Predictive Analytics: 'A Means to Harnessing the Power to Drive Healthcare Value
Wolf H. Stapelfeldt, MD Chairman, Department of General Anesthesiology Cleveland Clinic Vice Chairman, Surgical Operations, Medical Operations Division Vice Chairman, Information Systems & Technologies, Anesthesiology Institute Faculty, Samson Global Leadership Academy for Healthcare Executives
Learning Objectives Review the key elements of Clinical and Business Intelligence (C&BI) Recognize the rationale for enlisting C&BI as part of organizational strategy Appreciate an example of the value of C&BI in affecting meaningful clinical and business outcomes
Quality Value = Cost
Quality Value = Cost via the services that are being provided
Quality Value = Cost via the services that are being provided and by leveraging technology
Quality Value = Cost via the services that are being provided and by leveraging technology
Quality Value = Cost via the services that are being provided and by leveraging technology (Clinical & Business Intelligence)
Meaningful Outcomes In Hospital Mortality Length of Stay (LOS) Hospital Charges Re admission Rate 30 Day Mortality
Clinical Challenge (Patients, Populations)
Actions/Interventions Clinical Challenge (Patients, Populations)
Clinical & Business Processes Actions/Interventions Clinical Challenge (Patients, Populations)
Outcomes Results Data Clinical & Business Processes Actions/Interventions Clinical Challenge (Patients, Populations)
Outcomes Results Data Learning/Understanding Clinical & Business Processes Actions/Interventions Information Clinical Challenge (Patients, Populations)
Outcomes Results Data Learning/Understanding Clinical & Business Processes Actions/Interventions Information Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations)
Outcomes Results Data Learning/Understanding Clinical & Business Processes Actions/Interventions Information Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations)
Outcomes Results Data Learning/Understanding Clinical & Business Processes Actions/Interventions C&BI Information Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations)
Outcomes Results Data Learning/Understanding Clinical & Business Processes Actions/Interventions C&BI Information Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations)
Outcomes Results Data Learning/Understanding Clinical & Business Processes Actions/Interventions C&BI Information Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations)
Outcomes Results Data Learning/Understanding Clinical & Business Processes Actions/Interventions C&BI Information Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations)
Outcomes Results Data Learning/Understanding Clinical & Business Processes Actions/Interventions C&BI Information Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations)
Outcomes Device Integration Results Data ETL Processes Learning/Understanding Clinical & Business Processes Actions/Interventions C&BI Information Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations)
Outcomes Device Integration Results Data ETL Processes Learning/Understanding Clinical & Business Processes Actions/Interventions C&BI Information Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations)
Outcomes Learning/Understanding Device Integration Results Data ETL Processes Clinical & Business Processes C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations)
Outcomes Learning/Understanding Device Integration Results Data ETL Processes Clinical & Business Processes C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations)
Outcomes Learning/Understanding Device Integration Results Data ETL Processes Clinical & Business Processes C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations) Real-Time Processing
Outcomes Learning/Understanding Device Integration Results Data ETL Processes Clinical & Business Processes C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations) Real-Time Processing
Outcomes Learning/Understanding Device Integration Results Data ETL Processes Clinical & Business Processes C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations) Decision Support Toolbox (CPOE, Alerts, etc.) Real-Time Processing
Outcomes Learning/Understanding Device Integration Results Data ETL Processes Clinical & Business Processes C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations) Decision Support Toolbox (CPOE, Alerts, etc.) Real-Time Processing
Outcomes Results Learning/Understanding Device Integration ETL Processes Clinical & Business Processes Data C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations) Decision Support Toolbox (CPOE, Alerts, etc.) Real-Time Processing
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Learning/Understanding Device Integration ETL Processes Clinical & Business Processes Data C&BI Analytics Information Actions/Interventions Decision Support Toolbox (CPOE, Alerts, etc.) Knowledge/Experience Actionable Information (Decision Support) Clinical Challenge (Patients, Populations) Real-Time Processing
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Learning/Understanding Device Integration ETL Processes Clinical & Business Processes Data C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Intraoperative Hemodynamics Decision Support Toolbox (CPOE, Alerts, etc.) Real-Time Processing
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Learning/Understanding Device Integration ETL Processes Clinical & Business Processes Data C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Intraoperative Hemodynamics Decision Support Toolbox (CPOE, Alerts, etc.) Real-Time Processing
1. Current Status of Perioperative Care
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record Problems 1. Difficult to read (often not legible) 2. Not updated in real time 3. Not accessible electronically
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record Problems 1. Difficult to read (often not legible) 2. Not updated in real time 3. Not accessible electronically
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record Problems 1. Difficult to read (often not legible) 2. Not updated in real time 3. Not accessible electronically
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record Problems 1. Difficult to read (often not legible) 2. Not updated in real time 3. Not accessible electronically
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record Problems 1. Difficult to read (often not legible) 2. Not updated in real time 3. Not accessible electronically
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record Problems 1. Difficult to read (often not legible) 2. Not updated in real time 3. Not accessible electronically
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record b. Automatically-generated Record
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record b. Automatically-generated Record
1. Current Status of Perioperative Care a. Handwritten Anesthesia Record b. Automatically-generated Record ARKS
ARKS
1. Current Status of Perioperative Care ARKS Advantages 1. Legible 2. Accurate 3. Queryable
1. Current Status of Perioperative Care What constitutes hypotension severe enough to worry about? ARKS
1. Current Status of Perioperative Care What constitutes hypotension severe enough to worry about? ARKS
1. Current Status of Perioperative Care What constitutes hypotension severe enough to worry about? ARKS
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Learning/Understanding Device Integration ETL Processes Clinical & Business Processes Data C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Intraoperative Hemodynamics Decision Support Toolbox (CPOE, Alerts, etc.) Real-Time Processing
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Learning/Understanding Device Integration ETL Processes Clinical & Business Processes Data C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Intraoperative Hemodynamics Decision Support Toolbox (CPOE, Alerts, etc.) Real-Time Processing
Hypotension
Hypotension MAP < 70? < 60? < 50? < some other discrete value (such as 20% below baseline)? < 60!
Hypotension MAP < 70? < 60? < 50? < some other discrete value (such as 20% below baseline)? < 60!
Hypotension MAP < 70? < 60? < 50? < some other discrete value (such as 20% below baseline)? < 60!
Hypotension MAP < 70? < 60? < 50? < some other discrete value (such as 20% below baseline)? < 60!
Hypotension MAP < 70? < 60? < 50? < some other discrete value (such as 20% below baseline)?
When does hypotension become significant?
When does hypotension become significant? after 2 minutes? 5 minutes? 15 minutes?
When does hypotension become significant? after 2 minutes? 5 minutes? 15 minutes?
When does hypotension become significant? after 2 minutes? 5 minutes? 15 minutes?
MAP
MAP
MAP
MAP
MAP
MAP
MAP
Hypotensive Case 1 Case 2 Threshold [cum min] [cum min] MAP 55 10 0 74 20 160 73 20 160 72 20 155 71 20 155 70 20 155 69 20 155 68 20 155 67 20 155 66 15 155 65 15 150 64 15 150 63 15 150 62 10 145 61 10 145 60 10 145 59 10 125 58 10 95 57 10 60 56 10 0 55 10 0 54 5 0 53 0 0 52 0 0 51 0 0 50 0 0 49 0 0 48 0 0 47 0 0 46 0 0 45 0 0
Hypotensive Case 1 Case 2 Threshold [cum min] [cum min] MAP 55 10 0 74 20 160 73 20 160 72 20 155 71 20 155 70 20 155 69 20 155 68 20 155 67 20 155 66 15 155 65 15 150 64 15 150 63 15 150 62 10 145 61 10 145 60 10 145 59 10 125 58 10 95 57 10 60 56 10 0 55 10 0 54 5 0 53 0 0 52 0 0 51 0 0 50 0 0 49 0 0 48 0 0 47 0 0 46 0 0 45 0 0
Hypotensive Case 1 Case 2 Threshold [cum min] [cum min] MAP 55 10 0 60 10 145 73 20 160 72 20 155 71 20 155 70 20 155 69 20 155 68 20 155 67 20 155 66 15 155 65 15 150 64 15 150 63 15 150 62 10 145 61 10 145 60 10 145 59 10 125 58 10 95 57 10 60 56 10 0 55 10 0 54 5 0 53 0 0 52 0 0 51 0 0 50 0 0 49 0 0 48 0 0 47 0 0 46 0 0 45 0 0
Hypotensive Case 1 Case 2 Threshold [cum min] [cum min] MAP 55 10 0 60 10 145 73 20 160 72 20 155 71 20 155 70 20 155 69 20 155 68 20 155 67 20 155 66 15 155 65 15 150 64 15 150 63 15 150 62 10 145 61 10 145 60 10 145 59 10 125 58 10 95 57 10 60 56 10 0 55 10 0 54 5 0 53 0 0 52 0 0 51 0 0 50 0 0 49 0 0 48 0 0 47 0 0 46 0 0 45 0 0
Hypotensive Case 1 Case 2 Threshold [cum min] [cum min] MAP 55 10 0 60 10 145 73 20 160 72 20 155 71 20 155 70 20 155 69 20 155 68 20 155 67 20 155 66 15 155 65 15 150 64 15 150 63 15 150 62 10 145 61 10 145 60 10 145 59 10 125 58 10 95 57 10 60 56 10 0 55 10 0 54 5 0 53 0 0 52 0 0 51 0 0 50 0 0 49 0 0 48 0 0 47 0 0 46 0 0 45 0 0
Hypotensive Case 1 Case 2 Threshold [cum min] [cum min] MAP 75 20 160 74 20 160 73 20 160 72 20 155 71 20 155 70 20 155 69 20 155 68 20 155 67 20 155 66 15 155 65 15 150 64 15 150 63 15 150 62 10 145 61 10 145 60 10 145 59 10 125 58 10 95 57 10 60 56 10 0 55 10 0 54 5 0 53 0 0 52 0 0 51 0 0 50 0 0 49 0 0 48 0 0 47 0 0 46 0 0 45 0 0
Incidence, 30-day Mortality and Distribution of Average Cumulative Times Spent Below Various MAPs of Cases with MAPs Dropping Below Hypotensive Thresholds Ranging From 75 To 45 120 Average Cumulative Time Spent 100 80 60 40 20 75 70 65 60 55 at a MAP below 50 45 60 65 70 75 45 50 55 Hypotensive Threshold N=35904 Different hypotensive thresholds are indicative not only of time spent below that threshold but of differences in the time spent at any MAP between 75 and 45
Incidence, 30-day Mortality and Distribution of Average Cumulative Times Spent Below Various MAPs of Cases with MAPs Dropping Below Hypotensive Thresholds Ranging From 75 To 45 120 Average Cumulative Time Spent 100 80 60 40 20 75 70 65 60 55 at a MAP below 50 45 60 65 70 75 45 50 55 Hypotensive Threshold N=35904 Different hypotensive thresholds are indicative not only of time spent below that threshold but of differences in the time spent at any MAP between 75 and 45
Incidence, 30-day Mortality and Distribution of Average Cumulative Times Spent Below Various MAPs of Cases with MAPs Dropping Below Hypotensive Thresholds Ranging From 75 To 45 Average Cumulative Time Spent 120 100 80 60 40 20 75 70 65 60 55 at a MAP below 100% Incidence 50% 0% 50 45 60 65 70 75 45 50 55 Hypotensive Threshold N=35904 Different hypotensive thresholds are indicative not only of time spent below that threshold but of differences in the time spent at any MAP between 75 and 45
Incidence, 30-day Mortality and Distribution of Average Cumulative Times Spent Below Various MAPs of Cases with MAPs Dropping Below Hypotensive Thresholds Ranging From 75 To 45 Average Cumulative Time Spent 120 100 80 60 40 20 75 70 65 60 55 at a MAP below 100% Incidence 50% 0% 50 45 60 65 70 75 45 50 55 Hypotensive Threshold N=35904 Different hypotensive thresholds are indicative not only of time spent below that threshold but of differences in the time spent at any MAP between 75 and 45
Incidence, 30-day Mortality and Distribution of Average Cumulative Times Spent Below Various MAPs of Cases with MAPs Dropping Below Hypotensive Thresholds Ranging From 75 To 45 Average Cumulative Time Spent 120 100 80 60 40 20 75 70 65 60 55 at a MAP below 100% Incidence 50% 0% 50 45 60 65 70 75 45 50 55 6% 5% 4% 3% 2% 1% Hypotensive Threshold 30-day Mortality N=35904 Different hypotensive thresholds are indicative not only of time spent below that threshold but of differences in the time spent at any MAP between 75 and 45
Incidence, 30-day Mortality and Distribution of Average Cumulative Times Spent Below Various MAPs of Cases with MAPs Dropping Below Hypotensive Thresholds Ranging From 75 To 45 Average Cumulative Time Spent 120 100 80 60 40 20 75 70 65 60 55 at a MAP below 100% Incidence 50% 0% 50 45 60 65 70 75 45 50 55 6% 5% 4% 3% 2% 1% Hypotensive Threshold 30-day Mortality N=35904 Different hypotensive thresholds are indicative not only of time spent below that threshold but of differences in the time spent at any MAP between 75 and 45 and in 30-day mortality
Percent Increase in the Odds Ratio for 30 day Mortality Depending Upon the Duration of Hypotension Below Certain MAP Thresholds % Increase In Odds Ratio (30 day Mortality) normotensive (n= 21485, 60%) 50% 40% 30% 20% 10% 75 70 65 60 55 50 45 Spent at an MAP Below 10 2030 40 50 60 Cumulative Minutes
Percent Increase in the Odds Ratio for 30 day Mortality Depending Upon the Duration of Hypotension Below Certain MAP Thresholds % Increase In Odds Ratio (30 day Mortality) normotensive (n= 21485, 60%) 50% 40% 30% 20% 10% 75 70 65 60 55 50 45 Spent at an MAP Below 10 2030 40 50 60 Cumulative Minutes
Percent Increase in the Odds Ratio for 30 day Mortality Depending Upon the Duration of Hypotension Below Certain MAP Thresholds % Increase In Odds Ratio (30 day Mortality) hypertensive (n= 14419, 40%) normotensive (n= 21485, 60%) 50% 40% 30% 20% 10% 75 70 65 60 55 50 45 Spent at an MAP Below 10 2030 40 50 60 Cumulative Minutes
Percent Increase in the Odds Ratio for 30 day Mortality Depending Upon the Duration of Hypotension Below Certain MAP Thresholds % Increase In Odds Ratio (30 day Mortality) hypertensive (n= 14419, 40%) normotensive (n= 21485, 60%) 50% 40% 30% 20% 10% 75 70 65 60 55 50 45 Spent at an MAP Below 10 2030 40 50 60 Cumulative Minutes
Percent Increase in the Odds Ratio for 30 day Mortality Depending Upon the Duration of Hypotension Below Certain MAP Thresholds % Increase In Odds Ratio (30 day Mortality) hypertensive (n= 14419, 40%) 50% 40% 30% 20% 10% 75 70 65 60 55 50 45 Spent at an MAP Below 10 2030 40 50 60 Cumulative Minutes
Percent Increase in the Odds Ratio for 30 day Mortality Depending Upon the Duration of Hypotension Below Certain MAP Thresholds % Increase In Odds Ratio (30 day Mortality) hypertensive (n= 14419, 40%) 50% 40% 30% 20% 10% 75 70 65 60 55 50 45 Spent at an MAP Below 20% 10 2030 40 50 60 Cumulative Minutes The line in red represents the same (20%) impact on the Odds Ratio for 30 day Mortality
Percent Increase in the Odds Ratio for 30 day Mortality Depending Upon the Duration of Hypotension Below Certain MAP Thresholds % Increase In Odds Ratio (30 day Mortality) hypertensive (n= 14419, 40%) normotensive (n= 21485, 60%) 50% 40% 30% 20% 10% 75 70 65 60 55 50 45 Spent at an MAP Below 20% 10 2030 40 50 60 Cumulative Minutes The line in red represents the same (20%) impact on the Odds Ratio for 30 day Mortality
Percent Increase in the Odds Ratio for 30 day Mortality Depending Upon the Duration of Hypotension Below Certain MAP Thresholds % Increase In Odds Ratio (30 day Mortality) hypertensive (n= 14419, 40%) normotensive (n= 21485, 60%) 50% 40% 30% 20% 10% 37 21 Minutes 75 70 65 60 55 50 45 Spent at an MAP Below 11 5 3 20% 10 2030 40 50 60 Cumulative Minutes The line in red represents the same (20%) impact on the Odds Ratio for 30 day Mortality
Cumulative Time Spent Below an MAP Threshold of Associated Increase in Odds Ratio For 30 Day Mortality
Cumulative Time Spent Below an MAP Threshold of Associated Increase in Odds Ratio For 30 Day Mortality
Cumulative Time Spent Below an MAP Threshold of Associated Increase in Odds Ratio For 30 Day Mortality
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below Patients Carrying a Preoperative Diagnosis of Hypertension an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below Patients Carrying a Preoperative Diagnosis of Hypertension an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
Cumulative Time Spent Below an MAP Threshold of Associated with an Increase in 30 day Mortality Odds Ratio of
A Novel Risk Index Portending Adverse Postoperative Outcome Based on Patients Exceeding Certain Sets of Intraoperative Hypotensive Exposure Limits In Hospital Mortality Median LOS* 90 th Percentile LOS* Percent Patients Exceeding Limits 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 5% 4% 3% 2% 1% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 5 101520253035404550 7 6 5 4 3 2 1 0 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 5 101520253035404550 25 20 15 10 5 0 80% 70% 60% 50% 40% 30% 20% 10% 0% Hospital Charges Readmission Rate 30 Day Mortality # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 Percent Patients Exceeding Limits N=27,436 5 101520253035404550 $140,000 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 5 101520253035404550 20% 15% 10% 5% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% N=27,436 5 101520253035404550 Exposure Limit Risk Sets, as previously found to be associated with increased 30 day mortality (Stapelfeldt at al., 2012). Below limits Exceeding Limits 5% 4% 3% 2% 1% 0%
Percent Patients Exceeding Limits Percent Patients Exceeding Limits A Novel Risk Index Portending Adverse Postoperative Outcome Based on Patients Exceeding Certain Sets of Intraoperative Hypotensive Exposure Limits 80% 70% 60% 50% 40% 30% 20% 10% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% In Hospital Mortality Median LOS* 90 th Percentile LOS* # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=27,436 5 101520253035404550 5% 4% 3% 2% 1% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 7 6 5 4 3 2 1 0 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 Hospital Charges Readmission Rate 30 Day Mortality N=27,436 5 101520253035404550 $140,000 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 5 101520253035404550 20% 15% 10% 5% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=26,940 N=27,436 5 101520253035404550 Exposure Limit Risk Sets, as previously found to be associated with increased 30 day mortality (Stapelfeldt at al., 2012). Below limits Exceeding Limits 25 20 15 10 5 0 5% 4% 3% 2% 1% 0%
Percent Patients Exceeding Limits Percent Patients Exceeding Limits A Novel Risk Index Portending Adverse Postoperative Outcome Based on Patients Exceeding Certain Sets of Intraoperative Hypotensive Exposure Limits 80% 70% 60% 50% 40% 30% 20% 10% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% In Hospital Mortality Median LOS* 90 th Percentile LOS* # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=27,436 5 101520253035404550 5% 4% 3% 2% 1% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 7 6 5 4 3 2 1 0 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 Hospital Charges Readmission Rate 30 Day Mortality N=27,436 5 101520253035404550 $140,000 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 5 101520253035404550 20% 15% 10% 5% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=26,940 N=27,436 5 101520253035404550 Exposure Limit Risk Sets, as previously found to be associated with increased 30 day mortality (Stapelfeldt at al., 2012). Below limits Exceeding Limits 25 20 15 10 5 0 5% 4% 3% 2% 1% 0%
Percent Patients Exceeding Limits Percent Patients Exceeding Limits A Novel Risk Index Portending Adverse Postoperative Outcome Based on Patients Exceeding Certain Sets of Intraoperative Hypotensive Exposure Limits 80% 70% 60% 50% 40% 30% 20% 10% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% In Hospital Mortality Median LOS* 90 th Percentile LOS* # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=27,436 5 101520253035404550 5% 4% 3% 2% 1% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 7 6 5 4 3 2 1 0 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 Hospital Charges Readmission Rate 30 Day Mortality N=27,436 5 101520253035404550 $140,000 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 5 101520253035404550 20% 15% 10% 5% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=26,940 N=27,436 5 101520253035404550 Exposure Limit Risk Sets, as previously found to be associated with increased 30 day mortality (Stapelfeldt at al., 2012). Below limits Exceeding Limits 25 20 15 10 5 0 5% 4% 3% 2% 1% 0%
Percent Patients Exceeding Limits Percent Patients Exceeding Limits A Novel Risk Index Portending Adverse Postoperative Outcome Based on Patients Exceeding Certain Sets of Intraoperative Hypotensive Exposure Limits 80% 70% 60% 50% 40% 30% 20% 10% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% In Hospital Mortality Median LOS* * Live discharges 90 th Percentile LOS* # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=27,436 5 101520253035404550 5% 4% 3% 2% 1% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 7 6 5 4 3 2 1 0 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 Hospital Charges Readmission Rate 30 Day Mortality N=27,436 5 101520253035404550 $140,000 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 5 101520253035404550 20% 15% 10% 5% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=26,940 N=27,436 5 101520253035404550 Exposure Limit Risk Sets, as previously found to be associated with increased 30 day mortality (Stapelfeldt at al., 2012). Below limits Exceeding Limits 25 20 15 10 5 0 5% 4% 3% 2% 1% 0%
Percent Patients Exceeding Limits Percent Patients Exceeding Limits A Novel Risk Index Portending Adverse Postoperative Outcome Based on Patients Exceeding Certain Sets of Intraoperative Hypotensive Exposure Limits 80% 70% 60% 50% 40% 30% 20% 10% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% In Hospital Mortality Median LOS* * Live discharges 90 th Percentile LOS* # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=27,436 5 101520253035404550 5% 4% 3% 2% 1% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 7 6 5 4 3 2 1 0 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 Hospital Charges Readmission Rate 30 Day Mortality N=27,436 5 101520253035404550 $140,000 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 5 101520253035404550 20% 15% 10% 5% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=26,940 N=27,436 5 101520253035404550 Exposure Limit Risk Sets, as previously found to be associated with increased 30 day mortality (Stapelfeldt at al., 2012). Below limits Exceeding Limits 25 20 15 10 5 0 5% 4% 3% 2% 1% 0%
Percent Patients Exceeding Limits Percent Patients Exceeding Limits A Novel Risk Index Portending Adverse Postoperative Outcome Based on Patients Exceeding Certain Sets of Intraoperative Hypotensive Exposure Limits 80% 70% 60% 50% 40% 30% 20% 10% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% In Hospital Mortality Median LOS* * Live discharges 90 th Percentile LOS* # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=27,436 5 101520253035404550 5% 4% 3% 2% 1% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 7 6 5 4 3 2 1 0 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 Hospital Charges Readmission Rate 30 Day Mortality N=27,436 5 101520253035404550 $140,000 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 5 101520253035404550 20% 15% 10% 5% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=26,940 N=27,436 5 101520253035404550 Exposure Limit Risk Sets, as previously found to be associated with increased 30 day mortality (Stapelfeldt at al., 2012). Below limits Exceeding Limits 25 20 15 10 5 0 5% 4% 3% 2% 1% 0%
Percent Patients Exceeding Limits Percent Patients Exceeding Limits A Novel Risk Index Portending Adverse Postoperative Outcome Based on Patients Exceeding Certain Sets of Intraoperative Hypotensive Exposure Limits 80% 70% 60% 50% 40% 30% 20% 10% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% In Hospital Mortality Median LOS* * Live discharges 90 th Percentile LOS* # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=27,436 5 101520253035404550 5% 4% 3% 2% 1% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 7 6 5 4 3 2 1 0 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 Hospital Charges Readmission Rate 30 Day Mortality N=27,436 5 101520253035404550 $140,000 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 5 101520253035404550 20% 15% 10% 5% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=26,940 N=27,436 5 101520253035404550 Exposure Limit Risk Sets, as previously found to be associated with increased 30 day mortality (Stapelfeldt at al., 2012). Below limits Exceeding Limits 25 20 15 10 5 0 5% 4% 3% 2% 1% 0%
Percent Patients Exceeding Limits Percent Patients Exceeding Limits A Novel Risk Index Portending Adverse Postoperative Outcome Based on Patients Exceeding Certain Sets of Intraoperative Hypotensive Exposure Limits 80% 70% 60% 50% 40% 30% 20% 10% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% In Hospital Mortality Median LOS* * Live discharges 90 th Percentile LOS* # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=27,436 5 101520253035404550 5% 4% 3% 2% 1% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 7 6 5 4 3 2 1 0 80% 70% 60% 50% 40% 30% 20% 10% 0% 5 101520253035404550 Hospital Charges Readmission Rate 30 Day Mortality N=27,436 5 101520253035404550 $140,000 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 $0 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 5 101520253035404550 20% 15% 10% 5% 0% 80% 70% 60% 50% 40% 30% 20% 10% 0% N=26,940 # Limits Exceeded 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 15 14 13 12 12 12 12 11 11 11 N=26,940 N=27,436 5 101520253035404550 Exposure Limit Risk Sets, as previously found to be associated with increased 30 day mortality (Stapelfeldt at al., 2012). Below limits Exceeding Limits 25 20 15 10 5 0 5% 4% 3% 2% 1% 0%
Percent Increase in Risk (Odds Ratio) per Exposure Limit Exceeded (DSS Alert) Portended by a Novel Risk Index for Adverse Postoperative Outcome Based on the Number of Intraoperative Hypotensive Exposure Limits Exceeded (with and without adjustment for a set of 30 co morbidities identified by AHRQ) 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% In Hospital Mortality Average LOS* Readmission Rate* (N=27,436 ) (N=26,940) 3.5% * Live discharges (N=26,940) 3.0% 4% 2.5% 2.0% 3% 1.5% 2% 1.0% 1% 0.5% 0.0% 0% 51 10 2 15 3 20 4 25 5 30 6 35 7 40 8 45 9 50 10 51 10 2 15 3 20 4 25 5 30 6 735 840 45 9 10 50 15 210 315 420 525 630 735 840 45 9 10 50 5% Hypotensive Exposure, Unadjusted (95% Confidence Interval) Hypotensive Exposure, AHRQ Adjusted (95% Confidence Interval) Exposure Limit Risk Sets, as previously found to be associated with increased 30 day mortality (Stapelfeldt at al., 2012)
Percent Increase in Risk (Odds Ratio) per Exposure Limit Exceeded (DSS Alert) Portended by a Novel Risk Index for Adverse Postoperative Outcome Based on the Number of Intraoperative Hypotensive Exposure Limits Exceeded (with and without adjustment for a set of 30 co morbidities identified by AHRQ) 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% In Hospital Mortality Average LOS* Readmission Rate* (N=27,436 ) (N=26,940) 3.5% * Live discharges (N=26,940) 3.0% 4% 2.5% 2.0% 3% 1.5% 2% 1.0% 1% 0.5% 0.0% 0% 51 10 2 15 3 20 4 25 5 30 6 35 7 40 8 45 9 50 10 51 10 2 15 3 20 4 25 5 30 6 735 840 45 9 10 50 15 210 315 420 525 630 735 840 45 9 10 50 5% Hypotensive Exposure, Unadjusted (95% Confidence Interval) Hypotensive Exposure, AHRQ Adjusted (95% Confidence Interval) Exposure Limit Risk Sets, as previously found to be associated with increased 30 day mortality (Stapelfeldt at al., 2012)
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Learning/Understanding Device Integration ETL Processes Clinical & Business Processes Data C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Intraoperative Hemodynamics Decision Support Toolbox (CPOE, Alerts, etc.) Real-Time Processing
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Learning/Understanding Device Integration ETL Processes Clinical & Business Processes Data C&BI Analytics Information Actions/Interventions Knowledge/Experience Actionable Information (Decision Support) Intraoperative Hemodynamics Decision Support Toolbox (CPOE, Alerts, etc.) Real-Time Processing
1. Current Status of Perioperative Care
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS)
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base ARKS
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base ARKS
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS ARKS
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS ARKS
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS ARKS Pertinent, Patient-Specific Information (the right information at the right time to make the right decision)
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR ± History of hypertension Risk factors for hypotension (ex: hypertrophic obstructive CM) DSS Knowledge Base Association between hypotensive exposure & outcome ( Diving Charts ) ARKS Pertinent, Patient-Specific Information (the right information at the right time to make the right decision) Increased risk for adverse outcome portended by progressive hypotensive exposure
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS ARKS Pertinent, Patient-Specific Information
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS ARKS Pertinent, Patient-Specific Information Web-Based Secure (electronically, physical) Compliant with Standards (HL7, SNOMED ontology) Platform-Independent Scalable Universally Applicable
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS ARKS Pertinent, Patient-Specific Information Web-Based Secure (electronically, physical) Compliant with Standards (HL7, SNOMED ontology) Platform-Independent Scalable Universally Applicable
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS ARKS Pertinent, Patient-Specific Information Web-Based Secure (electronically, physical) Compliant with Standards (HL7, SNOMED ontology) Platform-Independent Scalable Universally Applicable
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS ARKS Pertinent, Patient-Specific Information Web-Based Secure (electronically, physical) Compliant with Standards (HL7, SNOMED ontology) Platform-Independent Scalable Universally Applicable
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS ARKS Pertinent, Patient-Specific Information Web-Based Secure (electronically, physical) Compliant with Standards (HL7, SNOMED ontology) Platform-Independent Scalable Universally Applicable
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS ARKS Pertinent, Patient-Specific Information Web-Based Secure (electronically, physical) Compliant with Standards (HL7, SNOMED ontology) Platform-Independent Scalable Universally Applicable
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS ARKS Pertinent, Patient-Specific Information Web-Based Secure (electronically, physical) Compliant with Standards (HL7, SNOMED ontology) Platform-Independent Scalable Universally Applicable
1. Current Status of Perioperative Care 2. Concept of Decision Support (DSS) EMR Knowledge Base DSS Supervising Physician OR ARKS Pertinent, Patient-Specific Information Web-Based Secure (electronically, physical) Compliant with Standards (HL7, SNOMED ontology) Platform-Independent Scalable Universally Applicable
EMR Knowledge Base Allows adverse physiologic developments to be addressed before they become crises DSS ARKS EMR DSS Knowledge Base OR ARKS EMR Knowledge Base DSS OR ARKS OR
EMR Knowledge Base Allows adverse physiologic developments to be addressed before they become crises DSS ARKS EMR DSS Knowledge Base OR ARKS EMR Knowledge Base DSS OR ARKS OR
EMR Knowledge Base Allows adverse physiologic developments to be addressed before they become crises DSS ARKS EMR DSS Knowledge Base OR ARKS EMR Knowledge Base DSS OR ARKS OR
EMR Knowledge Base Allows adverse physiologic developments to be addressed before they become crises DSS ARKS EMR DSS Knowledge Base OR ARKS EMR Knowledge Base DSS OR ARKS OR
EMR Knowledge Base Allows adverse physiologic developments to be addressed before they become crises DSS ARKS EMR DSS Knowledge Base OR ARKS EMR Knowledge Base DSS OR ARKS OR
EMR Knowledge Base Allows adverse physiologic developments to be addressed before they become crises DSS ARKS EMR DSS Knowledge Base OR ARKS EMR Knowledge Base DSS OR ARKS OR
EMR Knowledge Base Allows adverse physiologic developments to be addressed before they become crises DSS ARKS EMR DSS Knowledge Base OR ARKS EMR Knowledge Base DSS OR ARKS OR
EMR Knowledge Base Allows adverse physiologic developments to be addressed before they become crises DSS ARKS EMR DSS Knowledge Base OR ARKS EMR Knowledge Base DSS OR ARKS OR
Each alert portends a 5.1% increase in the projected odds ratio for death within 30 days (20% risk set) Update the effective MAP Matrix to include the most recent minute of the case executed every minute in near real time Alert Update the cumulative number of minutes spent below each of the MAP thresholds (75 to 45 mm Hg) Compare with the set of time thresholds for the selected level of risk (risk set) Count the number of thresholds exceeded for the current minute Count greater than the previous minute s count?
Odds of Mortality 5 4 3 2 1
12:00:00 13:12:00 14:24:00 15:36:00 16:48:00 Odds of Mortality 5 4 3 2 1
12:00:00 13:12:00 14:24:00 15:36:00 16:48:00 Odds of Mortality 5 4 3 2 1
12:00:00 13:12:00 14:24:00 15:36:00 16:48:00 Odds of Mortality 5 to be evaluated in a prospective randomized clinical effectiveness trial 4 3 2 1
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Learning/Understanding Clinical & Business Processes Device Integration Data ETL Processes Actions/Interventions C&BI Analytics Information Decision Support Toolbox (CPOE, Alerts, etc.) Knowledge/Experience Actionable Information (Decision Support) Real-Time Processing Intraoperative Hemodynamics
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Learning/Understanding Clinical & Business Processes Device Integration Data ETL Processes Actions/Interventions C&BI Analytics Information Decision Support Toolbox (CPOE, Alerts, etc.) Knowledge/Experience Actionable Information (Decision Support) Real-Time Processing Intraoperative Hemodynamics
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Device Integration Data ETL Processes Clinical & Business Processes Minute to Minute MAP Data Medical History (Hypertension) Analytics Learning/Understanding Actions/Interventions Information C&BI in real time (every one minute), for every patient MAP Matrix Knowledge/Experience Actionable Hypotensive Information Exposures Alerts (Decision Support) Number of Limits Exceeded Real-Time Processing Intraoperative Hemodynamics
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Device Integration Data ETL Processes Clinical & Business Processes Minute to Minute MAP Data Medical History (Hypertension) Analytics Learning/Understanding BP Actions/Interventions Information C&BI in real time (every one minute), for every patient MAP Matrix Knowledge/Experience Actionable Hypotensive Information Exposures Alerts (Decision Support) Number of Limits Exceeded Real-Time Processing Intraoperative Hemodynamics
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Targeted Postop. Care Device Integration Data ETL Processes Clinical & Business Processes Minute to Minute MAP Data Medical History (Hypertension) Analytics Learning/Understanding BP Actions/Interventions Information C&BI in real time (every one minute), for every patient MAP Matrix Knowledge/Experience Actionable Hypotensive Information Exposures Alerts (Decision Support) Number of Limits Exceeded Real-Time Processing Intraoperative Hemodynamics
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Targeted Postop. Care Device Integration Data ETL Processes Clinical & Business Processes Minute to Minute MAP Data Medical History (Hypertension) Analytics Learning/Understanding BP Actions/Interventions Information C&BI in real time (every one minute), for every patient MAP Matrix Knowledge/Experience Actionable Hypotensive Information Exposures Alerts (Decision Support) Number of Limits Exceeded Real-Time Processing Intraoperative Hemodynamics
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Targeted Postop. Care Device Integration Data ETL Processes Clinical & Business Processes Minute to Minute MAP Data Medical History (Hypertension) Analytics Learning/Understanding Hypotensive exposures are difficult to detect BP Actions/Interventions Information C&BI in real time (every one minute), for every patient MAP Matrix Knowledge/Experience Actionable Hypotensive Information Exposures Alerts and impossible to avoid (Decision Support) Number of Limits Exceeded Real-Time Processing Intraoperative Hemodynamics
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Targeted Postop. Care Device Integration Data ETL Processes Clinical & Business Processes Minute to Minute MAP Data Medical History (Hypertension) Analytics Learning/Understanding Hypotensive exposures are difficult to detect BP Actions/Interventions Information C&BI in real time (every one minute), for every patient MAP Matrix Knowledge/Experience Actionable Hypotensive Information Exposures Alerts and impossible to avoid (Decision Support) Number of Limits Exceeded Real-Time Processing Intraoperative Hemodynamics
In-Hospital Mortality; Length of Stay Readmission Rate; 30-day Mortality Results Targeted Postop. Care Device Integration Data ETL Processes Clinical & Business Processes Minute to Minute MAP Data Medical History (Hypertension) Analytics Learning/Understanding Hypotensive exposures are difficult to detect BP Actions/Interventions Information C&BI in real time (every one minute), for every patient MAP Matrix Knowledge/Experience Actionable Hypotensive Information Exposures Alerts and impossible to avoid (Decision Support) Number of Limits Exceeded Real-Time Processing Intraoperative Hemodynamics
References Implementing Business Intelligence in Your Healthcare Organization. Cynthia McKinney, MBA, FHIMSS, PMP, Ray Hess, MSA, RRT, FHIMSS, and Michael Whitecar, MIS, LCDR (ret.), MSC, USN. http://marketplace.himss.org/onlinestore/productdetail.aspx?productid=3329 Risk Based Decision Support Thresholds for Hypotension in Adult Patients Undergoing Non Cardiac Surgery. Wolf H. Stapelfeldt, M.D., Jarrod Dalton, Ph.D., Pamela Bromley, M.B.A., George Takla, Ph.D., Jacek Cywinski, M.D., Marc Reynolds, M.S., Bhaswati Ghosh, M.S. http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=9b5e4 3B933F1D63ABAED7E20D57A44D1?year=2012&index=14&absnum=4351 Prolonged hypotension in surgery linked to poor outcomes. Michael Vlessides. Anesthesiology News 38 (12), December 2012. http://issuu.com/mcmahongroup/docs/mman0012_2012_tab/1?zoomed=&zoom Percent=&zoomX=&zoomY=¬eText=¬eX=¬eY=&viewMode=magazine
Starter Question #1 Where to begin with C&BI? The opportunity for C&BI begins with a solid foundation of electronic acquisition of data that capture the essential clinical and business processes as well as indicators of their outcomes through device integration and ETL processes by interfacing with relevant data sources such as patient monitors, EMRs, patient registries etc.
Starter Question #2 What outcomes to focus on when it comes to C&BI? These could be key reportable patient outcome measures such as mortality, quality indicators, process measures or parameters such as cost per case. It is important to choose the most relevant ones and keep these in constant focus while realizing that it is resulting informed actions and interventions which affect these, not C&BI per se.
Starter Question #3 What types of data parameters are most suitable to be concentrating on when applying predictive analytics? While predictive analytics needs to account for any input parameters deemed relevant it is those that might be altered through intervention ( actionable information ) that would be most relevant. Example: hemodynamic management (alterable) versus certain pre existing comorbidities (very important, but not typically alterable).
Starter Question #4 How can predictive analytics be leveraged to affect relevant outcomes? There are essentially two important requirements: both, the analysis of clinical and business data for actionable information as well as provider notification to this information must occur within a sufficient time frame to allow any necessary actions/interventions to still be instituted and take effect in order to influence outcomes.
Starter Question #5 What is the ROI of instituting C&BI? It is the determined by the value attributed to the percent improvement in meaningful outcome(s) one can expect to attain as a result of the implementation of C&BI relative to the cost of instituting the latter. This is one reason why it is important, at the outset, to choose the highest impact outcomes to be affected (example: number of lives saved; incremental operating margin through reduction in LOS).