Digitized health

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

Frank WangWW Lead, Healthcare and Life Sciences HP Printing and Personal Systems

Digitized Healthcare

From Big Paper to Big Data

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.2

The Opportunity to Transform HealthcareE

cosy

stem

inte

grat

ion

Quality of care and outcomes

Today’shealthcare

Collaborativehealthcare

Transformativehealthcare

Low High

Low

Hig

h

Integratedhealthcare

• Culture of best-practices• Stand-alone IT• Best of breed• Fragmented systems

• Integrated EMR, EHR, PMS, CPOE

• Real-time alerts • HIE/improved

access to data

• Tight linkage between physicians & hospitals in different provinces

• Care collaboration• Regional, state and

national RHIOS, NHIN• Patient access to data

• Population Healthcare Management

• Personalized/evidence-based clinical decision support

• Patient engagement

Different providers will be at different stages

Data silos, many papers,

miscoding, comorbidity

Presenter

Presentation Notes

We view the Provider IT journey as a 4 step process – beginning with Todays relatively standalone and fragmented Healthcare that then moves to an integrated and collaborative care model and that over time will become an accountable care model standard. Current Status: $6.5 trillion global spend on healthcare1 17.9% of GDP in US 2009-20133 $1.2 trillion in waste in US alone2 $200B in over-testing US alone2 Forcing Structural Changes: Pay-for-Service Pay-for-outcome Accountable Care Population & Evidence Based Medicine


Impact to Costs/Security/Control/Quality of Care • Data/information outside the clinical system

• Caregivers still overwhelmed by paper

• Exposure to protected health information (PHI) violations

• Patient discharge information confusing

Coordinating Care Outside the Four Walls – EMR is Not Enough!

Pharmacy

Clinical Care

Radiology

Legal

Health Information Management

Physician Offices

Home Care / Hospice

Reference LabAudits

Human Resources

Patient Accounting

Billing / Payables

Patient Registration

Patient Discharge

• Faxing

• Paper forms

• Handwritten

• External documents

• Legacy records

Presenter

Presentation Notes

The adaptation of CPOE was intended to reduce the use of paper-based information capture and archiving. However, CPOE only captures a central core of information within its parameters. As we still see, paper is bridging many gaps via faxing, pre-printed forms, documents and communications coming in and sent outside the system. There are many legacy patients that still have paper records that pre-date EHR implementations that need to be integrated. All of this information drives the clinical and business workflow processes that are time-critical to the patient and the organization.


… 90% data is untapped for KPIs and analytics

• Needle Stick Injury Rate

• Reintubation Rate

• Ventilator Associated Pneumonia (VAP)

• Blood Stream Infection Due to Central Line

• Urinary Catheter Related Infection

• Overall Employee Satisfaction

• Patient Satisfaction

• Standardized mortality rate (SMR)

• Iatrogenic Pneumothorax

• Decubitus ulcer

• Length of Stay

• ICU readmission rate

• Patients' Fall Rate

• Medication error

• Adverse Events/Error Rate

Key Performance Indicators (KPIs)

Transaction Records Qualitative Human Data Quantitative Machine Data

Admission notes

Discharge summaries

Progress notes

Imaging study results

Consultant reports

Financial

& Operational

Transactions

Medication records Laboratory resultsPhysiologic testingBiometric sensorsRFID tags

Partial Intelligence


Electronic Medical Records Need More To Deliver the True Benefits to Patients“Untamed Technologies Enhance EMR and Related Clinical Systems”

Presenter

Presentation Notes

Forrester in a whitepaper titled, “Untamed Technologies Enhance EMR and Related Clinical Systems,” that current electronic medical record applications being deployed by most hospitals need additional applications in these areas: Forms automation Business process workflow and management Paper document capture and ECM Collaboration and communication Analytics This is where IPG solutions come in; they fill the gap and allow healthcare systems to meet “Meaningful Use Criteria.”


Search & Retrieve documents

Manage Clinical and Revenue Cycle Processes

Structured and Unstructured “Big Data” Analytics

Automatically generate output (Discharge Notes)

Create Personalized Patient Engagement Plan

Manage Document Retention Requirements

Capture “Big Paper” documents

with your MFP’s


Autonomy ECM Suite At a Glance

Windows – Outlook– Web – Tablet – Mobile – Cloud - MFP

Uncover connections and

insights

Faster processesMore accurate

More responsive

Improve operations,

Reduce costs

Enhance patient satisfaction

Reduce storage costsEnhance compliance

IDOL - Content Integration/Enterprise Search

Admissions documents

Test results

EHRBillingAP / AR

Call Centers

Patient Surveys

Grant Mgmt.

Human Resources

HP Process Automation

- Workflow & BAM

- E-Forms

- Digitized paper forms

Capture &Digitize

Automate Processes

Document &

Email Mgmt.

Enterprise Search

InformationGovernance

HP Intelligent Universal Search

- Search across diverserepositories, formats

- Meaning based analysis

HP WorkSite

- Integrate documents and e mails

- Secure Collaboration

- Mobility - capture

HP Records Manager(TRIM & Control Point)

- Policy based governance

- Records Management:

- Retention & Disposition

HP Teleform

- Digitize content

- Identify forms/docs

- OCR

- Extract data

Presenter

Presentation Notes

Here we introduce the Autonomy ECM suite: Teleform, APA, etc and define some of their capabilities Bottom Row -We also relate these to the healthcare functions/systems they can potential impact Top Row – We map to business impact/economic benefit


Let your MFP captures Big PaperSimplify your workflows

New Customer Application Find a Form

Add to Customer Application Find a Brochure

Submit Employment ApplicationExpense Re-imbursement

Scan a new customer application form

Add a scan to an existing customer file

Find and print a form

Scan and submit expense re-imbursements

Find and print a brochure

Scan a new employment application

Logged in: Kelly Thompson

Admit new patient Find a form

Scan and e mail

Find a brochure

Add to patient file

Expense reimbursement

Add a scan to an existing patient file

Scan admissions documents

Scan to patient file and e mail

Find and print patient education notes

Patient Management- New Patient Admissions- Patient Survey- Clinical Procedure workflows- Patient discharge workflows- Patient discharge instructions

Information Management- Patient Forms- Unified Patient File- Physician Notes- Clinical Narrative- Disease and Wellness Care Collateral

Presenter

Presentation Notes

Key points to highlight: OXP integration coupled with HPAC enables - personalized “jobs” to be presented as single buttons to each user based on their role - sophisticated workflows , capture functions are all enabled by a single push button - while some other vendors claim to have this level of integration (and do sometimes) this is a single vendor integrated solution fully tested by HP The top right button on the OXP screen says search/print from WorkSite. This is unique functionality to HP/Autonomy. Use this to actually search the document management system, preview documents and print any document on the MFP – another form of pull printing Use cases: You arrive at a remote office. Your files are synched wirelessly but then you want to print a document (maybe for an important presentation. With this solution any MFP becomes a print kiosk – no more figuring out how to map the local printers to your device, find the closes printer and its name . ID , etc – just search, preview and print (a recent documents feature shows on the second animated screen illustrates that your most recent docs are always available) You are in a conference room in a big meeting – no PC with you . You need to get a document - go to any device, log in search and print Forms library: store all forms in a worksite folder. Now every employee can search for and print forms on demand Collateral library: again with widely distributed retail operations and collateral changing all the time every MFP is a collateral production station – put all collateral in WorkSite (which can could as the document management / portal for marketing anyway - and the latest version will always be available ) only the latest versions are visible) and you are set


Serviceability Improvements• Integrated IT support.• Network Management, and

proactive alerting.• High Capacity Cartridges.• Field Service and support. • Ease of Hot-Swap device support.• Centralized configurations.Consolidated Footprint

• Single device replaces fax, label printer, and wristband printer.

• Also provides copy, print, and scan.• Multiple Paper Tray support.• Decreased desktop real-estate

requirement.

Improved Patient Experience• Color Photo Printing Support.• Addition of color Precautionary

codes.• Simplified admission processing.

HP Officejet Pro X – Healthcare Focus

Lower Cost of Ownership• Lower Acquisition cost than

multiple thermal devices.• Lower cost of wristband/label

printing.• Lower Annual Service Cost.• Simplified Help desk

troubleshooting.


Let your Healthcare Analytics search the “Big Data”Translate data into clinical insights

HP IDOL +

Patient Communications

ClinicalNarratives

TransactionalData

IT/OT WebSchedules

400+ Connectors

EMR Lab Pharmacy ADT Payer RIS/PACS Billing Documents

Knowledge Discovery

HAI DetectionCompliance Reporting

Predictive Analytics

Best Practices +Best Experiences

HypothesisGeneration

Search

Medical Guidelines

ProviderCollaborations

Industry Literature

Healthcare Taxonomies

Medical Codings

Clinical Classifiers

Healthcare Visualizations

Medical Workflow UI


Structured and unstructured information

<ICD9><Code>413.9</Code><Descr>NOS angina pectoris</Descr>

</ICD9>


The nuances of clinical documentation – Institutional Memory

• Context• Heart attack mentioned in History of Present Illness • Heart attack mentioned in Family History

• Meaning (in ED triage notes)• DOB to indicate Date of Birth• DOB to indicate Difficulty of Breathing

• Negation • The patient denied shortness of breath or chest pain


Approaches to unstructured information

Text processing

technologies: keyword, NLP, probabilistic

Taxonomies, ontologies, lexicons: SNOMED,

UMLS, ICD9/10, RxNorm, LOINC

Clinical documentation: encounter / admission /

progress / procedure notes, discharge

summaries, test results

Formal published medical knowledge: literature (PubMed), protocols, guidelines

Unconventional sources: Social

media, call center transcripts


Healthcare Analytics Use Cases

Clinical chart review is necessary for:

• Compliance Reporting: Clinical Quality Measures (CQM’s) , Core Measures Quarterly, PQRS, eRx reporting, Hospital Inpatient Quality Reporting Program, CHIPRA, (Children’s Health Insurance Program Reauthorization Act), ACO Programs

• Public Health Data: Syndromic surveillance, CDC, cancer registries, immunization reports, adverse drug events

• Research: Cohort identification, recruitment of eligible subjects

Manual chart review is labor intensive, time consuming, and has human variation


Application scope and adoption factors

Clinical Research and Population Health

Compliance Reporting and Public Health

Operational

• Adverse medical event reporting

• Syndromic surveillance

• Hospital inpatient quality

• Clinical Quality Measures (CQM)

• Cancer registry, immunization reports)

• Risk Adjustment

• Fraud, Waste, & Abuse

• Medical coding review

• Auditing

• Cohort identification

• Personalized medicine

• Clinical decision support

• Disease management

• Clinical trial subject recruitment

Adoption considerations

"Evidence" for change in clinical practice

Demonstrable ROI

Workflow modifications WRT target adopter

Availability of input data

Sponsor/champion for change

Legislative drivers

Privacy issues/worries


Application – Understanding hospital acquired conditions

HAC’s include adverse drug events, hospital acquired infections, procedural complications and incidents related to falls

• The incidences per 1,000 visits are:

• 65 incidents due to adverse drug events

• 60 events due to hospital acquired infections

• 51 events due to procedural complications

• 15 incidents related to falls

HAI’s result in extra costs of $5-10M /year for average hospital

ADE’s cost the average hospital about $5.6M/year

ADE’s increase LOS by 4.6 days and increases costs by at least $5K/incident

Consolidated in Patient Safety Primer and Fact Sheet, 10/2/2006, HIMSS Patient Safety and Quality Committee

Tinoco A, Evans R, et al. J Am Med Inform Assoc 2011;18:491-497

"Computerized surveillance systems that can access both coded and free text data such as that found in unstructured narratives

may improve surveillance without requiring the time and cost associated with manual chart review, alone.“


Application – Looking for depression1 in 10 adults met criteria for current depression, 4.1% met the criteria for major depression 1

Median delay from onset of depression to the beginning of treatment was estimated to be eight years 2

Treatment prevalence rates of comorbid depression for some chronic conditions is significantly lower than the expected comorbidity rates (e.g., 16% treated vs. 45% expected) 3

Comorbid depression increases medical services costs by average of $505/member/mo. and has significantly elevated odds ratios with poorer self care (e.g., high fat intake > 6x/wk, smoking, exercise < 1x/wk) 3

1: MMWR 2010;59(38);1229-1235

2: Melek, S. Halford, M. Measuring the Cost of Undiagnosed Depression. Contingencies. Jul/Aug 2012. Pps. 64-703: Melek, S. Norris, D. Chronic conditions and comorbid physchological disorders. Milliman Research. 2008


Wide range of healthcare use cases including ...

Reconciliation

ID discrepancies between

diagnostic code and clinical notes

Monitor KPIs and Metrics

Reporting

Abstraction

Rapid Chart Access

Ultimate flexibility to scale


HP Healthcare Analytics platform unlocks full data valueBuilt for unstructured and structured clinical data

Core Capabilities:

• Integrated modular platform for variety of use cases

• 400+ data connectors and 150+ data types

• Rapid identification of concepts, patterns and relationships

• Conceptual search on all data

• Advanced security for compliance

Healthcare specific capabilities:

• SNOMED CT taxonomy with 344K+ concepts and 2M terms

• Integrated ICD codes

• Intuitive workflow UI and visualization for healthcare applications

Intelligent search and actionable Insights powered by HP IDOL (Intelligent Data Operating Layer)

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.20 Copyright © 2013 HP Autonomy. All rights reserved. Other trademarks are registered trademarks and the properties of their respective owners.

Information transformed to enable success

• Improve reimbursements and quality of KPIs with comprehensive and contextually relevant insights

• Reduce costly and error prone manual overhead with intelligent search and automation

• Lower financial, operational and compliance risks with effective reconciliation to proactively uncover errors

Presenter

Presentation Notes

Achieve Improved Reimbursements and Quality KPIs using advanced analytics that understands 100% of clinical record including unstructured clinical notes. Gain insight and develop new clinical, operational, and quality measures not possible with tradition financial reporting and analytics tools. HPHCA automates report generation and integrates all available enterprise data (both structured data, and clinical narratives). Reduce costly manual labor intensive chart abstraction tasks in the areas of auditing, research, and quality reporting. HPHCA instantly locates clinical concepts, improving both efficiency and accuracy, and enabling greater chart abstraction functionality. Reduce Medical Miscoding: Both under and over-coding have substantial financial impact including under-reimbursement, liability from RAC audits, and inaccurate case-mix determinations affecting hospital operations. compreeHPHCA reconciles coding with clinical documentation, revealing discrepancies and improving accuracy before audits occur.