The Q&A: Jason Fish

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With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

Jason Fish, MD, MSHS, MS-MAS, is an associate professor of Internal Medicine, Health System Assistant Vice President of Ambulatory Quality, Outcomes and Performance Improvement Ambulatory Quality Officer, and Deputy Chief Medical Information Officer for the University of Texas Southwestern.

Fish did his internal medicine training at the University of California, Los Angeles, where he also was a graduate of the Robert Wood Johnson Clinical Scholars Program. He is also a graduate of the Jindal School of Management at the University of Texas at Dallas.

Fish led a team of four groups to develop a system to identify, track and report clinical quality and patient-reported outcomes across clinics in the UT-Southwestern health system. Their work received the 2016 Healthcare Informatics Innovator of the Year Award for the UT-Southwestern Medical Center.

Editor's note: This interview has been edited for length and clarity.

Trib+Health: What is the system that you and your team developed that you won an award for? Can you explain it?

Jason Fish: Dr. [Daniel K] Podolsky, the president, said to me and [the teams], “I need you to develop the outcomes of the campus in the outpatient setting. So we’re … all in the clinics, which traditionally doesn’t have a lot of metrics or cost metrics other than primary care …”

So he said that he wants every practice, whether you’re a GI doctor or cardiologist or colorectal surgeon. I want them to tell us what do they value in terms of outcomes and then I want to see that they’re striving to do that. That was the task and that was the goal.

…

In order to go from one patient at a time to looking at a population across whatever disease or prevention strategy you’re looking at, we had to really think how to redevelop that.

What I did was pull together four groups of people. ... I got to have at the table people who do quality — which is my group — I have to have the IT team because they’re the people who are going to build whatever we’re going to build to help support this approach. We needed to have also at the table the analytics groups. People who are going to get the data and make sense of it and report it back to you. We also had to have an operations group. The people who thought about workflow, processes and policies … I brought all four of them together.

[We] put each of the clinics in the center of the four groups and said, “This clinic has to have quality metrics so focused on the health of the patients they see and they’ve chosen to focus on this. The four of you are going to come together and do that.”

The system that came out of that is what we call an agile methodology in informatics. What that ultimately means is that we had to go very quickly through because we had to hit 51 medical directors and 51 health clinics within 10 months. So we had to be very fast at what we did.

We used the agile methodology to build over 12-week iterations a start-to-stop program that’s basically define your method, understand your current workflows. We developed the tools in our EMR (electronic medical record), then we developed registries of those patients so you can identify gaps in quality.

We developed dashboards to give you that audit and feedback. So if you think of the lifecycle of a quality metric: you design it, you collect, you analyze it and you report on it. What that ultimately did was give us a nice infrastructure for my office to now go out and do performance improvements.

We rotated through all these clinics rapidly and developed over 136 process and outcome measures around disease-specific strategies.

We built well over 100 tools, 90 workflow redesigns and we built 58 registries to support populations.

Today we have over 31,000 patients on our registries in just about 10 months. Most of it was from the fall to now.

Trib+Health: On the patient side, what are some changes they may notice, if they notice anything?

Fish: If we do anything and the patients don’t notice anything, I don’t know if that’s success.

One of the things they’re going to notice is that we’re asking for their voice.

So if I do surgery on you, success to me is that you didn’t bleed, didn’t get an infection, didn’t go back into the operating room. But from the patient perspective, six months or a year from now I want to be able to tell you it’s a success because I am able to actually lift my grandkids up … We get that through patient questionnaires.

No. 2 is they’re going to see a lot more focus on standardized care. They’re going to see that if they go to one physician or another they’re equally concerned about the same (outcome) because we built clinical decision support tools in. It either reminds people or they document in a similar way to make sure whatever that outcome we’re driving at ... that we’re all aiming for the same goal.

The third thing patients will see is a lot more of that interconnectedness. When you’re seeing ophthalmology for your diabetes retinal exam, they’re already seeing the results of what we’re doing in primary care … and how connected we’ve become rather than the traditional siloed approach you see typically.

You go out into the community you have siloed specialists and primary care. Here, we’re a health system and we’re trying to connect.

I also think in time patients should be able to see that the health system is focusing on the patient.

Traditionally, health care has had a physician-centric model and that, I think, we’re trying to turn upside down ... We want patients to come here because we know we’re focused on their health and trying to help them get where they need to.

There’s a lot of individualization, patient goals that go into that. But there’s also standardized processes that we need to make sure that we’re employing for patients. They should in time be able to see that.

Correction: Jason Fish's job titles were incorrectly listed in an earlier version of this story.