A clinical decision support tool that grew out of years of research on predictive modeling at Kaiser Permanente is starting to make a big difference in changing patients’ behavior when clinicians share personalized risk scores with them.
That Kaiser Permanente spin-off is San Francisco-based Archimedes Inc., and its decision support tool is called IndiGO.
As CEO John Beasley explains it, IndiGO is the first decision support tool that was designed to create guidelines that take into account an individual’s lab values, biomarkers, demographics, history, and medications. IndiGO makes use of more than 30 patient-specific variables and determines both the patient’s current risk profile and the reduction in risk provided by specific interventions. Organizations such as the Oakland, Calif.-based Kaiser and the Salt Lake City-based Intermountain Healthcare are now using it.
“It grew out of a realization that the majority of health decisions that impact quality and cost take place in the exam room between clinicians and patients,” Beasley says. IndiGo allows the provider to share with the patient their own risk of adverse events and what interventions can do to lower that risk, he adds. “The most impressive thing is that this activates patients to change behavior, because it is actually based on their own data. They take it home and put it on the refrigerator. It is meaningful to them.”
Mathematical modeling is key to decision-making in industries ranging from aerospace to transportation to finance. But until recently, predictive modeling has not been extensively applied in healthcare. Archimedes grew and developed over many years as an internal project led by David Eddy, M.D., Ph.D., a consultant to the Southern California region of Kaiser Permanente. His team worked to provide KP decision makers quantitative information about the outcomes they could expect from different clinical and administrative policies and programs. The Archimedes model also allows life science companies to simulate the impact of interventions before running actual clinical trials.
In 2006, Kaiser spun Archimedes out as a stand-alone company and hired Beasley as CEO. Although the project had incubated inside Kaiser for over 10 years, Beasley says it needed to “sharpen the blade of its capabilities by facing commercialization pressures and building a product that meets customer needs.”
With a 2007 grant from the Robert Wood Johnson Foundation, Archimedes made the transition from a consulting group of PhDs answering questions for people to a software platform it can market for other organizations to use. Customers can access its ARCHes tool via a web-based interface to run clinical trial simulations from their desktop. Researchers can examine treatments and outcomes related to conditions such as chronic obstructive pulmonary disease, congestive heart failure, diabetes and hypertension.
“Our business model has evolved from being a 100-percent consulting organization to a SaaS model that is scalable,” Beasley says. Its revenue is about two-thirds life sciences companies and one-third health systems, but the health system segment is growing the fastest, he says.
Not surprisingly, Archimedes is partnering with a growing number of organizations working to execute their population health strategies, including the Colorado Beacon Consortium, which was named the co-number-two winning organization in this year’s Healthcare Informatics Innovator Awards program (please see our February 2013 issue).
Archimedes has worked to integrate IndiGO with electronic health records (EHRs), and understand the best practices for using it in the exam room. Beasley says clinicians tend not to use it with every patient, but only with the top two or three patients on their list for the day who could get the greatest benefit from this type of information. Indigo uses business intelligence to rank-order patients based on who has the highest potential of benefiting from treatment. A study by Kaiser found that patients who see their IndiGO risk score are seven times more likely to pick up their medications than a control group.
Beasley still remembers the first time he was introduced to Archimedes. “When I saw what they had done so far, and David Eddy explained to me how far healthcare could go with quantitative decision-making, I was astonished and excited,” he recalls. “With the changes that every other industry has gone through, we ought to be able to do in healthcare to improve quality and reduce costs. One of the ways to do that is to integrate analytics into day-to-day decision-making processes.”
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