Healthcare data analytics firms are starting to compete on their prowess in natural language processing, Tierney said. “It's still at its infancy but it's much better than when it was in the womb a couple of years ago,” he said.
The PCCI system used at the Bedford hospital is an example of this progress. “One of the things this system does that a lot of the others don't is it uses natural language processing,” Land said. “Our docs use free text. They dictate. They do use the EHR almost exclusively. But unless you have someone going into the chart and abstracting the data, you can miss a lot.”
PCCI founder and CEO Dr. Ruben Amarasingham said that after working on a post-doctoral fellowship in bioinformatics and public health at Johns Hopkins University in the early 2000s, “It dawned on me the possibilities of predictive modeling for use by the healthcare system,” he said. When he arrived to work in Dallas, “I pitched it to Parkland and they took a chance on me,” Amarasingham said.
PCCI built a data-analytics platform, including natural language processing, that “that could sit on top of the electronic health record and pull data from it,” he said. As a result, a nucleus of PCCI predictive analytics software users has formed in Dallas, including Texas Health Resources, which was PCCI's first customer; Children's Medical Center; and Parkland itself.
At Parkland, the public hospital where Amarasingham first tested his system between 2008 and 2010, the first target was 30-day readmissions rates for heart failure. Using the predictive analytics system and a combination of patient follow-up activities it triggered, the system initially was able to cut the rate of Parkland patients readmitted to Parkland or any other Dallas-area hospital from 26.2% to 21.2%, according to published reports. Since then, PCCI has developed risk stratification modules for the two other Medicare readmissions core measures—pneumonia and acute myocardial infarction—as well as several other medical conditions and an all-risk module. “It's allowing us to really target those patients who have a high risk and higher need,” said Marilyn Callies, Parkland's vice president of care management.
All high-risk and some medium-risk Parkland patients receive a follow-up phone call within three days of discharge; a follow-up appointment with a primary-care physician or specialist within seven to 10 days; additional follow-up calls when necessary to make sure the treatment plans are effective; and an additional follow-up call after 30 days to make sure they're following their care plan, said Robert Zubrod, Parkland's director of clinical resource management.
Children's Medical Center in Dallas uses PCCI's predictive analytics tool to improve care for pediatric asthma patients. With 2,000 asthma patients, the medical center has had an asthma disease-management program for a number of years, said Summer Collins, its vice president of population health strategies. Adding PCCI's tool provides Children's with “information we never had access to before, she said. With patients' records being scoured and assessed in real time, “We can look at their utilization history, their social history, how many times they've had a payer change in the past 12 months, all of those things allow us to tailor the approach to that patient,” she added.
In Milwaukee, the 14-hospital Aurora Health Care system is using a predictive analytics tool developed by Humedica, a unit of UnitedHealth Group's Optum. Aurora is a member of the AMGA Collaborative, a data-sharing collective organized by the American Medical Group Association that is partnering with Humedica.
With Humedica's help, Aurora launched two predictive analytics pilots focused not only on readmissions, but also on keeping high-risk heart and chronic obstructive pulmonary disease patients out of the hospital. Aurora identified two groups of patients who were eligible for the pilots and living near its 10 participating outpatient clinics.
The two pilot projects each used six registered nurses as health coaches. Starting in June 2013, the heart failure teams oversaw 129 patients, working with 32 providers. Starting in January, the COPD teams looked after 363 patients, working with 32 providers, two pharmacists, one specialist and one home-care worker. For heart failure, readmission rates dropped to 2% for four months of the 2013 program, compared with 14.4% for the same months in 2012.
“This was a very seamless process and it went very, very well,” said Laura Spurr, Aurora's director of medical group operations. Aurora currently is analyzing return on investment for the pilots, but Spurr said the projects already have proved “a huge success.” Aurora is planning to roll out the program for the two conditions across the entire system over the next 12 months.
Follow Joseph Conn on Twitter: @MHJConn