Improving Clinical Outcomes for Malnourished Patients Through Healthcare Analytics

©Truven Health Analytics Inc. All Rights Reserved. 1
Sandeep Makhijani – Regional Director, APAC
Truven Health Analytics
Improving Clinical and Operational Outcomes by Leveraging
Healthcare Data Analytics at the Point of Care

News Flash !!
 There are currently about 7.1 billion
people on Earth, this number could rise
to about 9 billion by 2050 - and as many
as 25 billion by 2100 *
 The population is not only growing it is
also living longer
 Even another world war or a lethal
pandemic won't slow down the
population time bomb
 Can we use Data and Analytics to
transform Healthcare for this
unstoppable population growth?
* http://toi.in/pQsD1b

Discussion Points
 Healthcare Analytics
 Using Data and Analytics to transform Healthcare
 Role of Clinical Content and a Clinical Decision Support System to
support Healthcare Analytics
 Leveraging Healthcare Analytics for Evidence based real-time Clinical
Surveillance
 Using Healthcare Analytics to Improve Clinical, Operational and
Financial performance across the Continuum of Care

©Truven Health Analytics Inc. All Rights Reserved. 4©Truven Health Analytics Inc. All Rights Reserved. 4
Healthcare Analytics

 Healthcare Analytics is the systematic use of Patient Specific Data
and related insights developed through Applied Analytical Disciplines
to drive Evidence based Clinical Decision Making for patient safety,
care management, outcomes measurement and clinical learning.
 Healthcare Analytics helps achieve the following Business Goals:
 Healthcare Analytics Solutions will:
 Provide Real-time Surveillance and Real-time Intervention capabilities
leveraging Evidence-based Clinical Content
 Intervention Documentation Capability
 Measurement, Analysis and Reporting Capability

Need for Healthcare Analytics
Providers Needs
 Accelerated Demand for
healthcare services – Growing
and Ageing Population
 Optimal Usage of healthcare
resources
 Improve Clinical Outcomes
 Manage Cost of Care
 Effective gathering, sharing and
use of patient centric information
across the continuum of care
Patient Needs
 Higher Expectations from
healthcare providers
 More Educated about their
health and healthcare needs
 Greater Access to Information
than ever before
 Demanding increasing
Accountability from their doctors,
nurses and health plans.

An EMR is not enough….you need Data and Analytics
to Transform Healthcare!
Providers
 Improve service delivery and operations
 Provide means for measuring and
evaluating critical organizational data
 Expand access to healthcare, align pay
with performance and help hold down
growth in healthcare costs.
 Help design and plan healthcare policy
and programs
 Improved effectiveness and efficiency of
the Healthcare System
Patients
 Better insights into Patient Data can help
achieve better Clinical Outcomes
 Improve Patient Safety
 Aid exploration and discovery of new
treatments and technologies
 Personalized healthcare
 Information leading to insight can help
informed and educated consumers
become more accountable for their own
health

Role of Clinical Content and CDSS to
Support Healthcare Analytics

Medication
Management
Process
Patient’s
unique
physiology &
values
Evidence-Based
Medicine =
Clinical Content
and CDSS
Clinical Expertise
Role of Evidence Based Medicine in the
Medication Management Process

Creating Evidence Based Clinical Content
CONTENT CREATION
PROCESS

7
Clinical Decision Support System
 Clinical Decision Support System (CDSS) provides clinicians with
knowledge and patient-specific information, intelligently filtered
and presented at appropriate times, to enhance the practice of
health care

Clinical Content and CDSS is the foundation of
 Referential Evidence-based Clinical
Content
 Non-Patient Specific, Facility
Specific
 Cloud based access
 Stand Alone
 Patient Specific
 Available at Point of Care
 Integrated with EMR
 Provides Interaction Alerts based on
Evidence-based Clinical Content
 Patient Specific
 Available at Point of Care
 Integrated with EMR
 Real-time Surveillance and Real-time Intervention
leveraging Evidence-based Clinical Content
 Documentation Capability
 Measurement, Analysis and Reporting
Healthcare
Analytics
Active CDSS
Passive CDSS

Leveraging Healthcare Analytics for Evidence
based Real-time Clinical Surveillance

Leveraging Healthcare Analytics for Evidence based Real-
time Clinical Surveillance to Identify Patients at Risk of an
Adverse Event
16
Evidence Based
Clinical Content
CDS Rules
Clinical Decision
Support

Pre-Built Evidence-Based Clinical Decision Support
Rules
• CDS Rules should
be editable to
match hospital-
specific criteria
• Ability to create
new profiles on
demand
•Ability to query on
a virtually
unlimited number
of data elements

Clinical Dashboard Helps Clinicians Improve Outcomes
and Manage Risk
Real -time
surveillance of
at-risk patients
Easy documentation
of intervention within
the workflow
Comprehensive
medication, lab
and report
information – with
integrated access
to evidence-
based content
Quick view of critical values with
automated interaction checking
and pharmacy tools and
calculators

The key is being able to intervene before risk increases
and expenses are incurred
19

Healthcare Analytics for Evidence based Real-time
Clinical Surveillance
 Data Aggregation for Analytics
 Evidence-based CDS Rules
 Timely and effective Alerts
 Focused user-interface
 Integrated, context-aware CDS knowledge
 Documentation of Clinical Activity
 Data-mining and Reporting capabilities
20

Improving clinical, operational and financial
performance across the continuum of care
using Healthcare Analytics

Malnutrition in Adult Patient Population
Surveillance

Malnutrition in Adult Patient Population
• Adult malnutrition is a common problem, affecting as many as 60
percent of hospitalized patients in the U.S.
• A major contributor to poor patient outcomes, longer hospital stays,
and higher healthcare costs.
• Malnutrition is often present on hospital admission,
• Early Identification of malnourished patients, or those at risk of being
malnourished can be treated appropriately, leading to better
outcomes

This is a Problem in Singapore too… 1 in 3 elderly
Singaporeans not eating right
1 in 3 elderly Singaporeans not eating right
Thursday, 14 l 07 l 2011 Source: The Straits Times
By: Feng Zengkun
Lack of proper diet can put senior citizens at high risk of malnutrition
WHETHER out of a diminished enjoyment of food or the fact that they live alone, one in three elderly people is not taking in enough calcium,
carbohydrates and fibre. The upshot of their poor food choices? They are at high risk of malnutrition, a condition caused by a diet of too much or
too
few nutrients such as zinc or iron.
The findings were published recently in two separate studies by Tan Tock Seng Hospital and health-care company Abbott Nutrition. Together,
the studies surveyed about 700 elderly people in Singapore aged 50 and older. The Abbott study also found that the elderly living in one- and
two-room flats have a higher risk of malnutrition. Experts The Straits Times spoke to said the poor attention many elderly people paid to their diet
could lead to more frequent falls, slower recovery from injuries and a host of diet-related complications such as fragile bones.
At a nutrition seminar in Singapore yesterday, Professor Jean-Pierre Michel, 51, head of the geriatric ward at the Geneva Medical School and
University Hospitals, called the findings “serious”. He said the lack of a proper diet was linked to a condition called sarcopenia, which causes
people to lose muscle mass and strength. This could lead to the elderly becoming weaker and more prone to falls, he
added, noting that about 20 per cent of people who suffer hip fractures die within a year of the injury. “Half of them never regain their former
mobility,” he said.
Experts The Straits Times spoke to said reasons for the elderly’s poor diet ranged from a lack of interest in food to their living environment.
Dietitian Teo Soo Lay at the Singapore General Hospital said elderly people who live alone have no motivation to cook for themselves. “Most of
the time, they will just eat biscuits or plain bread for their main meals, which is very poor nutrition,” she added. Others said natural consequences
of ageing, such as problems with chewing and swallowing, also put the elderly off their food.
Mr Kavin Seow, director of Touch Home Care, which delivers meals to the elderly, said it makes sure the food comes in small pieces to aid
digestion. “We don’t serve hard and deep-fried food either,” he added. ……..
http://www.healthxchange.com.sg/News/Pages/Elderly-Singaporeans-not-eating-right.aspx

Freeman Health System
• 517 beds, 3 hospital
system
• Serves an area of
450,000 people from
Missouri, Arkansas,
Kansas, and Oklahoma
• U.S. News & World
Report recently ranked
Freeman as the #1
hospital in Southwest
Missouri and #4 hospital
in the state of Missouri.

Problem of tracking Malnourished Patients at Freeman
 Coders spent significant time each day manually reviewing patient
records to identify patients with signs of malnutrition
 Once identified in the hospital, a nutrition support pharmacist would
ensure intervention
 Charts were reviewed once more for coding accuracy to check for
reimbursement.
 Process was time-consuming, inefficient, and challenging to identify
malnourished patients early enough to avoid complications, as well as
prior to hospital discharge

Using Healthcare Analytics to track Malnourished
Patients
 Implement a real-time, enterprise-wide clinical surveillance technology
solution
 CDS profile identifies patients who have early warning signs of
malnutrition.
 Real-time surveillance of structured and unstructured patient data
 Alerts to Clinicians on Patients identified
 Leverage built-in evidence-based guidelines to address the warning
signs and avoid complications
 Easy to use tools to document the clinical intervention

Malnutrition Surveillance Profile
Created a clinical
profile within
Micromedex 360
Care Insights to
identify
malnourished
patients during
hospitalization

Results of Malnutrition Interventions
 Improved Patient Care
 Identification and treatment of malnutrition in the hospital results in
improved patient outcomes and decreased lengths of stay
 Time Savings
 Healthcare Analytics solution automated the extensive clinical data
review required to accurately identify patients
 After building the Malnutrition profile, their pharmacist ran a list every
morning, which takes 3 minutes.
 Cost Savings
 Between August 2013 - January 2014, Freeman’s Malnutrition profile
has resulted in 13 interventions, for a total dollar revenue of
$30,600.
 Average increased reimbursement of $2300 per identified case
 Estimate over $115,000 per year in increased reimbursement

Ebola Virus Disease (EVD) Surveillance

CDC Case Definition for Ebola Virus Disease (EVD)
• Suspected Case
 Illness in a person who has both consistent symptoms and risk factors as follows:
o Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5
degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain,
vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND
o AND - Epidemiologic risk factors within the past 3 weeks before the onset of symptoms,
such as contact with blood or other body fluids of a patient known to have or suspected
to have EVD; residence in—or travel to—an area where EVD transmission is active; or
direct handling of bats, rodents, or primates from disease-endemic areas.
 Malaria diagnostics should also be a part of initial testing because it is a common
cause of febrile illness in persons with a travel history to the affected countries.
• Confirmed Case
 A suspected case with laboratory-confirmed diagnostic evidence of ebola virus
infection.
31
Source: Centers for Disease Control, Health Alert Network, August 1,
2014, HAN 00364 at: http://emergency.cdc.gov/han/han00364.asp

Ebola Surveillance Profile

Final Thoughts….
 The world’s population is not only growing but living longer
 Expectations from Healthcare Service Providers have changed
dramatically
 Clinicians need tools and resources at the point of care to provide the
best possible care tailored to the unique needs for their patients
 There is an increased risk for communicable disease and infection
due to crowding and antibiotic over-utilization resulting in less efficacy
 We have to leverage Technology in the form of Healthcare Analytics
to Improve Clinical and Operational Outcomes
 ….Don’t forget we are All Future Patients!

Thank You
Questions and Comments
sandeep.makhijani@truvenhealth.com
Cell: +65-96863797

Improving Clinical Outcomes for Malnourished Patients Through Healthcare Analytics

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Improving Clinical Outcomes for Malnourished Patients Through Healthcare Analytics