1. Agenda
1
• The business problem
• Current solution
• Proposed solution
• User interface and technologies
• Ilog and integration with the user interface
• Real time rule detection
• Q&A

2. 2
Some numbers shown in
this presentation may alarm
you.

3. Who are we?
3
• A healthcare alliance with 2500 hospitals and 80000
healthcare sites, improving the health of our communities
• Premier collects data from participating hospitals. We
house the nation's largest detailed clinical and financial
database, holding information on more than 130 million
patient discharges.
• Web-based tools allow hospitals to compare their
performance in specific areas to peers and best
performers, find opportunities for improvement, and track
the results of their efforts. Also provide surveillance
capabilities with the clinical warehouse.

4. Business Problem
4
• Meet regulatory needs to decrease healthcare associated infection
occurrences and their associated costs.
• Improve infection prevention efforts and reduce costs associated with
HAIs by supporting automated infection control, surveillance and
medication management.
• Increase pharmacists' efficiency, optimize antimicrobial utilization,
enhance outcomes and reduce pharmacy expenditures.
• Handle complex event detection rules, to ensure accuracy in identifying
patients at risk of HAIs.
• Prevent too many false positive events which would generate too much
“noise” for clinicians leading to a lack of trust in the tool.
• Monitor and prevent outbreaks

5. Healthcare Associated Infections (HAIs)
Every year HAIs account for:
~ 2 million infections
90,000 deaths
$4.5 billion in excess healthcare costs
SafetyAdvisorTM
Improves infections prevention efforts
Reduces costs associated with HAIs
Positively impacts patient care

6. Customer Stories
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"SafetySurveillor has been a boost to productivity. Before we went through stacks of cultures every day and tried to pick out the
ones that were significant. With SafetySurveillor, we just set our alerts. We don’t have to go through that sorting process. It makes
data mining easy. It has really made us more efficient so we can dedicate our time to engaging with staff to make a difference in
patient care. Without SafetySurveillor, we’d be struggling with all the new CMS requirements. It would be scary. I don’t know how
we’d do it. I don’t know how facilities without automated surveillance do it. I really don’t."
Rebecca Bartles, MPH, CIC
Corporate Manager, Infection Prevention Mountain States Health Alliance
Johnson City, TN
"We get alerts 48 to 72 hours before we would
have gotten them before SafetySurveillorTM. In three months we
identified 13 cases where we were able to intervene before
anybody else... 12 were accepted immediately... I’m not saying
they wouldn’t have been caught in the old system, but they
wouldn’t have been caught by the pharmacy, and there would
have been delay. There is plenty of information in the literature
that supports the idea that delay of appropriate antibiotics or
antimicrobials in septic patients leads to increased mortality. All
the interventions were accepted within one to six hours...There
was a high success rate..."
Erik Schindler, Clinical Pharmacist
St. Luke's Hospital
An experienced user of SafetySurveillor®, Rochester General
chose to concentrate on sepsis and catheter associated urinary
tract infections – not necessarily to reduce costs, but to improve
patient outcomes and decrease mortality.
"SafetySurveillor is the mechanism that allowed us to be able to
initiate this project. When you’re looking at a large number of
infections in a house-wide project, especially when you’re
drilling down to each of the units, it’s impossible to do that
without electronic surveillance. . . . We did a very, very modest
estimate of our savings but for credibility with administration, I
always use a lowball figure. . . . SafetySurveillor is definitely on
the cutting edge. We’ve been pleased. We’ve been very, very
satisfied."
Linda Greene, RN, MPS, CIC, Director of Infection Prevention

7. SafetySurveillor
7

8. Challenges
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• Near real-time event detection (job runs every ten
minutes detecting events)
• Scalability (with the pod structure and the 250+
databases)
• Providing a broad range of events that can be detected,
in addition to tailoring event detection to specific patient
populations to reduce alert “noise”
• Event Detection/Rule Detection using set of stored
procedures limits the ability to modify events and extend
to support complex events.
• Data standardization using industry standards allowing
for a better match in rules and enhancing the data’s
usefulness.

9. Integrated Performance Platform
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Business
Intel.
Rules

10. Definitions
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Event Definition Template – A template defining a type of Event Definition. For
example, a Pharmacy Event type has the following as a list of parameters to choose
from (patient location, service, patient class, hours of hospitalization, lab test
timeframe, lab test result, % change of lab result, drug, drug route, age, gender,
drug schedule code). An event definition template is one that provides the above as
parameters to choose from.
Event Types – Categories of Event Definition. Some event types are Pharmacy,
Lab Only, Lab & Drug.
Event Definition – Applying values to an event definition template creates a set of
rules/rulesets. For example, using a pharmacy event definition template, I can
create n number of event definitions, such as if patient location = pediatric ward and
service = cardiovascular and (drug=xxx or drug=yyy) do blah.
Event – When applying the event definition to a set of data elements like patient or
lab, the decision that is derived creates an event.
Alert – The occurrence of the event for a subscribed individual is an alert.

11. High-Level UI Architecture
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WebSphere Portal 7
WAR
JSR-286 Portlet
Dojo Widget
Dojo Widget
Dojo Widget
Spring 3 Controller
[REST Services]
<<JSON>>
REST Web Services
Running on WebSphere
App Server
<<XML>>

12. Event Definition– An Example
Group 1 - ((Hydralazine [drug])
AND
Group 2
Set 1 - (Isosorbide Dinitrate [drug] OR Isosorbide Mononitrate [drug] ))
OR
Set 2 - (Angiotensin Converting Enzyme Inhibitors [drug group) OR (Angiotensin II Inhibitors [drug group])
AND
Group 3 - (Non-steroid anti-inflammatory agents [drug group])
12
Use Case
Patients at Premier Memorial Hospital with orders for drugs with significant interactions

13. Example – UI Cont.

14. Example – UI Cont.

15. Example – UI Cont.

16. Example – UI Cont.

17. Example – UI Cont.

18. Example – UI Cont.

19. Example – UI Cont.

20. Example – UI Cont.

21. Example – UI Cont.

22. Example – UI Cont.

23. Example – UI Cont.

24. Example – UI Cont.
24

25. Example – UI Cont.

26. Example – UI Cont.

27. Example – UI Cont.

28. Example – UI Cont.
28

29. Example – UI Cont.

30. Example – UI Cont.

31. Example – UI Cont.

32. Example – UI Cont.

33. Example – UI Cont.

34. Use case - Rules Created in RTS

35. The challenge
• Creation of multiple rules automatically in RTS without
any human interaction
• External Access to ILog vocabulary
• Guided Editor for Rule Creation
35

36. The Solution
• The Event Definition framework is primarily based on the
following key principles:
– Creation of a service to handle all the API level interaction with
ILog
– Business Rules Templates
36

37. Templates
• Templates are used to create Business Rules, based on
data entered in Safety Advisor UI.
• These Templates are created for each Parameter:
– Examples of Parameters include
• DRUG, TAG,FACILITY, PATIENT CLASS
• For a parameter, number of templates are created based
on the attributes and possible patterns
– Examples of attributes
• Route of Drug, Schedule Code of Drug, Dosage of Drug

38. Templates Design
• Templates are defined such that they are dynamic and support all
possible patterns of data. Following are the features in Templates:
– Has “definitions” so that the rules are run only on specific set
– Has “identifiers” that can be replaced with actual values when creating the
Rules
• Templates are designed to support any AND/OR conditions
between groups. It’s always OR condition within a Group.
• A Rule will be created for each Parameter within a Group. Each of
the rule is are evaluated for TRUE and the whole group is set to
True if any of the rule is TRUE within the group.
• In the final evaluation, each group is evaluated for TRUE and the
whole event is triggered based on how the groups are combined
(AND/OR). For example, if they have only OR between the groups,
evaluation of at least one group to TRUE will trigger the event.

39. Sample Rule Template

40. Sample Evaluation Rule Template

41. Event Definition - Rule Creation
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SafetyAdvisor
UI
Rule
Execu7on
Server
Rule
Template
Selec7on
Rule Creation
Request
BRMS Service
Web service call
1
HTDS - Get the Business Rule Template
Rule
Team
Server
Symphony
Rule
Project
Create Rules using ILOG API
2
Symphony
3
Deploy Ruleapp

42. Example Cont. - Rules Created in RTS

43. Example Cont. - Rules Created in RTS

44. Example Cont. - Rules Created in RTS

45. Example Cont. - Rules Created in RTS

46. Example Cont. - Rules Created in RTS

47. Projected Volumes – Clarified – add current
events + projected number of events
47
Projected 5% growth
factor from current
Projected 1 to 1 Ratio of
Lab Orders to Lab
Results (based on
Hans’ previous
experiences)
Assumes we
transmit all
messages, either
HL7 or XML or
both
The projected number of HL7 or XML messages that would be received at the
Premier application level if we were processing all four data types for all 250+
facilities in December 2011
Doubled if we
receive both HL7
and use Meddius
or an IBM edge
solution to
generate XML

48. Event Detection
48

49. Q&A
49