Digital Medicine Transformation The New Skill for CIOs

Transcription

1 Digital Medicine Transformation The New Skill for CIOs Session # 145, Feb 13 th 2019, Room W304A Ashish Atreja, Mount Sinai Health System and Shafiq Rab, Rush Health System 1

2 Conflict of Interest Shafiq Rab, MD, MPH, CHCIO, FCHIME No Conflicts of Interest Ashish Atreja, MD, MPH, FACP Scientific Founder, Rx.Health (Stocks, Board seat) 2

3 Agenda Value based health care transformation Potential for Digital Medicine and Digital Therapeutics Platform approach to unify and transform health systems Aligning Strategy with IT for Digital Transformation 3

4 Learning Objectives 1. Describe how value based care is making business case for a new wave of digital health technologies 2. Assess successful case studies of digital medicine adoption by patients and providers 3. Identify ways in which digital transformation can become sustainable and scalable through a platform approach 4

5 Dr. Shafiq Rab SVP & CIO HIMSS 2019

6 Things That Haven t Changed The problem we are trying to solve The value of IT Improving daily efficiency Getting consensus to adopt which has become more important as technology transforms

7 So What s Changed? Connectivity Machine learning and AI is there Mobility Contextual facial recognition Crisper Genomics itself All the tools to profile a patient Augmented reality Use technology to increase business and retain patients

8 Appointment s ER Visits What Makes Us - Us My Life Bank Personal Profile Genomics Proteomics EHR Location Disease Registries Rx Network Spendin g Habits Nutrition IoT & Wearables Social Determinants & Mental Health Interoperability Blue Button Caradigm Azure Machine Learning Analytics Azure Stream Power BI Oracle Cardiologi st Care Coordinator Population Health Systems Patient & Family Hospitals & Clinics

9

10 The Care Continuum

11 Thank You Discussion

12 Ashish Atreja Chief Innovation Officer, Medicine Icahn School of Medicine, Mount Sinai 12

13 Mount Sinai Health System Founded in 1852 Not-for-profit Academic Medical Center 7 Hospitals, 1 Medical School, 15 Institutes beds, 135 operating rooms 12+ Ambulatory Surgical Centers 200+ community location around New York 36,000 employees ~ 7000 Physicians 2.6 million outpatient visits 500 thousand ER visits 170 thousand inpatient visits 13

14 Provider Organizations are Unprepared for Value Based Care Value based care has arrived 76% of hospitals face readmissions penalties 50% of unprepared for bundles and MACRA 14

15 This is our Burning Platform Courtesy Mike Berger, Mount Sinai 15

16 Accenture,

17 We need tools to address triple whammy!!! 17

18 CIOs New Responsibility Going beyond the EHRs to enable digital transformation 18

19 Emergence of the new field of Digital Medicine 265,000 Mhealth Apps Telemedicine Linked Wearables AI/Machine Learning Secure Messaging Augmentic/ Virtual Reality Voice commands/ Alexa Chat Bots Biomarkers, CRISPR 19

20 In RCT, patients using BlueStar saw a greater mean A1c decline than those receiving usual care: 1.2% (1.9% vs 0.7%) over a 12 month period Quinn, C et al, Diabetes Care,

21 From: Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease: A Randomized Clinical Trial JAMA. 2015;314(12): doi: /jama At 6 months, levels of LDL-C were significantly lower in intervention participants (mean difference, 5 mg/dl with reductions in systolic blood pressure ( 7.6 mm Hg) and BMI ( 1.3),, and a significant reduction in smoking (26% vs 44%; relative risk, 0.61 [95% CI, 0.48 to 0.76]; P <.001). The majority reported the text-message program to be useful (91%), easy to understand (97%), and appropriate in frequency (86%). Enrollment of Participants in the TEXT-ME Randomized Clinical TrialLDL-C indicates low-density lipoprotein cholesterol. 21

22 Government Support for Digital Health and Ev What Startup Days FDA Pre-Certification Program CMS new CPT codes 21 st Century Cures Act AHRQ Set Up App Challenge Significance Support for innovation, telehealth and reducing regulatory barriers 22

23 Google AI Retinopathy 9963 images from 4997 patients Algorithm based on deep machine learning had high sensitivity and specificity for detecting referable diabetic retinopathy Could lead to improved care and outcomes, especially in areas with access issues to ophthalmologic assessment 23

24 Envisioning digital care in year 2020 Virtual care (telemedicine and messaging) 24/7 tracking (remote monitoring) Population health (AI,predictive analytics) Empowerment (SDH, AR, peer networking) Prescribing Apps (digital Fraction of Cost and Time Paul Sonnier, Storyofdigitalhealth.com 24

25 Digital Health: Problem of Plenty with Point and Click Solutions 25

26 26

27 The Burden of Proof In the wake of reports that question the accuracy and effectiveness of [Theranos ] technology health-tech companies will now face a greater burden of proof to demonstrate that their technology is effective. Future generations of startup founders should ensure they are working with venture capital firms that have ample experience in health care. These investors will understand that it takes time to build a successful and longlasting company. - Christina Farr, Fast Company 27

28 INNOVATION Digital Technologies RIGOR Evidence-based Medicine Evidence-Based Digital Medicine (EBDM) 28

29 NODE Health: Network of Digital Medicine 20+ Health Systems: HIMSS, AMA, ACC, Academy Health Startup Pharma Learning Network of Digital Transformation Hospital System & Patients Grant Agency To become the Largest Validation Networ Payer Industry VC and Angel 29

30 3 nd Annual Digital Medicine Conference Thurs, Dec 4-6 th 3 0 New Digital York Medicine Conference City Innovation, Evidence and Transformation 30

31 Digital Prescription Platform to Support Scalable Transformation by CIOs INNOVATION EVIDENCE EHR for fee for service care Digital Prescription Platform for Value based care Transformation 31

32 The Digital Daisy to Unify Fragmented Digital Medicine Digital Gateway Innovation Digital Experience Telemedicine Data Analytics mhealth Courtesy Bruce Darrow and Digital Medicine Team, Mount Sinai, NY 32

33 Creation of First Digital Prescription Platform to Prescribe Digital Assets, Right Within EHR 33

34 Digital Toolkits Deliver Value Multiple validated use-cases developed and and delivered delivered through through Digital Rx.Health s Medicine Platform platform Heart Failure Heart Failure Readmission Readmission Reduction Reduction Quality improvement trial trial monitoring monitoring CHF patients CHF patients 30 days 30 post days discharge. post discharge. Patients Patients prescribed prescribed app + app devices + devices Chronic Disease Management NIH NIH sponsored, 2-year pragmatic randomized randomized trial trial collecting collecting electronic electronic patient patient reported reported outcomes outcomes in IBD in Patients IBD Patients Provider Acceptance Within 8 weeks, more than 2000 digital app app prescriptions by providers 40% 73% 3x 75% 96% 92% Readmission Rate reduction Active Patients Quality of Life Improvement Active Patients After 2 Years System System Usability Usability Score Score Activated Patients 34

35 Digital Prescription Platform: Increased Patient Activation to 92% Patient activation: 92% patient engagement during in-person prescription Provider Validation: 96 th percentile rank in System Usability Scale for provider Usability and 90% ile for Learnability Makhni S et al. AMIA Annual Symposium 2017, 9 Nov

36 Validated Use-Case- Apps (MIPS) Long Term Patient Engagement and QI In a pragmatic randomized trial at Mount Sinai Medical Center (MSMC), patients using Health- PROMISE could update their e-pro information and receive a disease summary. Atreja A, et al. Impact of the Mobile HealthPROMISE Platform on the Quality of Care and Quality of Life in Patients With Inflammatory Bowel Disease: JMIR Res Protoc 2015;4(1):e23 36

37 Validated Use-Case- wearables Transitions of Care and Readmission Reduction Through the use of the mobile application, HeartHealth, healthcare providers are able to remotely monitor their patients blood pressure and weight in the 30 day high risk period post discharge. 37 Pinney S, et al. Use of Electronic Patient Reported Outcomes and Automated Devices for Heart Failure Disease Management iproc 2017;3(1):e24 and ACC 2018 (to be presented)

38 Fast Tracking Assessment of SDH using SDH Prescription Paper based nurse assessment not scalable Using Structured and Unstructured Data in EHR Prescribing SDH Assessment directly to patients and caregivers Smartphones Actionable data directly from patients or caregivers Cellphone numbers accuracy ios, Android Empty fields- hold value 38

39 Integration with EHRs and Care Management Systems Allowed Bulk Prescribing for Pop Health and Replicate Success Stories with other Health Systems Traditional ADT, HL7 Data Warehouse Stored Procedures EHR Reports Reporting Workbench API FHIR 1990s 2000s 2005s Ubiquitous But Inefficient Automate data export through stored procedures Capability and access vary by individual site One click upload of reports through Secure FTP Low technical skills required Most advanced and efficient Not widely available yet 39

40 CASE STUDY SBH Health: Bulk Prescription of C Plans For Curated Digital DSRIP Asthma Pop Health Integrated Clinical Initia Solutions Digital Toolkits Care Pathways Workflow 14% 2.6% 100% Engagement Rate In 12 Hours Opt-out rate ACT Completion Rate Within 12 hours of the initial message being sent, 14% of patients replied with more replying over the next 48 hours Only 2.6% of patients opted out of the Asthma Care Plan, showing that digital engagement can be high when done in the right way Every patient that started the ACT survey, completed the ACT survey showing that a 5 question survey isn t burdensome for patients 40

41 Yale Experience: Enterprise wide PHR Onboarding with bulk prescription A recurring report of patients offered activation code but who had not yet registered was uploaded to RxUniverse Patient List Digital Rx Sent Clicked in 24 hrs Clicked in 7 days Provided by Yale New Haven 1488 (6.33%) not cellphones Within 24 hours, 2170 (9.86%) Clicked 10.81% Clicked by end of 7 days 41

42 Real Time Clinical Trial Recruitment and Engagement 42

43 ROI by decreasing no-shows and better prerehab through digital care plans for Procedures and Surgeries Colonoscopy and Surgeries: Major source of revenue leaks Percentage of patients with missed or delayed appointment (~6%, 15%) Percentage of patients with poor preparation (15-25%) Percentage of patients with ER after procedures (2-8%) Patients not coming back at recommended intervals (30-70%) 20% 58% 92% Good to Excellent Bowel Prep Reduction in inadequate prep Useful or very Useful 43

44 Stitch Different Assets in Digital Toolkit Together and deliver them on demand throughout patient journey 44

45 In Summary: Digital Medicine is new Health IT There is an urgent need for CIOs to support Digital Transformation By unifying different solutions under one EHR connected platform, one can solve the problem of plenty and fragmentation created by point and click solutions Strategic deployment of platforms can yield exponential ROI for pop health as well as fee for service care, while enhance patient experience and outcomes Through sharing and learning networks, health systems can fast track their transformation journey 45

46 Questions 46