PRISM Group

Re-Admission Prevention agents customize post-discharge RED Care Plans by searching each EMR

Dan Corwin, Architect,

Lexikos Corporation

solution overview

High level solution –

PRISM uses a portable Daily News web app to help mine the EMR of each patient, especially its notes. It seeks specific "clinical conditions of interest“ cited in RAP Policies, and alerts caregivers to them.

Our challenge goals -

1. “Train" this app to alert intelligently about serious patient discharge conditions causing poor outcomes, then help a discharge specialist to extend a “RED Care Plan” so it custom-counters all their effects

2. Extensions should engage the patient on such condition-specific threats, tap his external support network for help on them, and arrange for after-discharge patient surveillance measures when required.

Healthcare and business problems addressed

Rapidly improve patient outcomes for serious discharge conditions and quickly reduce high re-admission rates for client departments.

“RAP Policies” drive searches

PRISM regularly compares

all RAP Policies approved

by the hospital with the

EMR of every in-patient.

Matches suggest Chapters

of a Discharge Guideline,

customized to that patient

usability and design – part 1 Our PRISM search agents run 7/24 behind institutional firewalls, automatically

analyzing EMRs for all patients scheduled for certain types of departmental medical exams or procedures.

Basically, the agents monitor each EMR for possible future problems, to be systematically sought as part of pre-defined departmental policies.

When any authorized user reviews in PRISM’s Daily News display the EMR of a patient scheduled for a covered procedure, that display may raise visual warnings. If so, it also offers to “justify" those alerts by using browser-based links to the specific medical records it noticed as relevant.

Our background EMR searches routinely save busy caregivers time, and sometimes they point out specific medical issues or hazards which the caregivers did not expect – a valuable RAP service.

Policy alerts drive Care Plans

Alerts are set for the patient

support network

PharmacyTherapist

Familyothers

usability and design – part 2

For pre-discharge patients with serious illnesses, optimum use of PRISM technology may require a trained "discharge specialist“, whose patients can get specially encouraged and motivated and trained to stay healthy.

By clicking on visual alerts from Daily News, a "discharge specialist“ can quickly locate RED Care Plan “chapters" pre-customized to each patient’s special conditions. Then s/he can quickly configure each such chapter by using embedded web forms designed to help handle its specific threat.

Better patient education is a central goal of providing each RED Care Plan chapter. PRISM lets this goal be realized more quickly and effectively by using semi-standard EMR searches and RED Care Plan “chapters"

usability and design – part 3

Executable partner applications, even if simple, can help out enormously by making the basic Care Plan suggested by PRISM more effective. It is shared data that helps integrate and unify caregivers, the patient, and her external support network.

Through NetDelivery, key external supporters and caregivers can get copies of the Care Plan extensions to help unify patient support. To make it seem interactive, active reminders for the patient or her support network can be easily scheduled.

If scheduled, HealthBotz applications can implement pro-active patient surveillance as necessary through lab test result graphing, tracking mobile medical devices, monitoring prescription refill, and social media questions and alerts directed to various human supporters.

development stage PRISM’s main EMR search engine is highly functional, and its

browser-based Daily News UI works okay for simple alerting. Both parts are being polished. So are our main partner applications.

1) NetDelivery runs as a co-process inside the hospital and helps with EMR imports and web-based document transport

2) HealthBotz runs in the cloud. It handles remote access to Internet services and devices, plus care plan assembly

RAP Policies and related Chapters of care plan documents for specific discharge conditions are the main artifacts still needed.

Each is merely XHTML – a pair of web pages that effectively summarize the “standard of care” for one condition, phrased and configured to directly control all the other elements above

.

integration description

Allscripts Care Management suite runs under the ASP model - up in the cloud. You can already access many forms of data on each patient there, even EMRs from competing systems.

Your suite seems the host PRISM really needs to establish good RAP Policies, and your Care Management suite in turn would benefit from PRISM’s executable components – it seems an easy, two-way fit.

Like an HIE, your suite could readily use and/or redistribute our RAP Policies & PRISM search agents. It can also support PRISM “follow-up” agents with medications-tracking software agents for patients.

Go to Market Plans – part 1

PRISM intends to beta test our working system for improving discharge procedures in Q2 at hospitals now using NetDelivery.

Candidates are not yet chosen, but one major selection criteria is that each one did poorly on a recent CMS evaluation for excess re-admission rates in Heart Attack, Heart Failure, and/or Pneumonia discharges. We will work with each beta department's "discharge specialist" to quickly affect meaningful and measurable changes

The specific RAP Policy Set we add to each departmental beta site, plus its semi-automatic aggregation into new local executable Care Plans, will be driven by local need, then steadily tested and refined. Before we end beta testing, we expect each customer’s re-admission rates to improve significantly.

Go to Market Plans – pt 2

Once our RAP Policy Set is better developed, we hope to find regional groups and Health Information Exchanges who will use it as well, and who help us to distribute our PRISM code into the regional hospitals using them.

Success seems likely, because state plans such as RARE (MN) have already strongly advocated such systematic programs for improving discharges. We are working with others like DHIN (DE) to refine our PRISM design model

Post-beta pricing for RAP search agents and policies is now estimated for a

medium sized hospital at $10,000 per discharge type, plus Daily News install fees, with a 20% annual support charge for ongoing enhancements.

If in 2013 we get even 100 hospitals buy in, every type of re-admission rate we improve should return PRISM revenues of $1 million. This, plus the healthcare cost savings, seems ample to financially justify development

Our video demo shows how RAP Policy web pages work

http://www.youtube.com/watch?v=7W2VtkLa1Fg&feature=youtu.be

PRISM runs 7/24 as a background “expert” system. It analyses

each scheduled EMR and suggests needed RAP Policies.

Daily News screens show visual alerts, but parts are still in coding. So are Guideline screens, plus HealthBotz screens. Both will come from our DataBotz UI partner, whose concurrent proposal shows Care Plan chapters configured for “diabetes” .

Why select PRISM RAP agentsto lower Re-Admission rates?

PRISM's 7x24 semantic analysis of clinical notes could offer Allscripts some subtle new powers in Care Management. Because PRISM works from textual notes and standard medical vocabulary, it is at core mostly EMR- vendor-agnostic. We will search whatever notes might get imported

By using us as a supplier of PRISM searches and related RAP Policies (just as our HIE distributors will), Allscripts could quickly offer text mining alerts and "executable” RAP Care Plan extensions that really succeed.

. But Allscripts could do all this on the national scale, not regionally. Give

PRISM a chance to move ahead by funding us; and we'll return the favor.