Decisio Health Overview

July 2015

© Decisio Health, Inc. 2015 www.decisiohealth.com

Actionable Information for Improved Outcomes SM


Value Statement

Decisio Health provides an FDA cleared class II medical device that displays real-time actionable information with the goal of increasing clinical guideline adherence, which has been shown to improve clinical outcomes and reduce hospital costs.


Clearly Decisio’s approach is innovative and focused on improved

patient outcomes. [The] value proposition is well supported by [the]

data. As we look across the spectrum of cost drivers in health care, the

variability in practice patterns is a major challenge and your approach

eliminates the variability while reducing cost, decreasing complications

and improving timely quality care.

– Richard Carmona, MD, MPH, FACS17 Surgeon General of the United States


Setting the Stage

• Decisio is based on platform technology exclusively licensed from the University of Texas Health Science Center, Houston; and their team of top trauma surgeons and intensivists

• The underlying clinical guidelines in the system has been shown to lower mortality rates and length of stay for patients (top 10 in UHC and TQIP) and generate considerable cost savings for hospitals

• The system has been up and running successfully since August, 2012 in one of the busiest trauma centers in the nation, Memorial Hermann Hospital (MHH) in Houston TX

• Decisio provides a novel real-time visual integration of critical care information, which increases situational awareness for clinicians

Mission statement: Improve clinical outcomes and reduce cost by providingactionable information to physicians, hospitals, and other healthcare groups


Deep Strategic and Clinically Experienced Medical Advisory Board

MAB Members

• Dr. John Holcomb (Chairman) – Vice Chair Dept. of Surgery, UT Health Science Center Houston

• Dr. Andriy Batchinsky – Research Scientist, U.S. Army Institute of Surgical Research

• Dr. William Cohn – Director Center for Technology and Innovation, Texas Heart Institute

• Dr. Matt Harbison – Medical Director of Hospitalist Program, Memorial Hermann Hospital

• Dr. Don Jenkins – Director of Trauma, Critical Care and General Surgery, Mayo Clinic

• Dr. Jay Johannigman – Chief, Division of Trauma/Critical Care, University of Cincinnati

• Dr. Michael Matthay – Professor, Medicine and Anesthesia, University of California, SF

• Dr. Lena Napolitano – Chief of the Division of Acute Care Surgery, University of Michigan

• Dr. Roberta Ness – Dean, School of Public Health, University of Texas Health Science Center

• Dr. Jose Salinas – Research Task Area Manager, U.S. Army Institute of Surgical Research

• Dr. Martin Schreiber – Chief of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University

• Dr. Shahid Shafi – Director of Rehabilitation Research, Baylor Institute for Rehabilitation

• Dr. Deborah Stein – Medical Director, NeuroTrauma Critical Care; Chief, Baltimore Shock Trauma, University of Maryland School of Medicine

• Dr. John Weigelt – Chief of the Division of Trauma and Critical Care, Medical College of Wisconsin

• Dr. Janice Zimmerman – Head of Critical Care Division, Methodist Hospital


Running in the ED


Running in a patient room


Problem Statement


The Problem: Too much data, no situational awareness, not enough actionable information, low compliance with existing protocols


Low Compliance Leads to Poorer Outcomes1

• In a recent study of 5 Level 1 trauma centers it was found that fully a quarter of all critical care patients received less than 50% of the recommended care

• Compliance with recommended care among 22 common guidelines was as low as 12% at some centers

• Furthermore, it was found that for every 10% increase in compliance with recommended care, there was a 14% decrease in risk of death

• Patients who received 100% of recommended care were 58% less likely to die

• Two additional studies found that average compliance specifically with Sepsis Early Goal Directed Therapy (EGDT) was between 31%-33%2,3

1Shahid Shafi, Sunni A Barnes, Nadine Rayan (2014). Compliance with Recommended Care at Trauma Centers: Association with Patient Outcomes. Journal of the American College of Surgeons, 219, 189-193. 2Mark Mikkelsen, David Gaieski, Munish Goyal (Sep. 2010). Factors Associated with Nonadherence to Early Goal-Directed Therapy in the ED, Chest, 138(3), 551-5583Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med 2010;38:1-8.


• Cost of treating a patient with sepsis is 33% higher than treating a nonseptic patient on a daily basis

• Nonseptic patients leave the ICU faster (median length of stay 1.9) vs. Septic patients (median 16 days) and overall LOS increases by 20 days1

• An episode of sepsis costs between $22.0k and $25.9k2

• Beginning in 2015 readmissions will potentially cost hospitals 3% of Medicare payments3

• Those hospitals in the bottom quartile of HAI rates will lose 1% of Medicare payments

1. Edbrooke, DL et al. The patient-related costs of care for sepsis patients in a United Kingdom adult general intensive care unit. Crit Care Med 1999 Sep; 1760-7.

2. Derek, Angus et al. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001 Jul 1303-1310

3. Boris, Adam A. “A revenue leak soon turns to flood: How payment penalties for high infection rates could drain hospital finances”, March 15, 2013, Becker’s Hospital Review, www.beckershospitalreview.com.

Economic Impact of Low Compliance


http://www.beckershospitalreview.com/

Lack of Real-Time Tools for Compliance Management

• Limited tools available to show deviations from compliance

• Available tools are only able to show information well after the patient is discharged

• Compliance is a labor intensive and inefficient process – administrators watching over the shoulders of clinicians

• Lack of tools, not malice, contributes to poor clinical compliance

• Lack of ability to track in real time means clinicians can not fix things as they happen


Decisio Health featured at FDA workshop May 10, 2015

“Your FDA clearance wasfeatured as the paving path inregulation of clinical decisionsupport tools in the U.S. The[FDA] regulatory attorney whowas presenting on this topicexplained that your clearancereflects FDA’s thinkingregarding the regulation forthese software tools.”

-- Anna Libman Manager Regulatory Affairs

Experien Group


Solution


Early results from pilot show dramatic decrease in variability

• July is first month of data (n=570) with Foley care bundle installed• Variability of care reduced to 0.6% across all nursing shifts after bundle installation• Average compliance of 95% across all shifts, highest since data collection began


Clinical decision support customized to the facility’s protocols


Deliver clinical information in a way that works for your facility

iPhone™, Android™ Android Tablet™, iPad™

PC/Nursing StationWall mount at Bedside


Compliance Measurement

• Customize the bundles to your workflow• Use real-time compliance measurement tools to track adherence and outcomes• Modify protocols based on efficacy


Run custom reports to improve and track clinical performance in real-time

Measure and review stats from customized bundles

Use real time aggregated data, such as a unit specific antibiogram, to make clinical decisions


Bring research protocols to the bedside

Theoretical autoregulation curve from research literature in traumatic brain injury population

Autoregulation curve running on the Patient DashboardTime to automate graph: 2 daysClinical time saved: 4 hrs/day


Decisio Health Patient Dashboard customized to your care setting


© Decisio Health, Inc. 2015

Decisio Health Patient Dashboard Mobile screens

• iPhone™ Android™• Android Tablet™, iPad™

I had doubts about this technology. There was legitimate worry that

having this information visible in the unit would compromise the

patient’s privacy and create more work for the staff that stayed at the

bedside. With all those worries being identified, having real time

experience with the patient dashboard for the past several months has

been nothing but a good experience. The lab results and trending of

vitals are in plain sight, and it is much more convenient than trying to

gather all the information through our electronic charting system. I have

also found it surprisingly easy to explain everything on the Patient

Dashboard to family members. It can actually be a tool that makes the

bedside nurse more time efficient. I find it to be useful, efficient, and

valuable. -- Wallace Hallum, STICU RN

Clinical Experience


Clinical Experience

When the dashboard was first implemented in the STICU, I must admit I

was a little suspicious of its usefulness.… But some experience with it

has quickly shown me its real value as a supplementary tool for patient

care. Being able to visualize key patient lab data and vitals while

standing at the bedside is very helpful in forming a complete clinical

picture and aids quite a bit in making sound patient care decisions….

As an added bonus, the visuals are easy on the eyes and clearly

defined so that abnormal values pop out with ease. Quick walk rounds

are much easier with the monitors in the patients’ rooms.

I must say that it’s difficult for me to imagine working in the ICU without

the dashboard at this point.

– Anthony Tannous, MD, Trauma/Critical Care Fellow, Baltimore Shock Trauma


Partners


Service and implementation backed by large, experienced firms


Pricing


Decisio: SaaS-based

• Decisio patient dashboard is sold on an annual recurring revenue subscription term basis

• Hospitals will be charged per bed / per month allowing them to scale the platform as appropriate

• SaaS model is becoming standard in Healthcare and Decisio’s platform was built with this in mind

• Decisio Platform significantly improves “value” derived from recent EHR capital investments

• Hospital is completely in control of their utilization, they can scale up or down based upon needs and demand.


Additional Information


Proven Clinical Effectiveness to Improve Patient Outcomes

Clinically proven improved outcomes:The protocols imbedded in the software have resulted in a sustained 20% drop in mortalityamong all trauma admissions at MHH over the past 4 years (> 20,000 patients)


• Cost of treating a patient with sepsis is 33% higher than treating a nonseptic patient on a daily basis

• Nonseptic patients leave the ICU faster (median length of stay 1.9) vs. Septic patients (median 16 days) and overall LOS increases by 20 days1

• An episode of sepsis costs between $22.0k and $25.9k2

• Integrated sepsis bundles reduce costs by $8.8k per episode3

• The Methodist Hospital Houston saw a $19m cost savings from 2009 to April 2013 after implementing the sepsis screening protocol which Decisio is currently integrating into its ICU product4

1. Edbrooke, DL et al. The patient-related costs of care for sepsis patients in a United Kingdom adult general intensive care unit. Crit Care Med 1999 Sep; 1760-7.

2. Derek, Angus et al. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001 Jul 1303-1310

3. Talmor, D, et al. The costs and cost-effectiveness of an integrated sepsis treatment protocol. Crit Care Med. 2008 Apr. 1168-74. 4. Data courtesy of Dry Laura Moore and Dry Steve Jones, 2013, The Methodist Hospital Texas Medical Center Houston, TX

Improved Economics from Clinical Algorithms in Action: Sepsis


Improved Economics from Clinical Algorithms in Action: Vent Days

Ventilator Days

– Memorial Hermann Hospital (MHH) decreased vent days from 5.58 In 2009 to 3.4 in 20121

– 27% decrease in 4 years

– Average savings of $8650 per patient2

1. Data courtesy of Memorial Hermann Hospital Texas Medical Center Houston2. Dasta JF, et al. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med 2005 Jun;

1266-71


Improved Economics from Clinical Algorithms in Action: LOS

• Length of Stay (LOS)

As LOS increases, profitability decreases

Majority of profit occurs in pts admitted for less than 11 days

Care guidelines have decreased LOS from 9 days to 7 days

Yielded a reduction of $400 per patient per day1

1. Taheri, Paul. Length of stay has minimal impact on the cost of hospital admission. Journal of American College of Surgeons. Vol 191. August 2000. 123-130

2. Image source: Fakhry, Samir M et al. Trauma Center Finances and Length of Stay: Identifying a Profitability Inflection Point. Journal of American College of Surgeons. Vol 210. May 2010, 817-821.

Negative Economic Impact of LOS


Decisio Health Overview

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