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Stamford Health’s Plunge into Analytics Has Closed Gaps, Opened New Doors

May 31, 2017
by Rajiv Leventhal
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It was about five years ago when executive leadership at the Connecticut-based Stamford Health came to the realization that their reporting across the organization was quite poor and needed a major improvement. What was most perplexing, according to Divya Malhotra, M.D., director of analytics and innovation at Stamford Health, was that there wasn’t much insight into why the reporting was failing, just that data was not being received in a timely enough fashion.

As such, Stamford Health’s CEO created a business intelligence (BI) department in 2012, which Malhotra was tapped to lead. One of the first things she noticed was that even though the data infrastructure at the 305-bed hospital with 125 physicians was sound, meaning getting the data from all of the organization’s applications on a daily basis, there was no way to get those insights in a real-time fashion. “That was the biggest gap I identified as I stepped in,” Malhotra recalled.

Indeed, as a single hospital system without a $5 million budget to invest in a big BI and analytics infrastructure, Malhotra’s team piloted software from Seattle-based data visualization vendor Tableau to a few departments and key personnel—such as physician leaders, the chief quality officer, and the chief medical officer. “We focused on the biggest impact areas at first,” says Malhotra. “So we took out the operational reports that were coming out of the external vendor software and converted that in-house, and we slowly started to convert our back-end live database, which was literally just a replica of our Meditech application, into a structured data warehouse, which then hooked up to Tableau on a nightly basis,” she says.

One of the very first people to pilot the technology was Stamford Health’s orthopedic service line leader, who was previously getting all of the necessary data from an external software company, which would then turn it around, analyze it, and give the department graphs and charts. But that became repetitive with Tableau in-house, so all of that data then was converted into a Tableau scorecard. Since Stamford Health is running some 100 data sources in all, having a system that was able to connect to those sources and manipulate the data quickly became mission critical, notes Malhotra.

In fact, siloed reporting was one of the biggest pain points at Stamford Health for years, Malhotra says. “People were running reports out of applications. So just like in any healthcare system, there are multiple applications for different departments, such as financial, inpatient, and outpatient, and even siloed electronic health records (EHRs) that were running out of their own applications,” she says. “The result was that nothing was syncing up.”


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An example of this, Malhotra explains, is having the finance department pulling up length-of-stay data one way, but clinicians pulling that data some other way from a different database which they submit information to. This would lead to the numbers from the two departments not matching up when they should be. “So we would get into this constant challenge of who’s right and who’s wrong,” says Malhotra. Is the [length of stay] definition right? What about the numbers are different?”

But with Tableau all of the data sources are connected, and there was also a desire to work on the definitions. “That’s a critical component. Data governance is critical for any kind of analytics program, as everyone needs to be talking the same language. If people are measuring things even slightly differently, it’s important to outline that and have that disclaimer anytime you publish a report, so everyone is on the same page, and we know when we’re comparing apples to apples and when we are not,” Malhotra says.

Another benefit, notes Malhotra, is that because they are now able to take data from different systems, what lacks in overall system interoperability is somewhat offset by the ability of these tools and technologies to connect data. For instance, she explains, Stamford Health’s eClinicalWorks outpatient EHR is not technically integrated with Meditech, its totally separate hospital-based EHR system. “We have used Tableau, data warehousing, and SQL queries, and we have connected patient level information and have actually matched patient identities,” says Malhotra. So If I am a patient in eClinicalWorks and end up getting admitted to the ED, we have reports running that would tell the primary care doctor that I ended up in the ED last night. That’s where the power lies in having a good analytics system that’s nimble and fast, and that’s where you can impact patient care and change the paradigm,” she says.

What’s more, in regards to financial, cost, and clinical variation that are certainly top of mind these days, Stamford Health has connected its OR module data with supply chain information. What this means is that for each surgeon and for each procedure, they can drill down to supplies used per case, and identify what the supplies are and what the pricing of that supply is, Malhotra says.

Taking a simple procedure like an appendectomy as an example, Stamford Health now has the ability to put all the surgeons who perform that procedure into one chart and look at variable costs. “We mapped our cost accounting data into the surgical data and then bumped it against our supply chain data. So I can say I am the cheapest but I might be taking three times as long [for surgery], for example. We can now get a comprehensive picture of clinical variation by surgeon, and our surgical chairs have shared that information with the surgeons,” says Malhotra.

Although many organizations struggle with proving the value of certain analytics efforts to end-user clinicians, that was not a problem at all at Stamford Health. “We were really hungry for the data, across the board, and challenges often come when you don’t like the data that’s being put in front of you,” Malhotra says. “You need data integrity and you need to be able to cleanse and normalize the data—especially for physicians, who I say are scientists and are driven by data,” she says.

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AMIA Charts Course to Learning Health System

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Initiative seeks to create virtuous cycle where clinical practice is not distinct from research

In September 2015, at AcademyHealth’s Concordium 2015 meeting in Washington, D.C., I saw a great presentation by Peter Embi, M.D., who was then an associate professor and vice chair of biomedical informatics as well as associate dean for research informatics and the chief research information officer at the Wexner Medical Center at Ohio State University. 

That day Dr. Embi outlined some of the limitations of the traditional approach to evidence-based medicine —  that it is a research/practice paradigm where the information flow is unidirectional, and clinical practice and research are distinct activities, with the research design as an afterthought. “We want to leverage information at the point of care and in engagements with patients so we can systematically learn. That is what the learning health system is all about,” Embi said.

But in the current model, he noted, there is little consideration of research during planning of health systems. That limits the ability to invest in and leverage clinical resources to advance research. Also, there are no financial incentives for non-researchers to engage in research. Research as an afterthought also leads to regulatory problems and wasted investments.

Embi argued for moving from “evidence-based medicine” to an “evidence-generating medicine” approach, which he defined as the systematic incorporation of research and quality improvement into the organization. Rather than findings flowing only from research done looking back at historical data, this approach creates a virtuous cycle where clinical practice is not distinct from research.

Flash forward to 2019 and Dr. Embi is now president & CEO of Regenstrief Institute Inc., vice president for learning health systems at IU Health, and chairman of the Board of Directors of the American Medical Informatics Association (AMIA). And he is still advocating for a shift to evidence-generating medicine. He and AMIA colleagues recently published a paper in JAMIA offering more than a dozen recommendations for public policy to facilitate the generation of evidence across physician offices and hospitals now that the adoption of EHRs is widespread.

The paper cites several examples of current high-visibility research initiatives that depend on the EGM approach: the All of Us Research Program and Cancer Moonshot initiative, the Health Care Systems Research Collaboratory, and the development of a national system of real-world evidence generation system as pursued by such groups as the US Food & Drug Administration (FDA), Patient-Centered Outcomes Research Institute (PCORI), National Institutes of Health (NIH), and other federal agencies.

The paper makes several recommendations for policy changes, including that the Trump administration should faithfully implement 2018 Revisions to the Common Rule as well as establish the 21st Century Cures-mandated Research Policy Board. The administration must implement this provision to better calibrate and harmonize our sprawling and incoherent federal research regulations.

Another recommendation is that the HHS Office of Civil Rights (OCR) should refine the definition of a HIPAA Designated Record Set (DRS) and ONC should explore ways to allow patients to have a full digital export of their structured and unstructured data within a Covered Entity’s DRS in order to share their data for research. In addtion, regulators should work with stakeholders to develop granular data specifications, including metadata, and standards to support research for use in the federal health IT certification program.

The AMIA authors also suggest that CMS leverage its Quality Payment Program to reward clinical practice Improvement Activities that involve research components. This would encourage office-based physicians to invest time and resources needed to realize EGM, they say.

Based on the paper’s findings, AMIA is launching a new initiative focused on advancing informatics-enabled improvements for the U.S. healthcare system. The organization says that a multidisciplinary group of AMIA members will develop a national informatics strategy, policy recommendations, and research agenda to improve:

• how evidence is generated through clinical practice;

• how that evidence is delivered back into the care continuum; and

• how our national workforce and organizational structures are best positioned to facilitate informatics-driven transformation in care delivery, clinical research, and population health.

A report detailing this strategy will be unveiled at a December 2019 conference in Washington, D.C.



More From Healthcare Informatics


Definitive Healthcare Acquires HIMSS Analytics’ Data Services

January 16, 2019
by Rajiv Leventhal, Managing Editor
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Definitive Healthcare, a data analytics and business intelligence company, has acquired the data services business and assets of HIMSS Analytics, the organizations announced today.

The purchase includes the Logic, Predict, Analyze and custom research products from HIMSS Analytics, which is commonly known as the data and research arm of the Healthcare Information and Management Systems Society.

According to Definitive officials, the acquisition builds on the company’s “articulated growth strategy to deliver the most reliable and consistent view of healthcare data and analytics available in the market.”

Definitive Healthcare will immediately begin integrating the datasets and platform functionality into a single source of truth, their executives attest. The new offering will aim to include improved coverage of IT purchasing intelligence with access to years of proposals and executed contracts, enabling transparency and efficiency in the development of commercial strategies.

Broadly, Definitive Healthcare is a provider of data and intelligence on hospitals, physicians, and other healthcare providers. Its product suite its product suite provides comprehensive data on 8,800 hospitals, 150,000 physician groups, 1 million physicians, 10,000 ambulatory surgery centers, 14,000 imaging centers, 86,000 long-term care facilities, and 1,400 ACOs and HIEs, according to officials.

Together, Definitive Healthcare and HIMSS Analytics have more than 20 years of experience in data collection through exclusive methodologies.

“HIMSS Analytics has developed an extraordinarily powerful dataset including technology install data and purchasing contracts among other leading intelligence that, when combined with Definitive Healthcare’s proprietary healthcare provider data, will create a truly best-in-class solution for our client base,” Jason Krantz, founder and CEO of Definitive Healthcare, said in a statement.

Related Insights For: Analytics


Machine Learning Survey: Many Organizations Several Years Away from Adoption, Citing Cost

January 10, 2019
by Heather Landi, Associate Editor
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Radiologists and imaging leaders see an important role for machine learning in radiology going forward, however, most organizations are still two to three years away from adopting the technology, and a sizeable minority have no plans to adopt machine learning, according to a recent survey.

A recent study* by Reaction Data sought to examine the hype around artificial intelligence and machine learning, specifically in the area of radiology and imaging, to uncover where AI might be more useful and applicable and in what areas medical imaging professionals are looking to utilize machine learning.

Reaction Data, a market research firm, got feedback from imaging professionals, including directors of radiology, radiologists, chiefs of radiology, imaging techs, PACS administrators and managers of radiology, from 152 healthcare organizations to gauge the industry on machine learning. About 60 percent of respondents were from academic medical centers or community hospitals, while 15 percent were from integrated delivery networks and 12 percent were from imaging centers. The remaining respondents worked at critical access hospitals, specialty clinics, cancer hospitals or children’s hospitals.

Among the survey respondents, there was significant variation in the number of annual radiology studies performed—17 percent performed 100-250 thousand studies each year; 16 percent performed 1 to 2 million studies; 15 percent performed 5 to 25 thousand studies; 13 percent performed 250 to 500 thousand; 10 percent performed more than 2 million studies a year.

More than three quarters of imaging and radiology leaders (77 percent) view machine learning as being important in medical imaging, up from 65 percent in a 2017 survey. Only 11 percent view the technology as not important. However, only 59 percent say they understand machine learning, although that percentage is up from 52 percent in 2017. Twenty percent say they don’t understand the technology, and 20 percent have a partial understanding.

Looking at adoption, only 22 percent of respondents say they are currently using machine learning—either just adopted it or have been using it for some time. Eleven percent say they plan to adopt the technology in the next year.

Half of respondents (51 percent) say their organizations are one to two years away (28 percent) or even more than three years away (23 percent) from adoption. Sixteen percent say their organizations will most likely never utilize machine learning.

Reaction Data collected commentary from survey respondents as part of the survey and some respondents indicated that funding was an issue with regard to the lack of plans to adopt the technology. When asked why they don’t ever plan to utilize machine learning, one respondent, a chief of cardiology, said, “Our institution is a late adopter.” Another respondent, an imaging tech, responded: “No talk of machine learning in my facility. To be honest, I had to Google the definition a moment ago.”

Survey responses also indicated that imaging leaders want machine learning tools to be integrated into PACS (picture archiving and communication systems) software, and that cost is an issue.

“We'd like it to be integrated into PACS software so it's free, but we understand there is a cost for everything. We wouldn't want to pay more than $1 per study,” one PACS Administrator responded, according to the survey.

A radiologist who responded to the survey said, “The market has not matured yet since we are in the research phase of development and cost is unknown. I expect the initial cost to be on the high side.”

According to the survey, when asked how much they would be willing to pay for machine learning, one imaging director responded: “As little as possible...but I'm on the hospital administration side. Most radiologists are contracted and want us to buy all the toys. They take about 60 percent of the patient revenue and invest nothing into the hospital/ambulatory systems side.”

And, one director of radiology responded: “Included in PACS contract would be best... very hard to get money for this.”

The survey also indicates that, among organizations that are using machine learning in imaging, there is a shift in how organizations are applying machine learning in imaging. In the 2017 survey, the most common application for machine learning was breast imaging, cited by 36 percent of respondents, and only 12 percent cited lung imaging.

In the 2018 survey, only 22 percent of respondents said they were using machine learning for breast imaging, while there was an increase in other applications. The next most-used application cited by respondents who have adopted and use machine learning was lung imaging (22 percent), cardiovascular imaging (13 percent), chest X-rays (11 percent), bone imaging (7 percent), liver imaging (7 percent), neural imaging (5 percent) and pulmonary imaging (4 percent).

When asked what kind of scans they plan to apply machine learning to once the technology is adopted, one radiologist cited quality control for radiography, CT (computed tomography) and MR (magnetic resonance) imaging.

The survey also examines the vendors being used, among respondents who have adopted machine learning, and the survey findings indicate some differences compared to the 2017 survey results. No one vendor dominates this space, as 19 percent use GE Healthcare and about 16 percent use Hologic, which is down compared to 25 percent of respondents who cited Hologic as their vendor in last year’s survey.

Looking at other vendors being used, 14 percent use Philips, 7 percent use Arterys, 3 percent use Nvidia and Zebra Medical Vision and iCAD were both cited by 5 percent of medical imaging professionals. The percentage of imaging leaders citing Google as their machine learning vendor dropped from 13 percent in 2017 to 3 percent in this latest survey. Interestingly, the number of respondents reporting the use of homegrown machine learning solutions increased to 14 percent from 9 percent in 2017.


*Findings were compiled from Reaction Data’s Research Cloud. For additional information, please contact Erik Westerlind at


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