Leveraging data driven solutions to improve health care and decrease costs at a population level
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humanphysiology@chsh.org
Using Analytics to Transform Cardiovascular Care with Joseph Ebinger, Director of Clinical Analytics for Smidt Heart Institute at Cedars-Sinai was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text. Our automated transcription algorithms works with many of the popular audio file formats.
Welcome to the Outcomes Rocket podcast, where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez.
Saul Marquez:
Welcome back to the podcast. Today, I have the privilege of hosting Joe Ebinger. Dr. Joe Ebinger is a clinical cardiologist and the director of clinical analytics for the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles. Beyond his clinical role, he oversees the integration, validation and analysis of the clinical data for the number three cardiovascular program in the country. He’s passionate about using data driven solutions to improve health care quality and decrease costs in the interests of improving value at a population level. Joe has done incredible work. His bachelor’s is in medical, microbiology and immunology from the University of Wisconsin, Madison and his M.D., also from the University of Wisconsin, Madison and Master’s in Health Policy and management from the University of California in Los Angeles. He completed his residency at UCSF and is board certified a nuclear cardiology cardiac computed tomography and just a fantastic individual overall thinking big at a system level. And so today we’re gonna tackle some of the things that are on his mind and proving population health and beyond. So, Joe, such a pleasure to have you with us today.
Joe Ebinger:
Pleasure’s mine. Thank you so much for having me.
Saul Marquez:
You bet. So tell me a little bit more about what inspires your work in health care.
Joe Ebinger:
Yes. So, first of all, thank you for the increased introduction. So as you kind of alluded to, I got into this initially, as you know, somebody who is really interested in medicine and helping people. And so what drives me on a day-to-day basis is trying to improve the lives of the patients that our all privileged should care for day in and day out. What I realized are my training is that as physicians, we have this incredible privilege to be able to impact the lives our patients on the most personal level. But we have a duty to be able to provide care to as many people as we possibly can. And so what I became interested in is how we can leverage the vast amounts of health care data in ways that really help to reach more and more people. So what I saw was, particularly with the launch of the EHR, that sort of idea of data at scale or what’s become known as big data allows us to understand what’s happened to our patients at a population level and learn from the experience not just of what patients are going through, but other providers are doing and how they are tackling different clinical problems that they see. So what drives me is being able to take on what I’ve learned throughout training and throughout the years that I’ve been treating patients and be able to expand that to a larger number of individuals, really at a population level.
Saul Marquez:
It’s really impactful to be able to do that. And I just think about all the issues that come up in trying to do that. And I’d love to hear your perspective. Dr. Ebinger, the word that everybody is tired of hearing is interoperability, but it’s very real. The you know, the challenges to to scale that data across the health system. And then the second thing is, how do you deal with that data? Once you get it. Is it clean? And what can you do with it? Maybe you could touch on those two things. I like your perspective points.
Joe Ebinger:
So the thing that I feel like people have the sense about sort of big data that all of a sudden things will become push button and you just open up your, you know, web browser or your desktop and and the answers are all sitting there. And that’s definitely not the case. The data that comes in is not perfect. It is not linked. It is not clean. And so I’m really fortunate to work at an institution that recognizes and values the fact that while that data may look kind of dirty coming out initially, once you kind of go through cleaning up and link it to these other different sources, the amount of value that can provide it puts an institutional and patient level honestly is immense. So we have two individuals who helps us go through, clean up that information and then link it to other sources. So the short answer is it’s a dirty process. The long answer is if an institution realizes how helpful it can be, you can really do a lot of it.
Saul Marquez:
It’s worth the investment.
Joe Ebinger:
Very much.
Saul Marquez:
Yeah. So give us some examples, Dr. Ebinger on how you and your team are adding value to the population and the ecosystem there where you work through what you’re doing there.
Joe Ebinger:
Great. So the thing that I always stress to people remember is value is not this either. TER Right. value is actually a quantifiable output within the health care system, which is defined by quality, divided by cost. So to give value means you got either increase quality, decrease costs or find some sort of positive balance between the two. And within coming out this from the clinical side of things, I was focused first on how do we improve quality. And so a couple of examples of things that we’ve done using our data sets is we look at waterways that we can decrease complications, for example, following procedures. So living in the cardiovascular world, one of the things that we look at are people who undergo different forms of cardiac surgery. There are folks who need to have their heart worked on for bypass surgeries or for valve problems and a whole slew of other things. And surprisingly are not the heart doesn’t always like having it exposed to the world and touched and manipulated. And one of the common complications that can happen if this is something called atrial fibrillation. So we called post-op a-fib what we looked at, as we said, hey. We have a higher rate of post up a-fib than we would like to see and the data showing us that there’s some variability between providers. So what we did was we found the best provider in our health system. We basically went through how he worked on things and what protocols he used and then sat down with the teams of which of these do you think is going to have the most impact integrated that into our EHR and found that we were able to reduce our post up rates by 20 percent.
Saul Marquez:
Nice that’s huge.
Joe Ebinger:
It’s huge. Not just for the fact of it makes numbers look better, but because you know what? Patients don’t like to have post-operative intra fibrillation and don’t like to have to spend more time in the hospital. It decreases their ICU length of stay is all really positive things. So we start that is a huge win. Similarly, a project that I hope to work on in our institution helped the fund was won to reduce complications of bleeding and after people have a stent put in. So we put in sensitive people for a number of reasons, like chest pain and heart attacks. But to put those in, we have to give people special meds that helped in their blood to keep the stents open. You can imagine if you’re giving people these medications and putting catheters into them, they have a risk of bleed.
Saul Marquez:
Yes.
Joe Ebinger:
It’s actually the most common complication for this procedure worldwide and in the country. We put in over six hundred thousand stents a year. So this is a pretty common thing. What we did was we took data and identify where the variation existed within our practice model, developed a solution that basically warned providers of how high of a risk of their patients before they did the procedure. What we saw was we saw for people undergoing this procedure they had a greater use of what we call bleeding avoidance strategies or techniques to try and decrease that bleeding risk. And we saw the rate of bleeding go down. So, again, using data that is at a population level and bringing that down to the individual patient. That’s what we really see as improving the quality of care and how you can leverage that.
Saul Marquez:
Love it, Joe. Two really concrete examples of leveraging data to both improve quality and even like satisfaction. Right. because you think about physician satisfaction as well.
Joe Ebinger:
Yes.
Saul Marquez:
Wow. My, my and my outcomes are better. Like you go home feeling great about yourself.
Joe Ebinger:
Exactly. And I think that that’s the important part is, is if you’re able to have that one-on-one impact with the provider and and with the patient and people walk away from that with a positive experience, that’s sort of the ultimate goal. Right., you’ve been able to improve the quality, improve the efficiency, really improve the entire experience with the health care system, which to be honest, over the last several decades for a lot of folks hasn’t been really positive. Right. The health care system is I think probably second in line to the DMV when it comes to where people want to spend their time. And so if you’re able to find a way to streamline and improve that, that’s really a win for everybody.
Saul Marquez:
But it’s definitely a way that you guys are doing things differently and better in the ecosystem. So kudos to you and the team. And I just can’t help but think about 12 years ago and I even, you know, 10 years ago, I mean, there wasn’t a guy like you or a person like you, male or female, in a seat like here’s in a leadership position, system level. But today it’s a more common thing. And thankfully for that, stuff like you’re doing is happening.
Joe Ebinger:
Yeah. And, you know, I think there’s a couple of things that led to that. One is, honestly, the high tech act, which really sort of pushed forward the use of electronic health records. And because data is only as helpful as this is, is it is accessible, right?
Saul Marquez:
Yes.
Joe Ebinger:
So we are still a country that has a far way to go when it comes to interoperability between our electronic health records and the vast amount of data that exists. But the high tech act really pushed us forward in terms of digitizing huge amounts of that. And so now it’s on us to say, OK, this is a new resources that our disposal how do we access it? How do we clean it? How do we utilize it in a way that’s going to be most beneficial? And so I think that that pushed us forward. And to be honest. Really, the entire tech revolution we’ve also. Twelve years ago. I mean, how often now do we go on our phone, search the Internet, Google something? Twelve years ago, I remember like, oh, I couldn’t possibly think about using the Internet on my phone because my own bill would quadruple. So. So we really come forward in terms of our computing technology abilities. And I think that’s what’s allowing us to really take advantage of this data opportunity.
Saul Marquez:
I agree. And so if you think about the future, Dr. Ebinger, what are your thoughts? I mean, yeah, ten years. Is this whole thing different or is it an iteration?
Joe Ebinger:
So I think that medicine is sort of this art of pragmatic incrementalism. So do I think that it it’ll be really different? Yeah, very, very much so. Do I think that we’re going to see change the same pace that you see change in areas like finance, industry or the tech industry? Probably not. And in my opinion, I think that’s a good thing. I think that anytime that you’re making changes that are going to affect people’s lives and some of the most personal levels, I think going slow is fair. That being said, we have no option but to increase because we are still the most costly health care system in the world with honestly not the best outcomes for what we pay for. And so I think that we’re going to see more and more of a demand from both patients and from payers to say you have to show us data driven solutions to the problems that are affecting on a day to day basis, and the only way to do that is to harness the information at your disposal.
Saul Marquez:
Love it. And, you know, I think important distinction. And I love your point right there. I mean, it’s just it’s critical. And I love the word that you use. Pragmatic incrementalism. Nailed it. I mean, that’s such a such a great way to classify it. And I think when you talk about payers, I believe that it’s the employers that are the payers that are creating a lot of this shift.
Joe Ebinger:
Yeah. And it’s because of the unique model that we’ve set up in the US. Right. I mean, we unlike other countries where it’s it’s paid for by the government. Health care is intrinsically linked. Currently in the US to your employer. So how do we find ways to maximize the health care that people are able to get for the dollar amount that employers are currently investing in and make sure that we’re not, a, bankrupting patients and b, bankrupting the economy? Right. These employers are the driving force behind what keeps our economy going and provides a livelihood for millions of Americans every day. And so we have a responsibility not just to the individual patients that we again have the privilege to treat, but to be honest to the rest of the country, because we’re going to make up a fifth of the entire GDP within the next few years. We really need to make sure that we are utilizing what our limited national resources appropriately to get the best benefit for every single year.
Saul Marquez:
Well said, well said. I vote for Dr. Ebinger.
Joe Ebinger:
Definitely will not see me on a ballot…
Saul Marquez:
But as you think about the work that you’ve done, what would you say is one of the one of the biggest setbacks? And what lesson did you learn?
Joe Ebinger:
Yeah. So one of the things that I think is really important coming into this is don’t think that you know everything and don’t think, you know more than what you’re… You know, the other people work in your health care system. When we try. We’ve tried, for example, to go in and implement new tools into the EHR to help us improve quality. And if we don’t have stakeholder engagement from the providers, we’re going to be using that on day to day basis. It’s going to fall flat on its face. So going back to one of my earlier examples with avoidance strategies, our initial push at this, when we pushed this sort of true with the EHR, we didn’t fully engage with the cut fab staff. We’re gonna be using this database. And what we saw was they didn’t use it. It was a tool that was great. And then the end actually provided a huge benefit. But we didn’t take their needs into account when we first put this into the clinical workflow. Once we sat with them and understood, oh, this isn’t you’re not using it, you think this is a bad product, you’re using this because it slows down your clinical workflow and other places. That’s what we we really were able to get traction after we made some changes and improve quality here.
Saul Marquez:
Love it. Love it. Now, it’s a great, great takeaway for anybody looking to implement. You can’t mess with workflow, I think. I think I shared this. We are like a year ago, we got some like new window treatments on the on the house here. And my son used to play in in the windowsill. And then all of a sudden these things are like blocking them. He was so mad that morning.
Joe Ebinger:
It’s so true. It’s the smallest things that completely affect folks. We’re doing all this for anyways. Right. And you really have to take them into account.
Saul Marquez:
Yep. Yep. And even personally, right? I mean, having gone through an E.R. and ERP implementation, gosh, I mean the workflow impacted it. So it’s a huge thing. So definitely take a note here from Joe. Are you impacting workflow? And if so, get the details and get the buy in from those stakeholders, because that’s what’s going to ensure your success. What are you most proud of today?
Joe Ebinger:
Yeah. So, I mean, again, at the end of the day, I’m a clinician, right.. I’m most proud of improving the lives of the patients that I care for. You seen the father leave the hospital after a heart attack? The mother who’s able to walk down the sidewalk with their grandson. The sister returns home for a heart transplant. Those are the reasons that I get up into what I do every single day. I guess what I’m most proud of from this type of work, though, is the fact that I can take that clinically generated data looking at the outcomes that we do in expand those experiences, those positive outcomes to an even broader number of individuals, meaning you can leverage clinically generated information that’s at the fingertips of all of us in the health care system now to reach out and help not just the patients that we see in the clinic day in, day out, but the clinics or the patients at a population level that our colleagues are providers are helping and care for. That’s really incredibly impactful going from patient to population. That’s what I’m most proud of.
Joe Ebinger:
Love it. And you guys are doing a great job of it. If you had to choose a book doctor living there that you didn’t, you’d recommend to the listeners. What would it be?
Joe Ebinger:
Great question. So I’m sort of a sucker for Atul Gawande. So anything that he writes in part because I think that I think that he takes the complexities of what exists in the healthcare system, not just from the medical standpoint, but honestly from the just sheer logistical standpoint. It puts it into ways that that people can understand, not just people outside of the healthcare system, but to be honest, people within the healthcare system, because there’s in medical school and residency, there’s no training in the business or operation of nurse.
Saul Marquez:
Totally.
Joe Ebinger:
You kind of learn it’s trial by fire. And he takes these sort of etheric experiences that all of us have in common and condenses them into a format that lets us sort of understand what it is we’re all collectively feeling and dealing with. It gives you, if not the solution, at least a roadmap to how you can try and find the answer. So pretty much. My hat’s off to Atul Gawande. Whenever he gets out his next book, I’ll be the first person in line to pick it up.
Saul Marquez:
Love it. You and me both. And, you know, on the website. Joe is as many listeners know or maybe not know, because this is a more recent thing that we did. We now have a little link with books. So I ask all of the guests and now you’ve had five hundred plus guests on the show what their favorite book is. And we’ve stack ranked them according to how many people have recommended them and Atul’s books. It’s I think that two out of the top 10. So. So yeah, I totally get it. And if you haven’t seen that list, folks, check it out. outcomesrocket.health/books are just go to the website and click on the book’s link at the top of the menu there. It’s the coolest. I prioritize the most recommended books and I recommend that any leader there, including tools, books like Dr. Ebinger has, has suggested incredible work. Joe, I really appreciate you sharing the successes and also the learnings that you guys have had. I’d love if you could just leave us with a closing thought. And then the best place where the listeners to get in touch with you to continue the conversation.
Joe Ebinger:
Yeah. So I think the thing is, as you always remember, don’t try to go it alone. Trying to solve the problems of the health care system are complex and are difficult to find a partner in that maybe folks within your institution and maybe externally institution. We’ve had a great partner in a company called Biome Analytics that’s helped us really derive benefit from our cardiovascular data. And without them, I don’t think I could do the work that I do day in and day out. But you’re going to need that either external partner or the folks within your institution who see this as a priority. If you have that kind of backing, you’re going to be able to do huge things for your patients day in and day out.
Saul Marquez:
A great message. What a great message. And what would you say is the best place for folks to reach out to you or follow you?
Joe Ebinger:
Yeah. So emails is is always the best. So if you do have questions, you can reach me at humanphysiology@chsh.org. And I’m more than happy to engage in and talk with folks who are interested in helping to drive the health care system forward.
Saul Marquez:
Love it. Dr. Ebinger, thanks again for your time and excited to share this with the listeners.
Joe Ebinger:
Pleasure’s mine. Hey, thank you so much. Have a great day.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.
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