Quality, safety focus no longer an option

BOSTON—The changing healthcare landscape means providers must “remake the delivery system to survive and succeed in the new healthcare world,” said Robert M. Wachter, MD, the Lynne and Marc Benioff Endowed Chair in Hospital Medicine at the University of California, San Francisco, speaking at the Big Data Healthcare Analytics Forum on Nov. 20.

“We can’t just have someone deal with it—we have to actually transform care.” Wachter said he never would have guessed how much change would occur in 15 years when considering Meaningful Use, value-based purchasing, accountable care, readmission penalties and more.

There was a steady progression from weak pressures but now there is “a confluence of forces.” The money at stake by 2017 is 8-10 percent of Medicare revenues. “No hospital can survive that pay cut.”

Big data fits in by helping providers find targets to work on, looking at performance and identifying patients at risk who will benefit from early intervention. The creation of new measures will require assessment and calls for a learning healthcare system that will impact providers locally and nationally, he said. Randomized controlled clinical trials was the old method. The new method is looking at variations across large populations. Wachter said it’s a short step from online shopping when buyers get product suggestions based on their past purchases to a system saying a certain patient cohort has done well on a particular drug.

New ways to visualize data also will have an impact, he said. While there is a certain “wow factor,” he said some of it “probably has real value.” New ways to present problems and answers can help inform improvement projects. He cited his own organization’s struggles with the appropriateness of transfusions. New guidelines have markedly lowered the hemoglobin thresholds for transfusions which was a surprising change, he said. Different ways of presenting data can help make tracking easier by focusing on individual providers, by service line and more. “Tabular representation is a very new way of visualizing data and can be extraordinarily powerful in targeting interventions.”

How practice deviations are handled will become a battleground, Wachter predicted. Getting the balance right between the guidelines and accommodating true outliers “is one of the trickiest issues we face. It’s exciting but concerning. We don’t want to pay more attention to the patients in the computer than the patient in the bed.”