Becker's Spine Review

18 Sign up for Becker's Orthopedic, Spine Business & Pain Management E-Weeklies at www.BeckersOrthopedicandSpine.com or call (800) 417-2035 Spine Moneyball: How Analytics Will Impact Spine Care Over the Next 5 Years By Laura Miller Analytics are the way of the future in healthcare and spine surgery is just beginning to jump on board. Jonathan Slotkin, MD, is the Director of Spinal Surgery at the Geisinger Health System Neurosciences Institute and Director of Spinal Cord Injury Research for Geisinger Health System. Dr. Slotkin serves as the Co-Chairman of the Operations Committee for the National Neurosurgery Quality and Outcomes Database. Matthew McGirt, MD, is a practicing spinal neurosur- geon at Carolina Neurosurgery & Spine Associates and is Associate Research Professor at University of North Carolina. Dr. McGirt serves as the Vice-di- rector of N2QOD and serves on the North American Spine Society Registry Committee. They share their thoughts on the most important benchmarking initiatives in spine care and how data will impact care delivery in the future. Question: What is the importance of data in spine care — both clinical and economic data? Why should spine surgeons collect and pay attention to their numbers? Dr. Jonathan Slotkin: A combination of forces has encouraged many nationally to re- ally scrutinize their data. When we start to think about value-driven, patient-centered outcomes and care delivery, spine surgery na- tionwide is one of the furthest behind and has more catching up to do. The area of analytics — some people call it "Spine Moneyball" — is now available to us. Historically, a lot of spine surgeons nationwide have been very good at clinical intelligence, and we as a field have been getting better at business intelligence. I think over the next five to 10 years we will need to master predictive intelligence and analytics. The challenge used to be a paucity of data. As EMR becomes required, everyone will begin to have access to the same data, or at least good data. The question for the next five to 10 years is what do we want to do with that data — how do we utilize it intelligently. Q: How can spine surgeons translate their data collection and understanding into useful information that will help them pro- vide better care and improve their practice? Dr. Matthew McGirt: At its essence, analytics in real time will measure care as it happens, like in a baseball game. We are able to gather informa- tion and learn from the variety of treatment out- comes about the best patient, best treatment, best setting and best timing. Feeding this data back to patients, physicians, and hospital decision makers enables practice based learning and allows hospi- tals to trim the fat (waste) in real time. A recently coined term "Science of Practice" — an article published in the January 2013 issue of Neurosurgery Focus — provides a technical framework to the process of systematic collection of care delivery data as a part of standard of care. All spine care providers generate data on what works and what doesn't in the surgeon's own hands in their particular healthcare setting and patient popu- lation. It's just a matter of collecting this data as its generated every day. This is no different from baseball players generating individual statistics to their play. "The Science of Practice," or systematic collection of outcomes data and integrated analytics, will allow the current healthcare reform paradigm to move away from paternalistic payer, policy maker, or hospital administra- tor dictated care parameters, and move towards smart evidence-based tools to help surgeons and their patients achieve the same desired outcomes and eliminate waste. JS: We have to be data literate and also translate those numbers into action. My colleagues and I have spent the last year home growing spine dashboards that draw from four to five distinct data streams within Geisinger. These are discrete data streams from electronic operative, outpatient, billing, patient demographic and quality outcomes data. Our IT team members have created impressive fuzzy logic algorithms to merge these distinct data sources. Right now, we are using these tools for business and clinical intelligence purposes and to increase the value in our care delivery. These efforts have been collaborative efforts involving neuro- surgery, orthopedics, medicine and several other segments of the provider environment. What we are rapidly moving toward is using those tools for predictive intel- ligence — to ask questions as to what variables most predict superior out- comes. Q: Many spine surgeons around the country work in smaller groups of 10 or 15 surgeons. is there an opportunity for them to participate in "Spine Moneyball" as well? JS: We are aware that [the Geisinger projects] are demonstration proj- ects and they won't apply in their entirety everywhere, but there are com- ponents that smaller groups can deploy at their institutions. The most important thing is for providers to become involved in data collection and analytics and not just respond passively to data being collected and analyzed by others. I would recommend they design their best practices and obtain local expert consensus using this data before moving forward with new initiatives. McG: Our group is an independent group of neurosurgeons and we have integrated data collection into our everyday care with standardized pa- tient reported outcomes measurements. We utilize a call center to track one-year outcomes via phone interview and are now investing in mobile health technologies that automate this process. We have a web-based por- tal that allows connectivity to our patients throughout a one-year episode of spine care. "At its essence, analytics in real time will measure care as it happens, like in a baseball game. We are able to gather information and learn from a va- riety of treatment outcomes about the best patient, best treatment, best setting and best timing." — Dr. Matthew McGirt, Carolina Neurosurgery & Spine Associates

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