Best Practices in Technology and Analytics

Optum Predicts Risk of Atrial Fibrillation Using Artificial Intelligence

An estimated 3-6 million people in the United States have (AFib), an irregular heartbeat that increases the risk of stroke and heart disease. Due to the aging population, the numbers are expected to increase and many patients are unaware of their condition. If AFib is detected early on, the risk of stroke and heart disease is reduced by >75% with proper care and medications. The department of Data Science and Transformation of Optum Enterprise Analytics is exploring the ability of machine learning and artificial intelligence to identify patients who might have an abnormal heart rhythm. In a recent study, Optum trained a tree-based model using a de-identified dataset and identified patterns of data that are associated with the presence of ICD coding for atrial fibrillation. If patients are determined to be at risk for AFib, they can be referred for further testing and participation in anticoagulant drug therapy. Identifying AFib and preventing potential heart disease and stroke presents health organizations with opportunities for medical cost savings. The end goal of Optum’s research is to improve the health of AFib patients, decrease medical spending, and possibly detect other chronic diseases and complications through machine learning, artificial intelligence, and predictive analytics.

This best practice was discussed as part of eHealth Initiative’s July 2018 Technology & Analytics Workgroup.

Big Data Analytics Best Practices: Understanding its capabilities and potential benefits for healthcare organizations​

To date, the health care industry has not fully grasped the potential benefits to be gained from big data analytics. While the constantly growing body of academic research on big data analytics is mostly technology oriented, a better understanding of the strategic implications of big data is urgently needed. To address this lack, this study examines the historical development, architectural design and component functionalities of big data analytics. From content analysis of 26 big data implementation cases in healthcare, we were able to identify five big data analytics capabilities: analytical capability for patterns of care, unstructured data analytical capability, decision support capability, predictive capability, and traceability. We also mapped the benefits driven by big data analytics in terms of information technology (IT) infrastructure, operational, organizational, managerial and strategic areas. In addition, we recommend five strategies for healthcare organizations that are considering to adopt big data analytics technologies. Our findings will help healthcare organizations understand the big data analytics capabilities and potential benefits and support them seeking to formulate more effective data-driven analytics strategies.

Best Practices

• Governance - Implementing big data governance successfully can allow for more efficient utilization of data
• Sharing - Developing an information sharing culture improves quality and accuracy 
• Training - Training key personnel to use big data analytics is the key to utilizing outputs effectively
• Cloud computing - Incorporating cloud computing into the organization's big data analytics can help address cost and data storage issues.  However, this must be balanced with patient information protection
• New ideas - Generating new business ideas from big data analytics promotes innovation, productivity, and competitiveness  

The full article can be viewed below.  

Surescripts Advancing Interoperability Best Practices

The results are in and the data tells a clear story: interoperability is alive and well across American healthcare. In fact, Surescripts 2017 National Progress Report shows that interoperability is not only expanding but also transforming health data exchange.In particular, the Surescripts Network Alliance is effectively advancing healthcare by:

Best Practices

• Measuring accuracy - Perfecting e-prescribing by measuring accuracy—at scale—to improve patient safety and increase efficiency
• Price transparency - Empowering prescribers at the point of care with prescription price transparency
• Utilizing technology - Bringing technology to the front lines of the opioid epidemic
• Highlighting the big picture - Delivering true interoperability by giving healthcare professionals a more complete view of a patient’s medication and clinical history directly in their EHR workflow

Interoperability is Rapidly Advancing Across Healthcare

Changing the Course of the Opioid Epidemic: The Power and Promise of Proven Technology - Best Practices

Surescripts is the nation’s largest health information network, transmitting nearly 13.7 billion secure health data transactions annually, including nearly 4.8 million e-prescriptions each and every day. The Surescripts Network AllianceTM connects virtually all electronic health record (EHR) vendors, pharmacy benefit managers (PBMs), pharmacies and clinicians, plus an increasing number of health plans, long-term and postacute care organizations and specialty pharmacy organizations. This cross-market experience gives us a unique perspective on the role that technology can play in providing actionable intelligence to help reduce opioid abuse while ensuring that patients receive quality care and clinically appropriate medications. 

We all know the bad news. The opioid epidemic is ravaging our communities from coast to coast— and if we are serious about stopping it, all sectors of society must step up. The good news is that health data and information technology exist today that can help healthcare practitioners better navigate the crisis. Here are five ways technology can help:

Best Practices

• EPCS and CancelRx - These promote effectively delivered pain relief while preventing potential abuse and patient harm by allowing tracking and secure delivery coupled with a way for prescribers to cancel an opiate prescription
• Medication History - Having readily available data promotes better informed decisions
• Clinical History - Knowing past care also promotes better informed decisions and allows suspect care patterns to be detected
• Clinical Direct Messaging - This promotes secure communications between healthcare practitioners who are concerned about potential addiction
• Insights for Medication Adherence - Real-time messages about patient medication habits can be given at the point of care

The full position paper can be viewed below.  

LifeWIRE Improves Patient Engagement at the VA

Many veterans have chronic conditions or other considerations that require additional support outside the realm of traditional care.  Tele-health is a mechanism that can help fill this need.  Goals include improving engagement, producing more patient-centered data and care, addressing problems before they escalate, improving resource use, increasing efficiency and value, and ultimately saving lives.  LifeWIRE is a patient engagement tool that uses automated dialogue to help meet these goals successfully.  

Best Practices         

• Outreach - LifeWIRE checks in with patients, an especially useful aspect for those with chronic conditions
• Follow-up - Reminder messages can assist with medication adherence, follow up appointments, and other patient tasks
• Feedback - Can check on medication and patient satisfaction
• Automation - Automated dialogue means that no APP is required
• Integration - Quantitative data can be combined with qualitative data
• Versatility - The program can be used on any device (400+ wearable medical devices are compatible) and any media
• Security - Data is cloud based and secure

Best Practices in Workflow for Provider and Patient Engagement
Cleveland Clinic Improves Patient Experience

Toby Cosgrove, former MD-CEO and President of the Cleveland Clinic experienced a revelation after speaking at a business class at Harvard University. One student shared her decision not to use the Cleveland Clinic for her father’s open-heart surgery. She did not feel the doctors were empathetic enough when dealing with patients. This story completely changed Dr. Cosgrove’s focus for the hospital. He began to transform the organizational culture by training all 43,000 Cleveland Clinic staff on empathy and in 2006, the Clinic hired a Chief Experience Officer. Physicians began to improve the ways they interact with their patients, encouraged patients to be engaged during their stay, and asked them to leave comments regarding the care received. Cleveland Clinic has ranked first place in a national measure of patient satisfaction amid other hospitals. The changes they implemented have been positive, effective, and worth emulating.

• Empathy. Empathy builds trust and communication with patients. Cleveland Clinic provides empathy training for all employees, which provides value to patients and caregivers throughout their care journey.
• Shared Medical Appointments (SMAs) offer an innovative and interactive avenue to healthcare that brings patients with common needs together with one or multiple healthcare providers, depending on the level of care needed. SMAs allow for patients in the same situation to build connections and feel a sense of support from one another.
• Distance Health is an initiative that was developed to remove the geographic barriers to care and allow for better patient experience. It includes remote outpatient/inpatient, ICU, and acute virtual visits, remote chronic health monitoring, remote imaging upload, and online second opinions through MyConsult. Distance Health visits have significantly increased over the years averaging up to 3,652 visits per month in 2018.
• Transparency. Cleveland Clinic improved transparency between physicians and patients by allowing patients to rate their providers and post positive or negative comments regarding their experience. Artificial intelligence is used to read and group comments, based on their theme, ultimately holding providers accountable for their patients’ experience.
• Same-day appointments are offered depending on the level of care a patient needs and if the call was placed before noon. Same-day appointments dramatically decreases patients’ waiting times for appointments, providing the care they need, right away, and driving up patient satisfaction.

This best practice was discussed as part of eHealth Initiative’s June 2018 Workflow for Provider and Patient Engagement Workgroup.

American College of Radiology Direct Image Transfer Best Practices

Medical image transfers used to be conducted by burning images onto CDs, a method that can be both time-consuming and inefficient.  Jonas Rydberg, MD at the Indiana University Health (IUH) Methodist Hospital spearheaded a project to create and promote a cloud-based system of image transfer.  

Best Practices

• Driven people - As long as you have a couple of people to drive the project forward, you don’t need a big, formal decision from the C-suite.
• Securing a hosting vendor - A vendor had to be chosen to host the cloud server.  Keeping costs low was a priority, and ultimately the transfer costs were actually less than CD handling cost.
• Taking physician needs into account - The system was designed to eliminate the need for physicians to log into the vendor's site, making the system more convenient.
• Encouraging hospitals to join the cloud - Benefits had to be emphasized and outside hospitals had to be assured that their system security would not be compromised.

Hancock- “Healthy 365” Story of Innovation
 

Hancock County System of Care is a partnership of local stakeholders across Hancock county that provide services to youth and families, which has developed Health 365. This is a population health initiative and whose goal is to address the needs of service delivery systems for substance abuse and mental health in the county. There are 47 agencies that are involved and provide input and support. They include the Juvenile Justice system, providers, social workers, local schools, state office for Medicaid and Family First. By promoting health, happiness and wholeness, they are approaching Health in a non-traditional and innovative way to ensure the policies and environment supports healthy behavior.

Health365 has developed over the past 4 months an action plan geared towards specifically addressing health behaviors. They are focused on building a coalition of diverse partners that work to
ensure Hancock County has neighborhoods, public spaces, work environments, transportation infrastructure, and retail venues that all promote physical activity and healthy living.

Best Practices

• Organized goals - They came up with three themes to address the full scope of this problem: Healthier Choices, Mental Fitness and Work Place Wellness. They all have within them 2-4 strategic areas of focus for which action items can be developed. E.g within Healthier Choices the goal was to increase access to and awareness of healthier food options.
• Partnerships - They made local partnerships to provide education in the communities about healthier food opportunities. They are providing information and access to care to everyone regardless of whether they are their patients. Also, there is an online farmers market that allows people to order fresh food and crops all year round to be delivered to a central location and picked up.
• Information -  There are 70 primary members who convene monthly to figure out strategies to disseminate this information in the community. They have thousands of secondary members who funnel information out through word of mouth. They are hoping to improve the way they measure improvements in health of the communities they serve. This will require improved and real-time data acquisition processes. They are also working on 3-4 health applications that can be provided to people, which will enable the collection of data from people’s smart phones and integration into their population health analytics software.

http://www.trusthchs.com/hancock

Johnson & Johnson- “CarePath & Care4Today® Connect” Best Practices

Care Path Healthy Engagement shared decision making tool is an animated avatar-type tool that helps educate patients and providers about type 2 diabetes treatment options. It helps patients and
providers make informed and shared decisions about what their next type 2 diabetes medication should be. The value of this is that its interactive, it’s online and it helps patients understand their treatment options and promotes better dialogue between the patients and the healthcare providers when they are making certain decisions.

Care4Today Connect platform (mobile app and web-based dashboard) is designed to empower patients to take an active role in their own health care. Healthcare professionals can assign appropriate, disease area educational content for the patient. If a patient elects to connect with his/her provider, the dashboard provides a direct connection between the patient and provider, allowing visibility to patient self-reported measures.

The problem we are trying to solve is data acquisition on one arm and the patient engagement and patient behavior on the other arm. Our goal is to keep the patient in the middle of everything we do, improve the quality of care and decrease the cost associated with treatment over a multi-year course. We have to think about how we engage patients and how we motivate them to take our products. Adherence to medication is a national problem. The core functionality of the Care4Today platform is the medication reminder. 

The CarePath platform conveniently offers online Digital Tailored Coaching which is designed to deliver highly personalized, insight-driven behavior change programs to help patients better focus on
their health and well-being. Digital Tailored Coaching can help motivate patients and encourage them to become more engaged with their health and their life. With periodic check-ins, these coaching programs are designed to encourage longterm engagement and participation. Furthermore, such resources could result in members having increased satisfaction with your overall health plan and offerings.

Best Practices

• Empower the patient - One of the benefits of the Care4Today platform is that it empowers patients to take an active role in their own health care. There are self-directed medication adherence reminders and patient recorded trackers for weight, BP, exercise, pain, mood, blood glucose, appointments and more Disease-based educational content delivery (health tips, etc.). Another benefit is that there is a personalized dashboard that is connected to healthcare professional (HCP). The platform provides a direct connection between the patient and provider, allowing visibility to patient self-reported measures.
• Provide the tools - We provide the providers, payers and patients with a series of tools and resources e.g. we provide payers with digital coaching tools, patients with educational resources. We have the one-touch reveal software that moves patient information to a cloud-based aggregation site that translates the readings into analytics that today give feedback to providers and in the future will give real time feedback to the patients.
• Make the process easy - The real skeptics are the provider groups as they don’t have a lot of time and energy to figure out new technologies, new processes and workflows. Anything you do has to be consistent with their workflows, it can’t create too many manual processes, can’t take yup to many FTE time and motion labor, it must be mostly automated; easy, behind the scenes and seamless with what you do. You have to convince providers why these tools will help them and the patient.

MedStar- “TeleStoke- MI2” Best Practices

MedStar Health is a not-for-profit 10 hospital integrated healthcare system serving the Baltimore/Washington region that has created the  MedStar Institute for Innovation (MI2) - TeleStroke Program.

The purpose of the MI2 is to catalyze the innovation of the health system to find opportunities to solve problems that we haven’t been able to respond to. The TeleStroke program is
under the MI2 division and provides 24/7 on demand remote service by the neurosciences line for three emergency departments in MedStar.  This helps address the increasing demand for clinical neurology services without requiring a doctor to be there in person.

We can now provide on demand access to an acute stroke neurologists who can be wheeled on a monitor to the bed side of the patient. This access would allow transferring hospitals to be able to
keep the patient locally. Time for treatment would be improved especially if someone needs urgent drug administered. Another benefit to the patient nin terms of quality of life is not having to be
transferred to another hospital. A benefit to our hospital is better management of volume and the avoidance of unnecessary patient transfers. 

Using Health technology is a means to bring “systemness” to a health system. Now that we have shown that we can pull of tele-consults with stroke and neuro in an ED this paves the way for other
future uses of telemedicine within our system. Now the primary care doctors want to use technology to really start to distribute care where it’s needed and
when it’s needed most. TeleStroke initially started as a way to provide services to external hospitals in need but then it got folded into a broader effort around “systemness”
for our health system. In the middle of the night we want to get eyes on a stroke patient at their bedside. Once we started doing this we realized all the other moving parts of this would also need to be evolved. So now our ability to do remote access to CTs has been improved, our ability to onboard and credential providers across sites had to be rethought and advanced,

Best Practices 

• Providing remote care - We shifted contracts of on-call physicians who normally would provide on-site services to now include remote patient care and monitoring. We uncovered that some of the downstream benefits from doing this would be better coordination amongst our sites and services and the reduction of unnecessary transfers.
• Commited time and patience - The programs that are still running are doing so because there are one or two individuals who are still committed and were willing to deal with all of the ugliness and not give up. Having flexible tools and solutions that you can be molded over time is also critical. The ability to automate processes with people instead of systems; we could wait for the perfect system to be built or we can have people do the heavy lifting in the meantime, it’s not the most ideal way to do it but it certainly gets the work done.
• Liscensing - We need to triple license a lot of our providers if they are going to be on any digital platform so that we are covered for DC/MD/VA.
• Getting the message across - Getting physician buy-in is a challenge as we are in this middle space where we don’t have a full virtual practice, how to get the early adaptors to infuse their enthusiasm across the system. Messaging and storytelling is such a huge part in getting buy-in.
• Supporting the system - Internally getting people to realize that it’s not just about the technology. The program also requires a change in staffing models and compensation, as well as integrating virtual scheduling and improved documentation. Clinical workflow around technology management in the ED and devices that get assigned for providers to use for video consultshad to be planned out.  The ways our multiple sites connect through our transport service had to be redesigned.