Hello, I am George Ann Garren, the System Cardiovascular Service Line Administrator for Baptist Memorial Healthcare Corporation, based in Memphis, Tennessee. And I am Keisha Medley, the System Cardiovascular Registry Director. We are honored to present this session, Owning Your Data, Dollars and Outcomes, based on our system's journey and success of creating and optimizing a centralized registry model. We have no disclosures to report and welcome you to review our bio page, including our contact information. During today's session, we will discuss positive impact of creating a centralized registry, demonstrate effective data reporting using national and internal benchmarks, provide cost justification for a centralized registry, and explore potential risks of external abstraction. Our organization has 22 hospitals serving Mississippi, Tennessee, and Arkansas. We have more than 3,500 licensed beds, and our facilities see over half a million emergency department visits annually. Our system implemented EICU in 2016, which provides important resources to our facilities, particularly during this pandemic. In terms of services, our flagship facility, Baptist Memphis, has performed over 400 heart transplant and provides mechanical circulatory support services. It is the only provider of adult ECMO services within the region. Within Baptist, we have seven facilities with cath labs, six facilities who provide cardiac surgery services. Four of our facilities offer TAVR services, and three provide a Watchman program. Due to the large footprint of our organization across the three states, these services are invaluable to our different markets. Within our system, we have over 5,000 affiliated physicians and licensed providers, including over 75 cardiologists and 12 cardiovascular surgeons. Baptist has over 19,000 team members and more than 5,000 nurses. You will note our footprint is largest in the state of Mississippi. We work in tandem with the Mississippi Healthcare Alliance promoting the systems of care for heart attack and stroke in the state of Mississippi. As I transition to the CV Service Line Administrator role, we performed an assessment of our data abstraction processes. We quickly identified a huge variation in our registry processes. We had five facilities participating independently in multiple CV registries. Three different data platforms were being used, plus external abstraction services. We had excessive amount of users with minimal understanding tasked with keying data, usually at deadline. We noted we had 21 extra sets of hands across the system abstracting data on a data entry level, resulting in incomplete and inaccurate data. With one facility, the abstractor was only looking in one specific location in the medical record for information. Upon drill down of several fallouts, we were able to locate the information. For another element, the person abstracting indicated she was told to always answer the item as yes by the person who trained her. Data results were not reviewed. Instead, they were usually just printed and placed on a shelf. We also had data that was not validated or utilized effectively. This all resulted in excessive costs with no value on return. At two of our facilities, CV techs were paid overtime to, quote, just key the data before the deadline. So you can see, we had a hot mess. It was difficult for me to trust the outcomes reports with so much variation. This impeded our ability to take action for improvement. I knew I would meet resistance with any stakeholder unless we made changes. We knew it was critical for our cardiovascular service line to develop a long-term system solution that would provide us with trustworthy data in one place. Keisha and I had seen great success at our previous facility where the cardiovascular service line director and the registry specialist worked cohesively and had made great strides. So we designed a team to meet our initial needs and have developed a model that is efficient, highly engaged, and solid. We hired an elite team of high-performing cardiovascular nurses and specialists who report through the corporate cardiovascular service line instead of the quality department. Our team focuses on quality and integrity in all aspects of their work and engagement remains at the top tier level. The director provides central oversight of registry staff, contract negotiations, expense and external evaluation, as well as remaining a subject matter expert for all registries. Additionally, she represents the organization at a state and national level. We now utilize only one data warehouse and have eliminated external obstruction while approving our obstruction goals of reporting cases to the registry from an average of 65 days to a maximum of 16 days after discharge. To be able to justify creating a centralized cardiovascular registry department, we developed a business case to present to our executive leadership. The business case detailed the cost of excessive staff and overtime pay for disparity of obstruction. We demonstrated a reduction of external obstruction and multiple data warehouse fees. We identified the best data warehouse to move forward with and utilize its specific subscriptions costs in our business case. To calculate FTE staff requirements, we use national benchmarks for obstruction time. Our business case highlighted the cost of low performance due to the shortcomings of inaccurate data and its impact on our public image. We also included a timeline for transition to the centralized registry model in the proposal. The initial phase required budget neutrality. This was achieved by transferring two quality department FTEs whose primary role was dedicated to CV registry obstruction from one of the facilities to the corporate CV registry team. We received approval and were able to realize savings greater than $400,000 within the first two years. These savings include overtime paid at the facilities, technology fees, amongst other things. The two FTEs who transferred were provided additional training related to the registry specifications. By removing non-registry related responsibilities that interfered with their obstruction, we quickly realized efficiencies, expanded their knowledge base, and improved their obstruction time to within the national benchmarks. As a team, we provide accurate, timely, and actionable data for our system. Our abstractors are dedicated to deep level understanding of registry specific guidelines, validation tools, and outcomes reporting. Our inter-rater reliability is validated and has maintained at 97 to 98 percent accuracy via internal tracking and third party consultants. We have improved our 65 to 90 day post-discharge obstruction rate to achieve 8 to 12 day post-discharge obstruction timeline. We provide real-time monthly reports with physician level and patient level details of fallouts and have created entity and system level dashboards to visually demonstrate performance using those registry benchmarks. Our team and the data also support ACC and Joint Commission accreditations. As we built this model intentionally with the end users in mind, it has strengthened our relationship with quality directors, CB service line directors, chief medical officers, physician leaders, and other key stakeholders across the system. We identified the key behaviors for success and these include accurate identification of cases for inclusion according to the registry specifications. Our team scrubs data to address data mismatch or missingness to meet those registry thresholds. It was also essential that we standardized granular level monthly and quarterly reports for our key stakeholders and this granular data and the reports are used for cardiac service line meetings, STEMI or cath lab, or even surgical team meetings as well as accreditations. We implemented follow-up calls by our team to those key stakeholders at each facility to ensure understanding of results, goals, and offer assistance with action planning. It is imperative to have consistent messaging and reporting to enhance engagement and understanding. Here is an example of one of our monthly reports. While it may be difficult to read each line or column, I will walk you through the framework of this report. This slide shows quarter two, which includes April, May, and June. There are four squares shown. The first three squares represents a month within the current quarter and the fourth square shows the rolling tick count of activity for that quarter. This fourth quarter helps visually cue all stakeholders to their expected quarterly outcomes. The rows left of the purple lines would display the provider's names. The purple column shows their individual volumes and the white columns displays each provider 's fallouts of our system focus metrics. It also provides a quick view for the facilities on their overall performance. This is the tool that we encourage the facilities to use in their monthly meetings and communications. They are standardized, consistent, and provide the details clearly for each specific registry. It is important to note that each of the tick count items represented for that month have an attachment to show the patient and physician level drill downs or granular level information I spoke about before. This is an example of one of our quarterly reports. Each hospital receives a dashboard showing each of their quarters performance. The framework for this report includes all listed registry metrics and our outcomes over the last four quarters including the most current registry benchmarks. At the top left corner we identify the registry, the name of the facility, and the reporting period. The peach color represents the last four quarters and the purple highlights the current rolling four quarter result. We update the 50th percentile and 90th percentile columns with information from quarterly reports published by the registry. Lastly, we provide spark lines to note trends in performance. We also note the case volumes under each quarter and that's shown in the black row. Our coloring system includes red for any metric performing below the 49th percentile. Yellow indicates the 50th to 89th percentile and green represents the 90th percentile and above. This brightly colored tool provides quick reference to identify trends, celebrate top performance, and highlight areas for opportunity. We then go the next step to pull those rolling four quarter results over to a system dashboard. This allows all participating facilities in our system to compare their performance internally. When we identify facilities performing well in one metric compared to others, we invite them to share their processes in our systems forums. In doing so, it makes our system stronger and allows us to standardize and adopt best practice. We noted this was very helpful during our ACC accreditations. So how have we taken the data to the next level? For physicians, the transparency of data provides a healthy, competitive, and collegial platform. It equips physician leaders with validated data to influence peers' performance and improve compliance. Physician performance is evaluated through their own professional societies based on guidelines, consensus statements, and best practice. We avoid the whole our organization says or I say and that makes them feel more confident. Additionally, consistent messaging has reduced confusion or misunderstanding of expectations. For the facility, our centralized registry model has allowed our facilities to achieve national performance recognition and star rating improvements. As previously stated, the data is used to support ACC and joint commission accreditations. And the granular physician and patient level reports are tools used to communicate current performance, recognize successes, and highlight areas for improvement. For the organization, we confidently participate in public reporting and our data results provide marketing opportunities that expand our market share. We leverage data for payer contracts and recognitions, including centers of distinction such as Blue Cross Blue Shield, Aetna, and Humana. The data also provides framework for development of clinical pathways and enhancing order sets to hardwire best practice. While we had a positive relationship with our external abstraction team, we learned from the combined experience during our transition of just how disjointed it can be to obtain accurate, detailed, and timely feedback. Some of the risks with external abstraction vendors include an extended data scrub and validation required by your organization prior to a deadline to decrease missingness. And their lack of ownership in your organization's outcome is definitely a risk. There's also a potential for additional costs for non-registry element capture. For example, in the TAVR registry, capturing the referring physician's name is not an included element in the registry, but we may need the information independently. External abstractor turnover fragments the working relationship and trust, including the feeling of continual retraining, and it also creates an extra communication layer between the data and outcomes. The external abstractor may not identify or report trends that may reflect a decline in performance. One example we saw is when the cardiac rehab order set changed due to an EMR upgrade, and we were no longer meeting the registry requirements. Well, it took time for us to identify the decline, dive back into the cases, determine the cause, and then take corrective action to change the order. We do understand there may be a need for external abstractors from time to time. For example, we underwent a hospital merger and needed to catch the new facility up to speed. But, there is a difference in vendors, so we urge you to choose wisely if you must utilize them and consider specific items within your contract to minimize risk and safeguard your program. So what was the COVID impact? Well, our team had been working on-site for over four years when COVID hit. When we created the department, we had purposefully required all staff to work on-site. The cubicle space area was even designed around the needs of the registry team to ensure open communication and support. For example, we placed the PCI team in close proximity. Fast forward to four years after its creation, the impact of COVID required an immediate transition to a hybrid remote setting. On-site abstraction partially transitioned to remote to reduce the footprint in the corporate building by 50%. Several team members elected to remain on-site, so we created weekly staff connections to increase employee engagement, including rotating hosts for our staff meetings. Skype utilization increased to provide virtual peer-to-peer communication. And we developed a new model for orientation and onboarding of our new team members, ensuring they were well-supported on-site as they learned their new role. The focus of my monthly rounding adapted to verify engagement and identify barriers resulting from working remotely or if any individual team member was detaching from our unit. Furthermore, we transitioned our vice president and senior leadership rounding to virtual-based to continue connecting with the team. The surprising result of this hybrid model was an even higher level of ownership and accountability of staff, and we remain a Tier 1 highly engaged team. It is important for us to review what we consider our critical success factors. Within our model, the CV Service Line Administrator has a working knowledge of the registry metrics and understanding its impact to our service line's business and operational performance and is reinforced with my clinical background. This is crucial to develop strategic initiatives for performance improvement at the system and facility level. The CV Service Line Administrator must actively work with the physicians and facility leadership to ensure engagement and remove any barriers. Our CV Registry Director serves as a clinical liaison, actively participating in CV Service Line meetings, as well as meeting individually with the physicians. She provides clarity on registry metrics and outcome results. Her role is to bridge the clinical work with the business strategies and professional relationships. To be successful, the model also requires boots on the ground. Each facility must designate someone on-site who routinely interacts with the physicians and reports to the facility's CV Service Line Director. The person must demonstrate a working knowledge of CV registry metrics and impact of key data components on awards recognition, such as the Chest Pain and My Platinum Awards. It's also important to note their impact on accreditations. The designated person communicates performance with physicians, leadership, and staff, explaining metric definitions and outliers. We ensure this individual understands and drives process improvements related to the performance at their facility level. For example, we have used the Chest Pain Center Coordinators at the facilities with great success for the Chest Pain and My and CAF PCI registries. Even if you do not participate in accreditations, we have seen facilities use a nurse navigator or even as part of their nursing clinical ladder qualifications. The most important consideration when identifying the boots on the ground person is that it be someone who is dedicated to this role and can provide consistency. The relationship of these three roles separates a successful centralized registry model from external abstraction as well as an individual hospital facility just trying to get by. So what has been the impact of our centralized registry? The physician and leadership trust the team and data results to improve patient care and advance the organization's performance. We have created onboarding education for each of our physicians and surgeons to help define what, why, and how we communicate their registry performance. This sets the expectation from the beginning to increase engagement and adherence to our system initiatives. Our centralized registry model increases confidence in public reporting and supports Chest Pain Center and CAF Lab accreditations. Our centralized registry team maintains top-tier employee engagement in office and remote settings. We have fully realized cost savings while contributing value to the organization and enabling duplication of our centralized model to other service lines. For example, we have branched out to helping our neuroservice line administrator with stroke registries. We are proud to report that 100% of all PCI receiving facilities within the Baptist organization received Chest Pain in My Platinum Award status this year. This is amazing for our system considering we were in a pandemic year. This demonstrates the impact of using data and benchmarks to hardwire processes that remained intact when other elements seemed to fall apart. As our centralized model has matured, we have some other notable items to mention. Our registry team is cross-trained to support at least one additional registry to prevent any unplanned staffing variances. Our CV registry director ensures efficiency within the department and helps identify our ability to expand services, including any FTE justification. As we have added services within our organization that require registry participation, such as TAVR and Watchman programs, we have had to ensure the business case for these new programs included the cost of any increased FTE needs for additional abstractors. By actively participating on state and national committees, our CV registry director is able to provide us with any potential and upcoming changes to the registries. This allows us to either monitor certain items or implement change quickly to prepare us for the changes. She has been identified as a valuable resource to these committees due to her knowledge of the registries, her connection to the clinical processes, as well as understanding the impact of changes on our large system. As a system, we have been able to dive further into the registry performance moving from low-hanging fruit to more complex performance metrics. We would not have been able to do so without our actionable, reliable, and timely data. So in summary, we maximize our data experience from point of care to published outcomes. Centralization has created cost savings, added value, and enhanced the integrity of documentation and abstraction. Real-time internal abstraction promotes real-time improvements, accountability, and ownership. Transparency within the organization allows comparisons internally and against national benchmarks, identifying any issues at system, facility, or even individual physician level. Regularly reporting to CV Service Line Administrator allows the administrator to connect quality with clinical and strategic initiatives, improving credibility with physicians and senior leadership. Overall, we have had a wildly successful experience transitioning to a centralized registry model. We cannot fathom where we would be without it today. We want to thank you for attending today's session and the opportunity to share our story. We truly look forward to answering any questions regarding our session. and I I I I I I I I I I I I I I I I I I I I I I I I I I I

centralized registry

cardiovascular services

data accuracy

patient care

performance improvement

expanding services