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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
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© 2014 Health Catalyst
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2015 HIMSS So. Cal Chapter Annual Health IT Conference
Will We Really Be Able to Predict Outcomes?
© 2014 Health Catalyst
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Presenter and Contact Information
4
Steve Barlow Co-Founder, Health Catalyst
801-708-6800
© 2014 Health Catalyst
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Acknowledgements
Dale Sanders, SVP Strategy, Health Catalyst
David Crockett, PhD, Health Catalyst
Eric Siegel, PhD, Columbia University
Wikipedia
5
© 2014 Health Catalyst
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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.
© 2014 Health Catalyst
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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
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The Basic Process of Predictive Analytics
8
© 2014 Health Catalyst
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We Are Not “Big Data” in Healthcare Yet
9
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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
© 2014 Health Catalyst
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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)
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12
Two Layers of Predictive Function Risk scores Simulation
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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
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
Clearsense and UCI Medical
• Clinical (Transfusion))
Clearsense and UCI Medical
• 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
"CAUTION--Investigational device. Limited by law to investigational use only."
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
"CAUTION--Investigational device. Limited by law to investigational use only."
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
//
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Thank you.
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!