Welcome

Connecting Insights to Results: Healthcare analytics at SOC Telemed

# T C 1 8

Robyn Baek

VP of Analytics

Devdutta Bhosale

Director, Business Intelligence

Agenda

1. Background / Business Challenges

2. Analytics Strategy and Objectives

3. Systems Set up – Trial & Error

4. Key Lessons Learned

5. Use Case & Impact

6. Key Benefits

7. Next Steps with Self-Service Analytics

Background / Business Challenges

Our VISION as an organization is to transform healthcare by offering the highest quality telemedicine to healthcare systems and the patients they serve.

L A R G E S T P R O V I D E R

O F A C U T E C A R E

T E L E M E D I C I N E S E R V I C E S

F U L L - S E R V I C E

I N N O V A T I O N C E N T E R A N D

T E C H N O L O G Y T E A M

2 0 0 + P R O V I D E R

P H Y S I C I A N P R A C T I C E

S E R V I N G O V E R 5 0 0

H O S P I T A L S N A T I O N W I D E

F I R S T A N D L O N G E S T - S TA N D I N G

T E L E M E D I C I N E O R G A N I Z A T I O N

T O E A R N J O I N T C O M M I S S I O N

A C C R E D I T A T I O N ( 2 0 0 6 )

2 4 X 7 X 3 6 5 C O V E R A G E

V I R T U A L H O S P I T A L

Business Challenges

• Silo departments vs. new management team

• No data warehouse, business intelligence or analytics function

• Reports were produced in Excel through manual, labor intensive

processes

• Therefore,

Business decisions could not be supported by data or

analysis in a timely manner

Low client satisfaction

X 117..and growing

every month

Q3 Q4 Jan Feb Mar Apr Avg Arrival to Call 15.0

Total Consults 399 448 161 195 218 236 Avg Callback Time 3.0

Avg Hos Call to Order 33.2

93% 92% 98% 96% 97% 98% 18.5

Routine - Within SLA (Video) 100% 100% 100% 100% 100% 100% 66.7

Consults Within SLA (Phone) 100% 100% 100% 100% 100% 100%

Apr 2015 Apr 2015 Apr 2015

Client 55% 55% 22% 23% 232.3 222.4

SOC 37% 38% 30% 30% 86.1 87.0

*This report contains illustrative data.

Stroke % tPA Rate Avg Activation

2014 2015 2015 DTN Statistics

Emergency - Within SLA (Video) Avg Order to Delivery

Avg DTN Time

80

120

160

200

240

280

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr

2014 2015

Consult Volume

93% 92% 98% 96% 97% 98%

7% 8% 2% 4% 3% 2%

0%

20%

40%

60%

80%

100%

Q3 Q4 Jan Feb Mar Apr

2014 2015

Video Time Review - Emergency ConsultsWithin SLA Outside SLA

62%

38%

Consult Priority Mix

Emergency Routine

55%

45%

Overall Stroke Volume

Stroke % Non-Stroke %

23%

77%

tPA Stroke Volume

tPA Stroke Non-tPA stroke

Additional Notes for Consideration: The consult volume for ABC Corporate has increased by 75 consults from January to April of 2015, a 32% increase. Further rese arch is warranted to improve overall SLA adherence rate. This may warrant additional physcian onboarding and/or scheduling in affected states to account for the incre ase in consults for the past 4 months and may require further consideration for the tiered-pricing structure. On average for the last 10 months, 38% of cases initiated at ABC were Routine cases, which indicates possible consideration for an addition of General Neurology Service Contract to account for non-time sensitive neurological cases to offset case loads for overall improvement in efficiency for time-sensitive emergent neurological cases.

Concluding Remarks/additional account analysis: Overall, ABC has seen an increase in consults from January of 2015 to April of 2015, an average of 32% increase. It is noted that the average arrival to call time is 15 minutes. Once a code stroke is identified we recommend contacting SOC to initiate a consult immediately. Additionally the hospital call to order time is 33 minutes. A review of current Stroke and CT protocols is recommend to help reduce this time in order to optimize the overall door to needle time. The average order to delivery time is 18.5 minutes and consideration should be given to reeducation opportunities for staff or a visit from a Genentech rep. which SOC can help facilitate. Facilities should consider mixing tPA bedside rather than in the pharmacy as this will reduce the time to delivery. For all consults, emergent and routine, the average activation time for 2015 for was 254.8 minutes. This is 2.5 times the average activation time for all other SOC clients. This could be due to specific outliers in certain cases. Nearly 2/3 of all consults called in from ABC were classified as emergent cases.

CBT Analysis: In Q3 of 2014, the adherence rate for Callback Time (CBT) SLA was 99%. In April of 2015, SOC was able to increase the adherence of CBT SLA to 99% within SLA (overall 1% increase in meeting SLA objectives for all consults). For the last 4 months, SOC was able to meet the initial call back time SLA objective for an average of 99% of all consults. This was achieved due to the addition of improved clinician case

management protocol, implemented in August 2014, allowing our clinicians to respond by phone for purposes of triage within the 15min. SLA objective.

VT Analysis: In Q3 of 2014, the adherence rate for Go to Video Time (VT) SLA was 92% for Emergent cases. In April of 2015, SOC was able to increase the adherence of VT SLA to 98% within SLA (overall 6% increase in meeting SLA objectives). Further research is warranted with an analysis of particular incidents for these consult delays. For the last 4 months, SOC has met VT SLA objective for an average of 100% of all

Routine cases . These improvements were achieved due to the addition of improved clinician case management protocol in August 2014, which enhanced the case triage process; for an overall improvement in efficiency by having patient information, triage information, necessary medical scans, and technical components tested to ensure readiness for our physicians prior to the examination of the patient via video.

Analytics Strategy and Objectives

Strategy and Objectives

Goal:Driving actions and results that transform healthcare industry by improving clinical outcomes and operational efficiency through fast, transparent, accurate, actionable data.

Tableau Server:A single point to access data. Single source of truth. An online portal accessible 24/7/365 for hospitals, physicians, clinicians, and internal employees.

What kind of actions and results?

• Operational improvement: SLA adherence, time to video, productivity

• Clinical improvement: Door-to-needle time, case mix, tPA administrations, discharge rates,

chart review

• Client satisfaction and retention: Utilization trend, health score

• Growth:

Demo dashboards

• Culture of transparency and data-driven business decisions

Systems Set Up

Telemed IQ Insights

Physicians- External- Internal

SOC Customers

SOC Employees

Biggest Challenge –Data security for different stakeholders.

BEFORE

AFTER

We had more than 600,000 excel files on our shared drive!!

Tableau Server(Production)

External Site

Public - Dept

Private - Dept

Private- Joe Smith

Users added to “Tableau Users” AD group with auto sync to Tableau

All Internal Users

Projects

Public Dept

CLP Summary

Exceptions

CSV Report

Demo

AD User Groups Projects

Real-time TV

Private - Dept Group

Joe Smith User

All External Users

Visual Analytics

Customer X

Demo User

Interactive Report

Workbooks Workbooks AD Groups

Drawbacks

Sites follow “share nothing” principle,

however, breaks the “DRY”

(do not repeat yourself)

approach for content

Internal Site

Content & Site Structure – Before – Multiple Sites

Base Reports/ Extracts

Visual Analytics

Customized

Demo

Interactive Report

Tableau Server(Production)

Public - Dept

Private - Dept

Private- Joe Smith

All Internal Users

Projects

Public DeptReport

CLP Summary

Exceptions

CSV Report

Demo

AD User Groups Projects

Real-time TV

Private - Dept

Joe Smith User

All External Users

Interactive Report

Workbooks Workbooks

Single Site

Content & Site Structure – After – Single Sites

Base Reports/ Extracts

Visual Analytics

Customized

Demo

Interactive Report

All external reports use a hybrid security approach based on list of authorized users in every row and/or user’s group membership.

Users are authenticated using SAML (Azure AD) and MFA

External users receive email summary reports which uses row-level security.

These reports give provide a quick-overview of different reports and encourages engagement.

Data Security – Key Takeaways

1. By setting Default permissions to “None,” users do not receive any permissions unless they are

explicitly granted.

2. All External users are in one parent AD group which is declined all permissions.

This sets the template for new projects only and minimizes the impact of human errors.

Key Learnings and Future Improvements• Setting up BI environment can benefit from applying software design principles – modularity,

encapsulation, component reuse, and “iteration” :-)• Row-level security can be easy to implement.• Multi-factor authentication is possible using Azure AD and SAML• Needs improvement on federated authentication and authorization for users from multiple

domains

Use Cases & Impact

Clinical Metrics Improvement – 1

Use Case

Partnered with a hospital to improve its

stroke program who was losing

neurologist coverage. Desired to meet

Joint Commission standard and continue

patient care.

Measurable Impact

Tableau dashboards provided insights

into operational workflow deficiency and

helped to improve door-to-needle time

from avg 57 minutes to 32 minutes which

decreases LOS and improved patient

outcome.

Clinical Metrics Improvement – 2

Use Case

Another hospital in jeopardy of losing

stroke certification due to lower than

required clinical metrics. Only 30% of

cases were meeting the goal (under 60

minutes door-to-needle).

Measurable Impact

Within a year, the hospital exceeded

goal (80+% under 60 minutes).

Feedback from the stroke coordinator

testifies that “easy to use” and “user

friendly” report was essential in

supporting her constant communication

and collaboration with her ED team.

Physician Performance Management

Use Case

Physicians work in silo and unaware of

their good/bad performance as well as

which metrics have bigger impact to

patient care.

Measurable Impact

• Physician productivity improved by

more than 200%

• Physicians themselves proactively

discuss ways to improve performance

Client Satisfaction and Retention

Use Case

Less than 20% of clients received

regular monthly reports, produced

manually in Excel. Unsatisfied with

operational performance. Client retention

was decreasing.

Measurable Impact

• NPS score improved by ~50 points

• Retention rate improved by ~600 bps.

• No terminations due to operational

performance since mid 2016.

• 100% clients receive standard

reporting package monthly. More than

half of clients have Telemed IQ

Insight account with increasing

engagement (260+ accounts).

Profit ImprovementUse Case

No visibility into future demand leading

to less than optimal scheduling of

physician hours. Poor SLA performance

due to difficulty in monitoring real-time

data.

Measurable Impact

• Profit margin improvement by more

than double (CAGR 24%)

• Demand & supply optimization drove

operational efficiency

• Physician productivity improved by

more than double (CAGR 20%)

• Profit and productivity improved while

improving quality (Current SLA

adherence = 98%)

Culture Shift from Silo to Radical Transparency

Use Case

Silo departments vs. new management

team. Business decisions could not be

supported by data or analysis in a timely

manner.

Measurable Impact

Culture of transparency and data-driven

business decisions.

May 2018

IVC Reversal Rate

Your Organization

80%

60%

40%

20%

5 10 15 20 25 30 35

IVC Reversal Rates by State

42%

Lessons Learned & Key Benefits

Lessons Learned & Tips

1. There is no such a thing as “user error.” Be user-centric.

2. Invite users to interact with data (self-service) through design and features

Action filters User-defined benchmarking

3. Build a culture of data. Top down approach helps.

Constant presence of data through multiple avenues

Obsess over sequential improvement in key metrics

Celebrate and quantify success (ROI)

Goal: Driving actions and results that transform healthcare industry

Key Benefits

• NPS score improved by ~50 points

• Retention rate improved by ~600 bps

• Profit margin improvement by more than double (CAGR 24%)

• Physician productivity improved by more than double (CAGR 20%)

• Profit and productivity improved while improving quality

Thank you!

#TC18

Robyn: rbaek@soctelemed.com

Devdutta: dbhosale@soctelemed.com

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