Using Digital Health Innovation to Improve Clinician Productivity and Quality Care

Martin Coyne, MD, MS CMO Hiteks
Gerry Petratos, MD, CEO Hiteks

How are Clinicians like doctors, nurses, pharmacists, and others directly involved in patient care doing?  From many reports, neither Clinicians nor their supporting administrative staff have fared well in the past decade—but don’t blame the Electronic Health Record (EHR) or downward wage pressure.

When you evaluate different segments of Clinicians, the ones who practice in a technologically rich environment for workflow simplification, compared to those lacking productivity tools, treat their patients more effectively with less frustration. Clinicians who have access through fewer steps to timely educational information and treatment reminders in context to their patient can provide better evidence-based medicine (EBM).  EBM such as new guidelines from medical societies, applied efficiently during care, translate to improved provider utilization of the EHR, clinical decision-making, and patient engagement.

The question of how to best apply technology to reach high-productivity amongst Clinicians makes the difference.  Most medical practices and hospital systems in the United States are mandated to use the EHR along with additional decision support capability, with other countries following suit.  While the EHR provides the digital foundation and framework into which workflow-based information services can be integrated and delivered to the Clinician, early experiences using the EHR have been dismal.   Clinician resistance is attributed to the lack of intuitive screens requiring many steps to accomplish what was previously done with the swipe of a pen and paper.

 

1st Stage of the Digital Health Revolution

 

The first stage of the digital revolution in US healthcare, which comprises 16% of the economy, was defined by the universal implementation of the EHR.  This digital tool was viewed by Clinicians as impeding their workflow and by patients as interfering with the physician-patient interaction.  In addition, addressing quality of care metrics and increased medical costs has been limited even with continued medical science advancement of disease treatments.

Heart disease is a good window into the future of global healthcare. According to the CDC, heart disease is responsible for 1 in 4 deaths in the US every year.  6 million Americans have heart failure, with a projected rise to 46% by 2030, driven by obesity and increasing diabetes.  Heart failure is the consequence of arteriosclerotic heart disease.

In the last 30 years, the use of statin inhibitors has markedly reduced heart disease. Despite this intervention, heart disease is still the leading cost driver for US healthcare.  The reason is that heart disease is now understood to be multi-factorial.  Not only elevated LDL but elevated PCSK9, high TMAO, interleukins, and myocardial enzymatic abnormalities are causative.  Specific treatments for each of these conditions are now becoming available to physicians and patients.  Costs for these new treatments/year range from $15,000 for PCSK9 inhibitors to $250,000 for Tafamidis for cardiomyopathy.

In advanced heart failure, similar advanced and costly treatment options are now offered.  These range from Sacubitril, a drug that improves cardio perfusion, to digital monitors of physical signs of heart failure like oxygen and blood pressure monitoring to miniaturized implantable pumps.  The key prerequisite for the decision to advance to these next steps is strict implementation of American Heart Association recommendations for generic heart failure medications.  This last step requires traditional close attention to patient symptoms, reviewing standard lab values and monitoring drug compliance.

Heart disease is emblematic of the opportunity and challenge for US healthcare.  The opportunity is that medical science is rapidly providing insight into the disease and building more powerful treatment options.  The challenge is failing to apply or inappropriately applying these advances at the point of care, leading to patient dissatisfaction, increased morbidity and enormous cost overruns.

 

2nd Stage of the Digital Health Revolution

 

The second stage of the digital revolution will enable healthcare providers to meet this challenge and fulfill their professional obligations to their patients.  This stage leverages the information available in the EHR by presenting it to the clinician in a timely and user-friendly format.  The promise of decision support to enhance patient-specific advice in fewer steps, clicks, and screens required to perform the job is now possible through software technology like natural language processing and artificial intelligence.

Technological advances using advanced clinical analytics and cloud computing over the past couple of years have now enabled constant monitoring of patient data to bubble up to Clinicians attention as the most pressing cases requiring action.  These innovations can monitor 15-20 data points in the EHR, necessary for modern management of complex conditions such as Sepsis monitoring, as well as Heart Failure, and then present it seamlessly to the physician for evidence-based treatment intervention. This workflow prioritization using the computer to identify the EBM options as next steps in Clinician management optimizes productivity.

The systematic approach of integrating decision support into the EHR workflows focuses Clinicians’ attention on improving population management of disease areas such as Sepsis, Heart Failure, Oncology Biomarker Testing, Back Pain, and others. The response to the initial Clinician backlash against the EHR is not to stop using the EHR, rather to enhance the EHR’s presentation of meaningful patient-specific information to speed decision-making.

The second stage of the digital revolution using advanced software technology to extract and interpret data in the EHR will bring the healthcare industry into the 21st century.  In the 20th century, physician productivity was described in a simplistic fashion, using outdated concepts of a worker producing widgets.  In this idiom, productivity tools helped a worker produce more widgets/hour, i.e., see more patients/hour.   But healthcare globally requires a more modern concept of provider productivity.  In this concept, productivity is defined as a tool that enables a physician to gather, review, interpret dynamic, multiple data points in a timely way and apply this to implementation of evidence-based, cost-effective treatment protocols.

This is what the patient wants.  This is what the physician wants and must do.  This is what society requires.  This is what digital productivity software tools like Hiteks provide in the context of individual patient encounters to enhance the EHR workflow experience.

 


Dr. Martin Coyne
A long experience as a clinical gastroenterologist combined with many years as CEO of large medical groups gave Dr. Coyne the perspective that the physician in real-time at the point of care is central to the multi-trillion dollar healthcare industry. It is this perspective that has informed the development of the Hiteks product portfolio. Experienced Medical Group Administrator (100+ physicians, $100+ million budget) Extensive Clinical Research Experience Published more than 40 Scientific Articles M.D., Boston University M.S. in Medical Informatics from Northwestern B.A. in History from Brandeis.

Dr. Gerasimos Petratos
Gerry Petratos, MD, MS, is CEO of Hiteks Solutions and began his career as an NIH-trained Medical Informatics physician with experience in EHR-integrated decision support systems from Intermountain and the University of Utah.  Dr. Petratos has 9 years of experience as the former Global Head of Healthcare Data Analytics at Roche and Genentech.

 


 

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Point of Care Decision Support

Ronald M. Razmi, MD, CEO, Kinders
Gerry Petratos, MD, CEO, Hiteks

POINT OF CARE DECISION SUPPORT

For years, Big Pharma has marketed its drugs to healthcare providers using a tried-and-true model: running clinical trials, publishing the results in journals, and presenting them at conferences. To drive awareness, brands leverage the evidence in marketing campaigns and physician detailing. Ubiquitous as it’s become, however, this approach has shown mixed effectiveness in commercializing drugs. Its overall return-on-investment is inconsistent, and its effectiveness in new product launches is declining. In many cases, brands underperform because physicians continue to use older and cheaper alternatives, even when a brand offers significant advantages in certain patient populations.

In other cases, several drugs are indicated to treat a single illness, and physicians do not remember the nuances of each alternative at the point of care. Increasingly important are the workflow distractions of the practicing physician; most of their time is now spent in the digital environment reviewing or entering patient data.

Ubiquitous as it’s become, however, this approach has shown mixed effectiveness in commercializing drugs. Its overall return-on-investment is inconsistent, and its effectiveness in new product launches is declining. In many cases, brands underperform because physicians continue to use older and cheaper alternatives, even when a brand offers significant advantages in certain patient populations.

CLINICAL DECISION SUPPORT: THE OPPORTUNITY

So, how do you overcome this issue? By spending even more on physician education to cover every possible clinical scenario and which treatment to use in it? Perhaps. Improving physician education is always a worthy goal. But brands reach a point of diminishing returns when it comes to information retention: physicians simply won’t remember each detail, in each scenario, at the point of care. eDetailing, in which interactive digital content is made available for clinicians to review on their own time, has drawn a positive response, but information about ROI is still limited. Some of the developments of the last decade offer a new path forward. In recent years, the adoption of Electronic Health Records (EHR) has significantly increased. The newest EHRs have improved functionalities, making relevant clinical information like radiology, pathology, and labs more easily available within the system. Given that clinical workflows are already increasingly digital, there is a natural opportunity to educate physicians about possible treatment options at the point of care, rather than before or after it.

CHALLENGES WITH POC SUPPORT TOOLS

What, then, is keeping point-of-care education and decision support from being widely used today? The answer is that although many things are possible in theory within EHRs, the reality is a long way from this theory. One of the key barriers is the difficulty of interfacing with EHRs. There are many reasons for this. EHR companies create obstacles to prevent access to their proprietary databases. Medical centers, meanwhile, have a high number of competing projects. Finally, nearly 80% of the data in EHRs is unstructured, meaning it must either be ignored or—often manually—converted before it’s accessible and available for analysis.

These barriers would give pause to any Life Sciences company. Indeed, they are some of the
primary reasons that the ROI for such projects to date has been unfavorable.

However, they are not insurmountable, as we discovered when we began to devise a business process and technology solution that could anticipate and overcome them. In fact, our experience building Kinders and Hiteks—two companies that leverage new technologies and enhance healthcare business models—suggests that with the right tools, Life Science companies can build point-of-care solutions that are highly effective marketing vehicles.

EVALUATING POINT OF CARE SUPPORT TOOLS

Here’s what companies should look for as they evaluate potential partners and systems:

– EHR integration: It’s no secret that the EHR landscape is complex and cluttered. But your installation costs will skyrocket if your point-of-care solution doesn’t easily integrate with the EHRs that are being used at the majority of medical centers. For Hiteks, we first built software that would integrate easily into of most major commercially available EHRs, especially Epic. Then, we fully integrated this into the Epic main engine to become an application for their customers. Because Epic has the largest base of users, this allows us to achieve the wide-scale adoption of new decision support solutions without additional local installation—and create a turnkey solution on the technical side.

– Effective methodology: False positives and irrelevant suggestions are a big problem in POC support. To minimize override rates, make sure your decision support solutions providers can work with you to create decision support that results in highly relevant advice. Our approach includes studying the clinical guidelines and drug labels for the brand, understanding current clinical decision making around the specific illness, mapping current workflows within the EHRs and listing the data used by clinicians to arrive at a management plan, clearly defining the pivotal points in decision process, and building logic to generate reminders at the right time.

– ROI measurement tools: You won’t be able to improve your POC support tools—or make the case for extending them to other brands—unless you keep rigorous track of your results. By combining software that’s fully integrated into the EHR and a robust clinical logic creation methodology, our software can launch point of care decision support reminders quickly and consistently. We then closely monitor engagement with our reminders, using EHR logs to track clinicians’ acceptance of the advice—and any resulting behavioral changes.

CASE STUDY: PUTTING POC TOOLS TO THE TEST

Our experience shows that point-of-care support solutions can be highly effective. One pharma brand we worked with had a novel treatment in sepsis. Yet while clinical evidence showed significant advantages for their treatment in certain patients—reducing progression from Sepsis and Severe Sepsis to Septic Shock by 25% and shortening the length of stay by half a day—72% of physicians continued to rely on commonly used antibiotics that have been the mainstay of sepsis treatment for decades.

After careful study of the clinical workflows and clinician decision-making process, we identified all of the key data elements that clinicians use in choosing a sepsis therapy. We then mapped where each one of these data elements resides in the EHR. Using the most up-to-date clinical guidelines and the drug label, we created the logic to generate a reminder in the EHR for the clinicians at the appropriate moment during the management process. This guidelines-based reminder showed the novel therapy as one of the options. It also summarized the reason physicians might select it and the potential associated benefits. Within 3 months, this solution led to 12% increase in the usage of the therapy as the first line of treatment.

Summary: Digital workflows now allow for the ongoing support of clinicians at the point of
care, using a combination of well-designed technical solutions and clinical logic that’s based
on patient data and the application of guidelines and drug labels.


Dr. Ronald Razmi

Ronald M. Razmi, MD, MBA began his career as a Cardiologist and as a McKinsey consultant worked with the world’s top life sciences companies in strategy, digital health, and product roadmap. He was CEO of Acupera, a digital health company focused on using analytics and digital workflows in improving chronic care management. He advises healthcare companies in a range of areas including commercial strategy, digital health, and Artificial Intelligence.

 

 

Dr. Gerasimos Petratos

Gerry Petratos, MD, MS, is CEO of Hiteks Solutions and began his career as an NIH-trained Medical Informatics physician with experience in EHR-integrated decision support systems from Intermountain and the University of Utah.  Dr. Petratos has 9 years of experience as the former Global Head of Healthcare Data Analytics at Roche and Genentech.

 


 

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Hiteks Supports Local NYC Artists to Strengthen Pediatrics Focus

Hiteks is proud to support the directors of a NYC-produced documentary film called The Candidates, which was shown in November at the DOCNYC film festival and at last week’s Big Sky Film Festival in Montana:

 

This high school in Queens serves as an example of how youth activities, including political ones, can be presented in an educational way and create engagement and knowledge generation amongst students. The film has already received distinction by entertaining offers from studios that will soon make the film available to audiences via streaming. If you are interested in screening this film at a local high school please let us know so that we can connect you with the directors.

The need for pediatrics-based education and focus is also paramount to health care, where knowledge can be shared of how to properly identify and manage children’s illnesses such as cancer, lung disease, infections, and many others. For instance, when these illnesses worsen they become the primary drivers of patients suffering from Sepsis and Status Asthmaticus and deterioration of outcomes seen when patients enter the hospital.

By sponsoring the directors of The Candidates, Hiteks is both fostering community awareness of political issues, as well as the co-morbid conditions which need to be captured for CDI (Clinical Documentation Improvement) and CDS (Clinical Decision Support) to improve care.  Hiteks’ approach of optimizing the EHR for clinical decision-making can be best seen through our Pediatrics CDIVigilantQA Sepsis Surveillance and CarePaths For Heart Failure programs. We are able to reduce false positive Epic BPA alerts for Sepsis and optimize advice for CDI from evidence-based guidelines through our engineering which accommodates patient age and demographics, along with client-specific logic.

We will be using the funds from our investment in this film for the continued research and development of pediatrics programs in CDI and CDS for sepsis surveillance programs.  If you are interested in how your local hospital or health system can better monitor for these conditions to improve CDI, patient safety and outcomes, please contact us.

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