL PATHWAY COST of TREATMENT
31. TARIFF DETERMINANT per DRG’S TARIFF Margin COST/DRG’s UNIT COST UNIT COST UNIT COST
UNIT COST UNIT COST ROOM & BOARD DRUGS LAB MED SUPPLIES OKTotal cost Q ACTIVITY BASED
COSTING + SIMPLE DISTRIBUTION
32. LAPORAN Clinical Pathway & Cost of Treatment Diagnosis Related Group (DRG’s)Sectio Caesaria,
Diare Anak & Katarak (2008)Apendictomy & Pneumonia Anak (2009 - 2010) DINAS KESEHATAN
Pemerintah Propinsi Daerah Khusus Ibukota Jakarta
33. REKAM MEDIK DI RUMAH SAKIT
34. LAPORANClinical Pathway & Cost of Treatment Diagnosis Related Group (DRG’s) 10 Dept –
International Wing 2009 - 2010 RUMAH SAKIT Dr Cipto Mangunkusumo, Jakarta
35. LAPORANClinical Pathway & Cost of Treatment Diagnosis Related Group (DRG’s) Rumatan
Methadon, 2010 RUMAH SAKIT KETERGANTUNGAN OBAT Cibubur - Jakarta
36. DIREKTORAT JENDERAL BINA PELAYANAN MEDIK DEPARTEMEN KESEHATAN 2005
37. • RS wajib memp.CP, Diagnosis mengacu pada ICD-10,Prosedur mengacu pd ICD- 9CM Flowchart
penyusunan CP ICD SPM Profesi Model Dummy Surgical Medical SPM RS Clinical Pathway
Terukur(admissi on to discharge) DRG contoh : -Diare anak SOP Aktivitas -Sectio Caesaria Case Mix
38. TUJUAN :• utk meningkatkan mutu Yan pasien• memaksimalkan penggunaan sumber daya scr
efisien dng mengurangi dokumentasi yg tdk diperlukan.• membantu identifikasi & klarifikasi proses Yan
klinis• mendukung efektivitas klinik, audit medis & risk management
39.  Dalam menyusun clinical pathway (C.P) di RS peru memadukan & menyesuaikan dng b’bagai
sistem yg tlh dibangun serta tlh b’jalan sehingga stiap bagian yg ada di RS lebih mudah menyesuaikan &
saling mendukung pd saat C.P. selesai dibuat & disosialisasikan. Komite Medik sngt bperan dlm
m’bantu penyusunan & plaksanaan C.P. di RS. Pedoman C.P. di RS diharapkan dpt m’bantu RS dlm
menyusun C.P. dlm rangka mendukung plaksanaan pengembangan DRG’s Casemix di RS.
40. TERIMA KASIHatas perhatian & kesempatan kerjasamanya www.ina-drg-rr.net
Clinical practice guidelines
1. CLINICAL PRACTICE GUIDELINES A GUIDE FOR CLINICIANSDeveloped by Clinical Quality and Safety
The Royal Children’s Hospital Melbourne, Australia Septe mber 2007 1
2. TABLE OF CONTENTS 1. Introduction 2. Process for Content Development 3. Guideline for Content
Development 4. Guideline for Writing Clinical Guidelines 5. Guideline Evaluation 6. Clinical Guideline
Development Resources 7. AppendixFurther informationIf you are interested in contributing to Clinical
Practice Guidelines or have other queries, please contact:Jody SmithClinical Guideline and Pathway
CoordinatorTel (03) 9345 6956Pager 6956Email: jody.smith@rch.org.auClinical Quality and SafetyRoyal
Children’s HospitalRenata KukuruzovicEvidence Based Clinical Practice (EBCP) consultant
paediatricianEmail: renata.kukuruzovic@rch.org.auClinical Quality and SafetyRoyal Children’s Hospital 2
3. 1. INTRODUCTIONWhat are Clinical Practice Guidelines?Clinical Guidelines are systematically

developed statements based on the best available evidence designedto assist practitioners with
develop guidelines involves a thorough evaluation of evidence basedon outcomes of treatment or other
health care procedures. Where research based evidence is notavailable, consensus by experts forms the
basis of the guideline.The Hospital Clinical Guidelines have been developed in accordance with the
National Health and MedicalResearch Council (NHMRC) published recommendations 1, 2, 3 to support
clinicians, with an emphasis onthe ongoing management of patients.Why are these guidelines needed?
There has been a widespread move towards developing clinical practice guidelines, which are designed
to: Improve the quality of health care. Reduce the use of unnecessary, ineffective or harmful
interventions. Facilitate the treatment of patients with maximum chance of benefit, with minimum risk
of harm, and at an acceptable cost.Recent research has shown that clinical practice guidelines can be
effective in bringing about change andimproving health outcomes. They are underpinned by the
evidence based clinical practice principles ofgood decision making which takes account of patients
preferences and values, clinicians values andexperience, the best available evidence and the availability
of resources.1Key principles for developing guidelines (NHMRC)1There are nine key principles for
developing guidelines these include: 1. Process for developing and evaluating clinical practice guidelines
should focus on outcomes. 2. Clinical practice guidelines should be based on the best available evidence
and should include a statement about the strength of their recommendations. Evidence can be graded
according to its level, quality, relevance and strength. 3. Taking the evidence - of whatever level, quality,
relevance or strength - and turning it into a clinically useful recommendation depends upon the
judgement, experience and good sense of the group developing the guidelines. 4. The process of
guideline development should be multidisciplinary and include consumers. Involving a range of
generalist and specialist clinicians, allied health professionals and consumers will improve the quality
and continuity of care and will make it more likely that the guidelines will be adopted. 5. Guidelines
should be flexible and adaptable taking into account clinical settings, costs and constraints. Provision
should be made for accommodating the different values and preferences of patients and families. 6.
Guidelines should be developed with research constraints in mind. 3
4. 7. Guidelines are developed to be disseminated and implemented taking into account their target
audiences. They should also be disseminated in such a way that practitioners and consumers become
aware of them and use them. 8. The implementation and impact of guidelines should be evaluated. 9.
Guidelines should be revised regularly.WRITING CLINICAL PRACTICE GUIDELINESAimsThe aim of this
document is to facilitate staff at RCH in the development, writing and evaluation ofmultidisciplinary
clinical practice guidelines.Why do we develop a Clinical Practice Guideline?The need for a Clinical
Guideline is identified as a result of: • Reflective practice • Variations of practice within the hospital •
New study findings • An adverse event or potentially dangerous practiceWho can write Clinical Practice
Guidelines?Development of Clinical Guidelines within the Royal Childrens Hospital
requiresmultidisciplinary involvement at all levels to ensure the clinical guideline encompasses the
requirements ofrelevant clinicians and patient groups.Clinical Guidelines can be written by: • Clinicians •
Working Groups e.g. a multidisciplinary team managing a patient group • Specific departments e.g.
Haematology, Dermatology, General SurgeryConsumer involvement (Family Centred Care)For guidelines
to have a Family Centred Focus consumer involvement is recommended in the developmentprocess
from the outset. Consumer input focuses on incorporating the core concepts of Patient andFamily
Centred Care including:Dignity and Respect • Respect family knowledge, values, beliefs and cultural
backgrounds in the delivery of care.Information Sharing • Providing families with timely, accurate and
complete information enabling them to participate in and care and decision making.Participation 4
5. • Patients and families are encouraged and supported in participating in care and decision making
at their chosen level.Collaboration • Facilitate patients, families, clinicians and leaders to work
collaboratively in the development, implementation and evaluation of guidelines, education and the
delivery of care. (Institute for Family Centered Care http://www.familycenteredcare.org/).Consumer
input is not intended to focus on clinical recommendations based on the best availableevidence.The
consumer approach should be individualised for each guideline and authors should contact us
forassistance with this aspect of guideline development.References 1. National Health and Medical
Research Council (NHMRC) 1999. A guide to the development, implementation and evaluation of clinical
practice guidelines. 2. National Health and Medical Research Council (NHMRC) 2000. How to use the
evidence: assessment and application of scientific evidence. 3. National Health and Medical Research
Council (NHMRC) 2000. How to put evidence into practice: implementation and dissemination
strategies. 5
6. 2. THE PROCESS FOR CLINICAL PRACTICE GUIDELINE CONTENT DEVELOPMENTIf you are intending
to develop a clinical practice guideline contact Clinical Guideline and PathwayCoordinator on ext/page
6956 to learn more about the process.Step 1 Determine topic Identify author/sStep 2 Author discusses
proposed topic with Guideline development team (Renata Kukuruzovic & Jody Smith).Step 3 Download
the Clinical Guideline Development Tools including: a guide for clinicians, guideline template, evidence
table, checklist for the guideline development and implementation.Step 4 Consult with appropriate key
stakeholders (medical, allied health, nursing and consumers). Involve them in the revision of drafts and
consensus of opinion where there is a lack of evidenceStep 5 Review guideline websites and current
practice.Step 6 Contact RCH library complete a literature search.Step 7 Author meets with Guideline
Team to present evidenceStep 9 Attend next available guideline development workshopStep 10
Formulate draft, utilising feedback from key stakeholders, evaluate evidence using table.Step 11
Guideline team review draft content using PAED agree toolStep 12 Clinical Guideline approval once
suggested changes are made to satisfactory level.Step 13 Clinical Guideline Approved (Signed off by
relevant Dept Heads and CQS guideline team)Step 14 Guideline published on the intranetStep 15 Review
of implementation and dissemination of the guideline (approximately 3 months post
implementation)Step 16 Author conducts a post implementation evaluation at 12 months evaluating
health outcomes for patients and changes in clinical practiceStep 17 Guideline to be reviewed every 3
yrs +/- audit 6
7. 3. CONTENT DEVELOPMENT (more information on some of the steps)Step 4: Key StakeholdersThe

overseeing multidisciplinary panel should include representatives from all relevant groupse.g. clinicians
(nurses, doctors, and allied health) with specialist expertise and clinicians with generalexpertise, other
relevant health professionals, representatives from consumer groups, professionals withexpertise in
guideline development.Step 5: Search Existing MaterialReview relevant current practice, guidelines,
clinical pathways, and educational resources relating to thetopic within the Royal Children’s
Hospital.Search evidence based CPG websites nationally and internationally for guideline topic.Critique
Guidelines, take note of the level of evidence used to develop guideline content andrecommendations
and the method of evidence collection utilised by the guideline site.Guideline Sites include: • National
Guideline Clearing House http://www.guideline.gov/ • National Institute for Health and Clinical
Excellence (NICE) http://guidance.nice.org.uk/CG/published • New Zealand Guidelines Group
http://www.nzgg.org.nz/ • Scottish Intercollegiate Guidelines network
http://www.sign.ac.uk/guidelines/published/ • British Medical Journal
http://bmj.bmjjournals.com/cgi/collection/guidelines • Royal College of Nursing
http://www.rcna.org.au/site/search.php • Royal Australian College of Physicians
http://www.racp.edu.au/hpu/evidence/index.htm • UK NHS
http://libraries.nelh.nhs.uk/guidelinesFinder/ • National Institute of Clinical Studies
http://www.nhmrc.gov.au/nics/asp/index.asp • National Health and Medical Research Council
http://www.nhmrc.gov.au/publications/categories/index.htmStep 6: Evidence Based Literature
Searching and Formulating the Evidence tableIdentify clinical questions to identify key search term using
PICO format to complete a thorough literaturesearch e.g. o Population – e.g. children with bronchiolitis
o Intervention – e.g. do bronchodilators o Comparator – e.g. compared with placebo, or other
treatments e.g. glucocorticoids o Outcome – e.g. show improved clinical scores, reduced hospital stay
etc.Evidence based literature databases can be accessed through ‘Library Services’ on the RCH Intranet
Site.http://www.rch.org.au/library/dbases.htm. Databases include: • Clin-eguide (formerly
ClinicalResource@Ovid). • MDConsult • SUMSearch • The Cochrane Library • Clinical Evidence • EBM
Reviews - ACP Journal Club 7
8. A copy of the literature search strategy and results should be saved and must be submitted to
CQSwith the final draft of the guideline to assist future guideline review.The RCH library in conjunction
with CQS facilitates a literature search to assist in finding the evidence (thisis a prerequisite for
developing a Hospital Clinical Guideline). Contact Jody Smith on 6956 or via emailjody.smith@rch.org.au
to make a booking.Step 7: Grade and Record level of evidence in the evidence table • Refer to Evidence
table template in the resource section of this booklet or on the website under development resources
http://www.rch.org.au/emplibrary/rchcpg/HCGEvidenceTable.doc • CQS facilitate a Clinical Practice
Guideline development workshop on a regular basis to assist in the development of guidelines including
searching and critiquing the evidence. • Please record details on the evidence table and return to
Clinical Quality and Safety (CQS) with guideline draft electronically.The Hierarchy of evidence is based on
the National Health and Medical Research Council (2000) andOxford Centre for Evidence-based
Medicine Levels of Evidence (May 2001) Level I Evidence obtained from a systematic review of all
relevant randomised control trials. Level II Evidence obtained from at least one properly designed
randomised control trial. Level ΙΙΙ-1 Evidence obtained from well-designed pseudo-randomised
controlled trials (alternative allocation or some other method). Level ΙΙΙ-2 Evidence obtained from
comparative studies (including systematic reviews of such studies) with concurrent controls and
allocation not randomised cohort studies, case control studies, or interrupted time series with a control
group. Level ΙΙΙ-3 Evidence obtained from comparative studies with historical control, two or more
single– arm studies, or interrupted time series without a parallel control group. Level ΙV Evidence
obtained from case-series, either post-test or pre-test and post test. Level V Expert opinion without
critical appraisal, or based on physiology, bench research, or historically based clinical principles.Please
note: Clinical guidelines are based on reviews of the best available evidence. Level 1 evidencerepresents
the gold standard for intervention studies; however it is not available for all areas of practice
andfrequently guidelines will use lower levels of evidence or consensus opinion where no studies are
available.This NHMRC Hierarchy can be used to grade the “level of evidence” however it does not give
informationabout the “quality of evidence”, e.g. an RCT is level II evidence, however an RCT may be of
poor qualityand therefore this evidence would not be included in a guideline or review.NB: Short
courses are also available through CQS and CEBU (University of Melbourne) in critical appraisal.We
strongly suggest that the main author take the opportunity to undertake one of these courses if they
areunfamiliar with different study types and critical appraisal of studies. 8
9. Step 9: Formulate draft • Refer to Clinical Practice Guideline template in the resource section of this
booklet or on the website under development resources
http://www.rch.org.au/emplibrary/rchcpg/Guideline_template.doc • Use the template to structure
guideline. This encourages uniformity but it can be modified slightly to suit guideline content
requirements. Content • Keep the audience in mind when writing guidelines. Guideline topics are rarely
restricted to one discipline so they must be relevant to medical staff, nursing staff and allied health. •
The guideline also needs to include content specific to the variety of settings in which the target patient
group or clinical practice is present. For example, does the guideline include management in the
community, in the ward environment and/or the acute care setting? • Work out what content is
essential to the guideline and what content can be part of a resource document, a link to another site or
a link to a PDF document etc. • If a consensus of expert opinion is used to determine Guideline content
due to an absence of available evidence or if there is discrepancy in evidence this should be stated in the
Guideline and reflected in the evidence table.Steps 10 to 13: Clinical guideline review process • The
draft Clinical Guideline needs to be circulated to relevant stakeholders for feedback and approval. • If
the guideline has hospital wide implications to practice and/or resources the guideline should be
presented/discussed at Executive Clinical Leadership level. • The final draft is returned to CQS and
reviewed by the Clinical Guideline and Pathway Coordinator and Evidence Based Clinical Practice (EBCP)
Consultant using the PAED-AGREE tool to appraise the content of the guideline. • The guideline will then
be presented to the Clinical Guidelines Reference Group* • Feedback from the appraisal is presented to
the author • The Clinical Guideline is again reviewed and once satisfactory signed off by relevant
Departmental Head/s, and the EBCP consultant and Clinical Guideline and Pathway Coordinator • Once
approved the Clinical Guideline will then be published on the Clinical Guidelines Site on the RCH
Intranet.Steps 14 to 16: Evaluation of clinical practice guidelinesThe purpose of evaluating clinical
practice guidelines is to assess the validity of the guidelines and theeffectiveness of their dissemination
and implementation.An evaluation plan should be generated when guidelines are being developed, and
this plan should takeinto account what data the evaluation will require e.g. data on processes, practices
and outcomes. 9
10. The Royal Children’s Hospital in accordance with NHMRC1 recommends that Clinical practice
guidelinesare evaluated at least once every three years. RCH also recommends that the author/s of
Clinical PracticeGuidelines conduct a post implementation evaluation at 12 months evaluating health
outcomes for patients.An evaluation plan of clinical practice guidelines should consider some or all of
the following: 1 • Assessment of guideline dissemination • Assessment of whether or not clinical
practice is moving towards the guidelines’ recommendations • Assessment of whether or not health
outcomes have changed • assessment of the guidelines’ impact on consumer’ knowledge and
understanding • an economic evaluation of the guideline processEvaluations may include conducting
audits on patient files, audits of other relevant clinic records,customised surveys and other data
collection initiatives. It may be appropriate to also collect data that canbe usefully compared against
national data.For assistance in developing an evaluation plan and conducting evaluations, please contact
the Evaluationand Analysis Coordinator in CQS on ext 5153 or email nichole.lister@rch.org.auUseful
resources for evaluation:1 National Health and medical Research Council (NHMRC) 1999. A guide to the
development,implementation and evaluation of clinical practice guidelines.Available at:
http://www.nhmrc.gov.au/publications/synopses/cp30syn.htmDate accessed: 22-06-072 Eccles M and
Grimshaw J. 2004. Selecting, presenting and delivery clinical guidelines: are there any“magic bullets”?
MJA 80 (6 Suppl): S52-S54Available at:
http://www.mja.com.au/public/issues/180_06_150304/ecc10749_fm.htmlDate accessed: 22-06-07. 10
11. RESOURCES:Clinical Guideline TemplateClinical Guideline Evidence TableClinical Guideline
Development FormClinical Guideline Implementation and Evaluation FormThe ‘AGREE’ Tool – Appraisal
of Guidelines for Research and Evaluation (HCG Use only) 11
12. Appendix 1:*Clinical Guidelines Reference GroupThe Hospital Clinical Guidelines Reference Group
facilitates best practice in patient management via theprocess of facilitating multidisciplinary evidence
based clinical practice guidelines at The Royal ChildrensHospital. They are directly accountable to the
Royal Childrens Hospital (RCH) Quality and SafetyCommittee.The objectives of the Hospital Clinical
Guidelines Reference • Guide the process of development, implementation and publication of
guidelines at RCH (except those managed by the Clinical Practice Guideline group). • Ensure the quality
of guideline content is maintained, based on the best available evidence and the development, review
and approval processes are consistent. • Encourage all disciplines at RCH to be involved in guideline
development. • Ensure there are appropriate processes for adequate communication with all
stakeholders involved in the guideline development including consumers. • Work collaboratively with
other guideline authorship groups (e.g. Clinical Practice Guideline group) to enhance organisational
processes for Evidence Based Clinical Practice (EBCP). • Review guideline drafts and initiate the revision
of existing Hospital Clinical Guidelines 3rd yearly or more frequently as indicated.MeetingsThe Hospital
Clinical Guidelines Reference Group meets on the second Monday of the Month over a 12month
period.A Quorum will compromise of 50% of the reference group members. 12
The US Patient Journey
1. The Patient Journey: US Patient and Provider Perspectives 75% of patients stated a well organized
and responsive service was the reason behind a good healthcare experience 52% Follow-up care was the
stage patients said required most improvement ONLY 35% Less than 20% of patients had access to a
booking portal PATIENTS PROVIDERS of providers are still storing patient records on paper 83% patient
management challenges are: TOP 2 Resourcing Being able to contact patients at short notice What else
did our respondents think...? Interested in registering for the full report? Go to
www.lumeon.com/resources 82% of providers think that the quality of pre-consultation and referral
services they offer could improve of patients ONLY 54% of providers report having ‘sophisticated’ and
‘integrated’ patient management software* believe the most important function of patient
management technology is to deliver an efficient billing process 94% 1 in 7 patients said they thought
the costs presented to them for treatment were in some way inaccurate were contacted by their
healthcare provider to check on their wellbeing after care of patients had to provide the same info more
than once * 'Sophisticated' was described as a highly automated integrated digital patient management
system as opposed to separate software systems or paper management of providers Source:
Commissioned independent research August–September 2015 via phone interview and online survey.
100 US healthcare professionals with responsibility for the technology and systems which support
patient management. 500 US citizens who have attended either a hospital, a private health clinic or have
been to see a family doctor to receive treatment in the past 12 months.
NEHR-patient_journey-RESIZED
1. Baby/ChildYoungAdultAdult Single Electronic Health Record AgedCare Born Administrator creates

new electronic health record that will follow you wherever you go. GP receives notification of your birth
when she logs into the system. You are selected to play soccer for the regions under-19s soccer team.
You run into another player and sustain a compound ankle fracture. Dad takes you to Middlemore
hospital ED and uses the kiosk to check into the system for the E.D. staff to prioritise you. ED staff access
your record and check to see if you’re on any medications. They see that you take magnesium and
Vitamin C. You are admitted for urgent surgery. Admin process your admission and schedule you into a
bed using the bed management portal. Clinician shows you your care plan and details of your care team
on MyChart Bedside. You’re very keen to get back to your prior fitness level, so you use your Fitbit to
record your progress and update it on MyChart to measure your development. You message from your
iPad to the nurse’s iPhone with MyChart Bedside to say the codeine you were given for pain is making
you feel nauseous. You get a notification of a physiotherapy appointment for tomorrow. The E.D.
clinician sends you to Radiology for an X-ray by sending a request in Epic. X-ray image is made available
on your record. You can see that your parents have lodged the ACC claim for the accident and it has
been accepted. You take videos of yourself doing physio exercises and load them on MyChart. GP has all
the info about encounter in hospital and will update your care plan to set goals for your recovery. You’ve
been selected to play soccer in Gloucestershire. Access patient portal while visiting new GP to load up
relevant info into new record. Your parents have access to your record and can review your birth record
in MyChart Bedside. Your Mother is shown where she can access info on breastfeeding etc and schedule
your vaccinations through the MyChart portal. You are taken to Starship. Paediatrician checks record on
Epic and sees you have no known allergies, you are a combination of breast and bottle-fed, and sleep in
your cot. Parents using iPad at bedside can view info and messages – they see a nurse will run them
through child CPR in the morning. You are observed overnight and blood test results are checked, no
reason for episode found. Sleeping monitor provided. Your parents are shown where info and videos
can be found through the MyChart patient portal. At 6 weeks the notification for first immunisations
comes through via a message on the patient portal. Your mother schedules an appointment on her
iPhone. GP reviews the info about the hospital visit, making a note using voice recognition tool to ask
follow up questions to check that there were no further incidents or concerns with your breathing.
Community nurse sends message to your parents to arrange collection of sleeping monitor. Your mother
has bought over-the- counter medication, and updates this information online. You have started
teething. You’re going home! Happy 16th birthday! You are six months old. You get married. You move
back to New Zealand and get a job as a sport advisor. Take a summary of your patient record from your
GP and some of the key information was entered into your record upon your return. Discharge summary
loaded into Epic requesting GP to refer to a physiotherapist on your return. Your GP pulls up key clinical
information in the Epic record and also approves consent for your children to have proxy access to your
record. Your daughter receives a notification on her phone and confirms your appointment. Care team
helps your family through telehealth video calls and messaging to complete the Advance Care Plan
through the patient portal. GP receives notification when the plan is complete. Schedules a recall
notification for 12 months time. Your children and husband add into your notes that your decision-
making is consistently unsafe and that your ability to communicate is deteriorating. You have started
wandering more often. Your care team use the messaging tools in Epic to determine a course of action.
They recommend that you move into a rest home. Your care team create a report for the Geriatrician
who endorses the request for subsidised aged residential care. A report is provided to your aged care
facility, which details your medical history, medication and care plan. Alzheimer's is determined as the
cause of dementia. A care team is notified through the Alzheimer’s care plan. GP refers you to ADHB.
Your GP receives a notification that pops up when they log into Epic, stating that you are on the waiting
list. You have been under investigation for dementia and you also have hearing problems. You and your
family request further investigation in Auckland and an opinion on what has happened to date. You take
a trip to the U.S. to celebrate your birthday. You roll your ankle while out partying. The clinicians can
access your info through care everywhere and see you previously had surgery on the ankle. Happy 70th
birthday! You’re 50! You have a positive pregnancy test. Schedule an appointment with your GP through
MyChart. GP orders a blood test during your visit discusses that due to your age you are classed as high
risk. You receive a text message reminding you to get a for flu vaccination. Obstetrician views results of
your ultrasound before your appointment. You get a promotion so you and your husband move to
Whangarei. Register on MyChart for a local GP. Have telehealth appointment with obstetrician. Approve
genomic testing for breast cancer, results show above average risk to breast cancer which is added to
her file which will be monitored throughout your lifetime. BONUS: This information will also help with
population health analytics for the region. You have a mole that has changed shape and is a bit darker
than usual. You look up some info on the patient portal and think it is worth getting it checked. Schedule
appointment through MyChart. GP is concerned about it and suspects it may be Melanoma. He submits
an HSC referral in Epic. You receive an appointment time to attend an urgent biopsy to be done at
Whangarei hospital. The surgeon sees on your file your historical reaction to codeine. You’re home.
Access information on wound care and videos through the patient portal. The report from the surgery
shows you require further surgery to remove the Melanoma, but it has not metastasised so won’t
require chemotherapy. You have a baby girl! You receive options in MyChart for an appointment time
for your ultrasound and obestetrician appointment. You tell your GP you would like an obstetrician as
your LMC. GP makes referral through Epic. Enters in your blood pressure and BMI so they’re accessible
to the obstetrician. Also adds referral for antenatal and anaesthetic assessment at Auckland Hospital.
Under medications he adds he’s given you a prescription for Folic Acid. Lastly he submits a referral for an
ultrasound. Happy 45th birthday! You’re 40! Midwife enters assessment into Stork. START Follow a
patient’s life journey through a single shared electronic health record The NEHR Game of
Health System CFO Infographic
1. COMPETITIVE ADVANTAGE To truly stand out in your market, CFOs should leverage emerging
technologies to create new healthcare delivery models, increase operational efficiencies, and strengthen
relationships with community partners. Download full CFO Priorities Report. © 2015 SCI Solutions. All
rights reserved. This data is from a 2014 survey on CFO priorities and strategies for revenue growth,
costs control, and community collaboration. 59% of CFOs plan to drive out costs by better managing
provider utilization 56% of CFOs believe centralizing and standardizing admin functions will drive out
costs $3.2 Billion By the end of 2019, patients booking appointments digitally will deliver $3.2 billion in
revenue. 92% of CFOs believe revenue growth is reliant on community partners 51% of CFOs expect
revenue growth by reducing network leakage 16% of CFOs never expected a return on their EHR
Delayed EHR & MU investments drastically impacted 94% of struggling hospitals 2005 64% Inpatient
2014 35% Inpatient The hospital profit base 10 years ago was 64% inpatient & 35% outpatient SCI
Solutions empowers communities by virtually integrating business processes across provider networks
to coordinate patient care and improve outcomes. scisolutions.com CFO PRIORITIES in Today’s New
Value-Based System of Care Today that has « FLIPPED »   EHR
How patient scheduling_helps_physicians_improve_revenue
1. How Patient Scheduling Helps Physicians Improve RevenueIncrease Revenue through Patient
SchedulingManaging appointments and keeping track of patientschedule information takes up the
valuable time ofphysicians. But this process cannot be avoided. This iswhere medical professionals can
benefit from patientscheduling system. With these timely and accuratepatient appointment scheduling
services healthcareprofessionals can manage their business proactivelyand improve productivity as well
as revenue.With patient scheduling system, you can • Schedule appointments of patients for multiple
services • View calendars • Print schedules and forms • Customize your scheduler • Keep track and
analyze the performance and utilization of the valuable resources of personnel, facilities, and
equipmentNo-shows reduce the throughput of the clinic and create wastage of time among staff.
Inaddition, revenue might be lost due to no-shows. By using patient appointment scheduling,you can
considerably reduce no-shows and enjoy a significant increase in accounts receivableand decrease in
data entry labor expense. 1
2. Effective patient scheduling can help your practice work smarter, boost revenue, and
improvepatient satisfaction by delivering greater flexibility in scheduling appointments. It
enableshealthcare enterprises to streamline information flow, improve operational efficiency,
increaseproductivity, reduce overhead costs, optimize cash flow and ultimately increase
revenue.Features of Patient Scheduling • Locate appointments by date, time, resource, procedure,
location or provider • Schedule multiple patient appointments at the same time • Detailed history for all
appointment changes • Appointment confirmation • Simultaneously schedule appointments for
multiple doctors, technicians and /or facilities • Identify and reduce the impact of overtime and
cancellations • Track no-shows and cancellations • Select the next available appointment based on
patient preferences • View daily, weekly, and monthly calendars • Extensive customization – customized
screen settings, user defined appointment for each healthcare provider • Schedule recurring patient
appointments • Simplify appointment rescheduling and cross-scheduling • Facilitates group scheduling •
Schedules delivered to PDA or other handheld devices • Access and update patient account information
• Multi-user and 24/7 accessibility 2
3. Benefits of Patient Scheduling • Patient appointments can be made rapidly and accurately •
Increased revenue • Enhanced office efficiency • Improved patient satisfaction • Anytime, anywhere
availability • Reduced financial overhead • Improved productivityConsidering the various benefits of
patient appointment scheduling services, a wide range ofhealthcare entities including hospitals, private
practices, outpatient clinics, group practitioners,long term care facilities, individual physicians, nursing
homes, acute care facilities, rehabclinics and multi-specialty practices outsource their appointment
scheduling work toknowledgeable and experienced outsourcing companies.For More
Information:OutSource Strategies InternationalUnited States Main Office8596 E. 101st Street, Suite
HTulsa, OK 74133Phone 800-670-2809http://www.outsourcestrategies.com 3
The Changing Role of Healthcare Data Analysts
1. The Changing Role of Healthcare Data Analysts— How Our Most Successful Clients Are Embracing
Healthcare Transformation
2. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would
appreciate a Health Catalyst citation. Data Analyst Roles in Healthcare Healthcare data analysts will play
a central role in the transformation of the industry. What follows is an exploration of the evolution to
value-based care and the changing role of data analysts Our most successful health system clients are
making this cultural transformation happen.
appreciate a Health Catalyst citation. The Importance of Analytics Performance improvement in the
healthcare industry has grown into a national movement, driven by: Costs and Quality Aging Population
and Longevity Demand for Healthcare Value and Transparency Population Health Management
appreciate a Health Catalyst citation. The Importance of Analytics At the core of healthcare
transformation is data-driven quality improvement. Healthcare analytics is a must for all major initiatives
underway to address value- based care in an automated, cost-effective/efficient manner.
appreciate a Health Catalyst citation. CHIMES Survey Health Catalyst recently surveyed members of the
College of Healthcare Information Management Executives (CHIME). The survey revealed: Consumers
will demand higher quality as they pay for a larger portion of their healthcare costs— and as quality,
cost and satisfaction metrics become more transparent through digital and social media.
appreciate a Health Catalyst citation. CHIMES Survey Healthcare analytics is the highest IT priority of the
survey group. Survey Results % Healthcare IT Priorities 54 Healthcare analytics 42 Population health
initiatives 30 ICD-10 29 Accountable care/shared risk initiatives 11 Consolidation-related investments
**Specific survey results highlighted on following slide
appreciate a Health Catalyst citation. CHIMES Survey CHIMES survey results—IT infrastructure
investments
appreciate a Health Catalyst citation. CHIMES Survey CHIMES survey results—the importance of
analytics The survey group overwhelmingly saw analytics as important to their organizations.
appreciate a Health Catalyst citation. CHIMES Survey CHIMES survey results—analytic drivers
appreciate a Health Catalyst citation. HAS Survey Health Catalyst conducted a recent survey of attendees
at the Healthcare Analytics Summit (HAS) Session: Getting the Most out of Your Data Analyst. The survey
data showed how important data analysts are to their organizations.
appreciate a Health Catalyst citation. HAS Survey Ninety percent claimed the role of data analyst is
either very important or important
appreciate a Health Catalyst citation. HAS Survey 79 percent of data analysts spend more than half of
their time gathering versus analyzing data
appreciate a Health Catalyst citation. The Importance of Analytics For data-driven healthcare
transformation to succeed, the paradigm must shift. To deliver their true value, analysts need to spend
the majority of their time analyzing rather than gathering data.
appreciate a Health Catalyst citation. The Future Role of the Healthcare Data Analyst Analysts must
move from gathering and collecting data to analyzing data and being part of performance improvement
teams. Their role will be to work on collaborative, multidisciplinary teams with clinicians and operational
leaders to develop the best presentation of data for consumption across the organization.
appreciate a Health Catalyst citation. The Future Role of the Healthcare Data Analyst Tomorrow’s
analysts of will interpret data daily to identify processes needing improvement. Their analyses will
identify gaps and include recommended actions that help drive improved performance outcomes.
Another recent survey confirmed that most business leaders and data analysts support this vision.
appreciate a Health Catalyst citation. Health Catalyst Newsletter Survey Newsletter survey results—BI
and data analysts’ responses to ideal time spent in front-end work
appreciate a Health Catalyst citation. Health Catalyst Newsletter Survey The newsletter survey asked
respondents to describe a time when they or their team used data and analysis to make a positive
impact on a patient or a process. It also asked them what they thought about the impact of their work.
Here are verbatim examples of the feedback: Can you describe a time where you or your team used data
and analysis to make a positive impact on a patient or a process? What inspired you? We are currently
using BI data for population health and outreach calls. Getting patients the care that is needed. We
measured and ultimately reduced heart failure readmissions. We developed daily operational patient
follow-up views to enhance communication between 64 teams to ensure patients receive timely follow
up care. Able to see the relief of patients when they knew they had the critical medication information
clarified by a pharmacist during a medication reconciliation encounter. We showed the team data and
trend lines to assess effectiveness of their intervention to reduce readmissions. Getting buy-in from
those most resistant to change.
appreciate a Health Catalyst citation. Health Catalyst Newsletter Survey Can you describe a time where
you or your team used data and analysis to make a positive impact on a patient or a process? What
inspired you? We often provide data used for analysis by performance improvement teams to help them
develop better workflows. We frequently discovered things happening that were surprises. We were
working on a sepsis program and we provided data that was used to help with predictive analytics. The
knowledge that we were saving people’s lives and helping our organization succeed. Utilized data points
to improve moving the patient through delivery of care. Improved staff and patient satisfaction. Recent
orthopedic project where devices, blood usage, CPM usage and Foley catheter removal issues were
analyzed and reductions in cost were received Ability to analyze provider practices that weren’t
evidence-based Tracking compliance with best practices around pressure ulcer minimization. The actual
measurable direct impact that BI had on patient care. Improving outcomes for diabetic patients. The
patients’ appreciation.
appreciate a Health Catalyst citation. Health Catalyst Newsletter Survey Can you describe a time where
you or your team used data and analysis to make a positive impact on a patient or a process? What
inspired you? Reducing the defect rate on patient home medication lists has greatly impacted patient
safety in general and allowed competency feedback and improvement to front line staff. Seeing happy
faces on patients, nurses, pharmacists, physicians. As the project produced positive results, senior
leadership became more engaged and enthusiastic. Chronic disease management and monitoring tools
with data-driven modeling to: (1) identify non-compliance, not at goal parameters and at-risk
populations, (2) help create population health-based care delivery processes to improve outcomes, and
(3) create processes to help align workflows at the point of care. Enhancing patient and provider
experience in healthcare delivery methods via improved technological interfaces. Not only are analysts
happier with their roles and pleased with their contributions, clinicians are happier as well.
appreciate a Health Catalyst citation. Health Catalyst Newsletter Survey When asked in the survey how
analysts are helping the teams, we received numerous examples, including: Our Patient Centered
Medical Home team gets data and identifies gaps in care. We are reaching out to patients in need. We
have implemented a team admission process through analytics. We reduced readmission rates and
improved length of stay for most frequent diagnoses. We pull data from patient satisfaction tools to
monitor our improvement in communication with patients and families about delays.
appreciate a Health Catalyst citation. Technology Solutions for Healthcare Data Analysts Data analysts
can’t fill this new role without technology that can take over the heavy lifting of gathering and
disseminating data. Analytics platforms—like the Health Catalyst Late-BindingTM Data Warehouse and
analytics applications have opened new frontiers for data analysis. In the newsletter survey, we asked
respondents to identify expectations of a healthcare analytics system:
appreciate a Health Catalyst citation. Health Catalyst Newsletter Survey
appreciate a Health Catalyst citation. Benefits of Analytics Our most successful clients are helping data
analysts and BI teams achieve these benefits by implementing foundational analytics tools such as:
Source systems that support SQL queries. A healthcare enterprise data warehouse (EDW) Business
intelligence development tools to build meaningful visualizations.
appreciate a Health Catalyst citation. Common Concerns of Healthcare Data Analysts Despite the
availability of these new and powerful tools, many data analysts have trouble reconciling the enticing
new vision of their role with the realities of their workload. Many analysts feel like they can hardly keep
their heads above water as they tackle their ongoing report queues.
appreciate a Health Catalyst citation. Common Concerns of Healthcare Data Analysts *Newsletter survey
results—common BI concerns
appreciate a Health Catalyst citation. Common Concerns of Healthcare Data Analysts Adding new
responsibilities seems impossible. Others simply feel uncertainty in the midst of change. What follows
are common concerns expressed by healthcare data analysts:
appreciate a Health Catalyst citation. Architecture Won’t Scale This concern has historically been
justified and validated, because traditional EDWs have been built using dimensional or enterprise
architectures that present significant challenges in a healthcare environment. Here is a brief overview of
why these architectures have not scaled well in healthcare.
appreciate a Health Catalyst citation. Architecture Won’t Scale Enterprise model: In this approach, the
goal is to model the perfect database from the outset—determining in advance everything the
organization would like to be able to analyze to improve outcomes, safety and patient satisfaction. This
is the right approach if the organization is building a new system in a vacuum from the ground up.
appreciate a Health Catalyst citation. Architecture Won’t Scale Enterprise model: But in the reality of
healthcare, organizations are not building a net-new system when they implement an EDW. They are
building a secondary system that receives data from systems already deployed.
appreciate a Health Catalyst citation. Architecture Won’t Scale Independent data mart: Organizations
start small, building individual data marts as they need them. If the organization wants to analyze
revenue cycle or oncology, they build a separate data mart for each, just bringing in data from the
handful of source systems that apply to that area.
appreciate a Health Catalyst citation. Architecture Won’t Scale Independent data mart: There are three
major drawbacks. 1. With isolated data marts, there is no atomic-level data warehouse to build
additional data marts in the future. 2. This method bombards source systems unnecessarily and requires
redundant feeds from each source system. 3. As data is brought into each independent data mart, it is
mapped into the predefined data model- inhibiting analytics adaptability.
appreciate a Health Catalyst citation. Architecture Won’t Scale An EDW architecture has been developed
for healthcare that avoids these pitfalls and allows the system to scale easily. This model—called a late-
binding EDW—is an adaptive, pragmatic approach designed to handle the rapidly changing business
rules and vocabularies that characterize the healthcare environment. This architecture is visualized on
the following slide.
appreciate a Health Catalyst citation. Architecture Won’t Scale Adaptive Data Warehouse
appreciate a Health Catalyst citation. Job Security Concerns Healthcare analytics is on the rise, and
executives see data analysts as playing a valuable role in data-driven healthcare transformation.
Removing the report queue from their duties will not put data analysts out of work. Analysts will
become part of multidisciplinary teams and apply their skills to improving performance outcomes.
appreciate a Health Catalyst citation. Increased workloads The potential for an increased workload may
seem daunting. Fortunately, the combination of a late-binding EDW and easy- to-use visualizations will
take a lot of pressure off data analysts. These technologies enable self- serve analytics. Clinicians will use
the data directly allowing analysts to work on more interesting analytical needs.
appreciate a Health Catalyst citation. Changing Care Delivery in a Large Health System The first example
is shared by Dr. John Haughom, currently a senior advisor at Health Catalyst. Dr. Haughom was senior
vice president of safety and quality and, later, CIO for a health system that spanned three states in the
Northwest. His job was to support 23,000 physicians and 11,000 employees.
appreciate a Health Catalyst citation. Changing Care Delivery in a Large Health System Dr. Haughom led
a 400-person department, 70 percent of whom were IT. During his tenure, the health system
implemented analytics technology to drive better quality. Prior to that, his group was producing tens of
thousands of reports, most of which went into binders that nobody looked at. It was not an effective use
of his team’s resources or data.
appreciate a Health Catalyst citation. Changing Care Delivery in a Large Health System To be successful,
the culture of the organization had to change and data analysts were integral parts of improvement
teams. Every member of these teams needed to share a common goal focused on improving the quality,
safety, efficiency and cost of care being delivered to patients.
appreciate a Health Catalyst citation. Changing Care Delivery in a Large Health System This healthcare
provider implemented a three-system approach to achieve success. An analytics platform Evidence-
based content Structure for implementing change through teams
appreciate a Health Catalyst citation. Changing Care Delivery in a Large Health System Dr. Haughom
shares: The light bulb clicked on for our analysts as they started to see improvement projects succeed
because of the support they were offering: direct correlation between the data they provided and
clinicians saving and improving lives.” Dr. Haughom found John Kotter’s eight- stage process a very
helpful resource.
appreciate a Health Catalyst citation. Changing Care Delivery in a Large Health System Kotter (2104). The
8-step process for leading change
appreciate a Health Catalyst citation. Transforming Analysts’ Roles in a Fortune 10 Technology Company
The second example comes from the technology sector where Paul Horstmeier, currently chief
operating officer and a Health Catalyst senior VP, served as a senior VP for Hewlett-Packard. He oversaw
a large organization of 720 people in 78 different countries with over 2,000 distributed IT systems.
Paul led his organization through a series of transformations, including restructuring the analyst roles.
He discovered the traditional ticket-oriented, report-queue model isolated the analysts, who were
already drowning in report production.
The first step in driving this change was to create a better technology infrastructure. To help analysts use
their time more effectively, he put them on teams where they were able to apply their data expertise
directly to business problems. The challenge was getting buy- in from the organization.
These are the steps Paul took to overcome this challenge: He found a senior leader who was empathic
to the big picture. Working with this leader he created a compelling message. He piloted the new system
with a dedicated and committed team. He ensured the team drove action that ensured success.
appreciate a Health Catalyst citation. Texas Children’s Hospital An EDW—Multidisciplinary Teams
Success Story One Health Catalyst client having considerable success with analytics implemented by
using multi-disciplinary teams is Texas Children’s Hospital. (TCH) In 2006 TCH set out on a quality and
safety initiative to develop a comprehensive enterprise-wide data management infrastructure.
Success Story Their first step was to implement an electronic health record (EHR) to collect raw clinical
and financial data. The EHR proved valuable as the means of digitizing care across the hospital. They
found the newly digitized clinical data difficult to extract and combine with other data sources in a
timely manner.
Success Story TCH’s Senior VP of IT, Myra Davis, M.E., recalls: Our clinicians thought that the EHR would
be a silver bullet to get the data they needed for quality improvement and operational reporting, and
they blamed IT when the information wasn’t forthcoming,” Davis was frustrated that IT was becoming a
“report factory” for TCH.
Success Story Beginning in September 2011, the hospital worked with Health Catalyst to implement a
healthcare EDW that would unlock data trapped in the EHR and other applications. With the EDW in
place and self-serve analytics rolled out to clinicians, IT receives fewer report requests and sees faster
reporting times.
Success Story TCH data analysts are serving as data experts on clinical and operational projects.
Accomplishments: • Improving clinical care outcomes • Driving labor cost savings and eliminating capital
expense • Implementing better processes for rolling out evidence-based guidelines • Streamlining
operations and care delivery in the radiology department • Integrating patient satisfaction data to
deliver better care and improved operational efficiencies
appreciate a Health Catalyst citation. More about this topic 4 Ways Healthcare Data Analysts Can
Provide Their Full Value Russ Staheli, Vice President, Analytics How to Avoid the 3 Most Common
Healthcare Analytics Pitfalls and Related Inefficiencies Russ Staheli, Vice President, Analytics Advanced
Analytics Holds the Key to Achieve the Triple Aim and Survive Value-based Purchasing Russ Staheli, Vice
President, Analytics Getting The Most Out Of Your Data Analyst (Webinar) John Wadsworth, Vice
President, Technical Operations Link to original article for a more in-depth discussion. The Changing Role
of Healthcare Data Analysts—How Our Most Successful Clients Are Embracing Healthcare
Transformation
appreciate a Health Catalyst citation. For more information: Download Healthcare: A Better Way. The
New Era of Opportunity “This is a knowledge source for clinical and operational leaders, as well as front-
line caregivers, who are involved in improving processes, reducing harm, designing and implementing
new care delivery models, and undertaking the difficult task of leading meaningful change on behalf of
the patients they serve.” – John Haughom, MD, Senior Advisor, Health Catalyst
appreciate a Health Catalyst citation. References American HospitalAssociation. (2014). Price
transparency efforts accelerate: What hospitals and other stakeholders are doing to support consumers.
Retrieved from http://www.aha.org/research/reports/tw/14july-tw-transparency.pdf Centers for
Medicare and Medicaid Services. (n.d.). Readmissions reduction program. Retrieved from
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-
Reduction- Program.html. Centers for Medicare and Medicaid Services. (2010). National health
expenditure projections. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-
Systems/Statistics-Trends-and- Reports/NationalHealthExpendData/downloads/proj2010.pdf. Curley,
A.L., & Vitale, P.A. (2012). Population-based nursing: Concepts and competencies for advanced practice.
New York, NY: Spring Publishing. Hall, H.R., & Rousell, L.A. (2014). Evidence-based practice: An
integrative approach to research, administration, and practice. Burlington, MA: Jones and Bartlett
Learning. Health Catalyst. (2014). Survey of CHIME members ranks analytics the number one IT priority.
Retrieved from https://www.healthcatalyst.com/news/analytics-outweighs-accountable-care-
population-health-icd-10-as-an-it-priority- say-health-system-execs/. Institute for Healthcare
Improvement (IHI). (2014). IHI TripleAim Initiative: Better care for individuals, better health for
populations and lower per capita costs. Retrieved from
http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx. Kotter International. (2104). The 8-
step process for leading change. Retrieved from http://www.kotterinternational.com/the-8-step-
process-for-leading-change/. Kotter, J.P. (1996). Leading Change. Harvard Business School Press. 53
Managing the hospital in-patient experience | Understanding where to invest
1. A Siegel+Gale webinar July 23, 2014 Managing the Hospital In-Patient Experience
2. 2 Our promise
S+G is the simplicity company. We define, design and deliver compelling brand experiences that are
both unexpectedly fresh and remarkably clear.
3. 3 We create
simplicity
Research Brand strategy Brand architecture Experience strategy Simplification Content strategy Content
development Naming Visual identity Environments Global implementation Employee engagement
Digital experiences
4. 4 Rolf M. Wulfsberg, PhD

Global Director, Quantitative Research   Nationally recognized expert in survey research with 44 years
of experience •  Author of the book Fact-Based Branding in the Real World: A Simple Survival Guide for
CMOs and Brand Managers. •  PhD and MA in statistics from the American University and BA in
mathematics and economics from Luther College (summa cum laude) •  Former Rhodes candidate and
Woodrow Wilson scholar •  Served as an expert witness before the U.S. House of Representatives and
the Pennsylvania Supreme Court !
5. 5 Rolf M. Wulfsberg, PhD

Global Director, Quantitative Research
6. 6 The in-patient experience affects a hospital from both an acquisition and retention standpoint
7. 7 An 8-step process for prioritizing touchpoints and subsequent investments in those touchpoints
1.  Create a journey map that identifies the various touchpoints
1.  Create a journey map that identifies the various touchpoints 2.  Create a list of various service aspects
within each touchpoint
within each touchpoint 3.  Measure satisfaction with the touchpoint and various performance aspects
within each touchpoint 3.  Measure satisfaction with the touchpoint and various performance aspects 4. 
Determine the importance of each touchpoint to the overall experience
Determine the importance of each touchpoint to the overall experience 5.  Determine the percent of all
patients who experience the touchpoint in a given period of time and the resulting impact on the
hospital
hospital 6.  Repeat Steps 4 and 5 for the performance aspects within each touchpoint to determine their
importance and impact
importance and impact 7.  Estimate the difficulty and/or cost associated with improvements to each
performance aspect
importance and impact 7.  Estimate the difficulty and/or cost associated with improvements to each
performance aspect 8.  Create a plan for short-term, medium-term and long-term improvement
investments
15. 15 Step 1:
Create a journey map that identifies the various touchpoints
16. 16 An example of a journey map

17. 17 Siegel+Gale’s nationwide hospital in-patient survey Last year, Siegel+Gale conducted a
nationwide survey of 500 patients or primary caregivers of patients who spent at least one night in a
hospital in the previous 6 months
18. 18 Siegel+Gale’s nationwide hospital in-patient survey 1.  Scheduling 2.  Emergency room 3. 
Admitting (non-ER) 4.  Signage and way-finding 5.  Physicians 6.  Nurses 7.  Technicians 8.  Hospital room
9.  Testing facilities 10.  Patient transport 11.  Food 12.  Treatment/Procedure 13.  Status updates 14. 
Discharge 15.  Billing The survey explored the in-patient experience with 15 touchpoints:
19. 19 Step 2:
Create a list of various service aspects within each touchpoint
20. 20 Example of service aspects for the hospital room touchpoint a.  Level of privacy I/my family
member was provided b.  Comfort of the room c.  Cleanliness of the room d.  Bathroom facilities e. 
Amount of room for visitors/ family f.  Noise level in the room g.  Availability of a working TV in the room
h.  Temperature in the room i.  Comfort of the bed j.  Adequacy of storage for personal items k.  Lighting
in the room l.  Visitor policies/visiting hours m.  Accessibility of call button and intercom to summon
assistance
21. 21 Step 3:
Measure the satisfaction with each touchpoint and each aspect of service within the touchpoint
22. 22 Traditional measurement focuses on a single touchpoint Typically, a hospital measures the in-
patient experience by conducting transactional surveys of patients who recently experienced a given
touchpoint. The problem with this approach is that the various experiences are not independent of each
other
23. 23 Consider the following example of a business traveler on her way to an important meeting 1.
After being delayed in traffic, she arrived at the kiosks to pick up her ticket only to learn that she has to
see a representative at the counter
After a long wait in the counter line, she learns that the ticket was issued incorrectly and has to be
reissued
She then encounters horribly long lines at the airport security checkpoint
Once through security, she realizes that her gate is at the end of a very long corridor
Upon arrival at her gate, she sees that her plane has already departed
She calls the airline customer service number to complain, but the damage has already been done: she
missed her meeting
29. 29 The result is an angry customer, but which touchpoint is to blame? If multiple touchpoints, how
do you quantify how much each contributed? •  The initial reservations representative? •  The counter
agent? •  TSA? •  The customer service representative? •  Someone or something else?
30. 30 Step 4:
Determine the importance of each touchpoint
31. 31 Traditional methods of prioritizing touch points Hospital staff discuss recent patient feedback,
complaints, etc., and identify touchpoints that generate the most “noise” The hospital conducts
transactional surveys and compares satisfaction to the stated importance of touchpoints
32. 32 Touchpoints for a hospital patient
33. 33 The fact that different patients touch different sets of touchpoints creates “missing data” ✔ H
✔✔H✔H✔H✔✔H✔HH
34. 34 Siegel+Gale’s nationwide hospital in-patient survey 1.  Scheduling 2.  Emergency room 3. 
Admitting (non-ER) 4.  Signage and way-finding 5.  Physicians 6.  Nurses 7.  Technicians 8.  Hospital room
9.  Testing facilities 10.  Patient transport 11.  Food 12.  Treatment/Procedure 13.  Status updates 14. 
Discharge 15.  Billing Take a minute or two and rank what you believe are the top 5 most important
touchpoints
35. 35 Nurses have the highest importance of the 15 touchpoints, followed by status updates and the
emergency room admission process 21% 16% 13% 9% 8% 8% 7% 7% 5% 3% 1% 1% 1% 1% 1% 0% 5%
10% 15% 20% 25% Share of Importance
36. 36 Step 5:
Determine the incidence of exposure and impact for each touchpoint
37. 37 Due to the low incidence of the emergency room among patients who stayed more than one
night, ER contributes only 1% to the overall NPS *Emergency room incidence low due to overnight stay
screening criteria
38. 38 Nurses and status updates are the highest contributors to NPS Share of Impact
39. 39 Touchpoint prioritization map
40. 40 Step 6:
Determine the importance and impact of various performance aspects
41. 41 Performance Aspect Map within the hospital room touchpoint

42. 42 Step 7:
Estimate the difficulty and/or cost associated with each improvement
43. 43 Performance Aspect Map within the hospital room touchpoint, by difficulty and/or cost
44. 44 Difficulty/Cost summary for hospital room touchpoint
45. 45 Step 8:
Create a short-, medium- and long- term improvement plan
46. 46
Q+A
47. 47 @siegelgale Today’s presenters: Rolf Wulfsberg, PhD Global Director, Quantitative Insights
rwulfsberg@siegelgale.com Jessica Kirk, Vice President jkirk@siegelgale.com Related links:
www.siegelgale.com We offer •  Research •  Brand strategy •  Brand architecture •  Experience strategy
•  Simplification •  Content strategy •  Content development •  Naming •  Visual identity • 
Environments •  Global implementation •  Employee engagement •  Digital experiences
48. siegel+galesiegel+gale The most important element nurses can contribute is responsiveness to
requests 48 1% 1% 3% 3% 4% 6% 11% 13% 15% 18% 25% 0% 5% 10% 15% 20% 25% 30% Explaining
my/my family member's situation in language that I could understand The access I/my family member
was given to the nurse(s) The extent to which it was clear that I was interacting with a nurse vs. a
physician, technician Willingness to answer my questions openly and honestly Friendliness of the
nurse(s) Frequency of the nurses' checkups Amount of time they gave me/my family member during the
stay Attentiveness of the nurse(s) The extent to which I felt the nurse(s) understood my/my family
member's situation Respect shown to me/my family member Responsiveness to requests and/or issues
Attribute Contribution – Nurses 8.58 8.88 8.68 8.74 8.73 8.73 8.88 8.85 9.01 8.82 8.98 Attribute
Satisfaction
49. siegel+galesiegel+gale Frequency and timing of Patient Updates with combat the anxiety that
affects satisfaction 49 5% 10% 17% 18% 22% 27% 0% 5% 10% 15% 20% 25% 30% Consistency of
information received from various hospital staff members The extent to which the hospital staff
communicated about my/my family member's situation in language I could understand Willingness of
the hospital staff to answer questions about my/my family member's condition openly and honestly
Availability of technology to communicate status updates (e.g., beepers, electronic status boards, etc.)'
Length of time between a procedure/test/etc. and receiving a status update from the hospital staff
Frequency of updates about my/family member's situation Attribute Contribution – Patient Status
Updates 8.58 8.88 8.68 8.74 8.73 8.73 Attribute Satisfaction

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