HL20: Aurelia Boyer—Analyzing Data, Reducing Costs

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Aurelia Boyer, RN, MBA.

This profile was published in the December, 2012 issue of HealthLeaders magazine.

 "I try to find the right doctor or nurse or administrator—to partner with them—to make those kinds of things really happen, and I think it energizes the IT staff, because they're pushed closer to the actual hospital business than they would otherwise."

The demands keep coming: Decrease length of stay. Reduce admissions. Produce good quality measures for all to see, even as an industry struggles to agree upon which quality measures are most important.

But given a visionary CIO with a passion for data accuracy, accompanied by some physician champions, progress is possible. At New York-Presbyterian Hospital, astute use of data aggregation cut the number of deep-vein thrombosis (DVTs) resulting from venous thromboembolisms (VTEs) by nearly 50% in a 12-month period.

"It's not as simple as you think it's going to be when you start," says senior vice president and CIO Aurelia Boyer RN, MBA. "How are we going to decide who's at risk for DVTs? With a great advocate in a particular physician, we started looking at those things using Amalga."

Amalga, created by Microsoft and now offered through Caradigm, the company's joint venture with GE Healthcare, supports patient-centric analytics, a unified view of data across disparate systems, and perspectives both from the individual patient and across a population of patients.

Among the surprises: more upper-extremity DVTs than expected. Another analysis with a different group of physicians dealing with congestive heart failure resulted in a savings of $1.5 million, Boyer says.

"We were trying to prove that Amalga could do something for us in real time," she says. Typical analysis of quality measures was more retrospective. The secret to moving the needle on DVT was to catch problems before the patients left the hospital, she says.

"It's a multistep problem," says Boyer. "We had to find advocates who really wanted to say, 'What's in the EHR? How do we collect that data? Do we have the exact right data? Once we have the exact right data, do we make sure all the users fill it out perfectly?' "

Another quality improvement effort looked at external wound infections. "You wanted to look at chest tube drainage," Boyer says. "What became very clear, the nursing notes had to be very well filled out in order to have the right data. So if you said it was this kind of chest tube, everybody had to use the exact same words and the exact same criteria, and then we had to show the doctors the data every week, all the time."

So even when a physician documents a patient as being not at high risk for complications, if the data shows otherwise, the mandate is to "do something about that right now, today, not after the patient's discharged," such as being placed on an anticoagulant, Boyer says.

A physician or a service line administrator can champion the change in thinking, but one option not available is to put another layer of people on the problem, Boyer says. "We're working very hard to make it part of your everyday work, so that you do it right the first time, and we don't have to do this collecting of data later," she says.

"It is a culture change to say we can manage these things, and I think we are," Boyer says. It's the same thinking behind New York-Presbyterian's aspirations to be a Level 3 patient-centered medical home. Using a combination of EHR data and analytics, the hospital is targeting diabetes patients and several other diagnosis groups to reduce readmissions and emergency department visits.

As a registered nurse, Boyer has moved up through the management hierarchy of New York-Presbyterian during her 18 years at the institution. "Whether it's as a director of nursing and being administrator on call and having more and more responsibility, I have a fairly process-oriented view of the hospital," she says. "And I actually do this job really to have that impact."

Boyer also represents the kind of CIO who moves more into traditional CMIO roles than usual. "I may be more clinically focused," says Boyer. "I really interact with my IT team about patient care all the time. I'm doing some great desktop work with the guys, asking, 'Do you really understand how the clinicians use this desktop?' Then I try to find the right doctor or nurse or administrator—to partner with them—to make those kinds of things really happen, and I think it energizes the IT staff, because they're pushed closer to the actual hospital business than they would otherwise."