© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Frank WangWW Lead, Healthcare and Life Sciences HP Printing and Personal Systems
Digitized Healthcare
From Big Paper to Big Data
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.2
The Opportunity to Transform HealthcareE
cosy
stem
inte
grat
ion
Quality of care and outcomes
Today’shealthcare
Collaborativehealthcare
Transformativehealthcare
Low High
Low
Hig
h
Integratedhealthcare
• Culture of best-practices• Stand-alone IT• Best of breed• Fragmented systems
• Integrated EMR, EHR, PMS, CPOE
• Real-time alerts • HIE/improved
access to data
• Tight linkage between physicians & hospitals in different provinces
• Care collaboration• Regional, state and
national RHIOS, NHIN• Patient access to data
• Population Healthcare Management
• Personalized/evidence-based clinical decision support
• Patient engagement
Different providers will be at different stages
Data silos, many papers,
miscoding, comorbidity
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.3
Impact to Costs/Security/Control/Quality of Care • Data/information outside the clinical system
• Caregivers still overwhelmed by paper
• Exposure to protected health information (PHI) violations
• Patient discharge information confusing
Coordinating Care Outside the Four Walls – EMR is Not Enough!
Pharmacy
Clinical Care
Radiology
Legal
Health Information Management
Physician Offices
Home Care / Hospice
Reference LabAudits
Human Resources
Patient Accounting
Billing / Payables
Patient Registration
Patient Discharge
• Faxing
• Paper forms
• Handwritten
• External documents
• Legacy records
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.4
… 90% data is untapped for KPIs and analytics
• Needle Stick Injury Rate
• Reintubation Rate
• Ventilator Associated Pneumonia (VAP)
• Blood Stream Infection Due to Central Line
• Urinary Catheter Related Infection
• Overall Employee Satisfaction
• Patient Satisfaction
• Standardized mortality rate (SMR)
• Iatrogenic Pneumothorax
• Decubitus ulcer
• Length of Stay
• ICU readmission rate
• Patients' Fall Rate
• Medication error
• Adverse Events/Error Rate
Key Performance Indicators (KPIs)
Transaction Records Qualitative Human Data Quantitative Machine Data
Admission notes
Discharge summaries
Progress notes
Imaging study results
Consultant reports
Financial
& Operational
Transactions
Medication records Laboratory resultsPhysiologic testingBiometric sensorsRFID tags
Partial Intelligence
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.5
Electronic Medical Records Need More To Deliver the True Benefits to Patients“Untamed Technologies Enhance EMR and Related Clinical Systems”
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.6
Search & Retrieve documents
Manage Clinical and Revenue Cycle Processes
Structured and Unstructured “Big Data” Analytics
Automatically generate output (Discharge Notes)
Create Personalized Patient Engagement Plan
Manage Document Retention Requirements
Capture “Big Paper” documents
with your MFP’s
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.7
Autonomy ECM Suite At a Glance
Windows – Outlook– Web – Tablet – Mobile – Cloud - MFP
Uncover connections and
insights
Faster processesMore accurate
More responsive
Improve operations,
Reduce costs
Enhance patient satisfaction
Reduce storage costsEnhance compliance
IDOL - Content Integration/Enterprise Search
Admissions documents
Test results
EHRBillingAP / AR
Call Centers
Patient Surveys
Grant Mgmt.
Human Resources
HP Process Automation
- Workflow & BAM
- E-Forms
- Digitized paper forms
Capture &Digitize
Automate Processes
Document &
Email Mgmt.
Enterprise Search
InformationGovernance
HP Intelligent Universal Search
- Search across diverserepositories, formats
- Meaning based analysis
HP WorkSite
- Integrate documents and e mails
- Secure Collaboration
- Mobility - capture
HP Records Manager(TRIM & Control Point)
- Policy based governance
- Records Management:
- Retention & Disposition
HP Teleform
- Digitize content
- Identify forms/docs
- OCR
- Extract data
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.8
Let your MFP captures Big PaperSimplify your workflows
New Customer Application Find a Form
Add to Customer Application Find a Brochure
Submit Employment ApplicationExpense Re-imbursement
Scan a new customer application form
Add a scan to an existing customer file
Find and print a form
Scan and submit expense re-imbursements
Find and print a brochure
Scan a new employment application
Logged in: Kelly Thompson
Admit new patient Find a form
Scan and e mail
Find a brochure
Add to patient file
Expense reimbursement
Add a scan to an existing patient file
Scan admissions documents
Scan to patient file and e mail
Find and print patient education notes
Patient Management- New Patient Admissions- Patient Survey- Clinical Procedure workflows- Patient discharge workflows- Patient discharge instructions
Information Management- Patient Forms- Unified Patient File- Physician Notes- Clinical Narrative- Disease and Wellness Care Collateral
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.9
Serviceability Improvements• Integrated IT support.• Network Management, and
proactive alerting.• High Capacity Cartridges.• Field Service and support. • Ease of Hot-Swap device support.• Centralized configurations.Consolidated Footprint
• Single device replaces fax, label printer, and wristband printer.
• Also provides copy, print, and scan.• Multiple Paper Tray support.• Decreased desktop real-estate
requirement.
Improved Patient Experience• Color Photo Printing Support.• Addition of color Precautionary
codes.• Simplified admission processing.
HP Officejet Pro X – Healthcare Focus
Lower Cost of Ownership• Lower Acquisition cost than
multiple thermal devices.• Lower cost of wristband/label
printing.• Lower Annual Service Cost.• Simplified Help desk
troubleshooting.
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.10
Let your Healthcare Analytics search the “Big Data”Translate data into clinical insights
HP IDOL +
Patient Communications
ClinicalNarratives
TransactionalData
IT/OT WebSchedules
400+ Connectors
EMR Lab Pharmacy ADT Payer RIS/PACS Billing Documents
Knowledge Discovery
HAI DetectionCompliance Reporting
Predictive Analytics
Best Practices +Best Experiences
HypothesisGeneration
Search
Medical Guidelines
ProviderCollaborations
Industry Literature
Healthcare Taxonomies
Medical Codings
Clinical Classifiers
Healthcare Visualizations
Medical Workflow UI
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.11
Structured and unstructured information
<ICD9><Code>413.9</Code><Descr>NOS angina pectoris</Descr>
</ICD9>
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.12
The nuances of clinical documentation – Institutional Memory
• Context• Heart attack mentioned in History of Present Illness • Heart attack mentioned in Family History
• Meaning (in ED triage notes)• DOB to indicate Date of Birth• DOB to indicate Difficulty of Breathing
• Negation • The patient denied shortness of breath or chest pain
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.13
Approaches to unstructured information
Text processing
technologies: keyword, NLP, probabilistic
Taxonomies, ontologies, lexicons: SNOMED,
UMLS, ICD9/10, RxNorm, LOINC
Clinical documentation: encounter / admission /
progress / procedure notes, discharge
summaries, test results
Formal published medical knowledge: literature (PubMed), protocols, guidelines
Unconventional sources: Social
media, call center transcripts
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.14
Healthcare Analytics Use Cases
Clinical chart review is necessary for:
• Compliance Reporting: Clinical Quality Measures (CQM’s) , Core Measures Quarterly, PQRS, eRx reporting, Hospital Inpatient Quality Reporting Program, CHIPRA, (Children’s Health Insurance Program Reauthorization Act), ACO Programs
• Public Health Data: Syndromic surveillance, CDC, cancer registries, immunization reports, adverse drug events
• Research: Cohort identification, recruitment of eligible subjects
Manual chart review is labor intensive, time consuming, and has human variation
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.15
Application scope and adoption factors
Clinical Research and Population Health
Compliance Reporting and Public Health
Operational
• Adverse medical event reporting
• Syndromic surveillance
• Hospital inpatient quality
• Clinical Quality Measures (CQM)
• Cancer registry, immunization reports)
• Risk Adjustment
• Fraud, Waste, & Abuse
• Medical coding review
• Auditing
• Cohort identification
• Personalized medicine
• Clinical decision support
• Disease management
• Clinical trial subject recruitment
Adoption considerations
"Evidence" for change in clinical practice
Demonstrable ROI
Workflow modifications WRT target adopter
Availability of input data
Sponsor/champion for change
Legislative drivers
Privacy issues/worries
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.16
Application – Understanding hospital acquired conditions
HAC’s include adverse drug events, hospital acquired infections, procedural complications and incidents related to falls
• The incidences per 1,000 visits are:
• 65 incidents due to adverse drug events
• 60 events due to hospital acquired infections
• 51 events due to procedural complications
• 15 incidents related to falls
HAI’s result in extra costs of $5-10M /year for average hospital
ADE’s cost the average hospital about $5.6M/year
ADE’s increase LOS by 4.6 days and increases costs by at least $5K/incident
Consolidated in Patient Safety Primer and Fact Sheet, 10/2/2006, HIMSS Patient Safety and Quality Committee
Tinoco A, Evans R, et al. J Am Med Inform Assoc 2011;18:491-497
"Computerized surveillance systems that can access both coded and free text data such as that found in unstructured narratives
may improve surveillance without requiring the time and cost associated with manual chart review, alone.“
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.17
Application – Looking for depression1 in 10 adults met criteria for current depression, 4.1% met the criteria for major depression 1
Median delay from onset of depression to the beginning of treatment was estimated to be eight years 2
Treatment prevalence rates of comorbid depression for some chronic conditions is significantly lower than the expected comorbidity rates (e.g., 16% treated vs. 45% expected) 3
Comorbid depression increases medical services costs by average of $505/member/mo. and has significantly elevated odds ratios with poorer self care (e.g., high fat intake > 6x/wk, smoking, exercise < 1x/wk) 3
1: MMWR 2010;59(38);1229-1235
2: Melek, S. Halford, M. Measuring the Cost of Undiagnosed Depression. Contingencies. Jul/Aug 2012. Pps. 64-703: Melek, S. Norris, D. Chronic conditions and comorbid physchological disorders. Milliman Research. 2008
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.18
Wide range of healthcare use cases including ...
Reconciliation
ID discrepancies between
diagnostic code and clinical notes
Monitor KPIs and Metrics
Reporting
Abstraction
Rapid Chart Access
Ultimate flexibility to scale
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.19
HP Healthcare Analytics platform unlocks full data valueBuilt for unstructured and structured clinical data
Core Capabilities:
• Integrated modular platform for variety of use cases
• 400+ data connectors and 150+ data types
• Rapid identification of concepts, patterns and relationships
• Conceptual search on all data
• Advanced security for compliance
Healthcare specific capabilities:
• SNOMED CT taxonomy with 344K+ concepts and 2M terms
• Integrated ICD codes
• Intuitive workflow UI and visualization for healthcare applications
Intelligent search and actionable Insights powered by HP IDOL (Intelligent Data Operating Layer)
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.20 Copyright © 2013 HP Autonomy. All rights reserved. Other trademarks are registered trademarks and the properties of their respective owners.
Information transformed to enable success
• Improve reimbursements and quality of KPIs with comprehensive and contextually relevant insights
• Reduce costly and error prone manual overhead with intelligent search and automation
• Lower financial, operational and compliance risks with effective reconciliation to proactively uncover errors