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HOW LOCATION INTELLIGENCE ADDS VALUE TO HEALTHCARE OPERATION

Session #144, February 22, 2017

Dr. Brian Jacobs, VP, CMIO/CIO, Children’s National Medical Center

Mark Zirkelbach, CIO, Loma Linda University Health System

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Speaker Introduction

Brian Jacobs, M.D.

VP, CMIO, CIO

Children’s National Medical Center

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Speaker Introduction

Mark Zirkelbach

CIO

Loma Linda University Health System

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Conflict of Interest

Dr. Jacobs or Mr. Zirkelbach have no real or apparent conflicts of interest to report.

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Agenda

• 8:30 – 8:33 Introductions

• 8:33 – 8:53 Dr. Jacobs - Population Health Management: Using Geospatial

Analytics to Enable Data-Driven Decisions

• 8:53 – 9:17 Mr. Zirkelbach - Wellness Map: Personalized Wellness in Your

Own Space

• 9:17 – 9:30 Questions

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Population Health Management:Using Geospatial Analytics to Enable

Data-Driven Decisions

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Learning Objectives

• Describe current applications of GIS in healthcare that are producing a

return on investment

• Explain how GIS can be used to enhance patient and clinician engagement

• Use location intelligence to improve personal health decision-making

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Healthcare Cycle

Health System: Small

Influence on Patient

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• Healthcare encounters impact a small fraction of health factors, others include:

– Diet

– Exercise

– Med compliance

– Pollution

– Climate

– Genetics

– Socioeconomics

– Race

– Gender

– Stress

– Relationships

– Substance Abuse

– Etc…

Healthcare Cycle

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Why Geospatial Analytics?

• Healthcare conditions have geographic & environmental variation

• Many co-variables effect the expression of health & disease

• Understanding geographic & co-variable distribution can impact epidemiology, prevention, treatment & research efforts

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Geospatial Analytics & Crime

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Geospatial Military Application

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Geospatial Analytics on Healthcare Claims Data

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EHR-Rich Granular Data Blood Pressure

Weight

Hemoglobin

Radiology Results

Age

Gender

Cost

ED Throughput

Lab Results

BMI

Heart Rate

Medications

Allergies

Immunizations

Procedures

Address

Insurance

Race

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Health Data Processing

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Environmental Data Gathering

Restaurants

• Dining

• Take out

• Fast Food

Food

• Delis

• Convenience Stores

• Supermarkets

Education

• Elementary, Middle & High Schools

• Colleges

Health Services

• Clinics

• Hospitals

Demographics

• Population Data

• Economic Data

Primary

Collection

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GIS Methodology Applied to EHR

Identify EHR

Data Fields

Write Data

Query

Run Data

Query

Filter/Clean

Data

De-identify &

Geocode

Data

Upload Data to GIS

Map Data Against Covariables in GIS

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Health Use Case

Burns in Infants

Childhood Obesity

Sickle Cell Disease

Healthcare Facility Location

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Epidemiology: Burn Injuries in InfantsLorch M, et al. Pediatric Emerg Care 2011;27:1022-6

• Studied factors determining ED disposition of infants sustaining burn injuries

• 344 patients treated in the ED – Analyzed EHR data, environmental & socioeconomic variables

• Scalds (53.2%) & contact burns (39.8%) were most common

• Race played significant role in mechanism & severity of burn

• Focal geographic distribution

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Burn Data – DC Neighborhoods

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Childhood Obesity

• Patients presenting to Children’s National Inpatient, Inner City & Suburban Clinics

• Weight, Height, Gender, Race, Age & Address extracted from 3-regional EHRs

• Primary extract cleaned, de-identified & analyzed

• CDC BMI percentile equations applied

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Results Total Population

Children Ages 2-20

CP&A, Goldberg, and Inpatients

October 1, 2009 - October 1, 2010

30773

61%2788

6%

6145

12%

7769

16%

2238

5%

Healthy

Morbidly Obese

Obese

Overweight

Underweight

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Obesity RatesObesity Cases

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Fast foodOverlay

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Sickle Cell Disease Readmission

• Retrospective analysis using EHR-derived data on children with SCD-related pain crises

• Readmissions described, geospatial analysis conducted

• Models constructed to obtain readmission risk factors

• 373 subjects, 125 with at least one 30-day readmission compared to no readmission group.

• Readmission risk factors: Older, decreased LOS, increased pain scores, >3 hospitalizations in 1-year

McMillan, JE, et al. Hosp Pediatr 2015;5:423-31

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Readmitted Patients withSickle Cell Disease

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Expanding Services via Demographic Landscape Analysis

Visual display of attractive

markets based on a scoring

model

Population & Growth Estimates

2016 Pediatric Population

2021 Pediatric Population

5-year Change Pediatric Population

5-year % Change Pediatric Population

2016 Female Population 15-44

5-Yr % Change Female Population 15-44

2016 Households

2016 Ped Pop. Density

Income & Insurance

2016 % Private Insurance

2016 Average HH Income

2016 Median HH Income

2016 HH Income > $200,000

Market Factors

FY2015 CNHS Inpatient Market Share

FY2015 Inpatient Market Opportunity

Market Share "sweet spot"

Distance to CNHS

Outpatient Planning

Ambulatory Surgery Estimates

Emergency Department Estimates

Outpatient Procedures Estimates

Outpatient Visits Estimates

Chronic Conditions

Cancer Estimates

Heart Disease Estimates

Other Factors

Number of Births

Number of NICU Admissions

Median age of Birth Mother

Births to Mothers older than 30 / 35 / 40

Physician Planning

Physician Demand Estimates (FTE)

Physician FTE Supply

Net Physician Need (FTE)

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Market Scoring Map

Areas highlighted in red

indicate most

favorable based on

the market scoring variables

Demographic Variable Weight

2016 Pediatric Population 4

5-year Chg Ped Population 5

2016 Ped Pop. Density 2

2016 % Private Insurance 4

2016 Median HH Income 3

FY2015 IP Market Opportunity 1

Market Share “sweet spot” 3

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Recommendations• Based on market scoring

model, this is most

attractive sub-market in

Prince George’s County

• Although a more

centralized location in the

County would be ideal for

patient access, market

demographic scores do not

support this strategy.

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Potential Locations

• Bowie Town Center: largest retail/shopping hub in this

market, directly off Rt. 50

• Vista Gardens Market Place: Another potential - right

off I-495

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Conclusions

• Improved health cannot rely solely on encounters with

healthcare organizations.

• Care redesign must harness other factors beyond the

healthcare system in addition to EHR data.

• Geospatial analytics is an important tool to bring

qualitative & quantitative information forward to augment

traditional approaches to healthcare analytics.

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Wellness Map Personalized Wellness in Your Own Space

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Learning Objectives

• Describe current applications of GIS in healthcare that are producing a

return on investment

• Explain how GIS can be used to enhance patient and clinician engagement

• Use location intelligence to improve personal health decision-making

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Accountable Care Ecosystem

Health System Data

Community Health Data

Community HealthManagement System

CHMS

Clinical

Medical Staff

Administrative

Demographics

Resources

Cultural

Hot Spot Analysis

TargetIntervention

Strategy

PredictiveAdmission

Status

Real-time data linkingthrough geographic technology

Community - where location becomes clinically relevant and provides meaningful context for diagnosis, treatment, and healing of patients.

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What Is The Wellness Map?

• Personalized map to help patient’s achieve their health & wellness

goals in addition to addressing their socioeconomic needs.

• Map is seamlessly integrated with the Epic electronic health record

system & MyChart patient portal.

• Leverages a flexible and scalable central repository of community

resources mapped to appropriate diagnoses and conditions, any

other relevant information; e.g., Religion, Scheduled Appointments,

etc.

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The 7th Vital Sign

• Body Temperature

• Heart Rate

• Blood Pressure

• Respiratory Rate

• Pain

• Distress

•Place

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Goals

• Bridge the gap of care between health care delivery systems &

patient’s home/community.

• Provide consistent community resources and referrals to patients.

• Provide an personalized and easy tool they can use at home or

smartphone.

• Improve patient utilization of community resources & help achieve

wellness goals.

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Key Benefits

• Patient’s have a mobile map app to quickly find community resources custom to their situations.

• Providers/Care Coordinators can quickly evaluate availability of community resources.

• Health system has one consistent, up-to-date community referral database.

• Highly customizable to cater search results to different patient populations & department needs.

• Can integrate with a wide variety of applications to create a synergistic user experience.

• Able to measure which resources are frequently viewed.

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• 3 month pilot at LLUH’s Center for Health Promotion w/ Dr. Peters.

• Focused on patients dx w/ metabolic syndrome & diabetes.

• Goal to have patients use map & community resources.

• MDs spent up to 15 min counseling, sharing Wellness Map, & how patient goals could be achieved using community resources.

• Patient feedback, “cool”, “this is helpful”, “needs more resources on map.”

• Provider feedback, “easy to use”, “has great potential”, “need mobile version.”

Benefits Identified During Pilot

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Workflow

Provider Performs

Evaluation, Management

& Set Patient Goals

Launches Map in

Epic Hyperspace

Reviews Resources

In Wellness Map

Staff Helps Patient

Enroll for MyChart Patient Visits

Care Clinic

Patient Goes Home

Reviews Wellness Map via

MyChart or MyChart Mobile

Patient Uses Community

Resources to Improve

Health & Wellness

My Appointments

Medical

Health & Wellness

Social

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Find resources by directly

searching for them

Resources are shown based

on distance from patient’s home

Patient’s appointments, Primary Care

Provider, and preferred lab & pharmacy

is automatically pulled from the EHR

There are 3 main categories of

resources with customizable

sub-categories that appear based

on the patient’s EHR diagnoses Map automatically centers on

patient’s home address from EHR

Resources can quickly be added,

updated & removed from database

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Directions are

automatically generated

Bus, walk, & other

transportation modes

available

Business address, hours,

phone, website, & list of

services

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ComparisonPersonalized

based on

patient’s

EHR

diagnosis?

Accurate

and Up-to-

Date?

Save

favorites &

print map?

Easy to find

the right

health

resource?

Easy to

use?Configurable?

Secure &

HIPPA

Compliant?

Mobile App?

No No No Yes Yes No No Yes

No No Yes No Yes No No Yes

No No No Yes No No No No

Yes YesNo;

future

Yes;

automaticYes Yes Yes Yes

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Identified CommunityResources

Epic InterconnectBackend Services

Patient Provider

MyChartInternet (External) via

Internet & Mobile

EpicHyperspace (Internal)

Survey

Service .ASPXGeoportal

Inte

gra

ted

- P

HI

IEHPClaims Data

LLUH Hub

Determine Outcomes

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Frequently Asked Questions

Q: How will POIs be deemed appropriate to add to the database?

A: Data governance along with guidelines will need to be created with the

help of all parties.

Q: Will a new map be generated when the patient’s diagnosis & other health

information is updated?

A: Yes, the map is dynamic and will automatically be updated when there are

updates to the patient’s EHR record in real-time.

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Future Use Cases

• Understanding our population to help us make better decisions (strategic –services and capital investments).

• Wayfinding to help people navigate outdoors and indoors in real-time around the campus.

• Tracking of equipment and assets for improved security and compliance (RTLS).

• Internal targeted messaging for routine communication and incident management (Emergency Management).

• Research of environmental factors that impact certain diseases and how to reduce their incidence (University), many more.

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Questions

• Dr. Jacobs

Children’s National Medical Center

bjacobs@childrensnational.org

• Mr. Zirkelbach

Loma Linda University Health

mzirkelbach@llu.edu

Please complete online session evaluation. Thank You!