models for innovation - amazon s3s3.amazonaws.com/rdcms-himss/files/production/public/...moderator:...

Moderator:

Sajid Ahmed, CIIO

MLK Hospital

Models for Innovation

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Panelists

© 2014 Health Catalyst

www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics


www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics

2015 HIMSS So. Cal Chapter Annual Health IT Conference

Will We Really Be Able to Predict Outcomes?



Presenter and Contact Information

4

Steve Barlow Co-Founder, Health Catalyst

801-708-6800

[email protected]

mailto:[email protected]



Acknowledgements

Dale Sanders, SVP Strategy, Health Catalyst

David Crockett, PhD, Health Catalyst

Eric Siegel, PhD, Columbia University

Wikipedia

5



Disclaimer

I am a PRAGMATIST…

6

Customer Success • We are passionate about helping customers improve outcomes

• We create deep relationships with many stakeholders and users

• We protect the private data of our customers’ patients

Ownership • We pace ourselves for long term success

• We balance the needs of customers, team members & investors

• We avoid an “entitlement” mentality

Pragmatic Innovation • We avoid academically appealing but impractical ideas

• We seek customer feedback early and often

• We measure the adoption of our solutions

Transparency • We communicate openly, frequently and honestly

• We celebrate successes and openly discuss challenges

• We treat sensitive information confidentially

A pragmatist is someone who is

pragmatic, that is to say, someone

who is practical and focused on

reaching a goal.



Healthcare Analytics Adoption Model

Level 8

Level 7

Level 6

Level 5

Level 4

Level 3

Level 2

Level 1

Level 0

Personalized Medicine & Prescriptive Analytics

Clinical Risk Intervention & Predictive Analytics

Population Health Management & Suggestive Analytics

Waste & Care Variability Reduction

Automated External Reporting

Automated Internal Reporting

Standardized Vocabulary & Patient Registries

Enterprise Data Warehouse

Fragmented Point Solutions

Tailoring patient care based on population outcomes and genomic data. Fee-for-quality rewards health maintenance.

Organizational processes for intervention are supported with predictive risk models. Fee-for-quality includes fixed per capita payment.

Tailoring patient care based on population metrics. Fee-for-quality includes bundled per case payment.

Reducing variability in care processes. Focusing on internal optimization and waste reduction.

Efficient, consistent production of reports & adaptability to changing requirements.

Efficient, consistent production of reports & widespread availability in the organization.

Relating and organizing the core data content.

Collecting and integrating the core data content.

Inefficient, inconsistent versions of the truth. Cumbersome internal and external reporting.

© Sanders, Protti, Burton, 2013

7



The Basic Process of Predictive Analytics

8



We Are Not “Big Data” in Healthcare Yet

9



What Are We Trying to Predict?

Common applications being marketed today

• Identifying preventable re-admissions: COPD, MI/CHF,

Pneumonia, et al

• Sepsis

• Risk of decubitus ulcers

• LOS predictions in hospital and ICU

• Cost-per-patient per inpatient stay

• Cost-per-patient per year by disease and comorbidity

• Risk of ICU mortality

• Risk of ICU admission

• Appropriateness of C-section

• Emerging: Genomic phenotyping

10



True Outcomes

11

Absence of:

Cardiovascular disease (angina, MI,

stroke)

Nephropathy/End stage renal

Diabetic retinopathy

Glaucoma

Cataracts

Lower extremity tissue narcosis, foot

ulcers

Peripheral neuropathy

Diabetic ketoacidosis

Diabetic preeclampsia

GI complications (nausea, constipation)

Erectile dysfunction Presence of:

Cardiovascular disease (angina, MI,

stroke)

Nephropathy/End stage renal

Diabetic retinopathy

Glaucoma

Cataracts

Lower extremity tissue narcosis, foot

ulcers

Peripheral neuropathy

Diabetic ketoacidosis

Diabetic preeclampsia

GI complications (nausea, constipation)

Erectile dysfunction

Diabetes Cohort

(~5 yrs and 26k patients)



12

Two Layers of Predictive Function Risk scores Simulation



Thoughts of The Next Five Years…

• Employers share risk and defined contribution

• Value-based payment model

• Provider and outcome transparency

• Proactive population health management

• Leveraging data

• Unstructured data storage (away from relational)

• Closing the analytics loop

• Predictive sophistication

13

A Move toward:

Chuck Podesta

CIO

UC Irvine Health

Evolution of BI at UC Irvine Health

Evolution of BI at UCI

Only

Spreadsheets

Tableau +

Spreadsheets

Data Source

Connectivity

Data-Driven

Alerting

Evolution of BI at UCI

Clinical Analytics Infrastructure Evolution at UCI

Excel

UHC

Website

Acces

s DB Acces

s DB Acces

s DB Acces

s DB Acces

s DB Acces

s DB

Chart Chart

Chart Chart

QI Analysts

Excel

Charts

Sharepoint

(PDFs)

Data Sources

Integration

Analytics

Visualization

eMail

PAST (before 2011)

Clinical Analytics Infrastructure Evolution at UCI

Tableau Dashboard

Portal

Data Aggregation

Integration

Analytics

Visualization

CURRENT (2013)

UHC

Exc

el

Char

t Char

t Char

t

QI

CDW

NSQI

P

HCAH

PS

Architecture Diagram

Future (2014 - )

Clearsense and UCI Medical

• Census Data


• Clinical (Transfusion))


• Clinical (Medications)

David A Price, MD

Vice-President, Medical Affairs- Dexcom

Continuous Glucose Monitoring- Changing the Game in Diabetes Management

Diabetes management decisions as it was and as it is, the impact of glucose monitoring approach

G4 PLATINUM: CGM system

Sensor Transmitter Receiver

• FDA approval adults in 2012. pediatrics in 2014,

combined with an Animas insulin pump in 2014

• Improved algorithm improved accuracy, approved 2014

Continuous Advances in Accuracy

4

6

8

10

12

14

16

18

20

STS 3-day Seven Seven Plus Gen 4 Pt Gen 4 Pt 505

Mean

AR

D (

%)

Accuracy (Mean ARD) for Dexcom Product Generations

Home Use SMBG Meters

26%

G4 Platinum G4 Platinum

With SW 505

Mobile Platform Integration

Dexcom Share System

Wi-Fi or Cellular

Wi-Fi or Cellular

Caregiver’s Phone

with Follow App

• Still the same high-performing CGM, now with Share

technology (Bluetooth) built into the Receiver

• Enables mobile 24 hour remote monitoring of CGM

Readings

Dexcom G4 Platinum With Share

Now FDA Approved

Dexcom G4 Platinum With Share

Continuous Integration

G4 PLATINUM

SHARE

Cradle

G5 Mobile

G4 PLATINUM

With SHARE

Dexcom G5 Mobile

• Same sensor (G4 Platinum)

• Software 505 algorithm

• New Bluetooth “Smart” transmitter

• CGM app

"CAUTION--Investigational device. Limited by law to investigational use only."

G5 Mobile Enables the Ecosystem


Dexcom Confidential

*In development Page continues…

Sweetspot CGM Web-based Software

Dexcom’s Next Generation Sensor

• Reduced calibrations

leading to factory

calibration

• Maintain high level of

accuracy

• No signal response to

Acetaminophen

• Extended duration


Empowering More People via CGM will Improve Outcomes

204

//

Frictionless Health Care A Necessity for Sustainability

Carol Robinson, RN, MSN

Director of Sales

© 2015 Qualcomm Life. All rights reserved.

Mar 2, 2015 // HIMSS SC

//

Mobile Frontier

Mobile is transforming health care

The next transformation

//

By 2020

Mobile is a catalyst for change

25 billion connected devices More than half will be non-handset

Source: Pew Research, Ever Accelerating Rate of Technology Adoption, March 2014 Nielsen Telecom Research and Insights, Sept. 2011

//

Mobile enables frictionless business process

It is the underpinning of new major business models globally

//

Frictionless transportation

UBER Request and pay for a ride

with just one click

//

The push pull for mhealth

Managing at risk populations

Value-based reimbursement models

Consumerism

Shift in point of care

Maturity of enabling technology

//

Mobile will power this experience and capabilities

Health Systems

leveraging consumerism

//

The home is the fastest growing health care setting in the US1

Point-of-care is shifting

//

BOLD mobile answers

Big challenges

➡ Consumerism

➡ Point-of-care shift

//

Copyright ©2014 Qualcomm Life, Inc. All rights reserved. Qualcomm and 2net are trademarks of QUALCOMM Incorporated, registered in

the United States and other countries. HealthyCircles is a trademark of MyTeleHealth Solutions, LLC, a wholly owned subsidiary of

Qualcomm Life, Inc. Other product and brand names may be trademarks or registered trademarks of their respective owners. All

QUALCOMM Incorporated trademarks are used with permission.

Follow us on Twitter @QualcommLife Visit QualcommLife.com

Thank you.

https://twitter.com/search?q=@QualcommLife &src=typd

http://www.qualcommlife.com/eu/

Scott Weingarten, MD

Senior Vice President

Chief Clinical Transformation Officer

•

•

•

•

•

Lowered accident claims • Mercedes 16% • Acura 15%

Clinical decision support – Scientific basis • Studies show significant improvements in care

310 alerts covering

180 Choosing Wisely Recommendations

> 58% of Choosing Wisely

content for inpatient and ambulatory

settings

intervention overridden (%) cancelled (%)

NSAIDS in hypertension 38% 23%

Benzodiazepines / SH in elderly 45% 15%

Carotid imaging for syncope 53% 27%

Antipsychotics in dementia 54% 10%

Echo after valve replacement 41% 9%

Low risk imaging for PE 76% 8%

Lyme disease testing 57% 24%

Brain imaging for syncope 67% 9%

Vitamin D deficiency testing 70% 10%

GCSF 0% 13%

DVT workup 84% 16%

inpatient alerts 11.1.13 – 1.26.14

alert

input optional times triggered (N)

input required times triggered (N)

change (%)

Benzodiazepine (amb) 365 228 -38%

Vitamin D deficiency (amb) 249 201 -19%

NSAIDS hypertension (inp) 218 125 -43%

NSAIDS hypertension (amb) 195 134 -31%

Benzodiazepine (inp) 120 95 -21%

Imaging for pulmonary embolism (inp) 69 42 -39%

Imaging for low back pain (amb) 64 39 -39%

Antipsychotics dementia (inp) 49 27 -45%

Vitamin D deficiency (inp) 41 18 -56%

Chest x-ray Pre-op or admission (amb) 74 29 -61%

HPV DNA testing (amb) 31 11 -65%

Lyme disease (amb) 28 13 -54%

CT brain- uncomplicated headache (amb) 25 16 -36%

R2=0.89, p=0.016

47 fewer carotid ultrasounds per 10,000 imaging studies in Q3_13 vs Q3_14

Projected savings per quarter = $ 179,661

Impact of

carotid

imaging

CDS

deployed in

Q4 2013

Estimated annual impact of clinical decision support integrated

into routine clinical workflows

# CDS alerts Savings

Savings from reductions in orders

11

$ 1.5 million

Savings from orders canceled when physicians are alerted

61 $ 2.3 million

Total 72 $ 3.8 million

Physician 2 - Before

Physician 2 - After

potential

impact

reduction in

benzodiazepine use

22 fall related injuries

3 hospitalizations

2 deaths from falls

6 ED visits

projected reductions

over 1 year

Woolcott et al. JAGS 2009,

CDC. MMWR Weekly 2008,

Schiller et al., Adv Data No. 392 (CDC) 2007,

Pariente et al, Drugs Aging 2008

• Savings projected from cancelled

orders alone immediately

following an alert are $4 million

annually

• Substantial improvements in

quality

• Mortality

• Morbidity

Benefits

Sajid Ahmed

Chief Information & Innovation

Officer

“There has never been a better time to be an innovator in health care.”

Innovation center, Medical office space, Urgent care, Mental health, Homeless recuperative care, Assisted living, Skilled nursing facility, Rehabilitative care, Senior housing

Source: Initiative for a Competitive Inner City

Los Angeles County Ambulatory Clinics

Shared Professional Staff

MLK Medical Campus Innovation

Hub/HealthCare Transformation

Medical Groups/IPAs UCLA and community-

based providers

Community-based Providers, FQHCs Care Coordination

Shared Data

Partnering Hospitals Tele-ICU/TeleHealth

Pre-Post Acute Providers

Home Visits Prevention, Education, and Wellness Partners

Learning Center, Wellness Center

Patient

California Hospital

Med Center

St. Francis Medical

Ctr

LAC DHS Rancho Harbor

LAC USC

UCLA Clinical

Leadership Quality

Telehealth

Hospital Partners

Community Partners

Physician Partners

Alta Med

SSC 8 FQHCs

Other IPAs

HCLA IPA

Alta Med IPA

Global IPA

Home Health,

DME, Rx

Payor Partners

Health-Net

Medi- care

Anthem

Medical Groups

SPA 6

MLK Campus

Public Health

Centinela Hospital

Outside SPA 6

Outside SPA 6

LA County

Molina

Indep. Physicians

DHS MLK OC

Blue Shield

Long-Term Care

Other Community

Partners

Associ-ations

CBOs

Govn’t Agen-cies

SNF

Applecare IPA

Care First

Omnicare IPA

Social Services, Transport

MOB

Gardena Memorial

DMH Hawkins

DHS MH Urgent

Care

MediCal LA Care

CHLA

Brand New Day

1) Contract Language with Data Sharing Partner that provide referral services to and from MLKCH…

2) Workflow Re-engineering; Current State Evaluation and Future State Training and Support for Care Coordination…

3) Interface Development and Financial Support for Data Sharing Partners; supporting MU 2 criteria and Patient Engagement…

4) Payment/Reimbursement Incentive participation; Risk sharing to financial support the Population Health Management model

MLK Health Care Transformation Center

A program to identify, pilot and adopt new

technologies, processes and

workforce development

initiatives, designed to enhance the care within Martin Luther King, Jr. Community

Hospital and the health of the entire South Los Angeles

Community.

Inpatient Care

• EHR secures past visit data & real-time patient info feeding important data into the clinician workflow

• EHR provide top opportunities according to patient information, prioritizing interventions

• Patient’s health record issues alerts providers of possible health risks to iPhones

• Using Telehealth to connect Patients with Specialists

Pre-Hospitalization

• Pre-admit screening via eConsult

• Planned admissions using risk profiles

• In-home medical monitoring to detect necessary admissions

• TCC helps high risk patients avoid unnecessary admissions

• Health system navigation education to avoid unnecessary admissions

Post-Discharge • Discharge

instructions using Care Coordination tools and MLK’s Mobile App to PCP and/or caretakers

• Securing transitional care: TCC, PCMH, Home Health Agency

• Assess patient’s needs and connect him or her with resources for continued care:

• In-home medical monitoring

• Using Social Media and Mobile Apps

Our Partners

Discussion and Questions

Thank You!

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