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Changing Medical Outcomes with Data Analytics

March 3, 2016

Harun Rashid, VP Global Health Services & CIO Dawn Jamison, Project Director Srinivasan Suresh MD, CMIO Fereshteh Palmer, BSN, MSIS, Analytics Lead

Agenda

• Introduction • World of Big Data • Evolution of Healthcare Analytics • Data Analytics – Success Stories

– Preventing CLABSI – Reducing the Use of Vancomycin – Condition E – Predicting cardiac and respiratory decline – SHARP – Real-time Readmission Prediction – ED monitoring Dashboard

• Value Realized with Health IT • The Future of Data Analytics • Implementation guidelines

Annual Stats

Outpatient visits 1,000,000+

Inpatient visits

20,000

Emergency visits 80,000

Surgeries 25,000+

HIMSS Stage 7

Children’s Hospital of Pittsburgh of UPMC

What is Big Data?

• Volume

• Velocity

• Variety

What can should we learn from other service industries?

Big Data and Analytics - Baseball

NFL Gillette Stadium/Patriots

Hollywood Paradigm: 4 Quadrants

Traditional Hollywood Four Quadrant

Legendary Applied Analytics

Micro Segment

Four Quadrants: 4 groups of 80 million Micro Segment: 80 million groups of 4

Case Study: Godzilla

• $180M production budget

• Built trailer based on analytics

• 10% less in media spend

• Found persuadable points

• Exceeded opening box office estimates by $30M

$525M worldwide box office and substantial home entertainment sales

Evolution of Healthcare Analytics

Growth of Healthcare Analytics Data Warehouse

• The EMR compiles the data

• Government regulation requires the data

• Quality improvement necessitates the data

• Research is enhanced by the data

• Business analysis is accurate and actionable with the data

Healthcare Analytics - Challenges

• Growing demand for advanced business and clinical analytics

• Traditional system design- Unstructured • Lack of integration / interoperability • Real-time information • Extraction of meaningful information • Vendor limitations • Expensive • IT priorities / Staffing (‘data scientist’)

Data Warehouse Technology

Tools: Business Objects, Informatica, Qlikview

Data: Inpatient, Ambulatory, Biomedical, Financial

Uses: Clinical, Quality, and Business reporting use the same technology solutions

Governance

Quality and

Clinical Informatics

Privacy &

Compliance

Requestor

Multi-Disciplinary

Team

Clinical and Quality Impact

Economic Impact

HIPAA Legal

Impact

Regulatory Impact

Impact + Need + Risk = Urgency

Data Analytics – Success Stories

• Avoiding CLABSI • Reducing the use of Vancomycin • Predictive Medicine - ConditionE • Real-time Readmission Prediction – SHARP • Dashboards for clinical value - ED

Preventing CLABSI (Central Line-Associated Blood Stream Infection)

CLABSI is one of the most deadly and expensive hospital associated infections leading to sepsis. It increases the length of hospital stay by up to 10 days.

Goal Decrease the frequency of CLABSI

Outcome 39% decreased frequency 21 less patients each year

Clinical Documentation Procedure Report Accountability Success!

Bundle to prevent CLABSI

17

Bundle documentation in EHR

EHR uses Smart Text to easily enter preparation steps

Reducing the Rate of CLABSI

Reducing the Rate of CLABSI

Daily Report that identifies patients at

risk for CLABSI

CLABSI – The Financial Outcome

Year Rate Average Cost* Estimated Cost Savings or Loss

Base Year – FY 2012 1.39 (53 infections) $55,000 -

Year 1 – FY 2013 1.47 (57 infections) $55,000 (165,000)

Year 2 – FY 2014 0.879 (32 infections) $55,000 $1,100,000

Year 3 – FY 2015 0.84 (32 infections) $55,000 $1,155,000

Total Savings

$2,090,000

CLABSI Rate per 1000 central line days * Becker’s Hospital Review

Monitoring Vancomycin Usage

Addresses concerns about the serious and permanent side-effects of Vancomycin including damage to hearing and kidneys.

Goal Only use Vancomycin when clinically necessary.

Clinical Documentation

Education Awareness

Report Accountability Success!

Outcome 27.2% decrease

2420 patients

Analyze Use of Vancomycin Name MRN FIN Age Admit Date Disch Date

Medical Service

Order Location

Order Status

Order

18 years 6/20/2015 6/29/2015

Critical Care Medicine PICU Completed caspofungin

PICU Ordered caspofungin

Emergency Dept Holding Ordered vancomycin

Vancomycin Day 3 ASP Note

06/24/2015 01:29:03 PM

No Proven Infection Continue Vancomycin For critically ill patient

No Proven Infection Continue Vancomycin OTHER === monitor serum trough levels closely as clearance is delayed and accumulation may occur

No Proven Infection Continue Vancomycin Per approved treatment guidelines

Caspofungin Day 3 ASP Note

06/24/2015 01:26:10 PM

No proven

Use of Caspofungin alone indicated Critically ill

Use of Caspofungin alone indicated Per protocol

Vancomycin Financial Outcome

Fiscal Year Patients Ordered Decrease Per Patient

Savings Total

Baseline- 2011 2225

2012 1578 647 $4,704 $3,043,210

2013 1749 476 $4,704 $2,238,899

2014 1528 697 $4,704 $3,278,388

Estimated -2015 1618 607 $4,704 $2,855,067

Total Savings $11,415,564

Alert Clinicians using Condition E

Electronic Alert Clinical Deterioration

Time Value of Predictive Tool

(Courtesy: PeraHealth, Charlotte NC)

Use Data to Predict Critical Events

Condition E – Early EMR-based Recognition of Clinical Deterioration

Condition E - Predictive Early Warning Signs

Goal Avoid readmission to critical care

Clinical Documentation Notification Procedure Clinical Action Success!

Outcome Of 69 patients (in 3 months), only 16 experienced a critical condition

and were transferred to ICU. 76.8% (53 patients) avoided critical condition

Condition E opens a window of opportunity to intervene before the patient arrives to a critical condition on average of 8 hours and 50 minutes in advance. The patient prognosis drastically improves and rate of unplanned ICU admission decreases when action is taken to reverse the declining medical condition.

Projected Savings Based on studies, each *pediatric ICU admission costs $9,150.00 per day and mean length of stay for pediatric ICU is 3.5 days. (Please see the reference below). For each patient for which the application helps prevent ICU admission, hospital saves $32,025.00. From April – July 2015, 53 conditions were avoided for a savings of $1,697,325. Extrapolating that to an entire year, it is expected that there will be a savings of $5,091,975.00. The platform built at Children’s Hospital can easily be replicated to other adult and pediatric hospitals with very little modifications.

Predictive Analytics – Example #2

ED Monitoring Dashboard

Disease Management System Appendicitis Dashboard

Population Health Dashboard

http://www.himss.org/ValueSuite

Value Realized with Health IT

3 Year Projection • Predictive Early Warning

• 477 patients • $15 Million

• Vancomycin

• 1780 patients • $8 Million

• CLABSI

• 38 patients • $2.2 Million

• Condition E / SHARP

• TBD

• Medical treatment methods will change • Patients will be better informed • Physician roles could change to more of a consultant

• Integration of wearable technology • Population Health

Future of Data Analytics

Health Wearables

Implementation Guidelines

• Culture • Governance

• Vision • Funding

Technology Staff Knowledge

Process Database Organization

Thank You