and to strongly improve the ability to optimize reimbursement in federal and private payer value-based programs, what are some other directions in which analytics work will evolve forward in the near future?

One has got to be in the leveraging of analytics to support physicians at the point of clinical decision-making, as doctors are actually on the verge of creating orders for care and tests, says Ryan Nellis of the Charlotte-based Premier Inc. Nellis, who is vice president and general manager for Premier Clinical Decision Support, which still operates under the publicly facing name of Stanson Health, says that “Physicians and other clinicians are struggling with an ongoing signal-to-noise ratio, an alert-fatigue epidemic.” What’s becoming more and more obvious, he says, is that all the alerts need to be powered by analytics, “at the moment when we can influence a patient’s health trajectory. What should a doctor do at the point of the care? Tell them to switch a med, cancel a wasteful treatment,” and so on. “And so as a market right now, we’ve got a lot of data; we’ve got it flying out of our eyeballs; we need to do a better job of distilling the data at the right time in the right place. A lot of us at Stanson were from Cedars-Sinai, based in LA, and we’ve got a team of doctors, nurses, and pharmacists, who are spend- ing their days thinking about how to get the right information to the doctor at the right moment. So you don’t pop up alerts at the beginning when the doctor opens up the EHR, but at the point of clinical decision-making.” There remain several challenges to moving forward effectively in this area, Nellis says. One is simply the exhaustion that clinicians are experiencing during the ongoing COVID-19 pandemic. But the other? “The fact is that 60 percent of the patient chart is still in the form of blurbs and blobs of text. In other words, it’s a freetext problem.” Indeed, he adds, “This is about the broader environment around EHR use.

“As one CMIO with whom we work told

me recently, ‘My EHR is like the lights of Las Vegas’: in other words, blinding” in terms of the amount of data and informa- tion being thrown at practicing physicians. What’s more, he says, “One common narrative is that everyone believes that EHR vendors are another barrier. In my opinion, they’re not a barrier; they’re mak- ing their systems better, and are open to third-party vendors. We have a really great

relationship with the EHR vendors. You might be surprised to hear that. People think in their heads that EHRs are a big challenge; I think they’ve really changed, and the EHR vendors are really trying to move forward to help us distill information to support patient care.”

Where we go from here So, where

does this leave lead-

ers of patient care organizations as they move forward on all these journeys-within-the-broader-journey? Well, for one thing, say those involved,

provider leaders have been learning about agility via their experiences dur- ing the COVID-19 pandemic. As UPMC’s Marroquin reports, “COVID accelerated the need for data to drive how we do

that requires institutional commitment that data/analytics are a priority, which then is manifested by having a dedicated team that is singularly focused on the task, with a lot of attention to detail, and the determination to keep pushing the ball forward on the goal of deriving meaningful insights from the data we have available that can be used to better deliver care for our patients.” Impact Advisors’ Dolezal emphasizes the vastness of the data landscape itself. “There is a massive, massive amount of information” involved now. “We used to focus on analytics coming from EHRs, transactional systems, ERPs, etc. Now, wearables, patient-provided informa- tion, social determinants of health” are also potential sources for analytics work.

“One common narrative is that everyone believes that EHR vendors are another barrier. In my opinion, they’re not a barrier; they’re making their systems better, and are open to third-party vendors. We have a really great relationship with the EHR vendors.” —Ryan Nellis

things. Because when you don’t have prior experience to rely on (‘priors’ in epidemiological lingo), one has to rely on the immediate learnings from near- real time data to drive how we go about delivering care. For example, when monoclonal antibodies came out, we had to rapidly identify who would be eligible for treatment with the antibodies so that we could provide this life-saving therapy to the largest number of eligible people; so, in a matter of days, we developed an algorithm that would help us alert clini- cians and patients that they were eligible for the antibodies within one day of a positive test. That was in contrast to what I mentioned above, that earlier on our analytics journey, that it would take us months-to-years to go from an idea to a deliverable, while with COVID this would happen in days. That is what I mean that COVID has proven to be an accelerator in how we use data. And we could only do that work because we actually had a lot of the pieces already in place here at UPMC.” More broadly, Marroquin testifies that “All the pieces that I’ve mentioned need to be put in place in order to meaningfully use data and analytics; because without them, one cannot do this at scale. And


“We’re now dealing with much more information, and it has to be defined and formatted, to create that insight. I think that interoperability, right out, is still a challenge. We haven’t solved that yet. Our ability to exchange data and information remains a challenge. And I still see some blocker mentality in some organizations, where freeing up the data remains a challenge. But one of the most vexing problems remains talent: it is harder and more challenging than ever to recruit good analytics talent into healthcare. Getting data scientists into healthcare, into a complex environment where data has to be curated and cleansed, it’s just a challenge, and we’re being forced to be really discerning because of that.” UCSD Health’s Sitipati says she and her colleagues are absolutely focused on reaching out to partner in all this work with public health entities and payers. She says she’s very excited that the man- aged Medicaid payers in her region are extremely interested in partnering in very concrete ways with providers to improve the health of the populations that they all serve. And, she concludes, “In terms of advice, I’d say that if you don’t have a plan for where you’re going, you have no idea where you’re going.” HI

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