health IT; performance management

1. Performance monitoring using data
(pay for performance projects)
Prof. Steven Boyages
MB BS PhD FRACP FAFPHM DDU
Wednesday, 31 July 2013
Clinical Professor The University of Sydney,
and The University of Western Sydney

2. Summary
• HIT allows rapid processing and storing of large amounts of
information
• The term “ Big data” describes the way we deal with the
astonishing accumulation of digital information which is often
stored in large unstructured data repositories.
• New tools such as business intelligence (BI) have emerged to
organise and interpret this vast array of information with benefits in
public health, research, patient care and hospital operational
systems.
• Performance monitoring of systems, providers and patients will
improve quality, experience and value for money
3/18/2022 2

3. Performance
• System level
– Community
– Group of hospitals
– Hospital
– Clinic
– Region
– State
• Provider level
• Patient level
• “Pay”
– Incentives
• Gainsharing
– Penalties
• Funding
– Case mix
– Coding
– Diagnostic Related
Groupings
• Linked to targets

4. The impact of public reporting
• There is strong evidence to support public reporting on
the performance of health care organisations. A
number of other countries are seeing the benefits that
it can bring, particularly when linked to health systems
improvement as part of an overall quality framework.
• Public health performance reporting offers significant
opportunities to improve the overall performance of
Australia’s health system, and achieve better
integration between hospitals and primary health care.

5. Nearly every transaction or interaction
leaves a data signature

6. Someone somewhere is capturing and storing

7. Sheer scale has far exceeded human
sense-making capabilities

8. At these scales patterns are often too subtle and
relationships too complex or multi dimensional to
observe by simply looking at the data.

9. Data mining is a means of automating the
process to detect interpretable patterns

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It helps us see the forest without getting
lost in the trees

11. 3/18/2022 11

12. Google Flu Trends

13. 3/18/2022 13
Google Trends Michael Jackson

14. 3/18/2022 14
Facebook can predict your breakups

15. New methods of scientific inquiry
• While it is attractive to contemplate the way
everything may become connected to everything
else, it presents a number of large challenges.
• The lab research model has been important for
over a century in both scientific advancement
and product development; soon it may also have
to accommodate a search for truth based only on
pattern-spotting.
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16. 3/18/2022 16
Your personality can be predicted

17. 3/18/2022 17
©2011 Healthcare Information
and Management Systems
Society
Eating Habits

18. Clinical Intelligence and Analytics:
Keeping Score in Health
18

19. Analogue Scoreboards
19

20. The Next Level:
Health Intelligence Systems
• Definition
 Responsive
 Agile
 Available
 Flexible
 Timely
Real time
Near Real time
Capability
Patient Care
 Safety
 Decision support
 Outcomes Research
 Patient Logistics
Performance Management
 State
 Area based
 Hospital/cluster/network
 Modality (scheduling)
 Bedside
20

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©2011 Healthcare Information
and Management Systems
Society
Table 2: Annual benefit paid by Medicare for
25-hydroxyvitamin D testing and percentage
increase since 2000
Year Annual Benefit ($) % Increase
2000 1,021,784 100%
2001 1,670,597 163%
2002 2,318,770 227%
2003 3,216,543 315%
2004 5,269,951 516%
2005 7,592,467 743%
2006 12,149,112 1189%
2007 22,621,733 2214%
2008 42,358,509 4146%
2009 67,643,016 6620%
2010 96,746,203 9468%

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b) Frequency of testing in individuals with more than one test
Frequency
of testing
per
individual
Number of
individuals
Cumulative
Percentage
Frequency
of testing
per
individual
Number of
individuals
Cumulative
Percentage
2 1026483 49.5 41 12 100
3 496225 73.4 42 11 100
4 251306 85.5 43 11 100
5 132173 91.8 44 10 100
6 71534 95.3 45 8 100
7 39857 97.2 46 6 100
8 22717 98.3 47 5 100
9 13165 98.9 48 5 100
10 7790 99.3 49 5 100
11 4665 99.5 50 4 100
12 2881 99.7 51 3 100
13 1826 99.8 52 3 100
14 1196 99.8 53 3 100
15 809 99.9 54 3 100
16 555 99.9 55 3 100
17 390 99.9 56 3 100
18 288 99.9 57 3 100
19 221 99.9 58 3 100
20 176 99.9 59 2 100
21 145 100 60 2 100
22 126 100 61 2 100
23 106 100 62 2 100
24 93 100 63 2 100
25 79 100 64 2 100
26 65 100 65 2 100
27 55 100 66 2 100
28 47 100 67 2 100
29 43 100 68 2 100
30 37 100 69 2 100

25. National Health Performance
Framework

26. General Performance Framework

27. Performance Indicators for Hospitals and Local Hospital
Networks

28. Emergency department performance in Australia

29. ED performance in Sydney

30. Summary
• HIT allows rapid processing and storing of large amounts of
information
• The term “ Big data” describes the way we deal with the
astonishing accumulation of digital information which is often
stored in large unstructured data repositories.
• New tools such as business intelligence (BI) have emerged to
organise and interpret this vast array of information with benefits in
public health, research, patient care and hospital operational
systems.
• Performance monitoring of systems, providers and patients will
improve quality, experience and value for money
3/18/2022 30

31. Needs
•Complexity
•Chronicity
•Severity
•Urgency
Benefits
•Improved experience
•Improved safety
•Improved clinical outcomes
Risks
•Increased clinical risk
•Privacy breach
Trust
•Design
•Credibility of information
•Security
•Privacy
•Ease of use
EHR
Adoption
Bottom up approach required for the
adoption of an effective EHR by patients