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Innovator Awards Program 2018: Semifinalists

February 19, 2018
by the Editors of Healthcare Informatics
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Editor’s Note: We at Healthcare Informatics were once again ecstatic with the exceptional quality of the submissions we received from innovating patient care organizations across the U.S. In addition to the four winning teams this year (whose stories will be posted throughout this week), our editorial team also selected several runners-up. Below, please find descriptions of the initiatives of the 14 teams whom we have awarded semifinalist status in this year’s program.

Centre for Addiction and Mental Health (Ontario, Canada)

Improving patient care through achievement of HIMSS EMRAM Stage 7

In May 2014, CAMH implemented a clinical information system using a big-bang approach with an integrated team of clinicians, information technology, and other staff. But after implementation, CAMH noted a lack of clinical practice standardization. A new initiative emerged that included work to refine the inputting of clinical documentation to the EHR, the development of electronic whiteboards to display and manage assessment and risk factors, leveraging data to inform improvement initiatives, and many other requirements as defined by the HIMSS EMRAM (EMR Adoption Model) Stage 7 criteria.

CAMH is the first academic teaching hospital to achieve HIMSS Stage 7 in Canada; this achievement is a milestone in both the Canadian and international health landscape. Now, more than 99 percent of CAMH clinically-relevant documentation is completed directly within the EHR and CPOE (computerized provider order entry) rates have been over 90 percent since December 2016. What’s more, the creation of a suicide risk dashboard has led to 90 percent of patients having a suicide risk assessment completed within 24 hours of admission.

Cleveland Clinic (Cleveland, Ohio)

An enterprise imaging service

The goal of the enterprise imaging service is to provide a comprehensive longitudinal medical record through incorporation of all medical images into a single archive. Through a universal viewer, the archive is integrated with the EHR and provides a foundation for image distribution to all caregivers throughout the enterprise. The archive also serves as a foundation for image sharing. Implementation required a comprehensive assessment of all image generating equipment throughout all hospitals and outpatient centers.

The Clinic’s officials say that the establishment of an enterprise imaging program has led to the consolidation of imaging archives throughout the health system. Images which were not previously easily accessible are now readily viewable through the EHR (electronic health record) with access points both within the firewall and from home. To date, 11 different service lines and more than 440 pieces of image generating equipment outside of radiology have been integrated.

Compass Medical (Massachusetts)

Annual wellness, chronic care management and quality outcomes

By leveraging new information technology, Compass Medical has been able to follow proven population health management and care management principles, allowing patient care leaders to identify and target specific population groups, stratify and prioritize care gaps and engage and individualize care plan activities. In 2016, for example, Compass Medical was able to identify and target more than 14,000 Medicare patients that were struggling to manage their chronic health conditions and needed a more personalized and comprehensive care plan. One year later, Compass Medical developed and launched a new Chronic Care Management Program to help engage with and closely manage Medicare patients that suffer from two or more chronic health conditions. With the help of its EHR and big data platform, Compass Medical positioned itself to automate many of the workflows for care management nurses.

The Annual Wellness Visit (AWV) is another example of a preventive care service that has been positively affected by leveraging IT. In 2017, national trends suggested utilization of AWV were still hovering around the low 20-percent range with the highest performing state reaching 35 percent. Utilizing EHR-based patient engagement campaigns for increasing focused outreach, incorporating a team based care model with scribes, and creating standard work processes for reducing provider burden have helped Compass Medical reach 57 percent AWV utilization for its Medicare eligible population by the end of year 2017.

Duke University School of Medicine (Durham, N.C.)

A NICU discrete event simulation model

Duke’s neonatal clinicians care for more than 800 babies each year in the Duke Neonatal Intensive Care Unit (NICU). Although the majority do well, about 40 babies do not survive. How could they improve outcomes and save lives? Duke’s neonatal research team partnered with analytics company SAS to create an analytics-based model of Duke Children’s Hospital’s Level IV neonatal intensive care unit. The result was the creation of a discrete event simulation model that closely resembled the clinical outcomes of Duke’s training unit, which was validated using data held back from the original model, which also closely tracked actual unit outcomes.

The model uses a vast resource of clinical data to simulate the experience of patients, their conditions and staff responses in a computerized environment. It creates virtual babies experiencing care within a simulated NICU environment, including virtual beds staffed by virtual nurses. The research team attests that they cannot find any evidence of discrete event simulation modeling being used in a NICU setting, making this a first in neonatal care.

Houston Methodist (Houston, Texas)

A coordinated care/Medicare Shared Savings Program (MSSP) initiative

Houston Methodist's MSSP program, Houston Methodist Coordinated Care (HMCC), can track and report Medicare patients’ healthcare visits and medical details. The successful execution of the program is a layering of technologies with the foundation being the organization’s integrated EHR platform and a separate population management tool.

The project was centered around six core elements: 1) becoming the first ACO (accountable care organization) in Texas to acquire real-time admission, discharge and transfer (ADT) notification capability that links all health providers; 2) chronic heart failure home monitoring; 3) real-time notification when HMCC patients came into the ED; 4) risk assessments for emergency room visits, hospital readmissions and the need for complex care; 5) same-day appointment facilitation; and 6) care team alerts. In sum, there were 17,000 Houston Methodist patients in HMCC in 2017, year-to-date, with 105 participating physicians. Total healthcare cost savings year-to-date are more than $1.3 million, according to officials.

Indiana University Health (Indianapolis, Ind.)

FHIR HIEdrant: making big data actionable at the point of care

One of the difficult challenges for many HIEs (health information exchanges) is the time and effort that it takes to reach out to a second system to search for needed data at the point of care. As such, the goal at IU Health was to develop an application within the clinical workflow that will, at the click of a single button, bring back data to that workflow relating to the patient’s chief complaint from the HIE.

The first phase of this project was building the framework and the mechanisms to make this a possibility and apply it to a single context: an emergency department patient with chest pain. Leaders at IU Health are utilizing the Fast Healthcare Interoperability Resources (FHIR) standard to communicate out from the IU Health Cerner EHR to the HIE to retrieve five specific data elements that are germane to caring for a chest pain patient in the emergency department and understanding their risk. Within the workflow, the clinician is being presented the most recent: ECG, cardiology note, discharge summary, catheterization report, and more. According to IU Health officials, this is the first FHIR-based application that directly accesses an HIE and delivers context-specific data about a patient directly to the clinical workflow.

Johns Hopkins Health System (Baltimore, Md.)

inHealth precision medicine initiative

The precision medicine initiative at Johns Hopkins Medicine and University–inHealth–seeks to improve individual and population health outcomes through scientific advances at the intersection of biomedical research and data science. Through a collaboration of The Johns Hopkins Applied Physics Laboratory (APL), and Johns Hopkins Medicine (JHM), inHealth is building a big-data precision medicine platform with the goal of accelerating the translation of insight into care delivery.

The first result of this broad, multidisciplinary effort was the successful creation of two Precision Medicine Centers of Excellence (PMCoE) focused on multiple sclerosis and prostate active surveillance. The organization’s Technology Innovation Center has developed applications to garner new data and learnings from clinical practice and feedback into discovery. Physicians have begun using the discovery platform to facilitate conversations with their patients about their treatment options and risks. The experiences of these centers will lead the next wave of PMCoEs, expanding the utility of the platform.

Lakeland Health (St. Joseph, Mich.)

Something wicked this way comes

Leaders at Lakeland Health set three core cybersecurity goals: (a) put risk management and cybersecurity near the top of health system leadership agenda; (b) use innovative strategies and tools to execute the cybersecurity program; and (c) shift focus from fear to clinical integrity. The cybersecurity program covered the hospitals, clinics, home care, hospice and all the different legal entities which comprised the health system. In order to ensure strategic direction and alignment, a steering committee was set up which met every two weeks.

The cybersecurity program execution was focused on three work-streams—process, technology and team members. In the process work stream, execution covered implementation and audit of policies and procedures, risk assessment and HIPAA (Health Insurance Portability and Accountability Act) compliance, and a monthly information security executive dashboard which was reviewed by the steering committee. Despite this continuing threat, the cybersecurity program delivered strong results in different areas, including: more than 100 business associate agreements (BAA) were signed; annual HIPAA risk assessment and remediation plans were put in place; the initial internal phishing campaign eventually lowered the click rate to 10 percent; there was a five-fold increase in the suspicious emails forwarded to the security team; and more than 1,000 laptops were encrypted.

Lexington Clinic (Lexington, Ky.)

Development of a direct-to-employer network

Costs of certain services often vary dramatically between providers, so by selectively designing benefits to increase cost-sharing at providers who provide more expensive care, enrollees are incentivized to see the more efficient providers who provide care at a lower cost, reducing average overall expenditure. Savings can then be passed on to the employer. In this project, implementation was examined with an organization with a self-funded insurance model. Steering beneficiaries toward a tighter network of providers resulted in significant overall reductions in expenditure while improving the health of the overall employee population. Rather than limiting their employee health plan to a lower percentage of area providers like most similar plan designs, the employer entered into a direct-to-employer program with a local, multispecialty physician group: Lexington Clinic.

A key component of a direct-to-employer plan is population health. Lexington Clinic was able to utilize analytics software to deliver value to the employer by implementing high cost/high utilization analysis, undetected chronic disease engagement, and ancillary modality management. Lexington Clinic also determined that there were specific interventions that could be made at critical junctures in the care continuum of the employee population. These interventions would be designed to prevent health issues before they arise, reducing future expenditures and worsened health outcomes. Via the Lexington Clinic premier network, the employer demonstrated a clear reduction in aggregate expenditure from the 2015 to 2016 time period of more than 4 percent.

Lutheran Medical Center (Wheat Ridge, Colo.)

An app for staff engagement

At Lutheran Medical Center, it became a priority to redesign the way in which the staff was engaged. The organization started to use an anonymous crowdsourcing platform in 2016 with the goal to create recipes for success that would help leaders in the organization ask the right questions through an anonymous tool to enhance engagement. Using the tool has established a venue for staff to engage in problem solving and design ideas on their own terms in an anonymous way where all can follow along in the conversation in real time. The application/website started its use in the pharmacy department as a means to understand low engagement scores. This tool allowed for all staff to be involved while not taking them away from their daily duties.

Lutheran Medical Center was in the 11th percentile when it came to staff satisfaction only two years ago, but now ranks in the 43rd percentile compared to the national average. Having the ability to get staff buy-in before a change happens has been critical in impacting staff satisfaction. Before, only those invited to certain meetings had the opportunity to voice their opinions; now everyone can be reached with a single email or app use. It has been used for solving several clinical problems as well, such as how to design a “cord-free” patient room, and how to transport oxygen tanks around the hospital.

Mercy (St. Louis, Mo.)

Using NLP for heart failure EHR documentation

The goal of this project was to use NLP to extract key cardiology measures from physician and other clinical notes and incorporate the results into a dataset with discrete data fields. This dataset would then be used to obtain actionable information and contribute to the evaluation of outcomes of medical devices in heart failure patients.

Three key measures that are commonly stored in clinical notes and not available in discrete fields include ejection fraction measurement; patient symptoms including dyspnea, fatigue, dizziness, palpitations, edema and pulmonary congestion; and the New York Heart Association (NYHA) heart failure classification. Mercy patients had 35.5 million clinical notes from both inpatient and outpatient encounters that were extracted, processed and then loaded onto an NLP server. NLP queries were developed by a team of Mercy data scientists to search for relevant linguistic patterns and then evaluated for both precision and recall. The use of NLP in this project facilitated the extraction of vital patient information that is not available in any discrete field in the EHR. Without the ability to track the changes in these three essential measures, it becomes much harder to identify the point of disease progression which is a crucial factor for the evaluation of current treatments and could inform future interventions, according to Mercy officials.

Mosaic Life Care (St. Joseph, Mo.)

Revenue management analytics dashboard

Mosaic Life Care provides healthcare and life care services in and around St. Joseph, Missouri and the Kansas City Northland area. The organization’s finance and revenue cycle teams faced challenges with data silos that required caregivers to manually obtain information from disparate systems and manually collate information, subjecting the process to human error, inconsistent processes and concerns about data accuracy.

With the goal of developing a flexible “source of truth” dashboard, the enterprise data warehouse team developed an integrated revenue management analytics solution with a front-end dashboard by leveraging the core EDW solution and architecture platform to extract data from the best of breed systems. Through the new dashboard, financial analysts and management teams can perform analysis and predict future trends. As a result, the dashboard enables real-time, data-driven business decisions inclusive of multi-disparate systems within a single unified platform.

NYU Langone Health (New York City, N.Y.)

Value-based medicine to improve clinical care

The goal of the project was to leverage health IT tools and related workflows to improve the value of inpatient care. Finance collaborated with the project’s physician champions to identify variations in care both internally and compared to benchmarked external institutions. The project’s physician champions collaborated with IT physician informaticists and IT project teams to design interventions to both reduce cost and improve clinical care.

The suite of interventions included: electronic clinical pathways; blood protocols; intravenous (IV) to oral (PO) medication changes; and lab ordering enhancements. Electronic pathways were created for heart failure, colon surgery, and pneumonia, and blood ordering clinical decision support and analytics were built. These projects realized significant two-year savings, including: electronic clinical pathways: $12.9 million; lab modifications: $3 million; blood utilization: $2.9 million; and IV to PO: $2.2 million.

Penn Medicine (Philadelphia, Pa.)

Standard clinical iPhone effectively enhances patient care

In January 2016, Penn Medicine met with Apple engineers to develop an economic and efficient full configuration Standard Clinical iPhone (SCiP) to work with Penn’s mobile device management tool while leveraging Apple’s Device Enrollment Program (DEP) and Volume Purchasing Program (VPP). Using this method saved the organization 975 man hours in its initial deployment using DEP streamlined setup (15 minutes versus one hour for each iPhone). Pushing additional apps to devices without needing an Apple ID and password for download or manual touch also made the implementation efficient. By implementing this project, it placed a vital tool into caregivers’ hands, officials say.

Just by using the secure texting, clinicians were able to coordinate patient flow across care settings with multiple providers and mended gaps in communication. One example had the cardiac surgery team on a thread with the patient’s current caregivers. The nurse took a picture of the surgical site and sent it securely with a description, concerned about swelling around the surgical site. The surgical team was able to provide immediate feedback and resolve the issue remotely.


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Take the Lead to Deploy Emerging Technologies for Improved Outcomes

December 14, 2018
by Brad Wilson, Industry Voice, former CEO of Blue Cross and Blue Shield of North Carolina
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It is a thrilling time to work in healthcare. As the former CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross N.C.), I have had the opportunity to be at the forefront of using new technologies to improve outcomes for our members. Now as a member of the CitiusTech advisory board, I continue that focus on emerging technologies, such as artificial intelligence (AI), and the potential to accelerate the shift to value-based care and improve the healthcare system in material ways.

AI is starting to make a distinct impact in helping providers deliver more effective care, lower costs and create a more consumer-friendly healthcare system. Blue Cross NC recently piloted the use machine learning, a type of AI, to identify spikes in prescriptions for a costly medication. The company reached out to doctors who had been prescribing the medicine in significant numbers. Alerting just one particular physician practice to a generic equivalent brought estimated annual savings of $750,000 for Blue Cross NC customers. The potential of AI is not measured only in dollars, but cost savings are an important consideration.

Machine learning works by applying sophisticated algorithms to rich datasets from electronic medical records (EMRs), patient-reported data, claims and a host of other sources. To be successful, this requires both access to data and significant investment to support the depth and breadth of data analytics capacity and capability.

Yet, historically, one of the biggest barriers to value-based models has been providers’ and payers’ possessiveness of their own data. There is a good business reason for that possessiveness: competitive advantage. The different parts of the healthcare system do not want competitors to use shared data to steal business. But the guarding of data drives healthcare costs higher and, more importantly, makes delivering better, more personalized healthcare more difficult. In the past, power came from hoarding information; today, there is power in serving as an information hub.  Healthcare providers and payers are starting to understand this and there is more willingness to work together in sharing what has traditionally been closely held information.

As consumers’ voices gain in numbers and decibels, it’s clear that analytics technologies that can lead to better care at lower cost are desperately needed, particularly for payers. But the entire healthcare industry needs to move more rapidly. Health plans need to enrich, deepen and widen their analytics capabilities as quickly as possible. If they don’t, we will continue to see disruptors like Google, Apple, and Amazon enter the healthcare market—companies that have a demonstrated ability to be nimble and maximize the impact of their data.

For both providers and payers, forward-thinking organizations recognize that building their own data analytics solutions is not always the answer. Often there is not enough time, resources or enough of the right talent to deliver the capacity and capability required. Fortunately, robust turnkey solutions coupled with deployment expertise are available to efficiently and cost-effectively integrate data and analytics within an organization’s clinical, financial and administrative processes.

As health plan executives map out their strategic plans, look to these emerging technologies as accelerators for leveraging data to manage risk, optimize performance, engage consumers, enhance population care, and improve clinical outcomes to reduce readmissions and further drive evidence-based medicine. The opportunity is here to transform healthcare delivery in significant ways. Success will go to those organizations that understand the potential of these new technologies and take the lead to deploy them effectively—today. 

Brad Wilson is former CEO at Blue Cross and Blue Shield of North Carolina and is a member of the new CitiusTech Advisory Board. Mr. Wilson joined Blue Cross NC in 1995 as General Counsel and held a variety of senior-level positions before being named CEO in 2010. Under his leadership, Blue Cross NC grew to a $9 billion company serving over 3.8 million customers. Mr. Wilson has also served as Director of the BCBS Association, AHIP and numerous other national and state healthcare organizations.

 


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Investors Have Strong Interest in HIT Sector, Despite Valuation Concerns

December 13, 2018
by Heather Landi, Associate Editor
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Healthcare IT remains a hot investment sector despite concerns about these companies being overvalued, according to KPMG-Leavitt Partners 2019 Investment Outlook, a survey of health care investment professionals.

Looking ahead to 2019, more than a third of respondents (34 percent) said they were most interested in investing in health care IT, followed by care management (31 percent), home health (23 percent), retail-centric medical groups (22 percent) and primary care practices (21 percent).

New York City-based KPMG and Leavitt Partners, based in Salt Lake City, surveyed 175 respondents online from corporations, health systems, investment banks, venture capital and private equity firms between September 17, 2018 and October 21, 2018. Of those surveyed 32 percent were C-suite executives; 29 percent were principal, partner or managing director; 32 percent were vice president or director; 6 percent were analysts/associates and 2 percent held other titles.

“We are not surprised by the great deal of interest in health care IT and care delivery outside the hospital,” Governor Mike Leavitt, founder of Salt Lake City-based Leavitt Partners and former Utah Governor and U.S. Health & Human Services Secretary said in a statement. “As health care continues to march toward value, the emphasis on moving care to lower cost sites and enhanced coordination will continue, and those who can increase quality and lower cost will win.”

According to an October report from Rock Health, 2018 is already the most-funded year ever for digital health startups. Digital health funding in this past third quarter soared to $3.3 billion across 93 deals, pushing 2018 funding to $6.8 billion, already exceeding last year’s annual funding total, which was $5.7 billion, by more than a billion dollars.

Drilling down into respondents’ predictions for investment activity in 2019, in the health care and life sciences market, 96 percent of respondents see either a lot or a moderate amount of investment in health IT and data next year, while a similar percentage (90 percent) see significant or moderate investment in outpatient services. Forty-four percent forecast a lot of investment in post-acute care services, 39 percent predict significant investment in provider services and about a quarter of respondents believe there will be a lot of investment in managed public programs, payer service providers and pharmaceutical and biotech manufacturers. Eighteen percent believe there will be significant investment in medical device and diagnostics and medical equipment.

The survey results indicate there is concern that health IT is overvalued, yet investors believe there is some room to climb.

The majority of investment professionals see health care IT investments as an overvalued sector (64 percent), yet 40 percent expect the valuations to increase in 2019 while 51 percent see them staying the same. About two-thirds of respondents (62 percent) think the health IT sector will grow faster than the market in 2019, and three quarters of investment professionals see increasing competition in the health IT market. Investors also estimate that the average purchase price multiple, in terms of EBITDA, will be 12.5 for the health IT sector in 2019. Survey respondents expect ongoing demand for tools to help with consumerism will impact investment and deal making in the sector, according to the survey.

About four in ten respondents believe the healthcare market is experiencing a “moderate bubble,” while 9 percent believe the bubble will likely burst.

Care management solutions for risk-bearing providers, a highly competitive sector which helps coordinate care of the chronically ill or seriously injured, are expected to be the second highest sector for investment behind health care IT, similarly driven by trends of consumerism and increased focus on early care interventions.

Looking at potential drivers of M&A activity in the health care and life sciences sector in the coming year, 64 percent of respondents cited cost consolidation and economies of scale, while 45 percent cited accretive acquisition strategies. Forty percent of respondents see changing payment models as a driver of M&A activity, and 38 percent cited pressure from competition. Other drivers cited by respondents include expansion/divestiture of service areas (25 percent), geographic expansion/contraction (24 percent), revenue synergies (22 percent), need to deploy cash on balance sheet (17 percent), and regulations and legislation (13 percent).

“Deals are largely being driven by the need for savings, economies of scale, and improving cash flow or accretive earnings per share,” Carole Streicher, Deal Advisory leader for healthcare & life sciences at New York City-based KPMG, said in a statement. “Secondarily, there is a bit of a defensive posture motivating investments as health care organizations contend with competition and reimbursement models connected to quality and efficiency, as well as the entrance of tech firms investing in the sector.”

 

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Report: Massachusetts General Hospital Targeting Various Blockchain Use Cases

December 7, 2018
by Rajiv Leventhal, Managing Editor
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Massachusetts General Hospital (MGH) researchers are partnering with MediBloc, a Korean healthcare blockchain company, with the aim to improve patient data sharing and storing, according to an article in CoinDesk.

Per the article, the Laboratory of Medical Imaging and Computation by MGH and Harvard Medical School will be escalating research in a variety of broad areas “from medical image analysis to health information exchange by leveraging our cutting-edge technologies such as blockchain, artificial intelligence and machine learning,” according to Synho Do who is the laboratory’s director.

Do specifically told CoinDesk, “In collaboration with MediBloc, we aim to explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

Interestingly, MGH won’t be using any real patient data for its research, but rather simulated data, according to officials, since the various institutions that have the real patient data keep it in a way “that can’t be shared securely and often is in various incompatible formats.”

MediBloc’s CEO noted that the company is not only developing a distributed ledger for storing and sharing medical data, but also working on a tool that would convert data now held by hospitals from existing formats to a universal one, per the article.

For this initiative, MediBloc has already gotten partners across Asia, including eight healthcare organizations and 14 technology companies, officials said.

Earlier this year, a testing environment version of the blockchain was launched, and the network is expected to go live before the end of the year before becoming fully functional in the second quarter of 2019. Furthermore, there are also apps in the works that are planning to go live next year, with one of them, currently in a beta testing phase, “designed for patients to sell the information about their symptoms and the prescriptions they get to MediBloc. After that MediBloc will analyze that data and sell the analysis to pharmaceutical and insurance companies,” according to the story.

In the end, the main goal of the blockchain project will be to let patients independently decide what to do with their information.

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