Welcome to our session today. So happy that you were able to join us on the new normal, innovative approaches to managing and measuring your accreditation and registry workforce. My name is Dr. Olivia Gilbert, and I am an assistant professor at Atrium Wake Health Baptist, and I am part of the organizing committee, the curriculum development work group member for the summit. I'm also a member of the science and quality committee, and I'm very happy to be here with you all today, as well as with our fabulous speakers. We have five speakers with us today, representing different size organizations and actually also with industry to share different perspectives on this topic. So with us today, we have Andrea Price, who is the director of quality reporting and analytics with Indiana Health University. Also, we have Nicole Curry, who's the director of clinical data and registry abstraction for Paralon CDRA. Additionally, we have Tina Tolling, who's the director of cardiac and vascular service line for HCA Healthcare, as well as Matt Pollingsworth, who's the CEO of Carta Healthcare. And finally, Andrea Marra-Peralto, who's the assistant vice president with Baptist Health of Southern Florida, Miami, Cardiac and Vascular Institute. And so I'll let each of those individuals give brief introductions on themselves to share a little bit more of their perspective. Thank you, Olivia. I appreciate the opportunity to share how Indiana University Health manages our registry workforce. Collectively, these will be our learning objectives from today's general session. I have no relevant disclosures for this presentation. For those of you unfamiliar with Indiana University Health, our healthcare system is comprised of 17 hospitals that span across the state of Indiana. Along with Riley Hospital for Children, our large academic health center is located in the middle of the state of downtown Indianapolis. There are three additional hospitals across the Indianapolis area that support cardiac services. Outside of central Indiana, we have three additional regions. Each region has a community hospital that offers full-service cardiac services. These hospitals are located in the college towns of Bloomington, Lafayette, and Muncie, Indiana. The eight remaining hospitals are critical access hospitals with limited cardiovascular services. We participate in a number of the NCDR registries, and like many of you, our teams support cardiac clinical registries outside of the NCDR. In addition to the NCDR cardiovascular and vascular registries, we support clinical registries such as AAOS, NISQIP, and those required eCQMs and chart-abstracted measures that are required by CMS and Joint Commission. There has been purposeful intention on developing our workforce for a number of years. If you want to use the data outside of your department, you first have to look inside your department to make sure that your structures are efficient and effective. We established an iterator reliability process, and during that time, we wanted to really ensure that there was consistency in how our data was being reported externally by each of our individuals supporting the registry. The NCDR had released an iterator reliability tool, and we adopted that within our department. We operationalized it by using the first tab, taking the sample cases from our certified third-party vendor. The second tab is then abstracted by a second person trained on the registry. The third tab will then show the opportunities on where there was mismatches, and our team will then look at those to try to figure out the best way to move forward. We utilize NCDR resources such as the FAQ to ensure that we have consistency on how we're abstracting the data. By using the certified third-party vendor as our data set source, we're able to look for data entry discrepancies as well as opportunities to look at how the data specs are being interpreted. Productivity grids were created. We tracked these for about 12 months, and our focus is not on the individual and how productive the individual was, but we really looked at the registry, everything that was included that you needed to have in order to participate in the registry, such as identifying your patients, your sample, the data abstraction, data validation, and your data submission. Once these productivity tools are created, you can actually use it as part of your onboarding process to see where people may be spending non-value-added time, such as looking for a procedure date from a number of years ago that really doesn't impact anything in the registry, as opposed to digging for a door-to-balloon time delay, which can directly impact a metric performance. Next, we looked at reducing our case log. We redefined our priorities and resources to get cases within 30 days of discharge. For us, that actually included defining what a completed case was. I feel that data needs to be able to provide information and insights, and it needs to be timely and actionable, and to that end, a case is not completed when the data elements are checked off on a piece of paper and stacked up on your desk. They're actually more valuable whenever they're submitted into the NCDR, which has caused our team to submit on a weekly or every-other-week basis. You have a certified third-party vendor. You need to look and see if it's actually helping you and is complementing your workflow. If it's not, consider changing it. And job description. What's your recruitment strategy, and is your job description allowing you to be successful? At our organization, we hire for background and not licensure, and so we had to work with our HR department in order to get a job description that would allow us to be able to recruit the type of cardiac care team members that we needed to have in order to be successful. An ROI. As a leader working in this space, you need to update your elevator speech to support the why you participate in the registries. Your speech needs to be crafted to make sure that you are speaking to mission alignment activities within your organization. So if you're looking at your AMI population to ensure that you're reporting out accurate, true AMI patients into the chest, pain, and mind, are you also looking to see how those patients may potentially be impacting your CMS readmission rates? Those readmission rates are publicly reported on Care Compare, and they are also used in many hospital reimbursement programs. So creating a high-performing team isn't easy, and once you've created that high-performing team, you've got to be able to put processes in place to sustain it. It shouldn't be about a person. It needs to be about processes in which your team can support, regardless of who the individual is. So we expanded upon our previous experience to develop six additional areas. You'll notice inter-rater reliability comes up again, because this is very important. So we established a quarterly cadence for all of our registries. We expanded upon the initial couple registries to include the whole suite that we now support. And what I would like to say is, if you're a team of one at your organization, this can still be done. You can put processes in place to make sure that you are abstracting the case the same way a couple weeks apart, or you can look at your outliers with somebody that is trained and understands the metric to double-check your interpretation. This could be a position champion or administrative champion in your area. Next we look at balancing our workloads. Once you have an understanding of how much time is being spent on each case, you need to look at the other job tasks, such as how much meeting prep is being done, to make sure that you are balancing the work across your whole team. This has been especially important over the last few years, as elective procedures have been canceled and new programs are launched. And technical issues have actually impacted our work assignments. Our assignments were normally reassessed on an annual basis, but since 2020, we've actually been doing it quite a bit more frequently. The next thing we looked at was co-creating standard work. And I really want to focus on the term co-created, because we worked very closely with our data team to figure out, what does the standard work look like? We included core working hours, how to handle PHI, and feedback loops to our regional colleagues, and where to store files. This document is used in annual performance reviews and helps guide to coach team members not meeting expectation. It was through this time that we began to move away from paper charts and use direct data entry to further develop our technology efficiencies. You need to develop expertise on your team, develop at your bench. And since we have a robust processes in place to monitor workflow and to monitor workload, we're able to try to figure out who may have bandwidth to learn a new registry. So we at least have a primary person and a secondary person that's very knowledgeable in the individual registry. This is really good. Whenever you have transitions and you need to bring on new people, there's always at least one person that's close that is able to step up in case of a departure. Operational alignment. Depending upon your reporting structure or the culture of your organization, this may look a little bit differently. CV operations may have an operational goal, such as the national coverage determination tracking for your ICD medical necessity or structural heart procedures. Mortality metrics, post-PCI bleeding, or acute kidney injury can be used to support patient safety efforts for those of you that may be reporting into the quality arm of your organization. If you're working in the CV registry world, it is very important for you to understand your organizational priorities and how you fit into those. Finally, we created an outlier document. Feedback loops are very critical, as well as managing secure databases. And to that end, our organization made a conscious effort to really close down our external databases for those individuals that are only trained on the registries. But with that, we had to create a solution in order to make sure that our patient outliers and our information from our performance was shared back to the facilities. So an outlier document was co-created with one of our hospitals. The first tab is an executive summary that lists all of the registry metrics that are used in public reporting or pay for performance measures. And then on the subsequent tabs, we have quarterly performance as far as what patients are the individual outliers. Those individual outliers are then able to be fed back to the CV operation team or your quality leader so that they can look up those cases. And like so many of you, early March 2020 forced our team to make swift adjustments to support a 100% remote working environment. During that time, we adapted to support our team, such as purchasing webcams, creating virtual connections with each other, team meetings with our regional colleagues, and providing grace and flexibility and scheduling for our team members to balance the work and home-life balance. As spring turned into summer, we redesigned some aspects of our work to support a hybrid work-from-home structure. For onboarding, we collaborated with our HR department in order to take a real hard look at how we were going to onboard successfully in a virtual setting. We utilized Teams document sharing. And many of our prior efforts, like developing the department standard work, has really become a foundational component of onboarding new team members so that they know what to expect in the virtual environment. We're in the process of creating department competencies. The composition of our team has really changed quite a bit in the 10 years that I've been working in this space. We now have many more mid-career professionals that are looking to work in our department for a time and then potentially go on to another career path. And so while they're with us, we want to make sure that we're creating and further developing their skills so that they will be able to make a transition if and when they choose to leave the department. And like as many other industries are now facing, the demands of the workforce are really evolving. And our department has created many different ways to support the robust virtual workforce. It's allowed us to be able to support our entire person. We're really able to remain flexible with our team members and still be able to measure individual accountability and support team member growth and development. In our last few rounds of interviews for our team, these are really things that have really come out from all of the applicants as to why they're looking to join our team. And finally, I talked about a lot of different processes and efforts that we've put in such as department standard work, inter-rater reliability, too much to share in this presentation, but please feel free to email me if you would like copies of what we have been able to develop with our organization. I'm happy to share those with you. Hi, my name is Sheena Tolien. I am the Director of Cardiac and Vascular Service Lines for HCA Healthcare in Nashville, Tennessee. And I lead clinical development for our cardiac and vascular services. Thanks Olivia for having us here today. My name is Nikki Curry, and I'm currently the Director of Clinical Data and Registry Abstraction for Parowan, a sister company of HCA. Thank you everyone for having us here today. Today we're going to discuss the new, normal, innovative approaches to managing and measuring your accreditation registry workforce across a large healthcare system. Here are overarching learning objectives for the group. So a little bit of a background on our healthcare system. So we are the largest US non-governmental healthcare provider. We are called HCA Healthcare, and we have a large size and scale across the nation. We have roughly 15 divisions within the US, and then we also span into the international division in the UK. We scale across multiple states in which we have roughly 184 hospitals, 123 ambulatory services, 170 access centers, and over 1,300 physicians. We do about 38 million encounters per year, and have a large task force across the enterprise. So with that, we want to really make sure that we are upholding our quality across our programs. And how we've been able to do this is really through registry completion across several of our programs within the hospital system. We really use the NCDR registry data to really drive competencies and capabilities across our network. We drive clinical operations across the healthcare system. We know that growth and operations are really rooted in clinical outcomes, and so we want to make sure that we are upholding those standards across our facilities. We leverage our size and scale to really understand our data and technology, and how we can use the NCDR to really support these clinical capabilities. And lastly, we assure corporate responsibility and organizational advocacy through our NCDR participation. Here you can see how we participate across several registries. From the NCDR side, we mandate that all of our programs participate in the CAF PCI registry. And then, as you all know, from a TBT and LAO standpoint, we make sure we are upholding the CMS mandates and that our TAVR programs and our LAO programs are participating appropriately in those registries. That being said, we do have several registries that are local decisions that multiple hospitals do participate in to ensure that they are assessing that quality across several cardiac and vascular areas within the NCDR registry space. Along with the NCDR, we do also mandate registries in other societies. So, for example, adult cardiac surgery from the STS is a mandated registry, along with our pediatric and congenital programs. In addition, we have several hospitals that participate in our BQI registry, along with other registries across the continuum, so ELSA, Intermax, and our AHA Get With The Guidelines registry. How do we use this data set? So, we really look at it across all of our facilities, and then we even aggregate the data up to our markets, divisions, and even at an enterprise level. This allows us to really report on key clinical metrics across the company and also have our facilities uphold the standards within those clinical metrics within the company. We benchmark our programs to the NCDR percentiles, so we're holding them accountable to the national standards. And we also do a ranking across all of our facilities so that we can really show how we can advance our facilities across our NCDR percentiles. And then, lastly, we hold our facilities accountable to submitting their data. So, we actually create a submission compliance score where we look at the number of procedures that they are submitting into the registry in comparison to our internal volumes to make sure that we are establishing a process to ensure that all of our cases are being submitted accurately into the registry database. From a registry abstraction model standpoint, prior to our centralized abstraction model that Nicky is going to go into more detail in the next couple of slides, we had variability across our divisions and facilities. Across multiple divisions, we had centralized models, we had dedicated FTE abstraction models, we had external abstractors, and we even had some facilities that had partial FTE abstractions. So, this caused a lot of varying degrees of submission across our enterprise, so we wanted to work closely to ensure that we are creating a model that can be as beneficial as possible for looking at concurrent data, trying to submit within those timelines, and getting the data that we need to be as accurate as possible. Due to this lack of standardized approach, we really worked with our Parallon partners in a way that we can actually create a model that centralizes abstraction across our large healthcare system to ensure that we have strong data implementation. And with that, I will turn it over to Nicky to speak to the new registry abstraction model. Thank you, Sheena. Thanks, everybody, for joining us today. So, my name is Nicky Curry, and I am the Director over CDERA for Parallon. We're a new initiative with HCA, and we support the clinical data abstraction for cardiovascular across the enterprise. And the reason this initiative began is because in our company, we had approximately or over 600 FTEs, and those FTEs were trying to get abstraction done for 13 different clinical registries. And a lot of times, especially in our smaller community hospitals, we had clinical staff that were taking care of patients that were trying to do this abstraction work in their downtime, right? And so, that was a challenge. So, our solution was to consolidate clinical data abstraction, and then what that is going to allow our company to do, it's taking the abstraction work off the clinical folks so that they can focus on patient care and drive quality performance in our facilities. And then the abstraction would be housed under a shared service model. And why Parallon? Parallon already had the infrastructure and the setup for this, and so that was why they were chosen. So, we consolidated abstraction into five service areas, cardiovascular core measures, infection prevention, NICU, and trauma. What we're really going to talk about today is the cardiovascular service line. And then over to the right side of your screen, you can really see that once we lifted and shifted our first phase of this, which I'll get into in a couple of slides, was really moving the people whose job was mainly to do abstraction 80% or greater of the time over to our shared service model, allowing the clinical folks, again, to stay and take care of patient care. And now what we're focused on in our future state is really, you know, streamlining communication platforms, picking up more efficiencies, optimizing workflow. So what was our approach to this? So we did a lot of discovery, you know, really looking at across the enterprise what different folks were doing. And as Sheena mentioned in her conversation earlier, is that we were decentralized, but we had a lot of different looks to abstraction. Some of our divisions across HCA were centralized at the division level, whereas we also had abstractors in-house at facilities who really didn't report to anybody that their job was abstraction. I'm not sure. Many people in the facility really knew what they were doing, and they didn't have a lot of support. So again, another great reason for this initiative. Then we did a lot of planning. You know, what did we need to do to train? What does success look like? We did a pilot and developed a model, tested that model through the pilot study, and then really did a lot of communication when we decided to move from the pilot to the rest of the enterprise for a full transition, a lot of engaged IT and HR, and had a lot of division kickoffs, communication to key stakeholders at all of our facilities from the C-suite down. And then once we migrated the people over, we really focused on operations, and again, that was really looking at technology, developing communication channels, and standardizing processes was our main focus. So as you see here, there's a lot of CV registries, as we all know on this call, but we really focused on what we considered, and we called them our phase one or our high priority registries. We also wanted to align with our corporate partners to make sure, because our corporation does require certain registries, especially around those registries that have CMS mandates. So we really focused on, if you see the orange box, all the registries in the orange box. We did, because of COVID and because of resource restrictions, if an abstractor moved over to Parallon that was abstracting one of the high priority registries in the orange box, but maybe they were also helping that facility with another registry that you see to your right, for example, General Thoracic, we would move that registry over so that we didn't leave a gap at the facility in an FTE need. And a lot of that had to do with making sure that our facilities were supported during that time of COVID. As you all know, resources were hard to come by, and so we took a lot of the registries here. So currently CDRA today is doing most of the registries you see on the page, but most of our abstraction work is with those high priority registries that you see around the orange box. The interesting thing about this transition is that we have a lot of technologies that we work into. We have a lot of registries that are direct entry, but we also have Q-Centrics in the space with Q-Apps, Lamedics, CRON, and then the EHRs. We work with all the different EHRs across our enterprise, which has proved to be a little bit of a challenge, but we are overcoming that with cross-training and mentoring. You see to the right our organizational structure. Really quickly, I have four operations managers. Each operations manager is responsible for about 20 different abstractors. They have a team lead that supports them. We also have a senior manager who is our subject matter expert. He really works on customer service with physicians, and then we have a data analyst, which is really nice to have for reports and analytics and all that good thing. We have a dotted line to COG, Sheena Tolleen, you heard from her earlier. She is my subject matter expert on the corporate side along with her team. We also have support in the Parallon leadership structure. This is just to give you an example of our model and really how we operate. What we have asked from the facilities is that they establish a point of contact. This person is responsible for really driving quality improvement on the ground. This is the person that our operations managers and team leads communicate with. If we see any data trends, this is the person that we inform. If we're missing any critical data, this is the person that we want to talk to. This person is instrumental in our workflow. A lot of times it can be a CV director for TAVR, it's usually for the TBT registry, it can be a coordinator. We establish that point of contact with the facility, and truly that person is responsible for driving the information and the quality at the facility level to drive quality improvement and improve patient care. The abstraction CDRA team, we're responsible for identifying the patient list, obviously abstracting all the registries, continuing monitoring, making sure that we are doing complete accurate data abstraction. We also are responsible for audits. If we see or identify a trend, especially a negative trend, we want to make sure that that point of contact, that the facility is aware of that. We do all the harvest prep cleanup and submission. And then we really believe that concurrent data abstraction is best practice. So we consider anything 30 days from procedure to be backlog for us, that's our definition. And we try to really stay in that sweet spot of two weeks. And the reason for this is we want to give physicians opportunities to make addendums to charts if they need to, if there's missing information that is required in the abstraction. We also include our providers, and I would just like to say that it's not listed here, but one of the main things we utilize at the corporate level and with our physician leadership is we engage physicians in this process, not only for their suggestions, but their feedback on how this program is going and how we can continue to improve. But part of their responsibility too, as you see here on this slide, is to ensure complete documentation and make sure that what we need to abstract is in the chart. So again, our communication process, in order to streamline communication, we're really trying to get away from abstract or speaking directly to the facilities. So we've created a SharePoint, bi-directional SharePoint site. We have a communication log that we put on that SharePoint site. Our communication log, it allows for us to provide the facilities with outliers and also missing information that's critical to abstraction for green submission. So through this communication log, and what's great about it is it lowers email, right? We're all in email jail as leaders these days. There's no email associated with this. So what the facilities can do is they have access to our SharePoint site and we can limit access based on the facility level. And then they go out to the log and they can go out at their convenience. And we can communicate actually through that log. We can right click on the cell in the communication log and send an email directly from that particular cell and it notifies them. And then when they respond, it notifies the abstractor that sent that as well. So it's very clever and it really saves a lot of back and forth in emails. I mean, obviously there's emails because it's through email, but the communication log really does work for this type of communication around outliers and missing information. We also use WebEx Teams internally more than externally. WebEx Teams is what we utilize to ask questions. We've created a WebEx team for PCI, for LAO, for TVT, and all the abstractors that abstract for that particular registry can ask their peers questions. We have a team lead over each registry and they monitor the questions and answers on that site and make sure that people are giving each other correct information. And so WebEx Teams has been really useful for us. So to wrap up, I just want to review a few lessons we've learned. So standardized processes, everybody transitioned over, like I said earlier in this presentation, we moved the people over first that were already doing this book of work. If we had any gaps after that, we then hired. So we spent a little bit of time in an uncomfortable space because we, and we still are in that uncomfortable space because we're trying to standardize processes. And so there's a lot of work to be done around that. Also to the technology, I would say is a really challenge is because there's so many EHRs and so many different technology components, third party vendors in the space currently. We hope to change that in the future. Visionary, we would have one platform for these abstractors to work in, but we're not there yet. And then communication too. Even though I just described some great communication that we've come up with, it still is a challenge because really our facilities were used to talking, abstractors lived in house a lot of times and they were used to that communication at the facility level. So that's been a little bit of a challenge for us, but they're acclimating very well with our communication log and it is working. So what are our next steps and what are we going to work on? We're going to continue to standardize operations. We've already seen a huge pickup in productivity based on standardization that we've already done, and we only see it getting better. The other thing we want to do is really like I talked about earlier, a single technology platform, and that's really going to help efficiency and productivity. And then a quality model too. Right now we do education monthly. We do a lot of things for our abstractors to make sure that they are getting the latest updates for each registry, but we need to work on a quality plan to make sure that we're catching any education gaps and that we can improve upon that. So that's all I have today. Thank you so much for your time. Hello everyone. And Olivia, thank you for that introduction. And as Olivia said, I am Andrea Mar-Peralto, the assistant vice president for Miami Cardiac and Vascular Institute within the Baptist Health System of South Florida. Just to disclose, I am a nurse practitioner as well, and I am overall advanced cardiovascular clinical practices within MCVI across the system. We just as a background, thank you for inviting me to participate in this program. I have gone through two chest pain accreditations with the Chest Pain Society previously bought by the ACC, and just recently went through with the ACC our TAVR certification for two hospitals and our EP certification for two of our interventional hospitals as well. We're also a part of and members of the ACC, and we are on several NCDR registries that we participate in. So thank you for allowing us to have the opportunity to talk about how we link accreditation with our initiatives, operations, as well as enhancing our quality, which I may add, I'm also over quality initiatives across the health system. So to give you a background of our health system, for some of those that are not familiar, Baptist Health of South Florida is a huge health system that we span across Dade, Broward, Palm Beach, and Monroe counties. We have a total of five hospitals within Miami-Dade County. In Palm Beach, we have three hospitals, so from the inpatient services side, and we also have two hospitals in the Monroe County from inpatient services. For outpatient services, we certainly have a lot. We span through all of those counties again, and we have several outpatient service lines across those counties to include diagnostics, sleep, ambulatory, outpatient services. So we do have a lot of services that we offer. And to add, Baptist Health System owns several specialty practices to include, we have our own cardiology practice. So we're a little, and probably not that unique, but we are a combination. We're not fully owned specialty practices. We do work with private practices within our health system, and we work with them closely. We talk about our system product line, which encompasses several different aspects related to providing care to our patient populations. And I won't go into detail with each one, but as you can see, it's several. I'm here to talk about alignment with the quality outcomes related to oral registry and accreditation, and how do we align that. And I created this slide because I want people to appreciate just how accreditation and registry participation affects so many aspects of our care. And it's not an importance. So this is why I made a circle, because they're all important. So I'm not going in a chronological order. I'm going in just discussing that basically registry and accreditation forces us, if we were not, to use evidence-based practices. And that is how we affect quality, right, by going by the evidence and not doing the things that we've always done. And so sometimes that is a challenge, because depending on the age of your provider, they may be used to doing something, and they want to continue doing it. So our goal is to have validation and evidence to support why is it that we want you to change your practice, so that we can align with accreditation necessities, as well as registry expectations, in order to provide quality to our patients. So another aspect is benchmarking. I mean, benchmarking gives us the opportunity to see how we do across the nation. How are we doing as opposed to someone else? So that kind of gives us that initiative to do better, to make sure that we are actually doing what everyone's doing, and we're not an outlier. Another very important aspect of registry and accreditation is the opportunity that it gives us to make sure we stay true to CMS guidelines. CMS guidelines are very important. Of course, you know, that's very important for us to get paid as well. But also, we're providing services to these patients, and we need to make sure that we're doing the right thing. So we, MCVI, we have created several procedural and surgical indication forms that must be filled out prior to a patient even getting on the table to make sure that they met the CMS guidelines. And in the past, what we learned was that when we had patients that may have fell out, maybe we didn't get reimbursed, it really was a documentation issue that, you know, the patient probably met the criteria and most often did, but if it's not documented, we didn't do it, right? So the patient didn't meet criteria because it's not documented. CMS is not going through all our medical records to read notes. So we want to make sure that the documentation is in the appropriate place. And a big thing that I think accreditation did for us was creating process and policies. So every day we work, and we as providers, we're doing the right thing, but do we have it on paper? Do we have a process? So when you go through a registry process, you have to show your documentation of processes or policies or standard operation procedures. And so for many things, we may not have a document that says we do X, but we do do it every day. So this forces us to create these documents that when someone asks us, or if we get audited or, you know, Jacob shows up at our door, we have all of these in place, which is, you know, definitely what we need to do. So I spoke about documentation before and how important documentation is. And our denials for claims prior to this was because of lack of documentation. So we have all these efforts in place to talk about, are we doing the right thing? Are we documenting the right thing? Are we justifying our procedures? And then let's talk about cost containment. I mean, we all want to make sure we have some Medicare dollars by the time we get there. And at this rate, you know, we're really concerned. We're using up all the dollars because we're doing procedures, maybe testing, diagnostics that may not be necessary. So staying true to the evidence, doing what we need to do as providers to get to a procedure and not overutilize contains costs. And a part of containing costs included us creating quality clinical guidelines, clinical pathways for care, for certain procedures. You follow that pathway that's based on evidence, then you're going to cost contain. And the registry and the accreditation process forces us to continue to do that. So we also look at our data, data review. We have several operational committees for quality, several. We have cardiac, clinical cardiology. We have interventional cardiology. We have structural heart that looks at all of our TAVRs or appendage closures or clips. We look and monitor all our patient care and we look for outliers. So we have put in a tremendous amount of resources in place to monitor, to make sure that we stay true to that evidence and to make sure that we stay true to what we put on paper in a process that we do. And lastly, but not least, because at the end of the day, we're here to serve patients. We want to make sure that we provide the best quality for our patients. And not only that, we want to make sure that we actually made a difference. So being a part of the accreditation process, being a part of these registries forces us to get the data needed to prove quality of life so that we can continue with these procedures. So we've had issues in the past with getting that 30 day, one year follow up for a lot of our procedures. And if the registry doesn't get that, we can't aggregate it to benchmark and we can't aggregate it to see, is this procedure really making a difference to patients? So all of these things, not in any preferential order, play an integral part in our operations, in our quality, in our healthcare delivery every single day. And we want to stay true to them. So how do we continue to make sure our efforts are always in place? We don't wait until our monthly meetings to talk about what we need to improve. So we have communication daily. We have daily reporting. We have clinical and operational teams that are on foot all day and we have DG groups for emails. We make sure is there something going on? Is there something we need to monitor? And we follow that. So we also look at our data and we look and make sure that the data is valid. We want to make sure that whatever we're looking at is not garbage because then we're going to produce initiatives that will not align with what our needs are. So we brainstorm on a weekly basis. We think about are there new measures? Are there new key performance indicators that we need to look at and create? Do we need to make a new project? Do we need to make a new team? Is the current data that we're looking at aligning with our strategies operationally and clinically? And what's our current plan review? I mean, what is working? What is not? Monthly, this is when we meet and we look at our registry data every single month. But again, the registry is delayed. We do not wait until three months to look and say, oh, we had a problem here. We have our own dashboards that are similar to the registry. They fall in line and we review those as well to see can we get ahead of this? Can we fix it? So most often, if we have a problem on the registry, we've already addressed that. And going through the accreditation process, we had to address some of those things. And we were able to show performance improvement initiatives that were already fixed with data to show that we improved it already, which was really great for us. So lastly, why are we here? We want to achieve what we call the quadruple aim. So we want to improve patient experience, right? We want to improve the patient's experience every day, the quality, their satisfaction, because at the end of the day, we could be doing all of these procedures. If we're not making a difference with a patient, then we're not doing what we're here for. So we want better health outcomes. We wanna improve the health of all the population, not just our patients. We want an improved staff experience, providers, physicians, nurses. We wanna make sure, because when outcomes are great, then everybody has a sense of self and we know we're doing the right thing. And at the end of the day, we wanna lower costs. And if we're doing the right thing based on evidence and we're not over-utilizing our resources, then we will contain cost without affecting quality. And so I hope that this gives an appreciation of what we use the registry and accreditation for to optimize our healthcare delivery and our outcomes to our patients within Baptist Health System. Thank you for the opportunity to be here. Hi, everyone. I'm Matt, CEO of Carta Healthcare, and thanks, Olivia, for the brief introduction. So for my background, I started off as a high-energy physicist, spent six years at a lab called CERN in Switzerland. I was part of the team there that found a particle called the Higgs boson. And essentially sort of everything since then has been data science related, but got very interested in, which may sound like an odd thing, data abstraction, largely because of my mom's experience being a cancer patient for five times. Incidentally, the fifth one was right after I left CERN. And I got to see how difficult it was for people to capture exactly what is going on for a patient's clinical story. And my particular experience in sort of understanding the past history of patients, but even more generally, just making sure that patient care stays on track and everything keeps moving on smoothly. And after sort of digging into why this is so difficult, which I did as part of a healthcare operations study under the business school at Stanford, I discovered that really the heart of getting good high quality data is data abstraction. And it is very difficult to do and to really sort of make it so that we can get reliable, actionable clinical data using these wonderful people who are the folks who go out and collect this data in the first place. So really that was my introduction to all of this. And basically the studies that I did during my time at Stanford is what eventually became Carta Healthcare. So essentially to boil it down into what we do, our mission is to use data to make patients healthier. And one of the biggest challenges with that as everyone here is already aware is getting that data in the first place. So collecting it and making it so that the data that we get is trustworthy and easy to use. So the way that you go about doing this is three phases in the way that we sort of outlined this. You first have to collect the data, then analyze it and then act upon it. And those three sort of milestones there correspond to three product lines under our umbrella. But like the relevant part for this particular discussion is the Atlas product, which is all about collecting data efficiently and accurately with sort of higher accuracy and less manual labor than was required before. And so this is important because this lays the foundation for every data-driven improvement than anybody would ever want to do. You have to collect the data first before it's ever going to be relevant. And I think a lot of you probably have seen, there are hundreds of papers at this point of people applying AI techniques like natural language processing and the like to collecting data. But it turns out it's a very difficult thing to operationalize. And that's really where our company came to be is building a real true operational deployment of all of these great technologies that have been developed over the past several decades. So that's what we do. And we believe it's really important because at the end of the day, abstracted data is the highest value data that there is. At the end of the day, but you have people who are looking over it and even more importantly, the definitions that are behind what is being collected by the abstractors have been agreed on to by hundreds, if not in many cases, thousands of institutions. That by itself is a very difficult task because as you know, nominally EHRs are configured to serve institutions needs. And it's really hard to have apples to apples comparisons across very detailed clinical documentation in the absence of something like a registry. So groups like the ACC managed to get physicians together, come up with definitions that everyone agrees on that can actually be compared meaningfully across institutions. And you can use that as a backbone for really groundbreaking quality improvement work. So by focusing our efforts on doing registry abstraction and applying these cool new AI techniques to collecting that data, we can build scalable foundational data that can then be used to improve quality across all institutions everywhere, which is really a great place to start and is essential if we ever want to get to the point where we're meaningfully using data to improve care. And at the end of the day, that's what brings us here. So again, very happy to be here. Thank you all for inviting us and looking forward to the discussion afterwards. All right. Well, thank you all so much for your fabulous presentations on the new normal innovative approaches to managing accreditation and registry workforce. This has been very, very informative and we appreciate you all being with us today. I just wanted to ask a couple of questions to the group and perhaps give the opportunity for individuals to jump in and provide different perspectives. So starting with my first question, focusing on working to build a more resilient healthcare system post-COVID, which adapted measures of care delivery from COVID-19 will stick with us from your organization? So Andrea, do you want to start us off? Yeah, thank you so much, Olivia. I really think that the virtual world and being able to keep and retain flexibility for our team, as well as keeping a high reliable in the data that we're supporting is really instrumental, especially for when you're looking at the workforce and women in healthcare and how we're trying to be able to balance the professional life and the personal life. And I have found that being able to support each other virtually and being able to be flexible in the work product and the hours that our team can do has really been a huge job satisfier for our team members. And given that we are approaching month 19 in the journey, I really feel that there's no going back to that. And we've been pretty successful to be able to sustain high quality care. Wonderful. And Nicola, anything additional from your perspective? Oh yeah, sure. I can add to that. Because my team is a hundred percent remote, I can tell you that they love it. And what we've done on our team is we've allowed flexibility in the fact of, I wanna speak especially to the moms that are to your point, Andrew, that are dealing with, or the dads, should say dads too, dealing with children at home during this pandemic has been one of the big challenges. So we've been able to be very flexible and instead of making or requiring them to use PTO, we allow them to make up their work time if it's later in the evening or on the weekends, so they don't exhaust that PTO. That's one of the things I've seen our company do for parents that has been really instrumental in helping through this pandemic. And Sheena, any developments from COVID that you see that will be here to stay for your organization that may have been actually beneficial? Yeah, absolutely. Thanks for the question. So I think from even just a corporate and an enterprise standpoint, this is an area that we continue to monitor as we've seen surges throughout our quarters in different pockets within the country. I think one area that we've really worked with our facilities with is being able to pivot and make sure that we are giving them the appropriate data that they need to support clinical care within their facilities and really enable them with the tools that they need to help support those COVID patients. Perfect, perfect. And Matt, anything else you'd like to add from your perspective? Yes, I mean, I would second everything that everybody said and also that we're an external entity, so we're not a provider, but the fact that the openness for remote work has been normalized means that approaches like the ones we're taking will work, which is great news for everyone who's interested in sort of using technology to help this whole endeavor succeed. So that's exciting and I think here to stay. Perfect, perfect. And then if you were to provide an on the spot return on investment pitch for accreditation and registry work, what would you say? Sheena, do you wanna start us out? Sure, absolutely. So I think an area that we continue to explore is really in the technology space and really capturing our data across the company in a more concurrent fashion. So one area that I think that this from an ROI perspective that really can help support our organization is really understanding these clinical outcomes and these clinical metrics in a more contemporary fashion as we start to bridge into this more centralized data abstraction model. Historically, we've been a little bit delayed with our data sets across our company, but I think as we kind of continue to move our programs into the centralized model, we've really been able to look at our quality outcomes in a contemporary fashion and really provide that clinical data to our executive leadership and even physician leaders. Thank you, Sheena. And Nicola, anything else you would like to say for your ROI pitch on these efforts with accreditation and registry work? Yeah, I'm working on that now actually. So I would say that, this new initiative that HCA is doing with CDRA, Sheena just touched on it. What she said was exactly what I would say, which is I think the future is technology, right? And I think COVID really helped push us in this direction. But if you're asking me about ROI, I'm gonna talk about automation. For instance, a good example of this with registry work is we have abstractors still getting paper patient logs in some of our facilities. We need to be able to automate those patient lists and push them into a platform so that the abstraction can be done and we're not missing patients. So one of the big things that we are working on now and we're so close to and it's exciting is patient automation that's gonna filter into our technology platform that we're working on. This is gonna pick up so much efficiency for our teams because currently, like I said, we have a lot of man hours in abstractors and our team leads making sure these patient lists are concise and accurate and they're out there in the electronic world. So we're just trying to figure out how do we get that accurate list and how can we automate that? So I am gonna say technology, technology, technology is really where we're at and automation. How much automation and mapping can we do from our different technology components within the hospital to try to filter in these key metrics that these abstractors have to hunt and search for and spend a lot of their time on finding, so. Makes a whole lot of sense. That absolutely makes a lot of sense. And Matt, what additional thoughts do you have for us? Oh, good. I'm glad you let me follow that. So I'll obviously second that. We're a company that is sort of, that's a big, that's what we do. But I'll add to that. So that's sort of on the cost reduction side, I'd say. And something that I wish was obvious to everyone and I think will become more and more obvious is on the benefit side of the equation. So like I can say for sure, like we have our navigator product line and the general theme there is like problem navigator. So like block navigator for surgical block optimization or anesthesia navigator for optimizing anesthesia staffing and things like that. And the reason that there aren't sort of off the shelf solutions for that that work across all institutions is because getting normalized data that is just like back to my apples to apples thing that I was mentioning in my intro blurb, getting translatable data across institutions is the fundamental blocker on that. So you can't build a product that assumes a certain definition unless you have that definition implemented everywhere. And so like the big secret that I hope people can sort of understand out of all of this work is that having well-defined data sets that have people making sure they're right is the prerequisite for data-driven interventions that improve things. And so like I would say on the return side of the ROI, that is a super unappreciated thing in this whole space, I think. And like our company exists largely to try to help people unlock that. So anyway, on the savings spectrum, I completely agree, obviously with the tech helping and then on the return on investment side, it also is maybe less obviously, but obvious after you think about it, also really important. Yeah. Makes a lot of sense. And Andrea, any additional thoughts on the ROI aspect? For sure. 100% support that the good clean data in and having somebody that's knowledgeable in the registries and the data specs, partnering with your IT or your decision support team or your CVIS vendors is very important. But I also wanna flip and make sure that we are also focusing on the value of clinical registries in general, you're able to look at good quality clinical care and benchmark on things that our national thought leaders in these spaces have brought together on what is actually meaningful to the specific patient. Not to dismiss any sort of claims measure, but clinical, you get out of it what you put in it. So if an organization that has the culture to where you're just checking the box and making sure that all of your registries and that you're going through accreditation just so you can put a seal on it, that's what you're gonna get out of it. If you invest the time and you get admin and physician leaders and you have good clean quality data and routine looking at and having difficult conversations, then you're going to get more out of clinical registry participation and your accreditation. So on top of making it easier for us to be able to have timely actionable data, we also need to remember why these registries and accreditation services were developed to begin with. Yeah, and can I speak to that just for one second? Because I think it's interesting. Absolutely. I think what you say, Andrea, is really interesting because if we could free up with technology, some of the bandwidth of what these abstractors spend their time on, we could focus more on exactly what you're talking about. Because I think some of the struggle is FTEs, right? We all know how hard it is. And so if you free up the time that you're paying an RN to abstract data and they're spending their time searching, searching, searching everywhere for it, and we can automate some of that, we can utilize these RNs to really improve patient care and look at trends and be the data analyst person instead of the person looking, hunting and searching for that one metric. And it could be in five different spaces, right? So that's where we need to get to from my perspective. Wonderful, wonderful conversation. Okay, and then final question would be that you are all here today as representatives of organizations or organizations that facilitate accreditation and registry work. If you had to provide one piece of advice for what led to the success of your program or to other programs, what would it be? Nicola, do you wanna start that conversation? Oh God, I knew you were gonna ask me. Okay, hmm. Okay, I'm gonna pass. I'm gonna pass and I need to think about that for a second. We will go ahead and- Mom, back to you. Yes, okay. Yes. I'm happy to go. I would say respectfully challenge the norm. Every ask has brought us through your accreditation and your registry work, whether it has to be a clinical RN, your job description, how they integrate. Challenge the norm, but keep the why at the focus. Your why needs to be that you're really there to make sure you have good, clean data and good, clean processes and practices to support your communities and your patients. So challenge everything that you can in order to make yourself more efficient and more actionable and timely. Fantastic advice. Thank you for that. All right, Matt or Sheena? Yeah, go ahead, Sheena. Andrea, I think that's great advice. I would also add accountability. I think this is a team sport between your administrators, your physicians and your abstractors. So making sure that they're working together and collaborating on the quality of that data and really looking and focusing on those outcomes. Fantastic. And Matt, anything from your perspective, your side of the world? For sure. So just to state my perspective here, like this will be for folks who have some sort of technology that actually want it to make an impact in this space. The only thing that matters is change management. Like the technology, the technology is hard. Like obviously I'm an engineer and like I care about it and I like working on it and it's not like it's trivial or something, but nothing matters if you go out and build something and nobody can take it and use it. And that is 99% of the rational, like what actually kills health tech companies trying to make a difference for large providers essentially is by far that. And so understanding exactly who the stakeholders are and how you can add value as instantaneously as possible and deal with that and let that drive the product as opposed to the opposite direction will improve your chance of success by a factor of at least a hundred. I think it is, change management is something that far too many of my engineering colleagues I think just sort of overlook and it's the only thing that matters at the end of the day. Change management. I like that. That's great. All right. And Nicola, anything else from your side? I'm ready. I'm really ready. Okay. Okay, good. Oh, so I would say that all of you had really great answers and I would wrap it up by saying that the reason that we all on this panel are in this business ties back to the patient. And none of us would be here if it wasn't for our care of making sure that patients are getting the best care that we're driving patient improvement in our facilities. Fantastic. Fantastic. Well said. Well, I think that's a really wonderful note to end on. And again, very much appreciate you all being with us today and for your wonderful presentations and perspectives and for participating in our Q&A. So thank you so much. We'd like to take a few moments to wrap up the day by thanking the faculty for their presentations. A few highlights to note include Dr. Pekus' phenomenal keynote, realizing your hospital EMS relationship is a commitment, understanding the economics of accreditation, discovering a Mississippi state of mind, learning what drives patient selection for atrial fibrillation ablation, and the other registry specific topic sessions. And as a reminder, if you couldn't attend all the sessions you wanted to, they will be available following the close of the Quality Summit on Friday. The Summit Showcase will stay open until 5 p.m. Eastern today. So stop by and check it out. Thanks for a great day. And we look forward to seeing you tomorrow, starting at 11 a.m. Eastern time. And until then, be safe.

Quality Summit

accreditation

registry work

innovative approaches

technology

data collection

virtual work environments

clinical registries

compliance

resilient healthcare systems