CDS Innovation Through Academic & Public Partnerships: MedCurrent "Brain Power"

Back row: Dragomir Stanojevic, Debashish Roy, Hasan Dharamshi, Aleksandar Penic, Dr. Steve Herman Front row: Dr. Suanne Wong, Syeda Firdaus, Shaina Raza, Dr. Cherie Ding Not pictured: Dr Paul van Arragon

Back row: Dragomir Stanojevic, Debashish Roy, Hasan Dharamshi, Aleksandar Penic, Dr. Steve Herman
Front row: Dr. Suanne Wong, Syeda Firdaus, Shaina Raza, Dr. Cherie Ding
Not pictured: Dr Paul van Arragon

“Two heads are better than one,” as the saying goes.  Make that three, four, five, or more and the possibilities are endless with a group of intellectuals.  At MedCurrent, I like to think of our team as self-proclaimed “brainiacs” – we are problem-solvers, innovators, and tenacious go-getters.  We are high-achieving doctors, developers, and consultants from around the world, well-suited to lead change within the healthcare system.  Together we drive the mission of MedCurrent, improving quality of care and reducing unnecessary healthcare costs through intelligent solutions that are supported by an outcomes-based client-centric team.

In this same spirit, we eagerly welcomed the opportunity to enhance our team and capabilities through the NSERC (Natural Sciences and Engineering Research Council of Canada) Engage Grants.  For the last 6 months, we have had the benefit of collaborating with three talented PhD students from Ryerson University: Debashish Roy, Syeda Firdaus, and Shaina Raza.  Under the direction of Dr. Cherie Ding, an expert in the field of information retrieval, recommender systems, and data analytics, the Ryerson group have dedicated their considerable “brain power” to enabling greater indication search efficiencies in our clinical decision support (CDS) application OrderWise™.  As the end of this R&D project approaches and the results are implemented by the MedCurrent Development Team, we would like to thank the members of our Ryerson group for their dedication and commitment to excellence.  We fellow “brainiacs” at MedCurrent have a mutual passion for shared knowledge and innovation, and we wish you all the best in making your own mark on the world.

Integrated Diabetes Clinical Decision Support + Optimized Care Plan Platform

Written by Paul Lasiuk, CEO/Founder of Healthy Interactions


Necessity is the mother of invention…”

A few months ago I was chatting with the CEO of one of our health system customers using the Healthy Interactions diabetes patient education platform. 

“Paul, we are thrilled with the results of the diabetes program.  Our patients with diabetes are more engaged with significantly better outcomes.  We have improved at-risk contracts performance and improved quality measures.  My challenge is, how do we get more patients enrolled into the programs?  How do we fill the funnel to the top?”

While thrilled to hear about the impact, filling the funnel became our necessity requiring a solution. The answer: Clinical Decision Support, using evidence-based rules to more efficiently evidence-based help providers diagnose patients with diabetes, at every transition of care point.

Healthy Interactions dove into the CDS space. Our goal was to license the most stable, most flexible CDS platform, with the best user interface, already proven to integrate into workflows and into EMRs. We found MedCurrent and licensed their CDS platform.

Healthy Interactions is developing very detailed diabetes CDS rules to efficiently identify and help diagnose patients with diabetes. We took it further. Healthy interactions' diabetes CDS platform also initiates an automated optimized care plan, per patient. The optimized care plan includes:

i) Perfectly matched patient education based upon the transition of care
ii) Automatically digitally connecting the patient with the appropriate care team member
iii) Providing a Rx recommendation and linking with the EMR e-prescribing
iv) Recommending and scheduling all tests and procedure for the next 12 months based upon the appropriate care plan
v) Initiating robust analytics tracking patient behaviors, impact, and PCP CDS rules compliance

This integrated diabetes CDS model AND automated optimized care plan is a tremendous leap forward, not just in filling the funnel, but also in advancing standards of patient care while dramatically simplifying and enhancing provider workflows. Healthy Interactions’ integrated CDS platform inventionis addressing the chronic patient care necessities with a growing number of health systems and pharmaceutical companies.

We are happy to talk about your chronic patient necessities and our inventive solutions. 

Key Value-Based Care Strategies: EMR-Integrated Clinical Decision Support (CDS) and Chronic Condition Patient Self-Management

Over a long career of clinical practice, physician executive experience, and population health data analysis, I (and many others) have concluded that improved patient engagement and appropriate influence of physician decisions at the point of care have the largest impact on waste.  That impact happens when patients are supported in making changes required to live a more healthy life, and when physicians and nurses as patients’ trusted advisors can guide patients with best evidence about the potential effectiveness and cost of a particular test and/or intervention.  It is critical to embed support systems in both of these key areas, which are under-supported with accessible, relevant, and efficient tools.

Delivering better care to more people at a lower total cost is a significant challenge facing all of us.  By most estimates, unnecessary or not evidence-based care represents the largest cost reduction and quality improvement available to us all.  The attached graphic estimates $762 B waste in the US healthcare system.  Approximately $400 B is identified as unnecessary care and administrative waste.  This blog posting is written by two companies that have great solutions to enhance efficiency and effectiveness, and rid of waste, within these nagging buckets.

Figure 1: Chase D. Report: The Future Health Ecosystem Today Provides Look Into Healthcare's Future. Forbes, Feb 2016. Available HERE. 

Figure 1: Chase D. Report: The Future Health Ecosystem Today Provides Look Into Healthcare's Future. Forbes, Feb 2016. Available HERE

Healthy Interactions: group learning, self- management education, digital distribution, behavior change and engagement

Patients and families who can openly share their feelings, select what they believe is most important to learn, and are supported in that make the right decisions and change their daily habits, are best equipped to adapt to living with a health condition.  Now touching over 25 million people in >120 countries, Conversation Map™ tools have been proven to be effective and satisfying in over 50 publications and over 30 independent studies.  Now available through digital distribution faster and more global impact is possible.  We will share much that has been learned and explore what lies ahead in the self –management education, patient engagement and behavior change landscape. 

MedCurrent: Clinical Decision Support (CDS) integrated in provider workflow

Physicians and nurses practicing with best evidence at their fingertips serve as best and trusted advisors for patients and families.  The challenge lies in efficiently embedding that in the daily work of our clinicians and evaluating and measuring how we are all doing at providing best advice at the point of care.

What is most exciting to me is that disequilibrium and dissatisfaction among clinicians and patients has made this a great time to innovate our way to better performance.  The good news is that it is happening all around, so stay tuned as we introduce you to an inside look at best practices that reduce waste and enhance health. 

Preparing for the Delayed - But Still Coming - PAMA Mandate for Radiology Clinical Decision Support

It’s unfortunate, but not a major surprise, that the CMS recently postponed its PAMA mandate for hospitals and imaging centers stipulating that radiology clinical decision support (CDS) systems must be in place by January 1, 2017. Ideally, the new deadline will not extend into 2018.

This mandate is not the first to be delayed. Like Meaningful Use and ICD-10 before it, the radiology CDS mandate will come.  And radiology practices need to prepare for it - now. 

 

Is inappropriate imaging a problem?  Does clinical decision support (CDS) work in reducing it?

Dozens of articles clearly document the size of the problem associated with the inappropriate ordering of medical images.  Figure 1 highlights data from the June, 2010 issue of the Journal of the American College of Radiology (JACR) article titled “Analysis of Appropriateness of Outpatient CT and MRI Referred From Primary Care Clinics at an Academic Medical Center: How Critical Is the Need for Improved Decision Support?”

Figure 1. Lehnhert BE, Bree RL. JACR 2010; 7:192-197.

Figure 1. Lehnhert BE, Bree RL. JACR 2010; 7:192-197.

An article published in a JACR the following year shows that CDS significantly helps in addressing the challenges associated inappropriateness. See Figure 2.

Figure 2. Blackmore CC, Mecklenburg RS, Kaplan GS. JACR 2011; 8:19-25.

Figure 2. Blackmore CC, Mecklenburg RS, Kaplan GS. JACR 2011; 8:19-25.

 

How will the use of clinical decision support impact radiology practices?

CDS works.  And despite the delayed mandate, CDS will soon be a reality for hospital and imaging center radiology practices.  With this reality come significant changes to these practices.

The mandate requires that CDS must be used for CT, MRI, and Nuclear Medicine studies (including PET) – specifically for non-emergency Medicare outpatients.  Once a CDS has been installed for this group, it’s logical that the organization will use it for all patients.

Whether or not ordering doctors follow CDS guidelines is a major question that comes to mind. According to the mandate, they will not be required to do so.  However, the mandate states that up to five percent of ‘outliers’ will need to use pre-authorizations on their patients by 2020, making it likely that CDS proposed guidelines will  be followed. 

Let’s say that proposed guidelines aren’t used.  Nothing will change, right? In reality, the volume of ordered imaging studies may decrease due to the ‘hassle factor’ of using a poorly-designed CDS system – but not necessarily in the best interest of the patient.  This was recently demonstrated when a radiology benefit management firm reported volume reductions despite no denials.  So assuming guidelines will be followed to at least some extent, practices need to develop an understanding of how deep reductions will be, and tools and mechanisms exist that will provide that analysis. 

As ordering via CDS systems becomes part of routine physician workflow, significant shifts will occur.  For example, fewer MRIs may be done or a large number of CTs could be replaced with ultrasound.  These changes would have a major impact on capital equipment acquisition staffing and other operational decision. 

No two radiology practices are alike, so it’s impossible to predict the exact changes that will occur at a specific hospital or imaging center.  Opportunity exists, however, for these organizations to analyze their own data to help in having a better understanding of shifting metrics

Sophisticated tools exist, such as MedCurrent Impact™, that analyze incoming orders to determine the shift in orders that would occur when a future CDS system would be present. Making the assumption that these same physicians will follow CDS recommendations in the future, one could secure a better estimate of how many fewer studies are likely to be done (by modality) while also learning about specific shifts that will happen across various modalities.    In addition, one could estimate the financial impact of the CDS system.  Armed with this knowledge, a practice has a reasonable chance of how to prepare for forthcoming repercussions of the mandate.

Despite the radiology industry’s delay with the PAMA mandate, financial and operational leaders should get an early start on understanding the implications associated with it.  Ample opportunity exist now for individual practices to get ahead of a situation that is sure to impact both operational and financial management.