As the third largest health care system in the country with more than 25 million patient visits a year, Providence St. Joseph Health collects an abundance of data about both the cost of care and the outcomes our patients experience. In the past, it’s been hard for caregivers to access data about cost and outcomes together, limiting our ability to truly measure the value of the care we provide. We’ve also been forced to rely heavily on third-part vendors (e.g. Premier) to reorganize our administrative data and feed it back to us, despite the high cost and low clinical resonance of these data.
We are very excited to announce a new program – Callisto – that is currently underway. You may have heard this program referred to by its provisional name, the Hospital Data Layer. As we approach go-live we are officially launching it under its permanent name, Callisto. Callisto is a collaboration between the Providence St. Joseph Health Healthcare Intelligence and Clinical Analytics teams, with key involvement from Finance and Regional Analytics teams, as well as clinicians, analysts, and quality leaders from throughout the system. Its purpose is enabling analysts, administrators and clinicians to get rapid, clinically meaningful answers to questions about many aspects of hospital care.
Callisto is powered by Healthcare Intelligence’s new data and analytics foundation called iXplore. iXplore refers to a state-of-the art stack of ‘big data’ tools, including a cloud-hosted data lake, an in-memory high-performance analytics engine, linkages to statistical software and data visualization tools. Taking advantage of this new data and analytics environment, Callisto brings techniques that were developed for the Value Oriented Architecture (a specialty-specific value measurement platform) to the entire universe of hospitalized patients. Callisto will include all hospital cost data, normalized and organized in a clinically intuitive way, as well as key quality data selected by a consortium of 35 clinical experts representing all PSJH regions (e.g. NHSN infections, HCAHPS scores, PSI complications, readmissions, mortality). Because Callisto is not restricted to administrative data, the consortium has also been able to develop a novel, clinically meaningful, method of attributing hospitalizations to clinicians, which is especially necessary in the case of hospitalist care.
Callisto, powered by iXplore, will allow:
- Easy comparison of inpatient resource utilization, attributed to the level of the individual hospital physician
- Hospital medicine value measurement across a variety of common clinical conditions
- Creation of ministry-specific dashboards to manage clinical standardization initiatives
- Generation of pre-built reports for physician credentialing, including information about case volume and outcomes
- Self-service ad hoc reporting pertaining to inpatient services
The development of Callisto will be ongoing as we continue to integrate new data sources and enhancements, but initial testing on Version 1.0 components will begin in April. Training for teams will be held from May through June for a July 1st go-live. Please feel free to talk with your teams about the Callisto, and to use the available presentation and FAQ below as a reference during that conversation. It shows a high level timeline, the workgroups leading the effort and all of the leadership stakeholders who have been involved along the way.
FAQ
Who will Callisto be relevant for?
- All analysts working with clinical and/or financial data related to inpatient care
- Hospital administrators
- Medical Directors, Chief Medical Officers, Medical Staff leaders
- Quality leaders
- Service Line leaders
- Nursing Unit leaders
- Value teams
Why is it called Callisto?
This program draws inspiration from the work of Galileo Galilei, who, with the aid of new measurement tools, observed the orbital behavior of Jupiter’s moons, one of which is called Callisto. These observations changed the way we conceive our solar system and paved the way for a radical rethinking of the laws of physics. We likewise hope that our new measurement methods will provide insights enabling us to redesign care delivery with an orientation around value. The symbol of this product follows a diagram that Galileo drew of Jupiter (circle) and its moons (star-like figures). Galileo’s diagram is also reminiscent of the ‘Value Plot’, a way of visualizing data about cost and outcomes that will be a key component of the Callisto program.
When will Callisto be available?
The planned launch date for version 1.0 is July 1, 2018. However, Callisto is a work in progress, and we expect it to grow and enhance over the next several years.
Will Callisto include data from legacy Providence Health & Services and legacy St. Joseph Health?
Yes. This has been part of the Callisto plan from day 1. The scale and complexity of this combined dataset is one off the main reasons the Healthcare Intelligence team needed to develop the iXplore data platform to enable this work. That said, data from legacy Providence and legacy St. Joseph health have different levels of readiness for inclusion in Callisto, and go-live dates will differ for different data types. On the initial go-live (July 1, 2018), Callisto will include all legacy Providence cost and outcomes data, as well as legacy St. Joseph outcomes data. Legacy St. Joseph cost data will not be available in the initial go-live, but is high priority for a coming release.
What data will be in Callisto?
- Cost-of-care data for all hospital services (including everything ordered by providers), sourced from Insights (and eventually from EPSi). Cost data will be passed through a normalization scheme that allows ‘apples-to-apples’ comparisons of utilization across ministries.
- Hospital outcomes data. Version 1.0 will include:
- Mortality (risk-adjusted)
- Readmission (risk-adjusted)
- Length of stay (risk-adjusted)
- HCAHPS patient experience scores
- NHSN-reported healthcare-associated infections
- Attribution, including:
- Admitting, Attending, Discharging provider
- Primary proceduralist
- Daily attributed physician, based on EMR data
How will users access data?
Users will access data in two ways:
- Non-analysts will use:
- Pre-built ‘configurable dashboards’ (like those in Value Oriented Architecture), allowing them to generate clear visualizations for frequently-needed analyses, after applying relevant filters to the data
- Simple Web Intelligence (WebI) reports that will allow them to generate a spreadsheet containing frequently-requested data
- Analysts will additionally be able to use the WebI interface for more flexible self-service in generating custom queries against the underlying iXplore data model
Will there be training?
Yes. We will communicate in advance with more details.
What will happen to Premier?
We currently spend $5 million/year on our Premier contract, and recognized that a great deal of Premier’s functionality will be duplicated by this internal effort. To address this, a clinical and administrative team with system-wide representation evaluated all the functions that Premier currently offers. It determined that in conjunction with the Callisto go-live, we can end our Premier contract for its main data provisioning services (‘Quality Advisor’ and ‘Physician Focus’). This will go into effect on July 1, 2018. However, we will continue to use Premier as our vendor for its ‘Quality Measure Reporter’ module, which ministries use for submitting Core Measures to CMS and other data to The Joint Commission. Note that existing Epic and Meditech-based reports will not be affected by this transition.
What will be the disadvantages of ending Premier and switching to Callisto?
- Version 1.0 of Callisto will not contain the full suite of benchmarking and risk-adjustment functions available in Premier. However, even version 1.0 of Callisto will have risk-adjustment for:
- We have replicated CMS’s open-source readmission risk-adjustment method, which they use for determining hospital readmission penalties.
- We developed a risk-adjustment method using a representative national dataset that includes hundreds of non-PSJH hospitals.
- Length of stay. Case Mix Adjusted LOS will be available in version 1.0.
Work is underway with external partners to improve these models and develop national benchmarks for other outcomes of interest.
- PSJH cannot use Premier’s proprietary definitions for complications, so any ministry reporting which utilizes these definitions (e.g. credentialing, OPPE, contracts, etc.) will need to be changed. It is recommended that Medical Staff Office leadership evaluate if bylaw changes may be needed.
- Some amount of ‘change trauma’ is inevitable when migrating away from a widely-used information system. This will include the need for training, platform unfamiliarity and the absence of some familiar features. We’re working to minimize the challenge of this transition by including system-wide representation in all Callisto workgroups to ensure that essential Premier functions are replaced and that key stakeholders are kept in the loop (see attached documents listing workgroup members). We’ll also be working with alpha- and beta-testers from around PSJH to help us optimize user experience, and we’ll continue to communicate as go-live nears.
What will be the advantages of using Callisto?
- Trustworthy cost data, allowing users to meaningfully measure the value of care
- A clinician-developed, EMR-based approach to determining attribution and identifying outcomes of interest. The aim is to create reports that clinicians feel is fair, meaningful and motivating.
- Data visualizations that are powerful, clear and can be used universally across the system
- Statistical tests available on-demand to separate signal from noise
- Substantial cost savings to PSJH
- Shortened lag time on clinical quality data (which is currently 3 months)
- Single location for extensive data on cost and a variety of outcomes, not previously available in one location. This greatly simplifies the work of accessing these data.
- ‘Single source of truth’ for analysts across PSJH
Thank you,
Amy Compton-Phillips, M.D.
Chief Clinical Officer
Providence St. Joseph Health
Janice Newell
Chief Information Officer
Providence St. Joseph Health
Vijay Venkatesan
Chief Data Officer
Providence St. Joseph Health
Ari Robicsek, M.D.
Chief Medical Analytics Officer
Providence St. Joseph Health