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AT NYU Langone Health, Driving Forward on Technology Innovation at an Enterprise Level

September 14, 2017
by Heather Landi
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At New York City-based NYU Langone Health, healthcare senior executive leaders are leveraging technologies like intelligent automation and machine learning to improve care quality and operational efficiency while also striving to enhance the patient experience.

Paresh Shah, M.D., director of general surgery and vice chair of quality and innovation in surgery at NYU Langone Health, outlined the ways that NYU Langone is leveraging health IT, as part of New York City-based consulting firm KPMG’s Annual NY Health and Life Sciences Summit, which took place at KPMG’s Manhattan office on Tuesday. During the summit, healthcare industry thought leaders tackled the impact of disruptive technologies, such as intelligent automation and robotics, in healthcare.

NYU Langone is an academic medical center that consists of five inpatient facilities and numerous outpatient facilities throughout New York City’s five boroughs. It also was announced this week, as reported by Healthcare Informatics, that NYU Langone Health received the 2017 global Healthcare Information and Management Systems Society (HIMSS) Enterprise Nicholas E. Davies Award of Excellence for healthcare technology innovations that improve patient outcomes.

“What does intelligent automation and robotics mean on the front lines? What does it mean for a large academic medical center like NYU Langone Health? Two things: either we use it to do what we already do better. That can mean higher quality, reducing variability and improving speed and efficiency. Or, we use it to do something new, and that can mean a new understanding in terms of how to run the business, how to take care patients, new interventions or new management,” Shah said.

Shah, who also is a professor of surgery at the NYU Langone School of Medicine, said NYU Langone senior executive leaders have a mission to be the No. 1 medical center in the world, and the intelligent use of technology will play a critical role in fulfilling this mission. He discussed how technology will be at the core of NYU Langone Health’s campus transformation project in Manhattan, including the new Helen L. and Martin S. Kimmel Pavilion, an all-private-room hospital that will open in June 2018. As part of its transformation into what Shah referred to as a “truly digital hospital,” NYU Langone has invested more than $400 million in the last seven years in a variety of IT initiatives and systems across the health system.

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The health system aims to leverage technology to create an integrated, seamless workflow that will optimize direct patient care time, improve staff efficiency and maximize patient safety, he said. The new facilities will incorporate technology such as a new iPhone-based tool for clinicians, called the Clinical Mobile Companion, that provides text messaging between providers and real-time telemetry monitoring for patient vitals and lab results. The new facility also will use TUG robots to deliver food and medications throughout the hospitals and the BrainLAB, an integration platform across all of the operating rooms and procedure suites.

NYU Langone also plans to implement new technologies aimed at improving the patient experience, including digitizing many of the traditional in-person or paper activities and providing patients with digital tools. The health system is implementing digital wayfinding tools throughout the hospital and the MyWall system in patient rooms, a tablet-controlled screen that provides patients with information about their care team, information about their condition as well as the ability to control lighting and climate in their rooms.

The Potential of Robotics and Big Data

NYU Langone surgeons have been performing minimally invasive robotic surgery in multiple specialty areas for more than a decade. The hospital performs more than 2,000 robotic-assisted surgeries each year, and the robotic surgeries are performed using one of seven da Vinci surgical systems. Shah noted that healthcare is currently only scratching the surface with robotic technologies. “Most robots in healthcare today perform assistive functions, it’s certainly not autonomous. The da Vinci is not a robot, it’s a very good power-operated instrument. It does assistive functions and helps to reduce variability and improve quality. We don’t have cognitive automation now, but we will,” he said.

Shah said that the robotics marketplace is expanding dramatically and the spectrum of what’s available also is expanding. “We’re going from what was historically massive, in terms of size and cost, much like the original mainframe, and we’re moving away from the mainframe and moving to surgical robotics that are modular, function-specific and lower cost, so more cost effective, easier to use and smaller,” he said.

One of the things that robotics brings into play is the world of big data, he noted. “What we just now are starting to understand is that we’ve got all these operations done with the da Vinci robot and that machine could capture everything that happened in that operation—every movement—and can tell me who is the more efficient surgeon, and show me why that surgeon is more or less efficient. We’re just now beginning to understand that we can pull that data and analyze it. Big data will be transformative in the next three to five years, as we start to get granular about how we physically do this,” he said.

Drilling down, Shah addressed the implications of intelligent automation and leveraging big data at the healthcare delivery level, especially as many healthcare provider organizations move into population health management and increasingly take on financial risk.

Currently, one significant challenge is that most healthcare providers are at a low level of data maturity, Shah stated. Citing Health Catalyst’s Healthcare Analytics Adoption Model, which features eight levels of data maturity, Shah contends that most healthcare providers are “somewhere between zero and one.” They have pieces of level two or level three, but they haven’t really matured through these levels of data maturity,” he said. For instance, many large health systems still do not have a cost-based accounting model even as they move into accountable care organization (ACO) contracts. “This is at the crux of the problem within our healthcare delivery system, there is so much variability. You have to have a plan and a strategy on how you’re going to get up to these higher levels of data maturity,” he said.

NYU Langone Health, which Shah referred to as “on the bleeding edge” if not the leading edge of technology, has continued to roll out a range of IT capabilities, including consolidating into a single enterprise data warehouse. “We have a single source of truth. We’ve gone through automated reporting, we have gone through population health, and now we’re at predictive analytics and moving more to prescriptive analytics,” he said.

“Here is the opportunity; if we could leverage what we get out of just what we have today, forget about what’s coming a year from now or five years from now, just the technology that’s available today, we could reduce the cost of healthcare today in the U.S. by almost half. Most of it comes from doing the things that we do better, by leveraging technology,” Shah said.

Shah also cited examples of how NYU Langone’s team of data scientists are leveraging analytics and machine learning to improve clinical and business operations in what he called “deep learning” IT initiatives. These data-driven projects include identifying better ways to screen for breast cancer, better ways to classify diseases, improving the health system’s process to risk stratify within its at-risk populations, and better managing patients with chronic disease, he said. “We’re looking at being able to predict exactly how long a patient needs to stay in the hospital,’ he added.

As an example of an IT-driven clinical project, two years ago, NYU Langone implemented a colon surgery pathway. The intervention applies the best-practice protocols for elective colon surgery using a novel clinical pathway tools integrated into the electronic health record (EHR), with the aim of demonstrating that E-pathways will result in high compliance with the protocols and lead to reduced length of stay and direct costs without compromising clinical outcomes including post-operative complications and mortality.

“Every single patient that has an elective colon operation at NYU hospital has a very standardized way of coming into the hospital, a very standardized preparation for it, and has a very standardized plan for recovery after the surgery. Just by managing all these parts of their pathway, we have reduced our variability dramatically; to the point now, where two years into that enhanced recovery pathway of colon surgery, I can tell walking in the door whether a patient is going to go home at noon on the third day, or at 4 pm on the fourth day, or at 9 am on the fifth day, with better than 90 percent predictability,” Shah said, adding, “That helps me, that helps the patient. That allows us to reduce errors that are generated from variability and improves the quality of care.”

Moving forward, the adoption of technologies such as intelligent automation and machine learning will be critical for healthcare provider organizations, yet there are factors influencing the rate of adoption. Reimbursement is both a driver and a barrier to technology adoption, he noted. “We have to adopt some of these technology as a provider organization because we’re at risk now, we’re at risk at the dollar level. If we don’t really manage our costs, we’re going to lose money,” he said, yet, he also pointed out, “If you’re in a restricted cost environment, in a reimbursement austere environment, you have limited room to play with. Most hospital provider organizations are happy with a 2 to 3 percent margin; that doesn’t leave a lot of room to invest $3 million in new technology that may or may not pan out.”

At the same time, many provider organizations are not at a point of readiness to leverage these technologies effectively. Rather than focusing one on-off pilot projects, Shah said provider organizations should focus on developing the data architecture to support intelligent analytics as well as the management process to leverage the insights gained from analytics to move forward with operational change.

“Data structure, technological readiness and management structure are all really key here. Most organizations don’t have structure to leverage the opportunities that are available,” he said.

 

 

 

 

 


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VCU Health Motto: ‘In God We Trust; Everyone Else Must Bring Data’

October 19, 2018
by David Raths, Contributing Editor
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CMIO Colin Banas, M.D., talks about winning 2018 HIMSS Davies Enterprise Award

VCU Health System in Virginia was recently named a 2018 HIMSS Davies Enterprise Award recipient for leveraging health IT to improve outcomes. Colin Banas, M.D., the health system’s chief medical information officer, said the organization prides itself on using data to improve patient outcomes. “I am reminded of a quote from one of our senior leaders,” he said. “She even puts it at the bottom of her meeting minutes. It says, ‘In God we trust. Everyone else must bring data.’”

HIMSS cited three use cases that demonstrate VCU Health’s commitment to using data and technology to improve outcomes. The first is an Enhanced Recovery after Surgery (ERAS) protocol that improved colorectal surgery outcomes.

As VCU redesigns processes such as this, technology is always one of the last steps.   “When you sit in on these meetings, they are not going to talk about tech solutions for the first two months,” Banas said. “We stress the mantra of people, process and then technology. In a 7-stage flow chart, you don’t see technology until stage six and seven.” Once a team is identified and a standard of care is spelled out, then they turn back to IT and figure out how to hard-wire the changes into the electronic health record.

Because the VCU mascot is a ram, Banas said, the “ninja swat team” that works on process improvement projects is called the RAM Care team. RAM stands for reliable, appropriate and measurable. “We try to remind people that the RAM Care team is not just implementing order sets,” he said. There are five stages of people and processes first and then technology, including decision support and dashboards. “The way to drive variation out of a lot of these care processes is to be data-driven and consensus-driven,” he said. “That is what RAM Care really does – it is all about reducing variation.”

The other efforts HIMSS highlighted involved new tools that streamlined the patient discharge process and automated documentation tools that reduced catheter-associated urinary tract infections (UTIs).

Banas says it is an exciting time to be a CMIO. “We are getting out of the doldrums of regulatory reform and meaningful use, and ICD-10 sucking up all the oxygen, and we are starting to get better tools and better interoperability platforms to start doing innovative things,” he said.  He pointed to SMART on FHIR and open APIs as allowing users to do new things.

VCU Health is a client of Cerner, which has an Ignite API engine. “We have one SMART on FHIR app, Visual DX, and we have just signed the paper to allow the Apple health record beta for VCU Health, so our patients will be able to link their portal data to the native Apple experience,” he said. Cerner is creating its own app store. “Some are free and others have a cost, but it is exciting,” Banas said. “A lot of these people are solving things that have really bugged us and Cerner for quite some time, and they have done it way better. Kudos to Cerner for opening up and allowing other people in this space. They openly acknowledge that some of the things people are developing are in direct competition to core functionality they try to sell to their clients. Competition is good.”

 

 


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How a Data-Driven Approach Can Bolster the Fight Against Opioid Abuse

October 12, 2018
by Steve Bennett, Ph.D., Industry Voice
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I want to tell you about Andy. Andy’s mom, Pam, is a colleague of mine. Growing up an only child, Andy was a happy kid. He was a straight-A student, loved to play the violin, and spent a year as an exchange student in Europe. Andy had two loving parents. But Andy suffered an injury in college, and needed to have some minor surgery performed to repair his sinuses. Following that surgery, his doctor prescribed opioid pain medication for him, to which he became addicted. Despite several years of effort, Andy was unable to shake the addiction, and tragically lost his life to a heroin overdose two years after his surgery. This was a normal kid with a normal family, like mine, and like yours.

Andy’s story is an important story. The opioid epidemic has led to the deadliest drug overdose crisis in the history of the United States, killing more than 64,000 people in 2016 alone – the last year numbers were available. This is a true national epidemic, and one that continues to get worse. For the first time in nearly 60 years, life expectancy for Americans has dropped for two years in a row due to the opioid epidemic.

The opioid crisis has been so difficult to curtail, in part, because of the inability to integrate data from various stakeholders and systems. With so many players and data sources, today’s information is partial, fragmented, and often not actionable.

While this disconnect applies directly to the opioid epidemic it is a systematic problem that affects the healthcare community at large. Better data and analytics can help develop better treatment protocols for a wide array of medical and public health challenges that affect the general public. For opioids, that could be to develop better pain management programs or for better, more-targeted remediation and rehabilitation for those that become dependent on drugs.

A Data-Driven Healthcare Approach: Making Information Real

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Ample data has been collected on the opioid epidemic, but disparate sources are not communicating with one another. Addressing this disconnect and lack of communication is something that can provide researchers, lawmakers and the public with improved insights.

Data-driven healthcare can help provide this guidance by using available data and analytics to help create programs that can make a tangible difference on population areas that need the most help. By looking at the data, lawmakers, hospital administrators and doctors can begin to make impactful changes throughout the system.

While much can be learned from this data, most of it is not being analyzed in a way that brings true benefits. It has been put in a silo and/or it is not organized in a way that is interoperable with other data systems.

The 21st Century Cures Act, which established the Health Information Technology Advisory Committee, shows the commitment of national leaders to improving healthcare information sharing. Analytics can take this data and turn it into something real. Subsequent visualization of this analyzed data presents the information in a way that can truly tell a story, making sense of data that analysts sometimes miss. Analytics can arrange and organize data in different ways and pick up previously undetected trends or anomalies. This information can be turned into real programs that produce real outcomes for those affected.

The data management and integration process can also help us understand where our knowledge gaps are, revealing flaws in data quality and availability. Organizations may learn that they lack sufficient data in a certain area where they want to learn more, but are currently limited. They can then make changes to data collection efforts or seek out different sources to fill these larger gaps. They can resolve data quality issues across systems and arrive at a consistent, reliable version of the truth.

As organizations get better at assembling and managing the data, automating processes to generate standard reports and file exchanges can ease the burden on analysts. Streamlining the user interfaces for prescription drug monitoring programs and other systems allows analysts and medical informatics staff to spend less time working on the data itself and more time enabling and encouraging the use of predictive modeling and “what-if” scenario capabilities.

Helping to Solve a Problem

The national opioid epidemic is a terrible and complex issue. It is not something that can be solved with just one action, approach or program. It is a layered issue that will require systematic changes to how patients are treated and how the healthcare system operates. Some of the nation’s best continue to work on providing operational solutions to these problems, but as the statistics show, they need more help.

A data-driven approach can be that help. Using data analytics to find better and deeper insights into the root problems of this epidemic can help decision-makers make real change. While opioids are the focus now, there will come a day when a new problem emerges. Having data and analytic solutions in place can prepare these organizations to tackle these future challenges as well.

64,000 people died in 2016 as a result of opioid abuse. But 64,000 is more than a large number – it’s also Andy and his family. With analytics and a data-driven approach, government and healthcare leaders can make better decisions that can help people in need.

Steve Bennett, Ph.D., is the director of SAS' global government practice. He is the former director of the National Biosurveillance Integration Center within the Department of Homeland Security


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DOJ Approves CVS-Aetna $69B Merger, On Condition Aetna Divest Part D Business

October 10, 2018
by Heather Landi, Associate Editor
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The Department of Justice (DOJ) has approved a $69 billion merger between mega-pharmacy retailer CVS Health and health insurer Aetna, after Aetna entered into an agreement with the DOJ to divest is Medicare Part D prescription drug plan business.

According to a statement released by the DOJ on Wednesday, the settlement, in which Aetna will sell off its Part D business, was a condition of the merger’s approval and resolves the DOJ’s “competition concerns.”

The deal is the latest in a wave of combinations among healthcare companies, including many pharmacy benefit manager (PBM) and insurer integrations. Last month, the Justice Department approved Cigna’s $67 billion takeover of Express Scripts.

CVS Health announced in early December 2017 its intention to acquire Aetna in a $69 billion-dollar merger, marking the largest ever in the health insurance industry. Woonsocket, R.I.-based CVS operates the nation’s largest retail pharmacy chain, owns a large pharmacy benefit manager called Caremark, and is the nation’s second-largest provider of individual prescription drug plans, with approximately 4.8 million members. CVS earned revenues of approximately $185 billion in 2017. Aetna, headquartered in Hartford, Connecticut, is the nation’s third-largest health-insurance company and fourth-largest individual prescription drug plan insurer, with over two million prescription drug plan members. Aetna earned revenues of approximately $60 billion in 2017.

Following news of the deal back in December, there was speculation that antitrust regulators might not approve the deal. Back in January 2017, a federal judge blocked a merger that would have resulted in Aetna acquiring Louisville, Ky.-based insurer Humana, which at the time was the largest acquisition of its type in the history of health insurance in the U.S., reported at $37 billion. At the time, U.S. District Judge John D. Bates in Washington said that proposed deal would “violate antitrust laws by reducing competition among insurers.” Similarly, a proposed combination of two other health insurers, Anthem and Cigna, was also shot down last year.

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According to the DOJ’s statement issued today on the CVS-Aetna deal, the Justice Department’s Antitrust Division had significant concerns about the anticompetitive effects of the merger with regards to the Medicare Part D businesses. CVS and Aetna are significant competitors in the sale of Medicare Part D prescription drug plans to individuals, together serving 6.8 million members nationwide, according to the DOJ.

In a press release issued today, CVS Health said, “DOJ clearance is a key milestone toward finalizing the transaction, which is also subject to state regulatory approvals, many of which have been granted.” CVS Health's acquisition of Aetna remains on track to close in the early part of Q4 2018, the company said.

“DOJ clearance is an important step toward bringing together the strengths and capabilities of our two companies to improve the consumer health care experience,” CVS Health president and CEO Larry J. Merlo, said in a statement. “We are pleased to have reached an agreement with the DOJ that maintains the strategic benefits and value creation potential of our combination with Aetna. We are now working to complete the remaining state reviews.”

Merlo also said, “CVS Health and Aetna have the opportunity to combine capabilities in technology, data and analytics to develop new ways to engage patients in their total health and wellness. Our focus will be at the local and community level, taking advantage of our thousands of locations and touchpoints throughout the country to intervene with consumers to help predict and prevent potential health problems before they occur. Together, we will help address the challenges our health care system is facing, and we'll be able to offer better care and convenience at a lower cost for patients and payors.”

Following the close of the transaction, Aetna will operate as a standalone business within the CVS Health enterprise and will be led by members of its current management team.

The American Medical Association (AMA), an industry group that has been opposed to the merger, issued a statement saying the agreement that Aetna divest its Part D business doesn't go far enough to protect patients.

"While the AMA welcomes the U.S. Department of Justice (DOJ) requiring Aetna to divest its Medicare Part D drug plan business, we are disappointed that the DOJ did not go further by blocking the CVS-Aetna merger," Barbara L. McAneny, M.D., president, American Medical Association, said in a statement. "The AMA worked tirelessly to oppose this merger and presented a wealth of expert empirical evidence to convince regulators that the merger would harm patients. We now urge the DOJ and state antitrust enforcers to monitor the post-merger effects of the Aetna acquisition by CVS Health on highly concentrated markets in pharmaceutical benefit management services, health insurance, retail pharmacy, and specialty pharmacy."

Agreement with DOJ Resolves “Competition Concerns”

Late last month, Aetna agreed to sell its Part D business to WellCare. According to a Securities and Exchange Commission (SEC) filing from WellCare Health Plans last month, WellCare entered into an asset purchase agreement with Aetna to acquire the company’s entire standalone Medicare Part D prescription drug plan business, which has 2.2 million members. According to the agreement, Aetna will provide administrative services to and retain the financial risk of the Part D business through 2019. In that filing, it states that Aetna is divesting its Part D business as part of CVS Health’s proposed acquisition of Aetna.

“Today’s settlement resolves competition concerns posed by this transaction and preserves competition in the sale of Medicare Part D prescription drug plans for individuals,” Assistant Attorney General Makan Delrahim of the Justice Department’s Antitrust Division, said in a statement. “The divestitures required here allow for the creation of an integrated pharmacy and health benefits company that has the potential to generate benefits by improving the quality and lowering the costs of the healthcare services that American consumers can obtain.”

In its statement, the DOJ referred to WellCare as “an experienced health insurer focused on government-sponsored health plans, including Medicare Part D individual prescription drug plans.”

The Department’s Antitrust Division, along with the offices of five state attorneys general, today filed a civil antitrust lawsuit in the U.S. District Court for the District of Columbia to enjoin the proposed transaction, along with a proposed settlement that, if approved by the court, would fully resolve the Department’s competitive concerns. The participating state attorneys general offices represent California, Florida, Hawaii, Mississippi, and Washington.

In a complaint filed to the U.S. District Court, DOJ attorneys argued that without the divestiture, the combination of CVS, which markets its Medicare Part D individual prescription drug plans under the “SilverScript” brand, and Aetna would cause “anticompetitive effects, including increased prices, inferior customer service, and decreased innovation in sixteen Medicare Part D regions covering twenty-two states.” DOJ attorneys also argued that the loss of competition between CVS and Aetna would result in “lower-quality services and increased costs for consumers, the federal government, and ultimately, taxpayers.”

Under the terms of the proposed settlement, Aetna must divest its individual prescription drug plan business to WellCare and allow WellCare the opportunity to hire key employees who currently operate the business.  Aetna must also assist WellCare in operating the business during the transition and in transferring the affected customers through a process regulated by the Centers for Medicare and Medicaid Services (CMS).

 


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