Digitized Healthcare: From Big Paper to Big Data

© Copyright 2012 Hewlett-Packard Development Company, L.P.
The information contained herein is subject to change without notice.
Frank Wang
WW Lead, Healthcare and Life Sciences
HP Printing and Personal Systems
Digitized Healthcare
From Big Paper to Big Data

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.2
The Opportunity to Transform HealthcareEcosystemintegration
Quality of care and outcomes
Today’s
healthcare
Collaborative
healthcare
Transformative
healthcare
Low High
LowHigh
Integrated
healthcare
• Culture of best-practices
• Stand-alone IT
• Best of breed
• Fragmented systems
• Integrated EMR,
EHR, PMS, CPOE
• Real-time alerts
• HIE/improved
access to data
• Tight linkage between
physicians & hospitals
in different provinces
• Care collaboration
• Regional, state and
national RHIOS, NHIN
• Patient access to data
• Population Healthcare
Management
• Personalized/evidence-
based clinical decision
support
• Patient engagement
Different providers will be at different stages
Data silos, many papers,
miscoding, comorbidity

Impact to Costs/Security/Control/Quality of Care
• Data/information outside the clinical system
• Caregivers still overwhelmed by paper
• Exposure to protected health information (PHI) violations
• Patient discharge information confusing
Coordinating Care Outside the Four Walls – EMR is Not Enough!
Pharmacy
Clinical Care
Radiology
Legal
Health Information
Management
Physician
Offices
Home Care / Hospice
Reference Lab
Audits
Human Resources
Patient Accounting
Billing / Payables
Patient
Registration
Patient Discharge
• Faxing
• Paper forms
• Handwritten
• External documents
• Legacy records

… 90% data is untapped for KPIs and analytics
• Needle Stick Injury Rate
• Reintubation Rate
• Ventilator Associated Pneumonia (VAP)
• Blood Stream Infection Due to Central Line
• Urinary Catheter Related Infection
• Overall Employee Satisfaction
• Patient Satisfaction
• Standardized mortality rate (SMR)
• Iatrogenic Pneumothorax
• Decubitus ulcer
• Length of Stay
• ICU readmission rate
• Patients' Fall Rate
• Medication error
• Adverse Events/Error Rate
Key Performance Indicators (KPIs)
Transaction Records Qualitative Human Data Quantitative Machine Data
Admission notes
Discharge summaries
Progress notes
Imaging study results
Consultant reports
Financial
& Operational
Transactions
Medication records
Laboratory results
Physiologic testing
Biometric sensors
RFID tags
Partial Intelligence

Electronic Medical Records Need More To Deliver the
True Benefits to Patients
“Untamed Technologies Enhance EMR and Related Clinical Systems”

Search & Retrieve
documents
Manage Clinical and
Revenue Cycle Processes
Structured and Unstructured
“Big Data” Analytics
Automatically generate
output (Discharge Notes)
Create Personalized Patient
Engagement Plan
Manage Document
Retention Requirements
Capture “Big Paper”
documents
with your MFP’s

Autonomy ECM Suite At a Glance
Windows – Outlook– Web – Tablet – Mobile – Cloud - MFP
Uncover
connections and
insights
Faster processes
More accurate
More responsive
Improve
operations,
Reduce costs
Enhance patient
satisfaction
Reduce storage costs
Enhance compliance
IDOL - Content Integration/Enterprise Search
Admissions
documents
Test
results
EHR
Billing
AP / AR
Call
Centers
Patient
Surveys
Grant
Mgmt.
Human
Resources
HP Process Automation
- Workflow & BAM
- E-Forms
- Digitized paper forms
Capture &
Digitize
Automate
Processes
Document &
Email Mgmt.
Enterprise
Search
Information
Governance
HP Intelligent
Universal Search
- Search across diverse
repositories, formats
- Meaning based analysis
HP WorkSite
- Integrate documents
and e mails
- Secure Collaboration
- Mobility - capture
HP Records Manager
(TRIM & Control Point)
- Policy based governance
- Records Management:
- Retention & Disposition
HP Teleform
- Digitize content
- Identify forms/docs
- OCR
- Extract data

Let your MFP captures Big Paper
Simplify your workflows
NewCustomerApplication Finda Form
Addto CustomerApplication Finda Brochure
SubmitEmploymentApplicationExpenseRe-imbursement
Scan a new customer
application form
Add a scan to an existing
customer file
Find and print a form
Scan and submit expense
re-imbursements
Find and print a brochure
Scan a new employment
application
Logged in: Kelly Thompson
Admit new patient Find a form
Scan and e mail
Find a brochure
Add to patient file
Expense reimbursement
Add a scan to an
existing patient file
Scan admissions
documents
Scan to patient file
and e mail
Find and print patient
education notes
Patient Management
- New Patient Admissions
- Patient Survey
- Clinical Procedure workflows
- Patient discharge workflows
- Patient discharge instructions
Information Management
- Patient Forms
- Unified Patient File
- Physician Notes
- Clinical Narrative
- Disease and Wellness Care Collateral

Serviceability Improvements
• Integrated IT support.
• Network Management, and
proactive alerting.
• High Capacity Cartridges.
• Field Service and support.
• Ease of Hot-Swap device support.
• Centralized configurations.Consolidated Footprint
• Single device replaces fax, label
printer, and wristband printer.
• Also provides copy, print, and scan.
• Multiple Paper Tray support.
• Decreased desktop real-estate
requirement.
Improved Patient Experience
• Color Photo Printing Support.
• Addition of color Precautionary
codes.
• Simplified admission processing.
HP Officejet Pro X – Healthcare Focus
Lower Cost of Ownership
• Lower Acquisition cost than
multiple thermal devices.
• Lower cost of wristband/label
printing.
• Lower Annual Service Cost.
• Simplified Help desk
troubleshooting.

Let your Healthcare Analytics search the “Big Data”
Translate data into clinical insights
HP IDOL +
Patient
Communications
Clinical
Narratives
Transactional
Data
IT/OT WebSchedules
400+ Connectors
EMR Lab Pharmacy ADT Payer RIS/PACS Billing Documents
Knowledge
Discovery
HAI Detection
Compliance
Reporting
Predictive
Analytics
Best Practices +
Best Experiences
Hypothesis
Generation
Search
Medical
Guidelines
Provider
Collaborations
Industry
Literature
Healthcare Taxonomies
Medical Codings
Clinical Classifiers
Healthcare Visualizations
Medical Workflow UI

Structured and unstructured information
<ICD9>
<Code>413.9</Code>
<Descr>NOS angina pectoris</Descr>
</ICD9>

The nuances of clinical documentation – Institutional Memory
• Context
• Heart attack mentioned in History of Present Illness
• Heart attack mentioned in Family History
• Meaning (in ED triage notes)
• DOB to indicate Date of Birth
• DOB to indicate Difficulty of Breathing
• Negation
• The patient denied shortness of breath or chest pain

Approaches to unstructured information
Text
processing
technologies:
keyword, NLP,
probabilistic
Taxonomies, ontologies,
lexicons: SNOMED,
UMLS, ICD9/10,
RxNorm, LOINC
Clinical documentation:
encounter / admission /
progress / procedure
notes, discharge
summaries, test results
Formal published
medical knowledge:
literature (PubMed),
protocols, guidelines
Unconventional
sources: Social
media, call center
transcripts

Healthcare Analytics Use Cases
Clinical chart review is necessary for:
• Compliance Reporting: Clinical Quality Measures (CQM’s) , Core Measures Quarterly, PQRS,
eRx reporting, Hospital Inpatient Quality Reporting Program, CHIPRA, (Children’s Health
Insurance Program Reauthorization Act), ACO Programs
• Public Health Data: Syndromic surveillance, CDC, cancer registries, immunization reports,
adverse drug events
• Research: Cohort identification, recruitment of eligible subjects
Manual chart review is labor intensive, time consuming, and has human
variation

Application scope and adoption factors
Clinical Research and
Population Health
Compliance Reporting
and Public Health
Operational
• Adverse medical event reporting
• Syndromic surveillance
• Hospital inpatient quality
• Clinical Quality Measures (CQM)
• Cancer registry, immunization reports)
• Risk Adjustment
• Fraud, Waste, & Abuse
• Medical coding review
• Auditing
• Cohort identification
• Personalized medicine
• Clinical decision support
• Disease management
• Clinical trial subject recruitment
Adoption considerations
"Evidence" for change in
clinical practice
Demonstrable ROI
Workflow modifications
WRT target adopter
Availability of
input data
Sponsor/champion
for change
Legislative drivers
Privacy issues/worries

Application – Understanding hospital acquired conditions
HAC’s include adverse drug events, hospital acquired infections, procedural
complications and incidents related to falls
• The incidences per 1,000 visits are:
• 65 incidents due to adverse drug events
• 60 events due to hospital acquired infections
• 51 events due to procedural complications
• 15 incidents related to falls
HAI’s result in extra costs of $5-10M /year for average hospital
ADE’s cost the average hospital about $5.6M/year
ADE’s increase LOS by 4.6 days and increases costs by at least $5K/incident
Consolidated in Patient Safety Primer and Fact Sheet, 10/2/2006, HIMSS Patient Safety and Quality Committee
Tinoco A, Evans R, et al. J Am Med
Inform Assoc 2011;18:491-497
"Computerized surveillance systems that can access both coded
and free text data such as that found in unstructured narratives
may improve surveillance without requiring the time and cost
associated with manual chart review, alone.“

Application – Looking for depression
1 in 10 adults met criteria for current depression, 4.1% met the criteria for major depression 1
Median delay from onset of depression to the beginning of treatment was estimated to be eight
years 2
Treatment prevalence rates of comorbid depression for some chronic conditions is significantly
lower than the expected comorbidity rates (e.g., 16% treated vs. 45% expected) 3
Comorbid depression increases medical services costs by average of $505/member/mo. and has
significantly elevated odds ratios with poorer self care (e.g., high fat intake > 6x/wk,
smoking, exercise < 1x/wk) 3
1: MMWR 2010;59(38);1229-1235
2: Melek, S. Halford, M. Measuring the Cost of Undiagnosed Depression. Contingencies. Jul/Aug 2012. Pps. 64-70
3: Melek, S. Norris, D. Chronic conditions and comorbid physchological disorders. Milliman Research. 2008

Wide range of healthcare use cases including ...
Reconciliation
ID discrepancies between
diagnostic code and clinical notes
Monitor KPIs and Metrics
Reporting
Abstraction
Rapid Chart Access
Ultimate flexibility to scale

HP Healthcare Analytics platform unlocks full data value
Built for unstructured and structured clinical data
Core Capabilities:
• Integrated modular platform for variety of use cases
• 400+ data connectors and 150+ data types
• Rapid identification of concepts, patterns and relationships
• Conceptual search on all data
• Advanced security for compliance
Healthcare specific capabilities:
• SNOMED CT taxonomy with 344K+ concepts and 2M terms
• Integrated ICD codes
• Intuitive workflow UI and visualization for healthcare applications
Intelligent search and actionable Insights powered by HP IDOL (Intelligent Data Operating Layer)

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.20 Copyright © 2013 HP Autonomy. All rights reserved. Other trademarks are registered trademarks and the properties of their respective owners.
Information transformed to enable success
• Improve reimbursements and quality of KPIs with
comprehensive and contextually relevant insights
• Reduce costly and error prone manual overhead with
intelligent search and automation
• Lower financial, operational and compliance risks with
effective reconciliation to proactively uncover errors

Digitized Healthcare: From Big Paper to Big Data

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