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In South Los Angeles, a High-Tech Hospital Delivers Healthcare to an Underserved Community

September 11, 2018
by Heather Landi, Associate Editor
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A culture of innovation has spurred progress at one California hospital
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When Martin Luther King, Jr. Community Hospital (MLKCH) opened in South Los Angeles in July 2015, it marked the opening of a hospital built from the ground up while incorporating the latest technology into its design. It also marked the closing of a one chapter of South Los Angeles’ health history and the beginning of a new one, as MLKCH shares the same site in the Willowbrook neighborhood as the area’s previous hospital, Martin Luther King Jr./Drew Medical Center, which closed in 2007.

South Los Angeles continues to be a community facing significant socioeconomic and health challenges. According to MLKCH officials, the area is federally designated as Medically Underserved and a Healthcare Professional Shortage Area. Residents rank lowest in life expectancy and worse than L.A. County in nearly every healthcare indicator, and the poverty rate is two times that of the rest of California. The average U.S. community has 10 times the number of doctors as found in South Los Angeles, hospital officials say.

“It’s a community that is reflective of the challenges of delivering healthcare in an urban, low-income, medically underserved community. We have very significant health disparities among our population. We have inadequate outpatient healthcare. We have a 1,200-physician deficit in this community. We have fewer hospital beds than in other communities. We have a lot of social conditions that contribute to poor health, and all of those add up to the challenges that we’re addressing here,” Elaine Batchlor, M.D., CEO of MLKCH, says.

According to a 2015 article in the Los Angeles Times, when King/Drew hospital opened in South Los Angeles in 1972 it was viewed as a victory of the civil rights era and a source of pride for black Los Angeles, as the hospital served one of the neediest parts of Los Angeles. However, the county-run hospital was plagued in later years by poor medical care, staff errors and a series of controversial patient deaths, according to the Los Angeles Times, and the facility shuttered in 2007.

The new private, nonprofit MLKCH is smaller than the previous hospital, with 131 beds, has a new management structure and was built as a state-of-the-art, “all-digital” hospital that serves as a safety net for the local community, according to MLKCH officials. While MLKCH shares the same ground as its predecessor, the new hospital is operating in a different healthcare landscape, one in which hospital leadership can leverage technology and digital tools to provide high-quality care to an urban, underserved community of about 1.3 million people. The hospital operates in partnership with Los Angeles County and the University of California.

“One of the benefits and opportunities of creating a brand-new hospital and a brand-new healthcare organization is that we were able to look for best practices from every area and incorporate those best practices. And, we could build an infrastructure that could support future healthcare delivery,” Batchlor says.

“We were fully unencumbered by technology and the systems that you would have in a hospital that had been opened for many years,” says Tracy Donegan, MLKCH chief information and innovation officer. “We were able to implement a fully integrated electronic health record (EHR) from the get-go.”

Donegan is slated to be the keynote speaker at Healthcare Informatics’ Beverly Hills Health IT Summit at the Sofitel Los Angeles at Beverly Hills November 8-9, where she will share her organization’s journey to developing a world class IT infrastructure.

Built from the ground up, MLKCH incorporates technology into every aspect of its design—from the facility itself to service delivery to post-discharge care, according to Batchlor. “We deliberately sought the technology and used the technology as we designed our policies, procedures and approaches to care delivery from the beginning,” she says.

Elaine Batchlor, M.D.

The hospital was recognized by HIMSS Analytics, the analytics arm of the Healthcare Information and Management Systems Society (HIMSS), as Stage 6 on the EMR (electronic medical record) Adoption Model in its first year of operation. This year, the hospital was recognized as HIMSS Stage 7 for EHR best practices—a status achieved by only 6.4 percent of hospitals nationwide by the end of 2017.

The inpatient facility was constructed to integrate technology into care delivery. All inpatient beds are “smart beds” that weigh each patient automatically each day and record the findings in the patient's EHR. The “smart beds” also detect when a patient is getting out of bed and can alert the attending nurse if the patient is deemed a fall risk, Donegan says. Inpatient rooms also are wired with MyStation technology for patient interaction. “By using the TV in the patient’s room, we can engage the patient in health education when he or she first arrives at the hospital. They take a fall risk assessment on their TVs, and that’s integrated with the EHR so that clinicians are notified of patients with a fall risk,” she says.

The hospital’s clinical staff carry secure smartphones that interface with the EHR system and inpatient biomedical devices. Donegan also notes, “We also have over three dozen unique medical devices integrated with the EHR, and that was unique and progressive at the time we opened the hospital.” The hospital opened with clinical protocols programmed into the EHR system, she says. “That helps clinicians practice in a manner that’s consistent with best practices and evidence.”

“Technology is really about supporting high-quality patient care and patient safety,” Donegan says. “One area that we are really proud of is our ability to leverage technology to support medication safety. We use smart bar coding and scanning for dispensing medications in the hospital and for use of blood products. That is a huge patient safety boost.”

Hospital leadership also deployed technology tools to compensate for a shortage of physicians in the community. The entire hospital is wired for telemedicine, and telemedicine services are provided by physicians at UCLA Medical Center. “One of the areas where we use [telemedicine] is in our labor and delivery area, where we use tele-neonatology. We also use tele-radiology, tele-neurology and tele-psychiatry. In an area that has a severe shortage of physicians, telemedicine is a huge benefit to link residents to premier healthcare centers and to give them access to high-quality care,” Batchlor says.

MLKCH leaders note that the hospital is filling a need in the community for quality patient care. The hospital is on track to see 90,000 patients in the ED this year, and MLKCH’s patient satisfaction scores are in the top 20 percent of all hospitals nationwide, hospital leaders say.

A Culture of Innovation

Opening a new hospital has certain advantages, such as the ability to deploy the latest technologies without having to address older legacy systems. However, MLKCH leadership faced the unique challenge of designing and planning the IT infrastructure without having a full clinical staff in place.

“One of the huge challenges we had was that we had very little staff when we made decisions about what to purchase, what to implement, how to set it up, or the design of systems, and we used a lot of expert consultants and a pretty small group of staff members to make those decisions,” Batchlor acknowledges, “One the challenges we had after we opened was that we had to make a lot of adjustments for the permanent staff, and for the actual patient population that we were serving.”

Donegan initially began working with MLKCH as a consultant and then moved into the permanent CIO position. “With regard to technology, we had a very clear vision from the start that we wanted to use the technology to promote high-quality patient care, but we also wanted to use it to differentiate the hospital and attract high-quality talent. That helped us guide our technology portfolio because we understood, at the end of the day, what was really needed to be done to achieve these goals.”

Tracy Donegan

And she notes that the complexity of the project was one reason she wanted to be involved in the design and opening of MLKCH. “What also attracted me was the mission of the hospital. It was very exciting. I’ve been in healthcare 20 years, and I felt that this would be the opportunity of a lifetime to have a direct impact on a community.”

Batchlor credits the hospital’s culture of innovation for the successful implementation of an advanced IT infrastructure.

“Some of the decisions we made were not obvious decisions,” Batchlor admits. “I often hear our IT team say that we implemented more Cerner modules than any other hospital has ever implemented. Some of that was risky and did require a willingness to work through problems, as we’re using technology that’s fairly new,” she says, adding, “It’s not always a slam dunk.”

She points to the deployment of the clinical staff smartphones as one challenging project. “The clinicians had some concerns and we listened to them. And, because of their concerns, we made a change to a different platform. It’s that kind of responsiveness that helps to make an IT initiative successful,” she says. “You have to be willing to struggle through those challenges, persist and solve problems. And, I think that’s something that is different about us compared to other places; a culture of supporting that kind of innovation.”

While MLKCH leadership faced a unique situation as a brand-new hospital, there were important lessons learned about technology adoption, Donegan says. “You have to involve the clinicians and any other stakeholders every step of the way in the choices and in the design; that is critical. It’s also extremely important to be very responsive to their concerns and their needs.”

Approaching Care Delivery Beyond the Hospital Walls

Beyond hardwiring technology into the inpatient facility, MLKCH executive and IT leaders also integrated technology into patient care plans. Each patient in the hospital, even those in the ED, is assigned a care coordinator, with the goal of reducing readmissions and providing targeted care to each patient. The EHR is integrated with dashboards and population health management tools for disease management and patient tracking.

“One of the things that’s important to us is continuous quality improvement and because we have such a great health information system, we also have access to real-time information about what’s happening with our patients, what’s happening with care that we’re providing, and it fuels our ability to monitor performance and improve that performance over time,” Batchlor says.

What’s more, MLKCH leadership are focused upstream from hospital care to prevention, disease management and community health.

“We are able to collect information about our population and approach our care delivery from a population health management perspective. We’re not just focused on what we are doing when our patients are within the four walls of our organization, but we’re thinking about what they need before they get here, what they need after they leave and we’re able to invest in building out other parts of the delivery system and just managing that whole continuum of care,” Batchlor says.

To this end, in December 2016, MLKCH launched its first outpatient medical practice, Advanced Care Clinic, with a post-discharge clinic and specialty care, and launched a nonprofit medical group, with five providers.

“One of the things that we quickly recognized after we opened was that many patients were coming to the emergency department with medical conditions that were not adequately treated in the outpatient setting,” Batchlor says, adding, “We are growing that medical group, it’s a multispecialty medical group. We have plans to build out a medical office building on campus, and that started with the recognition of the needs of the patients that we were seeing.”

The organization plans to break ground on the medical office building, the Wellness Center, later this year, offering space to accommodate specialty care physicians, along with services such as outpatient surgery, a dialysis center, an infusion center, a wound clinic and a retail pharmacy.

2018 Raleigh Health IT Summit

Renowned leaders in U.S. and North American healthcare gather throughout the year to present important information and share insights at the Healthcare Informatics Health IT Summits.

September 27 - 28, 2018 | Raleigh


Town Hall Ventures Close First Fund at $115 Million

September 20, 2018
by David Raths, Contributing Editor
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Adds Landmark Health, Bright Health, Strive Health to Portfolio

Town Hall Ventures, an investment firm built to address the healthcare challenges of the most vulnerable Americans, has closed its first fund at $115 million.

The founding partners — Trevor Price, Andy Slavitt, and David Whelan — announced the firm’s formation on May 7, 2018, at the HLTH Conference in Las Vegas. Their goal is to help build companies to improve care in Medicare, Medicaid, and risk-based care, and in addressing complex conditions and social determinants of health.

The fund and its limited partners represent multiple large nonprofit health systems and payors, along with entrepreneurs, executives and investors. 

Town Hall also disclosed investments in three companies:

• Landmark Health LLC, which provides home-based care to high-acuity Medicare, Medicaid, and Dual Eligible populations who are frail and chronically ill. Landmark’s new CEO, Nick Loporcaro, was recruited by Trevor Price and Oxeon Partners, and the company is backed by General Atlantic and Francisco Partners.

• Bright Health Inc., a technology-enabled health insurance plan that is built in partnership with leading health systems. Bright’s CEO is Bob Sheehy, former CEO of UnitedHealthcare, and the company is backed by NEA, Bessemer Ventures, and Flare Capital Partners.

• Strive Health LLC, a leading provider of chronic kidney disease solutions, focused on transforming healthcare and patients’ lives through early engagement, comprehensive coordinated care, and expanded treatment options. The company's co-founder and CEO is Chris Riopelle. The concept for the business was developed with the co-founders inside the Oxeon Venture Studio and backed by lead investor NEA.

Existing investments include:

• Cityblock Health Inc., which provides primary care, behavioral health, and human services to address unmet health and social needs in urban populations.

• Somatus Inc., which provides treatment and new models of care for patients with chronic kidney disease and end-stage renal disease.

• Welbe Health LLC, a provider of integrated medical and social services to frail seniors who qualify for PACE. 

• Aetion, Inc., a provider of real-world analytics and evidence to help biopharma companies and payors better understand how drugs work in the real world to enable value-based care.

Town Hall also announced that Ann Hickey has joined the firm as a vice president. She previously worked at Audax Group, Oak Hill Capital Partners, Castlight Health, and, most recently, Archimedes Health Investors.

Town Hall is led by Andy Slavitt, former Administrator of the Centers for Medicaid and Medicare Services (CMS) and Group Executive Vice President of Optum; Trevor Price, Founder and CEO of Oxeon Holdings – the parent company to Oxeon Partners, a retained executive search firm – and Oxeon Ventures, an investment firm and venture studio; and David Whelan, Managing General Partner of predecessor firm Oxeon Ventures and former General Partner and CFO of investment firm Accretive LLC.



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At Partners HealthCare, Bringing Digital Transformation to Clinical Care

September 18, 2018
by Rajiv Leventhal, Managing Editor
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Last spring, Partners HealthCare, founded by Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital, and California-based software company Persistent Systems, announced a strategic collaboration to develop a new industry-wide open-source platform with the goal of bringing digital transformation to clinical care.

Indeed, with the digital platform, Partners’ leaders hope to enable greater exchange of information across healthcare providers everywhere, and make available open source applications to any health system. At the time of the 2017 announcement, officials said that the co-developed digital platform will be based on Substitutable Medical Applications & Reusable Technologies (SMART), an open, standards-based technology platform along with Fast Healthcare Interoperability Resources (FHIR). “The platform will enable provider systems across the country to rapidly and cost effectively deploy industry-leading best practices in clinical care across their ecosystems,” according to the announcement.

Healthcare Informatics Managing Editor Rajiv Leventhal recently spoke with Sandy Aronson, executive director of information technology at Partners Healthcare, about this collaboration, its specific goals and outlook, and how things have come along so far. Below are excerpts of that discussion.

What would you say is the greatest significance behind this collaboration?

I have been at Partners for about 15 years, and the first 13 of those years were primarily focused on the clinical use of genetics and genomics. In that space, we created a suite of applications that was architected differently than health IT applications are typically architected. These were applications that helped with the generation of interpreted reports for genetics and genomics sequencing test results. So, where normally in health IT applications you create a transaction system and then try to bolt a knowledge base on top of it to the extent you can, we decided to architect this in the opposite way.

We built a knowledge base that deeply modeled the tests that a laboratory offers, the genes that are covered by that test, variants known to exist in these genes, variants that are learned over time, and the state of knowledge linking those variances to clinically relevant facts—so disease states, drug response, drug efficacy, etc. So we built this deep knowledge base and built a transaction system on top of it, and made a rule that you can’t report out test results unless you keep the knowledge base up-to-date and consistent with your test results. And that enables you to automate the generation of reports.

But as a result, we wound up with this continually-updated knowledge base, so based on that we created what would now be a SMART on FHIR app that plugs into the EHR [electronic health record] and provides clinicians with alerts if something new and potentially clinically relevant is learned about a variant previously identified in one of their patients. So it created this notion of a knowledge base alert being interjected into clinical care.

We studied this and found that clinicians liked it, but the rate at which this learned was dependent on the number of transactions that flow through the system, because that’s how geneticists would gather the data that would enable them to improve their assessment of variants. So we registered this as a medical device, distributed it outside of Partners, and networked the different instances together, so it could learn not just based on our volume, but other folks’ volume as well. Ultimately, we sold that to Sunquest [Information Systems]. The thing we feel was most important was creating this infrastructure that facilitated new clinical processes and captured, shared, and federated data in a way that enabled learning to care.

After having done that, we took a step back and said OK, what should we do next? The infrastructure we built was very specific to issues where genetics and genomics are the major components to deciding what to do for a patient. So we wanted to look at all of the things that made that infrastructure hard to do, and build a platform to make it easier to build things like GeneInsight [an IT platform company owned and developed by Partners], and then distribute that platform, so that in addition to building examples of a similar infrastructure, others can build those examples, too. We wanted that platform to make it easier to distribute apps that are created by different folks in different organizations, ultimately with the goal of networking those apps together.

We are at a unique point in time where you have these new data types coming online that can be helpful to the care delivery process, you have algorithmic-based medicine starting to come into use, both machine learning-based and not, and you have people looking at transformative ideas on how to alter clinical processes where in order to incorporate these new data types and incorporate algorithmic-based approaches to care, you need new kinds of IT support in order to enable these transitions to occur. And that creates an opportunity, not only related to the specific transitions, but also to start collecting data for specific clinical problems in a much finer-grained way that lays the groundwork for these networks that can build the data that’s required to underlie continuous learning processes.

All of this is happening in a time with incredible cost pressure in healthcare, which does constrain internal investment but also makes organizations far less resistant to change. The goal here is to fundamentally enable clinicals to evolve their practices, their care, new data, ideas, and techniques in ways they haven’t done in the past.

Sandy Aronson

And how are you working with Persistent Systems on this, specifically?

We are building this platform together. The platform is called HIP, or health innovation platform, and the platform itself will be open-source, and it sits on top of the current clinical IT ecosystem. You interface it to underlying systems, and then it handles things like some aspects of security, authentication, and HIPAA, but also access to data as well as incorporating shared algorithms.

The goal is having different places hook up the platform, and once it is hooked up, it should create a uniform surface on top of the platform so that apps built on top of the platform become more shareable and distributable. We are now focused on both building the platform and building certain apps. And the apps get interjected to the EHR as SMART on FHIR apps.

Can you give some examples and details of the apps that are being built?

One example is that we have been working with BWH’s cardiology [department] on this program that they have, where if you look at heart failure, which affects about 2 percent of the population and has a very high mortality rate with a great deal of costs associated with it, there are guidelines that have been shown to really be helpful, yet very few people are treated in a way that actually adheres to guidelines. And that’s because the process of getting them to guideline-based care involves this drug selection and titration process that requires a lot of interaction, some of which can make patients unconformable.

But as it turns out, you can instantiate a process where you use patient navigators to take patients through this drug selection and titration process, interacting with them far more frequently than a cardiologist would ever be able to, to get them to guidelines. It’s a data-intensive process. So we are providing support for that program through the HIP platform today and we are really focused on deepening that support.

What are your goals in the next 12 to 24 months regarding this partnership? What would you like to see happen?

The ideal world is that our group and Persistent Systems will continue to add more capabilities to the platform, and that the platform is reducing costs. So many clinicians have ideas on how to fundamentally improve care but they can’t put those ideas into use without these kinds of IT interventions.

One thing I hope is that this will continuously reduce the cost of building those interventions and as a result, our team, and others, too, will develop more of these apps. We hope to see some cross-institutional adoption of apps built here and elsewhere, that the sharing will begin at the app level and ideally, in two years or so, we will be having real conversations about how we can get the networking between apps really going.

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Cigna to Invest $250M in Venture Fund with Eyes on Healthcare Startups

September 17, 2018
by Rajiv Leventhal, Managing Editor
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Cigna, the Connecticut-based health services company, has announced the launch of Cigna Ventures, a corporate venture fund focused on investing in promising healthcare startups and growth-stage companies.

Cigna has specially committed $250 million of capital to Cigna Ventures to invest in transformative and innovative healthcare companies “that are unlocking new growth possibilities in healthcare and will bring improved care quality, affordability, choice, and greater simplicity to customers and clients,” officials said in a press release.

Cigna Ventures is particularly focused on companies across three strategic areas: insights and analytics; digital health and retail; and care delivery/management. Officials say the venture fund was created to help Cigna identify, assess and sponsor early-stage innovation ideas that warrant deeper exploration through focused pilot and test-and-learn activities with the goal of realizing meaningful business value.

“Cigna’s commitment to improving the health, well-being and sense of security of the people we serve is at the front and center of everything we do,” Tom Richards, senior vice president and global lead, strategy and business development at Cigna, said in a statement. “The venture fund will enable us to drive innovation beyond our existing core business operations, and incubate new ideas, opportunities and relationships that have the potential for long-term business growth and to help our customers.”

As an article in Bloomberg noted, “Health insurers have been starting venture-capital arms to find new ideas to improve their businesses and generate financial returns. UnitedHealth Group Inc., the biggest health insurer, said in November that its Optum unit was creating a venture arm with $250 million in funds. Humana Inc., Kaiser Permanente, and a group of Blue Cross and Blue Shield insurers all have venture units.”

According to officials, the venture fund builds on Cigna's existing venture activity, including collaboration with five venture capital partners and an equal number of existing direct investments. These include leading the C1 round of financing with Omada Health, investments in Prognos, Contessa Health, MDLIVE and Cricket Health.

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