big data for enterprise imaging in health it

Big Data for Enterprise Imaging

Cristine KaoGlobal Marketing and Growth Ops

@cristinekaoSIIM2016 Booth 509-511

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© Carestream Health, 2016

"A journey of a thousand miles begins with a single step."

North Bay to Mattawa: 64 kms

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Your Navigational Map

1. Have a Business or Clinical Goal

2. Know your inventory

3. Phased approach: Start Small

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© Carestream Health, 2016

Problem with Big Data in Healthcare

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© Carestream Health, 2016

5 V’s •Velocity•Volume•Variety •Variability•Veracity

http://en.wikipedia.org/wiki/Big_data

Volume-based

Transactional

Radiologist centered

Interpretation focused

Commoditized

Invisible

Value-based

Consultative

Patient centered

Outcomes focused

Integral

Accountable

American College of Radiology

Transitioning from Imaging 2.0 to Imaging 3.0

AppropriatenessQualitySafety

EfficiencySatisfaction

© Carestream Health, 2016

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Value = Quality

Cost

How do You Measure Value?

© Carestream Health, 2016

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Business Value of Big Data

“...value from [big] data could be more than $300 billion every year, two-thirds of which would be reducing national healthcare expenditures by about 8 percent.”

“In the developed economies of Europe, we estimate that government administration could save more than €100 billion ($149 billion) in operational efficiency improvements alone by using big data.”

—McKinsey Global Institute, Big data: The Next Frontier for Innovation, Competition, and Productivity

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© Carestream Health, 2016

How do you monitor your system?

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Quality and Productivity Planning• Valuable real-time intelligence aids strategic planning,

performance review and business- decision support• Identify potential bottlenecks in the workflow and proactive

corrections• Foundation for an insight-driven decision model to improve

quality and efficiency

© Carestream Health, 2016

Know Your Inventory

Images Reports

Big Data in Imaging applies to information in:

© Carestream Health, 2016

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What’s in an Image?

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© Carestream Health, 2016

Oncology Screening and Follow Up?

Cardiac Testing? Mammography Screening and Follow Up?

Surgery Work Up? Melanoma Screening? Biospy?

How are images managed?

Public HospitalResearch Institution

(Oncology) since 2011EMRAM Score 6 Facility

900 beds53 units

35.000 admissions/year (+16.000 Day Hospital Admissions)

2900 Clinical Operators1500 Workstations

(400 mobile)

Referring citizens: 530.000

Foracchia, M ECR/HIMSS 2015 https://youtu.be/uWknBv99O5w© Carestream Health, 2016

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You can’t analyze what you don’t have

36% of the patients could have had a follow up at a closer-to-home location, but could not because prior data cannot be accessed.Could have further reduced wait-list at central location.

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© Carestream Health, 2016

36%

Foracchia, M ECR/HIMSS 2015 https://youtu.be/uWknBv99O5w

Cost of Managing Silo’s

40,000 € per year per department

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© Carestream Health, 2016Foracchia, M

ECR/HIMSS 2015 https://youtu.be/uWknBv99O5w

Big Data in Relation to Imaging

Images Reports

Big Data in Imaging applies to information in:

© Carestream Health, 2016

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What’s in a Report?

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© Carestream Health, 2016

End product of the imaging departmentsUnstructured Text to Templates to Multi-media Interactive

Question: “How would you like to have tumor measurements presented in radiologist reports?”

Survey of Oncologists & Radiologists at NIH

Our results verify that both oncologists and radiologists prefer more quantitative, multimedia reports with measurements and hyperlinks from the report to the

annotated ImagesFolio L, Nelson CJ, Benjamin M, Ran A, Engelhard, G, Bluemke DA

AJR – Annual Journal of Radiology © Carestream Health, 2016

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Oncologist time savings to assess tumor burden

Text only reports: 15.4 minutes (+/Std Dev 5.9 minutes)

Multimedia reports: 6.2 minutes (+/Std Dev 2.9 minutes)

Mean time savings with multimedia report: 8.9 minutes (P<0.001)

Above boxplot shows the time savings for oncologist to assess tumor burden using the multimedia reports (IP or Information Processing). The mean time

savings was 8.9 minutes when compared to previous text only reports. (P<0.001)

Folio L, Asary Yazdi, A, Merchant M, Jones, ECRSNA 2015© Carestream Health, 2016

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Gelareh Sadigh, MDa, Timothy Hertweck, BAb, Cristine Kao, BScc, Paul Wood, BAd, Danny Hughes, PhDe,f, Travis S. Henry, MDa, Richard Duszak Jr, MDa,e ACR http://www.jacr.org/article/S1546-1440(14)00737-6/abstract

– Carestream Sponsored Study

ACR study: Traditional Text-Only Versus Multimedia - Enhanced Radiology Reporting: Referring Physicians’ Perceptions of Value

8 out of 10 Physicians are more likely to refer patients and other doctors to a facility that uses Multi-Media Interactive Reporting Capabilities

© Carestream Health, 2016

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Problem with Reports… Even with the Multi-Media Elements

80% of data remains unstructured

What about? Laterality Gender Contrast Views Correct body parts Critical results Follow-up

recommendations Uncertainty

Natural Language Processing (NLP) can help!

http://hitconsultant.net/2015/03/31/tapping-unstructured-data-healthcares-biggest-hurdle-realized/© Carestream Health, 2016

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REDUCELENGTH OF

STAY

IMPROVECOMPLIANCE

INCREASEREVENUES

DECREASEERRORS AND

MEDICOLEGAL RISK

OPTIMIZEPRODUCTIVIT

Y AND

EFFICIENCY

EVALUATEOUTCOMES AND

QUALITY

Use Case: Montage Healthcare Solutions

www.MontageHealthcare.com

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Imaging Appropriateness and Outcomes

Identify how many of the PE studies performed in the ER are positive.

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Failed Follow-up Recommendations

Find how many radiology follow-up recommendations are overdue and follow-up exams not performed.

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Gender Error Detection

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Errors are Not Evenly Distributed

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Laterality Error Detection

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Decrease length of stay by identifying actionable recommendations for interventional procedures

Length Of Stay Reduction

Intra-abdominalAbscess on Inpatient

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Can your analytics do this?Length Of Stay Reduction

Decrease length of stay by identifying actionable recommendations for interventional procedures

# of Days till Inpatient

Image-guided drainage

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Diagno

sis to

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Diagno

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20

40

60

80

100

120

140

52

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123

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Before After

Hou

rs

Dr. Syed Zaidi reduced Length of Stay at Aultman Hospital by 3 days for patients who underwent inpatient IR procedures resulting in nearly $360,000 in savings for the hospital.

Reduce Length of Stay

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Start Small

Understanding High Value Clinical Pathways

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© Carestream Health, 2016

“Using Big Data to Make Wiser Medical Decisions”

At BIDMC, we don’t overwhelm clinicians with big data but instead reduce their burden by staying one step ahead of what they need to make wise clinical decisions. —John D Halamka MD: MS, Chief Information Officer of Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA.

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© Carestream Health, 2016 https://hbr.org/2015/12/using-big-data-to-make-wiser-medical-decisions

We now use a tool called “screening sheets” to support continuous data analysis. Experts decide what data elements and what questions are important for common diseases — and that information is built into the screening-sheets tool. As patients receive new medications, lab results, and diagnoses, the electronic health record alerts clinicians when to take action. For example, a patient with newly diagnosed diabetes is automatically enrolled in a protocol that includes eye exams, foot exams, and pneumonia vaccines. Any gaps in care for the patient are coupled with information about best practices, and the clinician is proactively informed about both so that he or she can make a wise clinical choice.

Patient Oriented Apps

There are over 40,000 healthcare apps available for smart phones

Less than 15% of breast-related apps were regulated or had any professional input1

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© Carestream Health, 2016 1 http://www.thebreastonline.com/article/S0960-9776(14)00136-2/fulltext

Patient Services Can Differentiate

© Carestream Health, 2016

2 out of 3 people would consider switching to a physician who offers access to medical records

through a secure internet connection. Patients are expecting a personalized experience• Patients are demanding to have access to their own data for

Personal Health Record• Patient services can improve patient satisfaction, and secure

referrals

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Paul Wood, BAd, Timothy R Hertweck, IDR Medical “Patient Attitudes Regarding Use and Utility of a New Patient Portal Platform” – Carestream Sponsored

Study http://www.carestream.com/campaign/study-findings-patient-preferences-online-image-portals.html

Your Navigational Map

1. Have a Business or Clinical Goal

2. Know your inventory

3. Phased approach: Start Small

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© Carestream Health, 2016

Checklist – for Your Consideration

1. How do you define value within your organization? Cost? Quality or Both?

2. How are you managing and accessing your clinical content?

3. How are reports managed and accessed? 4. What are the new strategic growth plan or high value

services you would like to focus on?• Stroke Assessment?• Breast cancer screening?• Tele-triage or tele-medicine?• Patient wait time?• Patient engagement?

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© Carestream Health, 2016

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© Carestream Health, 2016

"A journey of a thousand miles begins with a single step."

Big Data for Enterprise Imaging

Cristine KaoGlobal Marketing and Growth Ops

@cristinekaoBooth 509-511

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Carestream.com/vue-healthIT