HIMSS Clinical & Business Intelligence Community of Practice. January 24, 2013

Transcription

1 HIMSS Clinical & Business Intelligence Community of Practice January 24, 2013

2 Welcome Agenda HIMSS C&BI Community Updates New Community Sponsor HIMSS13 activities Presentation and Discussion: Man + Machine Pieter Schouten, General Manager, Healthcare Solutions, Opera Solutions Announcements Wrap-Up

3 Welcome Michael Brooks, BS, MBA, CPHIMS C&BI Community Co-Chair Specialist Leader, Healthcare Information Management Deloitte Consulting LLP J.D. Whitlock, MPH, MBA, CPHIMS C&BI Community Co-Chair Corporate Director, Clinical & Business Intelligence Catholic Health Partners Shelley Price, MS, FHIMSS C&BI Community Staff Liaison Director, Payer & Life Sciences, HIMSS Nancy Devlin C&BI Community Staff Liaison Senior Associate, Payer & Life Sciences, HIMSS

4 HIMSS C&BI Community Updates

5 New Community Sponsor

6 C&BI at HIMSS13

7 Guest Speaker

8 Man + Machine: Transforming Healthcare Through Analytics Pieter Schouten General Manager Healthcare, Opera Solutions

9 Center of Machine Learning Science and Big Data Analytics: 230+ Scientists Expand Limits of Machine Intelligence Bring to Front Lines to Drive Productivity

10 The Opportunity Transforming Healthcare Big Data Era: Tectonic shift driving vast new analytics opportunities U.S. Healthcare Analytics Opportunity: $300Bn Clinical Analytics: $100Bn Payment Analytics: $50Bn Note: Findings from McKinsey Global Institute

11 Why Is Man + Machine So Powerful?

12 Terrence Deacon Chair of Anthropology Department University of California, Berkeley What makes the human brain different?

13 Three levels of cognition

14 Iconic Is/is not something

15 Indexic Things associated by space, time, or category

16 Descriptive Analytics: Indexic Representations of Reality

17 Predictive Analytics: Indexic Representations of Reality Staffed Nurse Hours, Demanded Nurse Hours versus Optimized Nurse Hours # of Hours, Sample hospital Staffed Nurse Hours Demanded Nurse Hours Optimized Nurse Hours :00 AM 12:00 PM 12:00 AM 12:00 PM 12:00 AM 12:00 PM 12:00 AM 12:00 PM 12:00 AM 12:00 PM 12:00 AM 12:00 PM 12:00 AM 12:00 PM

18 Symbolic Ideas and concepts beyond space, time, or current reality Synthesis Wholeness Understanding

19 Symbolic Indexic Iconic Man + Machine Integrated Cognition

20 Man + Machine Example

21 Existing Rules-Based Guidance Poor Indexic Examples of Output Case 1: 372 charges flagged 1 actually anomalous Case 2: 52 charges flagged 0 actually anomalous

22 New Pattern-Based Guidance Superior Indexic METHODOLOGY Models Predict the incorrect charge code for a particular visit by comparing it to all visits in the hospital. This method captures missing codes on a global, not neighborhood level. + ENSEMBLE MODEL An ensemble score combines individual scores produced by each model Group similar patient visits into neighborhoods. Then determine the likelihood of incorrect charge by comparing a patient record to its neighborhood. + Identifies patterns and correlations in the visit-level data and uses these to predict incorrect codes on new patient records Ensemble Model 1 Model 2 Model 3 Model 4 Group patient visits into clusters that share a common set of charge codes. Use these clusters to reconstruct a given visit and determine incorrect charge codes

23 Better Indexic Representation Rules-Based Case 1: 372 charges flagged 1 actually anomalous Pattern-Based Case 1: 1 charge flagged 1 actually anomalous Case 2: 52 charges flagged 0 actually anomalous Case 2: 3 charges flagged 1 actually anomalous

24 Symbolic Transformation: Bringing Analytics to Human Scale Search Welcome, John Smith Date, 2012 OPEN ITEMS/FURTHER INVESTIGATIONS YOUR SCORECARD Acct/ Invoice Last Examined Summary of Matter Proceed to Record? Today This Month YDT 1798/ /30/12 Venous insufficiency (diag 45981) veins inflammation hypertension (Diag 4019) and ulcer of ankle (Diag Missing lidocaine, $1,200, HIGH PROBABILITY X Yes No Later Remove # Corrections Amount $ ACCT. INVOIC E DIAGNOSIS PROCEDURE INACCURACY AT ISSUE WHY A PRIORITY? RECOMMENDED INVESTIGATORY PATHWAY ACTION/ DECISION NOTES Respiratory virus (diag.796) and urinary tract infection (diag. 5990) Antibiotic injection (proc 9921) Missing ceftriaxone sodium injection (J0696) Probability: Dollar Amt.: $1,200 Factors: Customary for this physician, this procedure, this hospital Physician Orders Medical Notes Outpatient Clinic Records Rebill Do not rebill/ close matter Investigate further Atherosclerotic heart disease of native coronary (Diag 41401) and hypertension (Diag 4019) Heart function evaluation Missing electrocardio -gram (93005) Probability: Dollar Amt.: $500 Factors: Required for diagnosis; subsequent tests that appear on invoice rely on procedure Physician Orders Medical Notes Outpatient Clinic Records Rebill Do not rebill/ close matter Investigate further Powered by

25 Better Machine Identification, Higher Human Productivity Indexic Symbolic Rules-Based Case 1: 372 charges flagged 1 actually anomalous Pattern-Based Case 1: 1 charge flagged 1 actually anomalous 4X improvement in human productivity Case 2: 52 charges flagged 0 actually anomalous Case 2: 3 charges flagged 1 actually anomalous + 50 BPS revenue

26 + Man vs. Machine

27 How do you get started? Carefully control the scope and impact of change. Adopting a new analytics solution need not and should not require major changes in workflow or investments in new IT and infrastructure. Don t discard existing rules and practices out of the gate. Instead, incorporate existing systems and build on them. The existing systems represent years of relevant experience and provide a strong foundation for new solutions. The best approach is to roll out the machine learning based solution in stages. After the models are trained on historical data, hospital systems should pilot the solution in one or a few locations before moving to full execution. In addition, the solution should be designed to permit extensive human input, ensuring that frontline employees experience and expertise informs and complements machine learning models.

28 Profit from Big Data Flow Pieter Schouten General Manager Healthcare, Opera Solutions

29 HIMSS Announcements Annual Call for Committee Applications Open Until March 8 HIMSS opens its annual call for volunteers to serve on a committee for the fiscal years. Service on a HIMSS Committee focused on specific settings and constituencies within health IT and key industry topics, is an excellent opportunity for professional development, networking and active engagement. Committee participation is open to all individual and corporate HIMSS Members who are not serving in other leadership positions within the Society and have been a member in good standing for at least the past 12 consecutive months. To apply, visit the Committees & Volunteer Opportunities page on the HIMSS website. For questions or more information, Joan Flagg, HIMSS Executive Assistant, or call (734)

30 Wrap-Up Want to get involved? Speaker or topic ideas Key note or 2-Minute Drill presenter Blogger, twitter Contact Nancy Devlin Community Website

31 Wrap-Up Next meeting: Thursday, February 21, 2013 Jonathan Everett, Chinese Community Health Care Association & Bob Rogers, Apixio -- A Successful ACO Infrastructure in San Francisco

32 FY13 Leadership and Contact Information Co-Chairs: Michael Brooks, BS, MBA, CPHIMS Specialist Leader Deloitte Consulting LLP J.D. Whitlock, MPH, MBA, CPHIMS Corporate Director, Clinical & Business Intelligence Catholic Health Partners HIMSS Staff Liaison: Shelley Price, MS, FHIMSS Director, Payer and Life Sciences HIMSS Nancy Devlin Sr Assoc., Payer and Life Sciences HIMSS 32

33 Thank You

34 Appendix

35 Diane M. Carr Clinical & Business Intelligence Chair Deputy Executive Director North Bronx Healthcare Network Kelly Aldrich, RN* Director, Nursing Informatics HCA CSG EHR Program Office William Beach, MBA,MLA, RRT* PhD Student, Research Assistant University of Missouri Thompson Boyd, MD, CPHIMS Physician Tenet Health Systems Michael Brooks, BS, MBA, CPHIMS * Specialist Leader Deloitte Consulting LLP Julie Burgoon, MBA, CPHIMS SR IS Manager, Health Informatics BlueCross BlueShield of Tennessee C&BI Committee COMMITTEE MEMBERS Linda Campbell, BS, MS, CPHIMS, FHIMSS Partner and National Practice Leader for Clinical Implementations CSC Ray Hess, MS, FHIMSS VP, Information Management The Chester County Hospital Maxine Rand, RN* Director, Clinical Ed, Practice & Informatics Kaiser Permanente Wolf Staplefeldt, MD* Chairman, Department of Gen. Anesthesiology; Vice Chair, Surgical Ops Cleveland Clinic J.D. Whitlock, MBA, CPHIMS Corporate Director, Clinical & Business Intelligence Catholic Health Partners Lori Yackanicz, BS* Administrator, Information Services Lehigh Valley Health Network BOARD LIAISONS*: Dana Alexander, RN, MSN, MBA, FHIMSS Chief Nurse Officer GE Healthcare Kathleen C. Kimmel, MHA, RN, CHE, CPHIMS, FHIMSS Chief Nursing Officer MedeAnalytics * Indicates a 1-year appointment Indicates a 2-year appointment

36 C&BI Task Forces Information Management and Data Technology Task Force CHAIR: David Dobbs, Vice President, Health Analytics, Vitalize Consulting Services This group creates resources and tools to help providers and provider organizations manage, integrate, and aggregate information necessary to support robust data analyses resulting in improved decision-making. Topics addressed may include data governance and ownership, clinical and business data integration, data lifecycle management, data warehouses, and data storage and enabling technologies. Meeting times: 3 rd Wednesday of the month, 1:00-2:00pm ET Analytics and Information Delivery Task Force CHAIR: Carol Muirhead, MBA, Sr. Informatics Project Specialist, PinnacleHealth This group creates resources and tools to help providers and provider organizations facilitate effective reporting by translating data into meaningful knowledge resulting in improved quality, clinical, and financial outcomes. Meeting times: 3 rd Tuesday of the month, 2:00-3:00pm ET Value of Operationalizing the Data Task Force CHAIR: Terri Gocsik, CRNA, MS, CPHIMS., Manager, Clinical Informatics Center of Excellence, Aspen Advisors, LLC This group creates resources and tools focused on industry use cases. The use cases highlight best practices and lessons learned by providers and provider organizations using information to drive improved business and clinical decision-making. Meeting times: 1 st Thursday of the month, 1:00-2:00pm ET

37 C&BI Community of Practice The goal of the C&BI Community is to bring together thought leadership and share knowledge that will support the future success of our members by improving their ability to understand and form partnerships to manage C&BI as a part of doing business and providing accountable and quality care to their members. The Community will support activities that promote peer-to-peer networking, problem solving, solution sharing, and education. Topics of focus may include: Storage and Management of Data and Supporting Technologies Knowledge Management to Support Accountable and Quality Care Case, Risk & Cost Management Best Practices Clinical & Business Analytics Clinical Decision Support Research Data Warehousing/EDW Data Lifecycle Management

38 C&BI Community of Practice Open to all HIMSS members (current membership: approx 557 people) Will meet virtually 6-8 times/year Agenda for the meetings may include: Commencing with a short series of 2-Minute Drills presented various Community members Topical discussion with key note presenter The 2-Minute Drill is based loosely on the sports analogy, and in this case is a fast-paced (short in length) presentation on a hot, emerging, or timely topic, news event (e.g. research paper, game-changing market or technology news), or recent and relevant event (e.g., federal public meeting, legislative/federal/judicial news, critical conference or educational event). 2-Minute Drills foster greater peer-to-peer networking, member engagement, problem solving, solution sharing, and education. If you are interested in presenting any drills, please contact Nancy or Shelley.