Customer Profile:
Dr. Rachel Weir

Jonathan Nellermoe,
Healthcare Data Journalist

UHealth providers bring a broad set of clinical questions to their data when seeking analytics help, spanning a range of epistemic starting points.

We like to think of data analytics as a journey up a mountain.

Some clinical questions are more basic than others; together they form a natural sequence. Each question requires the exercise of natural curiosity and focus to move toward useful data insights. Our best work is done when we move with providers through the full scientific discovery process. Every analytics exchange we're a part of is an extension of this mountain journey, traversing ridges in search of summits to materialize analytics output and transform how we care for our patients.

*The contents of this interview have been edited for clarity and length.

Where do you place yourself in the kind of questions you are asking these days?

Well, for some of the questions that have matured, I'm starting to think about prescription and translation, such as “We have learned all this, now what are we going to do about it?” And then for some of them I am still early in the journey, such as with behavioral health referrals: “Why do we have such a problem?” and “Where's the breakdown occurring?”

But with depression screening, I think now we're definitely getting into “What can we do about this?”

How has your thinking changed about the data you have access to in your leadership role and clinical practice of psychiatry? 

Prior to working with MGA—I had just barely joined the U-- I would be in clinic meetings and we'd hear, “Our wait time is 6 months” or “We have this much demand for services but we can't keep up with it”, but we didn't have great data to show how many patients are in need. How many are calling per day? How do we triage potential patients? None of that was captured-- and nothing clinically, the only data available was just showing there was a potential of people needing services.

Our first, real look at what was happening clinically occurred with the PRO (“patient-reported outcomes”) rollout through mEVAL. Though mEVAL existed outside of EPIC and so wasn't ideal, it leveraged PROMIS measures in mental health assessing someone's depression, anxiety, insomnia, mania, psychosis, substance abuse, and childhood trauma.

We started to look at our patients by the severity of their disease and if they were presenting to primary care versus psychiatry. And that was interesting work right off the bat because in primary care we are often seeing sicker patients than in psychiatry.

Part of the reason for this might be that access to primary care is really good, people are able to come in when they're in distress compared to outpatient psychiatry where you have longer wait times.

Results emerge from a sustained question.

I suppose your question is sharpened at this stage in your career, as you work to create an innovative replacement of the 1:1 model at scale.

Yes, I think we are actually quite a bit closer to having our hands on an answer. There are a few programs that we've developed that just need to be expanded. Implementing depression screening and following up on all those positive depression screens is something we can do. Working on both improving screening rates as well as our follow-up does take some degree of manpower, but the way we have it set up, it doesn't take a lot.

Here's how it works: the screening is automated through MyChart and then visible in EPIC, and within EPIC a report is generated with all the patients who screened positive. Our behavioral health team members review this report daily and call patients who need outreach, offering them an appointment for a clinical assessment with one of our clinicians. In this way it's possible to screen a lot of patients without much additional ask of clinic staff and still follow up on everybody who wants or needs it.

After a positive screen, getting people who have depression into collaborative care at our primary care clinics is step 1.

It’s where we have good clinical outcomes. We have great access. It's evidence-based therapy plus med management. It's a lot of active outreach to patients that aren't improving and may not follow up on their own without someone checking in with them. It's all those things we know help people that we often don't do because of the ways we think of only helping people with direct patient appointments… But you overcome all that within a collaborative care model and maybe that explains why people get better.

As a leader, you have the ability to influence the system so it can seek adjustment. How are you using a clinical outcomes display to do that?

It’s unique within depression care to be able to state how many total patients you've ever enrolled, how many are currently enrolled, and compare baseline scores against current scores for the same population… Our goal is a 50% or more improvement over the baseline score, we're hovering around a quarter or more of our patients showing that improvement. This is higher than our system-wide improvement and that difference is one slice of what we've learned with our dashboard so far.

So when a patient is enrolled into this kind of program, their improvement is expected to be much higher?

Yes, that's why there are cost savings associated with the program. Depression improves and quality of life improves, and people use the hospital or emergency room less.

Has the dashboard helped you connect the outcomes you're observing to practical "bottom-line" considerations when addressing leadership?

It's been really helpful to have access to the dashboard because it's tough to argue with good data, you know? We have evidence supporting a significant opportunity within primary care, where we can demonstrate great impact as a result of depression screening. And more than that we can address the mounting backlog of people waiting months and months to have their depression screen even looked at, not to even mention given an appointment…

It helps to move the needle at the leadership level to say "these are things we can do, these are the low-cost interventions that can identify and treat depression, with them we can avert psychiatric crises and hospitalizations, and most importantly make a meaningful difference in our patients' lives."

Thank you Dr. Weir for your commitment to drive the conversation about mental health innovation within our health system and community. We are thrilled to be working with you!