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DDBD Strata Conference Oct 15–17, 2014 New York, NY

Improving Healthcare Business Strategies through lean data partnerships

Brigitte Piniewski, MD Chief Medical OfficerPeaceHealth Laboratories, Vancouver, WA

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The concepts and opinions presented are solely those of the author

and do not necessarily represent the views of PeaceHealth.

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1. Get started collaborating2. Pearl: Lab data 3. Precision living > precision medicine

Summary

MORE: Pairing EMR Data with an Open Commons to Engage Communities, Provide Work Force Development and Predict Community Health Futures10/16/2014 4:15pm - 4:55pm EDTRoom: 1 E12/1 E13

Office Hour: Unleashing a swarm of micro-health work10/16/2014 5:05pm - 5:45pm EDT (40 minutes)Room: Table A

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Time

life

Problem: Out-dated business models

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Time

life

life

1) Experience-based Staffing

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1. Experience-based Staffing / Subscription

2. Cost savings from crowd-based prevention (ACO)

3. Precision Medicine, pulse therapy, dynamic pill-packs (PHARMA)

Case Study Proposed Business models

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Question: Cardiovascular threat Index

SilentEventStream

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IcdDiagCode IcdDiagName786.59 CHEST PAIN NEC 4,675

786.5 CHEST PAIN NOS 2,853427.31 ATRIAL FIBRILLATION 1,606

785.1 PALPITATIONS 830410.71 SUBENDO INFRC-INIT EPISD 804786.51 PRECORDIAL PAIN 716

428 CONGESTIVE HEART FAILURE, UNSPECIFIED 423428.23 ACUTE ON CHRONIC SYSTOLIC HEART FAILURE 420427.89 CARDIAC DYSRHYTHMIAS NEC 412428.33 ACUTE ON CHRONIC DIASTOLIC HEART FAILURE 350414.01 CORONARY ATHEROSCLEROSIS;NATIVE CORONARY VESSEL 314427.32 ATRIAL FLUTTER 224

427 PAROX ATRIAL TACHYCARDIA 192427.5 CARDIAC ARREST 174

428.43 ACUTE ON CHRONIC COMB SYSTOLIC&DIASTOLIC HRT FLR 161410.41 INFER AMI NEC-INIT EPISD 126

427.1 PAROX VENTRIC TACHYCARD 107428.21 ACUTE SYSTOLIC HEART FAILURE 105410.11 ANTER AMI NEC-INIT EPISD 101428.31 ACUTE DIASTOLIC HEART FAILURE 86427.69 PREMATURE BEATS NEC 83

785 TACHYCARDIA NOS 80427.81 SINOATRIAL NODE DYSFUNCT 71

413.9 ANGINA PECTORIS NEC/NOS 70411.1 INTERMED CORONARY SYND 68

414 CORONARY ATHEROSCLEROSIS;UNSPEC.TYPE,NATIVE/GRAFT 58427.41 VENTRICULAR FIBRILLATION 53

426 ATRIOVENT BLOCK COMPLETE 53410.91 AMI NOS-INITIAL EPISODE 46

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IcdDiagCode IcdDiagName996.74 COMP NEC D/T VAS DEV NEC 42

423.9 PERICARDIAL DISEASE NOS 38427.61 ATRIAL PREMATURE BEATS 35

420.9 ACUTE PERICARDITIS NOS 33424.1 AORTIC VALVE DISORDER 32

410.01 ANTEROLAT AMI-INIT EPISD 29427.9 CARDIAC DYSRHYTHMIA NOS 26

996.72 COMP NEC D/T HRT DEV NEC 25410.51 LATRL AMI NEC-INIT EPISD 22

996.1 MALFUNC VASC DEVICE/GRAF 21996.61 INFEC DUE TO HRT DEVICE 18410.21 INFEROLAT AMI-INIT EPISD 18

428.3 UNSPECIFIED DIASTOLIC HEART FAILURE 17428.41 ACUTE COMBINED SYSTOLIC & DIASTOLIC HEART FAILURE 16

428.2 UNSPECIFIED SYSTOLIC HEART FAILURE 16426.13 AV BLOCK-2ND DEGREE NEC 16996.62 INFEC DUE TO VASC DEVICE 15

425.4 PRIM CARDIOMYOPATHY NEC 15421 AC/SUBAC BACT ENDOCARD 15

410.72 SUBENDO INFRC-LATR EPISD 15428.22 CHRONIC SYSTOLIC HEART FAILURE 14410.31 INFEROPOS AMI-INIT EPISD 14

410.7 SUBENDO INFRC-EPISOD NOS 12996.04 MECH.COMPL.OF AUTOMATIC IMPLANTABLE CARDIAC DEFIB. 10414.02 CORON.ATHEROSCLEROSIS;AUTOLOGOUS VEIN BYPASS GRAFT 10428.32 CHRONIC DIASTOLIC HEART FAILURE 9

414.8 CHR ISCHEMIC HRT DIS NEC 9429.83 TAKOTSUBO SYNDROME 7

424 MITRAL VALVE DISORDER 7

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IcdDiagCode IcdDiagName420.91 AC IDIOPATH PERICARDITIS 7

396.2 MITRAL INSUF/AORT STENOS 7413.1 PRINZMETAL ANGINA 6

996.01 MALFUNC CARDIAC PACEMAKE 5426.12 ATRIOVEN BLOCK-MOBITZ II 5

426.7 ANOMALOUS AV EXCITATION 5411.89 AC ISCHEMIC HRT DIS NEC 5

410.9 AMI NOS-EPISODE NOS 5426.11 ATRIOVENT BLOCK-1ST DEGR 4425.11 Hyprtrophc obst cardiomy 4

423.8 PERICARDIAL DISEASE NEC 4414.05 CORONARY ATHEROSCLEROSIS OF UNSPEC.TYPE BYPASS GFT 4410.81 AMI NEC-INITIAL EPISODE 4398.91 RHEUMATIC HEART FAILURE 4997.02 IATROGENIC CEREBROVASCULAR INFARCTION/HEMORRHAGE 3

429 MYOCARDITIS NOS 3428.42 CHRONIC COMBINED SYSTOLIC & DIASTOLIC HEART FAILUR 3

428.4 UNSPEC COMBINED SYSTOLIC & DIASTOLIC HEART FAILURE 3428.9 HEART FAILURE NOS 3

425.18 Oth hyprtrophic cardiomy 3422.91 IDIOPATHIC MYOCARDITIS 3

V53.32 FITTING & ADJUST;AUTOMATIC IMPLANT.CARDIAC DEFIB. 2996.71 COMP D/T HRT VALV PROSTH 2

440.3 ATHEROSCLEROSIS;UNSPEC BYPASS GRAFT;EXTREMITIES 2427.2 PAROX TACHYCARDIA NOS 2426.9 CONDUCTION DISORDER NOS 2426.3 LEFT BB BLOCK NEC 2

420.99 ACUTE PERICARDITIS NEC 2414.1 ANEURYSM OF HEART 2

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IcdDiagCode IcdDiagName414.04 CORONARY ATHEROSCLEROSIS OF ARTERY BYPASS GRAFT 2

412 OLD MYOCARDIAL INFARCT 2410.92 AMI NOS-SUBSEQUENT EPISD 2410.61 POSTERIOR AMI-INIT EPISD 2

V43.3 HEART VALVE REPLAC NEC 1785.2 UNDIAGNOSED CARDIAC MURMURS 1

440.32 ATHEROSCLEROSIS;NONAUTOL.BIO.BYPASS GRAFT;EXTREM. 1440.31 ATHEROSCLEROSIS;AUTOLOGOUS VEIN BYPASS GFT;EXTREM. 1

429.4 HRT DIS POSTCARDIAC SURG 1428.1 LEFT HEART FAILURE 1427.6 PREMATURE BEATS NOS 1

426.89 CONDUCTION DISORDER NEC 1426.82 LONG QT SYNDROME 1426.53 BILAT BB BLOCK NEC 1426.52 RT BBB/LFT ANT FASC BLK 1

426.6 OTHER HEART BLOCK 1426.4 RT BUNDLE BRANCH BLOCK 1425.5 ALCOHOLIC CARDIOMYOPATHY 1424.9 ENDOCARDITIS NOS 1423.2 CONSTRICTIV PERICARDITIS 1

423 HEMOPERICARDIUM 1422.9 ACUTE MYOCARDITIS NOS 1

414.12 DISSECTION OF CORONARY ARTERY 1411.81 ACUTE CORONARY OCCLUSION W/O MYOCARDIAL INFARCTION 1410.82 AMI NEC-SUBSEQUENT EPISD 1

410.8 AMI NEC-EPISODE NOS 1410.52 LATRL AMI NEC-LATR EPISD 1410.42 INFER AMI NEC-LATR EPISD 1410.22 INFEROLAT AMI-LATR EPISD 1

410.2 INFEROLAT AMI-EPISOD NOS 1410.12 ANTER AMI NEC-LATR EPISD 1

410.1 ANTER AMI NEC-EPISOD NOS 1396.8 MITR/AORTIC MULT INVOLV 1396.3 MITRAL/AORTIC VAL INSUFF 1

396 MITRAL/AORTIC STENOSIS 1394.9 MITRAL VALVE DIS NEC/NOS 1

112.81 CANDIDAL ENDOCARDITIS 1

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FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015Date

SHRB

SJH

SJMC

10

20

30

ED Visits

10

20

30

ED Visits

0

10

20

ED Visits

Chest Pain-Related ED Visits by Facility5 Years

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Laboratory Marker variance

1401/01/2011 to 05/31/2013, with a total of 882 days

1 23 45 67 89 111

133

155

177

199

221

243

265

287

309

331

353

375

397

419

441

463

485

507

529

551

573

595

617

639

661

683

705

727

749

771

793

815

837

859

881

0

10

20

30

40

50

60

70

80

Eugene Troponin/date n=35,447

count

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1 27 53 79 105

131

157

183

209

235

261

287

313

339

365

391

417

443

469

495

521

547

573

599

625

651

677

703

729

755

781

807

833

859

0

10

20

30

40

50

60

70

80

90

100

Longview Troponin /date n= 30,580

count

01/01/2011 to 05/31/2013, with a total of 882 days

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1 25 49 73 97 121

145

169

193

217

241

265

289

313

337

361

385

409

433

457

481

505

529

553

577

601

625

649

673

697

721

745

769

793

817

841

865

0

20

40

60

80

100

120

count

01/01/2011 to 05/31/2013, with a total of 882 days

Whatcom Troponin/date n=58,823

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Harmonizing Data > Predict Chest pain Yesterday Tomorrow

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Eugene day cycle, start shift, error:28, 14, 7.4714285714285715,7, 1, 7.554147465437788,14, 0, 7.686635944700461,21, 20, 7.833333333333333,

Eugene 17.2%Longview 32.37%Whatcom 13.2%

Kent State Results

Dr. Ruoming Jin Associate Professor of Computer Science at KSU is an expert on Big Data, Complex and Social Network, and a NSF CAREER awardee. Wei Xiong is the KSU postdoctoral researcher

First two years’ data as training data and the last half year data as test data. Error measure is the average of every day’s relative error in a given time period

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Combine available data sets

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Unemployment and Stock Market effects

Eugene

Longview

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• Staffing• Prevention• Push notifications• Personalized medicine• Just-in-time Intelligence

Discussion

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• Dan Nielsen, PeaceHealth• Dejing Duo, University of Oregon• Gabriela Queiroz,  Alpine Data Labs• James Boyle, PeaceHealth• Ruoming Gin, Kent State• Wei Xiong, Kent State

Acknowledgements

MORE: Pairing EMR Data with an Open Commons to Engage Communities, Provide Work Force Development and Predict Community Health Futures10/16/2014 4:15pm - 4:55pm EDTRoom: 1 E12/1 E13

bpiniewski@peacehealthlabs.org