Patient Self-Service: Duke University HealthSystem uses Analytics to Deliver Optimal Care

Duke University HealthSystem gets smarter forits patientsAs the need for healthcare transformation becomes more apparent,Smart is…some of the more prominent themes that have begun to emerge are anincreased focus on prevention and results, the need for safer practicesDelivering more personalizedand a more active role for the consumer in making healthcare choices.care, stimulating a deeper levelSteady growth in the number of healthcare transformation initiatives—of patient engagement in health-involving both large and small providers—reflects an increased focuscare managementon these imperatives by many healthcare providers.The instinct to innovate has long been apart of Duke University Health System’sAmong a subset of the most innovative providers, the quest for a betterorganizational DNA. Ahead of the curvein the healthcare industry, Duke recog-way to deliver healthcare services has been an ever-present goal. Northnized the need for a new level ofCarolina’s Duke University Health System is one such organization.patient engagement for healthcareDuke prides itself on a deeply rooted culture of innovation that mani-transformation initiatives to achievetheir full potential. What makes suchfests itself in every part of its organization, from clinical operations thatengagement possible is a deep per-are consistently ranked among the top 10 in the United States, tosonalization capability enabled byworld-class academic and research capabilities that drive breakthroughpowerful healthcare analytics. It’s partof Duke’s strategy of becoming a discoveries.continuously learning healthcareprovider—and a reason Duke’s qualityA foundation for changeratings consistently rank in the 100thpercentile nationally.About four years ago, Duke framed an ambitious plan to change theBy drilling down into its millions of clini-way it delivered healthcare. As with other healthcare organizations, ancal records, Duke was able to develop aimportant part of Duke’s transformation would involve the addition ofpredictive model for identifying high-a series of new clinical information capabilities, such as physician orderrisk scenarios, and use those insightsto improve training, which ultimatelyentry. What made Duke’s approach different—and, in many ways,improves patient safety.ahead of its time—was its strategy of implementing new capabilities inadherence to a broader transformation framework. But this isn’t abouttechnology as much as it is a set of guiding principles that Duke sees asthe foundation of the future of healthcare delivery.The first is the principle that meaningful changes to healthcare deliv-ery can occur only when individuals are fully engaged in the Business benefitsexperience—and not only when they’re sick. For Duke, this means ●Increase in patient engagement andgiving its patients the means to proactively manage every aspect ofsatisfaction through proactive healthmanagementtheir health by keeping them informed on a personal level and helpingthem to make the right decisions. The second principle is that Duke●Improved clinical outcomes anditself needs to become a continuous learning organization, able to increased patient safety through theability to define best clinical practicessystematically adapt its practices by rapidly determining which treat-ments and approaches work best—and which don’t—and changing●Improved ability for patients to manage chronic diseases throughcourse as needed. What binds these two qualities together is the essen-personalized health coachingtial role that intelligence plays in making them work, since it provides●Improvement in workflow efficiencythe basis for personalized interaction with patients, as well as the“brains” required to continually identify and apply the most effective●Increase in NIH grant funding due toimproved research capabilitiesclinical practices.Duke CIO Asif Ahmad had been down the healthcare transformationroad before. Brought on board to direct Duke’s transformation activi-“In healthcare transfor-ties, Ahmad was determined to apply the lessons and insights he hadmation, IT has to haveacquired in previous projects with similar goals and challenges.Technology issues were only a small part of the equation. Perhaps thea very solid footing as anbiggest overarching issue was the need to establish support for chang-independent driver ofing deeply rooted practices and building confidence among key stake-holders that such an ambitious goal could be achieved. To that end,strategic thinking.”Ahmad took a methodical series of steps that ultimately proved integralto the success of the project.—Asif Ahmad, CIO, Duke UniversitySmarter healthcare:Strengthening patient engagement through personalizationInstrumentedAll information related to a patient’s clinical activities is automati-cally stored in a central data repository, accessible by health analyticstools.InterconnectedPatients (and eventually caregivers) can access and manage healthinformation and services from a single healthcare portal.IntelligentDuke’s health analytics system continuously updates best clinicalpractices for specific illnesses, enabling physicians to deliver the opti-mal course of treatment.2Solution componentsThe inside story: Getting thereSoftware●IBM Cognos® BIRevising the governance model●IBM WebSphere® PortalOne of Ahmad’s first actions was to realign Duke’s IT governance●IBM InfoSphere™ DataStage®model. The most basic tenet behind Duke’s new thinking was that●IBM InfoSphere QualityStage™●IBM Lotus® Formsenterprise-wide transformation requires an IT governance frame-work that spans the entire Duke organization. Ahmad also main-Serverstained that as the mission focus of IT shifted from providing●IBM Power Systems™support to being “an innovation performer,” driving innovationServicesacross the enterprise, the profile of IT within Duke’s executive●IBM Software Servicesleadership had to reflect that. This resulted in two importantchanges to Duke’s IT governance model. The first was a consolida-tion of its department-specific IT resources into a new entity“What we’ve done withknown as Duke Health Technology Solutions, headed by the quality and patientCIO. The second was to make the CIO report directly to Duke’schancellor, effectively giving IT an equal footing with the financialsafety analytics is simi-and operational parts of the Duke organization.lar to what the airlineBuilding credibilityindustry has done—toAhmad realized that building a foundation of credibility was anmodel different clinicalabsolute prerequisite to gaining the support he would need to pur-scenarios and outcomes,sue a broader change agenda. His strategy was to start small—yetall the while working within the big picture. Over the first severaland use that to trainmonths, he and his team initiated a series of point projects, in theand educate our staff.”process assembling a string of successes that gave key stakeholdersa sense of what could be accomplished, and in so doing laying thegroundwork for driving broader changes.—Asif AhmadGive the patients what they wantAlthough Ahmad and his team had made the case for enablingcloser consumer engagement, the specifics—what that would actually mean in terms of services and capabilities—had yet to beestablished. To gain this insight, the team went straight to the bestpossible source: Real patients. In addition to conducting a series offocus groups, Ahmad’s team also worked closely with Duke’sPatient Advocacy Council (a group of patient volunteers who meetwith clinical leaders on a routine basis) to elicit both ideas andfeedback. Above and beyond the specific wish list that came backfrom the research was an overarching theme: That while informa-tion is an essential building block of enabling consumer involve-ment, intelligence—knowing what information to deliver andwhen—is the key to deep and lasting consumer engagement.3These lessons found their expression in the HealthView Portal, Duke’sone-stop source of healthcare information and services for its patients.HealthView synthesizes information from across the Duke enterprisefor presentation through a unified portal interface that provides accessto services such as the ability to request and book appointments, paybills, view personal medical information and history, and completeappointment registration in advance of appointments to save time.Duke also sees HealthView as an important communication conduit,and an ideal venue for leveraging intelligence. In the recent flu season,for example, Duke was able to identify 120,000 patients at risk forcomplications from the H1N1 virus and communicate a personalizedprevention strategy to them. In the same session, patients could thenlearn which clinics had stocks of vaccine and then schedule an appoint-ment for a flu shot. Similarly, HealthView provides a channel throughwhich primary care physicians can coach their patients on how to stayhealthy. It’s through experiences like this that the seeds of deeper con-sumer engagement are planted.Learning through health analyticsIn Duke’s drive to become a continuous learning organization, healthanalytics plays an important role. Its impact is especially powerful inthe area of chronic disease management, a health issue expected tomushroom in importance in the coming decades. At its most basic,Duke’s health analytics environment enables it to identify patients withchronic conditions and to intervene through a primary-care setting tohelp them manage the condition. The framework provides even morepowerful tools for caregivers, such as the ability to guide clinicians to best practices for specific conditions based on the tracking of real-world results (such as Duke’s database of some 46,000 diabetespatients). If the course of treatment is found to be less than optimal,built-in triggers alert the physicians to conditions that need immediateattention that may even change the course of treatment to ensure thebest possible care, to minimize the need for hospitalization and to keeppatients healthy and functional.4Ahmad sees an even stronger example of continuous learning in theway Duke tracks events that could have happened—such as nearmisses—and uses that information to apply predictive modeling thathelps to flag high-risk future scenarios. “What we’ve done with qualityand patient safety analytics is similar to what the airline industry hasbeen able to do, which is to model scenarios and educate our staffbased on the scenarios,” explains Ahmad.The success of Duke’s efforts to deepen engagement is evident in thespeed with which patients have adopted it. After growing from zero to30,000 users in less than three months, HealthView is now used bymore than 150,000 patients, roughly one third of Duke’s overall patientbase. Thus far, Duke has collected US$16 million in co-pays throughthe portal. These figures suggest more than a good start for establish-ing the closer patient engagement necessary to drive future improve-ments in healthcare delivery.While difficult to quantify, Duke’s investments in health analytics areclearly helping to fulfill its aspiration of becoming a continuous learn-ing healthcare organization. Its ability to continually grow and adapt itsbase of best clinical practices is real, as are benefits such as improvedoutcomes, patient safety and overall high quality (with Duke consis-tently ranked in the 100th percentile). As its transformation journeycontinues, Ahmad expects intelligence and engagement to remain atthe center of future innovation efforts. “We’re establishing the founda-tion for delivering smarter and more engaging healthcare services forour patients,” says Ahmad. “While innovation has always been part ofDuke’s culture, advanced technology and insights are helping us reachnew heights.”5For more informationTo learn more about how IBM can help you transform your business,contact your IBM sales representative or IBM Business Partner.Visit us at: ibm.com/smarterplanet/healthcare© Copyright IBM Corporation 2010IBM Corporation1 New Orchard RoadArmonk, NY 10504U.S.A.Produced in the United States of AmericaJuly 2010All Rights Reserved.IBM, the IBM logo and ibm.com trademarks of International Business MachinesCorporation, registered in many jurisdictions worldwide. Other product and service names might be trademarks of IBM or other companies. 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