business intelligence & analytics for healthcare

Business Intelligence & Analytics for Healthcare

Utilizing remote monitoring patient-data for analytics and decision making by healthcare professionals

Proteus Duxbury, PA Consulting Group

San Diego, July 11th 2011

© PA Knowledge Limited 2011. PPT US presentation template V2-4.ppt

Agenda

What is Telehealth and why is it a game changer?

Acute care and patient home remote monitoring settings

The opportunities for analyzing and exploiting Telehealth data

The challenges of analyzing and making sense of Telehealth data

How can these challenges be addressed?

About PA Consulting

Questions


The best way to contain spiraling healthcare costs is to promote better health

In 1970, <20% total healthcare expenditure was associated with management of chronic conditions. Today it is nearly 80%. And the total has more than trebled.

Changes in lifestyle and diet are a major contributor to this. Passive lifestyle choices are affecting health at a population level. The best way to contain spiraling healthcare costs

is to promote better health.

When conditions surface is too late and too expensi ve.

What is Telehealth


What is Telehealth?

• The delivery of health-related services and information via telecommunications technologies

• As simple as two health professionals discussing a case over the telephone

• Or as sophisticated as using videoconferencing between providers at facilities in two countries, or even as complex as robotic technology

• An expansion of telemedicine, and unlike telemedicine it encompasses preventive andcurative aspects.

.

What is Telehealth


The case for Telehealth and remote monitoring

• Increase patient wellness

• Reduce re-admissions

• Help address workforce shortages

• Improve access to healthcare in rural areas

• Drive referrals and improve physician and hospital outreach

• Provide quality care for patients close to home.

What is Telehealth

Economist Robert Litan estimates the use of home telehealth can bring about $197 billion net savingsto the health care system over the next 25 years

In Centura (Colorado) nurse home visits dropped to an average of 3.5 monthly visits from 6-8 monthly visits under a telehealth pilot. Re-

hospitalizations of CHF patients in the pilot was just 3.2% (7.9% for co-morbidity). Patient and

physician satisfaction have increased.

The VA found that remote monitoring of chronic

conditions has reduced hospital admissions by 63%

and ER visits by 40%


Agenda






About PA Consulting

Questions


Remote monitoring in acute settings (eICU)

Acute and at-home care settings

What is eICU

• Vital signs monitoring; relaying ICU bedside monitoring readings to a remote RN or physician.

• Algorithmic and active decision support to identify high risk patients.

• Improves the care being given to patients with a limited number of intensivists.

• UMass study showed financial return on investment from two primary sources:

– Improved margins from reduced bed nights

– increased patient retention and reimbursement at remotely monitored locations.

Who is using eICU?

• 300 hospitals in 40 healthcare systems across 30 states. More than 300,000 patients a year

• Main products are Philips VISICU and iMDSoft

• Sutter Health group operate a distributed eICU covering 405 beds across 20 hospital sites

• Avera monitor 33 sites with an average census of 55 patients per day and physician coverage from noon to 8:00 am.


Remote monitoring in the patient home setting

• Sensors and monitors to read patient vital signs

• Data is stored and aggregated within a home hub unit

• Connect to patient’s telephone lines, through a broadband connection, or through a cellular connection

• Data captured is transmitted directly into the health record of the patient, or can be directed to an intermediary system to support nurses in identifying high risk patients

• Leading products include Bosch Healthbuddy, Honeywell HomMed and American Telecare inLife.



Centura Health Home Telehealth services (remote patient monitoring)

• Telehealth system that allows patient monitoring through the use of a two-way video monitoring station

• Systems includes:

– Stethoscope

– Blood pressure meter

– Scale

– Pulse oximeter

– Glucose meter

– Digital image capture suitable for wound and diabetes applications among others.

• They are putting ‘telehealth patient monitoring stations’ in peoples homes.



The market is intensifying with many new technologies and innovations

Medication adherence support / monitoring

Wound monitoring

Patient reported outcomes

Home rehabilitation and exercise monitoring

Fetal monitoringMobile health –for clinicians and patients



Agenda






About PA Consulting

Questions


Telehealth is the ‘CRM’ of the healthcare industry and enables lifestyle monitoring

Analyzing Telehealth data...

• If EMR / EHR is the ERP of the healthcare industry then Telehealth is the CRM

• Telehealth allows us not only to monitor a patients health but also more importantly their Lifestyle moving to a paradigm of just in time medicine

• Remote Patient Monitoring widens the availability of timely, actionable, individualized health data

• Very large quantities of real-time data, monitoring the patient in their natural environment

• Data can be, and often is, imported into the patients EMR / EHR helping to build a longitudinal record of care and lifestyle over time.

Disease monitoring Lifestyle monitoring


Telehealth data can enable a richer analysis of health information for a variety of system participants

• Healthcare providers - can use the latest recorded information to monitor compliance, assess a patient’s health status, modify the patient’s care plan accordingly and drive disease management activities

Providers can also use the data to examine the efficacy of medications and find new ways to reduce their formularies

• Health insurance companies - will utilize Telehealth data to adjust reimbursement schemes based on disease conditions, drug compliance and efficacy and population susceptibility

• CDC, NIH and other public health organizations - can use Telehealth data to compile census data and to understand the health of the population (public health reporting)

• Pharmaceutical companies - can utilize Telehealth data to understand disease trends , examine the efficacy and safety of their drugs and for trial recruitment, study design and management.



The eICU research institute is aggregating and analyzing large volumes of patient data

• VISICU eICU data is captured from customer sites and stored by the eICU Research Institute:

• eICU data is being used for analyzing trends in aggregated acute care monitoring data. For example in helping to:

– Provide a model for identifying donors

– Create clinical decision-support protocols

– Improve billable encounters (beneficial for Insurance companies and HCPs)

– Achieve better verification of medical orders / drug decision making.

• However the focus to date has been on measuring the benefits and successes of implementing eICU rather than wider and broader reaching analysis that would benefit the system as a whole.



There are many collaborative looking to aggregate and analyze longitudinal patient health data to further clinical research

• Partnership to Advance Clinical electronic Research (PACeR www.pacerhealth.org) – impact of EHRs on Clinical Research – Pfizer, J&J, Merck, Quintiles

• PONTE consortium (Europe www.ponte-project.eu) - semantic interoperability between clinical research and clinical care information systems

• Observational Medical Outcomes Partnership (OMOP) - public-private partnership designed to help improve the monitoring of drugs for safety through use of real-time EHR data

• Pfizer ASTHER project - Adverse Drug Event Spontaneous Triggered Electronic Reporting - exploring how they can help physicians better recognize and report adverse events, and by improving the quality of data in safety reports.

• EHR Consortium – Dossia - AT&T, Applied Materials, Cardinal Health, Intel, Wal-Mart, Pitney Bowes, BP America, Vanguard Health Systems, Sanofi-Aventis, and Abraxis Bioscience

• Verizon Medical Data Exchange Consortium -exchange of health information

• Connecting For Health is transforming the UK’s National Health Service with one of the biggest IT investments.

• Practice Fusion has teamed with Microsoft to offer a set of de-identified health information to researchers entirely for free.

• The DHHS has an online initiative to provide open access to the agency's trove of health information.



The larger remote monitoring systems ship with basic analytics software

• The larger remote monitoring vendors provide Business Intelligence and data access tools for analysis by healthcare professionals

• Individual Patient Reports Include

– Date-range patient vital sign monitoring trends and graphs

– Triggers for intervention

• Aggregate Population Reports Include

– Average Length of Stay

– Patient Alpha Roster

– Patient Count by Protocol

– Physician Patient Count.

• Data can be used to understand nurse visit frequency and unplanned hospitalization trends (important with the 2012 re-admit policy)

• Data can be imported into the EMR / EHR for further analysis Health Buddy® System*



Agenda






About PA Consulting

Questions


Healthcare professionals are finding it challenging to make use of Telehealth data

• Security and trust is an issue – patients and providers are nervous about sharing data captured as part of in-home or acute setting monitoring

• Very little Telehealth specific registries – those that do exist are EMR / EHR focused

• Analytics are not being widely adopted – focus is mostly on the provision of alerts to prompt an intervention. Little deep analytics is taking place or analysis focused towards health-reform and accountable care

• Telehealth data can be voluminous and un-wieldy – good benefits are being delivered globally through remote patient monitoring. But how to make sense of these very large data sets and understanding the best way to import data into the EMR is proving elusive.

Challenges of analyzing Telehealth data


Healthcare professionals are finding it challenging to make use of Telehealth data…

• Quality of data can be poor – for example patients entering data into their phone manually. Often the technology is cheaper / hard to use which can result it false readings if the patient is not properly trained. What if a family member submitted their readings instead?

• The technology is still Immature – Telehealth technology is still relatively immature and the industry is changing rapidly. This is especially true at the device layer where patients soon want to ‘upgrade’

• There is a lack of industry standards - for device to device communication and interfacing to other systems like EMR / EHR

• Many barriers exist for the adoption of Telehealth – for example re-imbursement, physician and patient adoption and difficulty in developing long term sustainable financial models.

Challenges of analyzing Telehealth data


Agenda






About PA Consulting

Questions



• The development and adoption of open ‘plug and play’ standards should be encouraged (for example Continua)

• The movement of patient data should be automated and streamlined as much as possible (take out the human element)

• Monitoring devices need to be as consumer friendly as possible. They will be replaced frequently

• Increasingly the industry will transition from focusing purely on the analysis of chronic diseases to understanding how a patients life-style has an impact on their wellness

• Analysis efforts should be focused on showing the relationship between Telehealth and healthcare reform / accountable care

• For trust to be won there must be a clear benefit for the patient and the clinician and innovative consent models need to be adopted

• The Telehealth industry needs to be more active at creating registries of aggregated data for research purposes.

Addressing the challenges of analyzing Telehealth data


Aging Independently

• Fall Detection

• Motion detection

• Medication monitoring

• ...

Continua Health Alliance is working to “establish an eco-system of interoperable personal health systems that empower people & organizations to better manage their health and wellness”

PA’s people have been active in Continua and currently lead work on new use cases for the Alliance

Health & Fitness

• Cardio-Vascular monitoring

• Strength Monitoring

• Activity monitoring

• …

Continua currently recognize and

promote development of key

use cases in connected health devices and data

Disease management

• Blood Glucose

• Blood pressure

• Pulse Oximetry

• Weight

• Heart rate

• Temperature

• Insulin Pump

• Advanced Medication Monitoring

• …

The Continua Alliance is promoting standards within Telehealth



“Consumer friendly” constant monitoring systems – sensor network

Instrumented plaster –Flexible sensors measure and record muscle movement throughout the day

Breathing ‘vest’ – MEMstechnology records breathing rates and volume

Pedometer + GPS

Balance sensor in-soles measures and records foot weight distribution and core stability



Ten years from now? - Home Healthcare Experience

Ambilight – TV, Close Circuit TV to see activities (tennis, swimming etc)

Integrated Control Systems – hospital link, Caregiver link, Web cam, Facial

Sensor

Wii Controller

Wii Fit

Patient Monitoring

iPhone – links with Polar & Wii, trend analysis,

Caregiver support,

Emergency back-up,

Medication reminders,

Hospital links

Lighting/ Temperature/

Humidity Control

Exercise Bike

Emergency Contact Device

(necklace)

Caregiver Cam Humidifier

Meal Service per

diet/condition



Agenda






About PA Consulting

Questions


PA is a leading technology, systems, and management consulting firm

Employs 2600 experienced people in over 25 countries

65 years of corporate experience

Annual revenue in excess of $700m

Provides consultancy support to successful, multi-national organisations

Delivers long-term, sustainable benefits

From ‘Insight to Implementation’

Consistent venture success

At PA Consulting Group, we deliver a visible difference by helping transform the performance of organizations.

Clients call on us when they want:

- An innovative solution: leading edge thinking and groundbreaking solutions

- A highly responsiveapproach: we listen, and then we act decisively and quickly

- Delivery of hard results: we get the job done, often trouble-shooting where previous initiatives have failed.

Complex programme

delivery

Strategic

management

Innovation &

technology

Operational

improvement

Information

technology

People &

organisational

change

Equipped to deliver any kind of business transforma tion

About PA Consulting


PA’s Track Record in healthcare

About PA Consulting


PA presenting on the inhaler of the future

http://www.paconsulting.com/events/pa-presenting-on-the-inhaler-of-the-future-london-29-june-2011/

About PA Consulting


Agenda






About PA Consulting

Questions


Thank you for your time today – any questions?

For more information, contact:

Proteus DuxburyManaging Consultant100 Overlook Center 2nd FloorPrincetonNew Jersey 08540

Tel: 212 973 5966Cell: 610 772 0125E-mail: [email protected]

Proteus is an experienced Program Manager and Enterprise Architect specializing in Healthcare. He has worked at the cutting edge of Health IT since 1999 when he helped design and build Scotland's premier primary care EMR solution GPASS and a protocol based referrals and electronic outpatient booking system. He recently completed a study / white paper describing the progress States are making with implementing the State Health Information Exchange Cooperative Program and is currently helping a large provider in the US implement innovative Telehealth solutions.

http://www.paconsulting.com/healthcare

Questions

Subscribe free to PA’s Impacts newsletter at: www.paconsulting.com/healthcare

business intelligence & analytics for healthcare

Documents