Presentation for the mHealth Israel community by Dr. Thomas Maddox, Director, Health Systems Innovation Lab, Washington University School of Medicine / BJC Healthcare

1. The Health Systems Innovation Lab
Thomas M. Maddox MD MSc
Professor, Washington University School of Medicine
Director, Health Systems Innovation Lab, Washington
University School of Medicine/BJC Healthcare

2. The Health Systems Innovation Lab (HSIL) develops
and incorporates innovations into clinical practice
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3. The mission of HSIL is to create sustainable, technology-
enabled care delivery innovations focused on solving
critical problems in our health system and community.

4. 4
BJC Center for
Clinical Excellence
WU Institute
for Clinical
and
Translational
Sciences
WU Institute of Public Health
WU Institute
for Informatics
HSIL

5. Health System and Community Priorities
Critical Problem
Academic Partner
Tech/Informatics Solution
Operational Home
A World of Possibility
HSIL Portfolio

6. It takes a village…
HSIL projects
Health care
providers, patients,
and communities
Designers
Informaticians
Investigators
External partners
Executive sponsors
Project managers

7. Examples of innovation projects

8. What if we could predict the future of AMI patients?
Presentation
with AMI
Bleeding & AKI
Avoidance
Begin D/C
Planning
NSTEMI
STEMI
Cath?
PCI
PCI
Discharge & Care
Transition
Cardiac Rehab &
Post-acute care
to 90d
Risk Strat-
ification
Case Managers
• Predicted LOS
• Mean
• Short
• Need for SNF
Interventionalists
• PCI Bleeding Risk
• AKI Risk/Safe
Contrast
Case Managers &
Home Health
• 90d Readmit Risk
• Benefits of CR
ED Physicians
• Need to admit CP
Inpatient MD
• TIMI Risk Score for cath
• Risk of needing CABG
• DAPT pre-loading
• AMI Bleeding Risk

9. What if our DNA could help us avoid heart
attacks?
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AbsoluteRiskReductions(%)
Low Genetic Risk High Genetic Risk
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Intermediate Genetic Risk
JUPITER ASCOT CARE PROVE IT
TIMI 22
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AbsoluteRiskReductions(%)
Low Genetic Risk High Genetic Risk
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Intermediate Genetic Risk
JUPITER ASCOT CARE PROVE IT
TIMI 22
Number needed to treat
Low genetic risk ASCOT
trial
NNT ~ 100
High genetic risk ASCOT
trial
NNT ~ 33
Mega and Stitziel et al. Lancet 2015

10. NICOTINE
DEPENDENCE
CANCER DIAGNOSIS/
PREVENTION
CHRNA5
TREATMENT/
CESSATION
30% more likely to be
dependent smokers
Smoked more cigarettes/day
Inhale deeper
4-yr delay in median age
of quitting
Increased exposure
to carcinogens
4-yr earlier median
age of lung cancer diagnoses
Higher overall mortality
If quit, 50% less risk for lung cancer
If quit, 7-yr delay in lung cancer
1/3 odds of quitting
without medication
3X more likely to
benefit from nicotine
replacement therapy
What if our genes could help with smoking
cessation?
CLINICAL TRIAL

11. What if we were better at understanding how
cancer and cardiac risk interact?

12. October 25, 2017
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13. Emerging strategic priorities
• Standardizing and optimizing clinical workflows
• Prediction algorithms to risk-stratify and triage patients
• Tools to support care teams
• Patient service interfaces
• Virtual care platforms
• Visualization of resources between health system and
community social services

14. Challenges for innovation
• Change management is difficult in large health systems
• Both clinicians and administrators need convincing with rigorous
evidence
• Margins are shrinking and cost containment is key
• Staff turnover and burnout is high, partly due to workflow
• Academic physicians and departments have a disproportionate
influence over clinical decisions
• The EHR at BJC is undergoing a major overhaul, but will become the
default technology
• BJC is a federated system without integrated service lines or
centralized purchasing, though this is changing

15. tmaddox@wustl.edu