Agenda

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

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Some numbers shown in this presentation may alarm

you.

Who are we?

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•  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.

Business Problem

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•  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

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

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

SafetySurveillor

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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.

Integrated Performance Platform

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Business Intel.

Rules

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.

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>>

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])

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Use Case Patients at Premier Memorial Hospital with orders for drugs with significant interactions

Example – UI Cont.

Example – UI Cont.

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Example – UI Cont.

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Example – UI Cont.

Example – UI Cont.

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Example – UI Cont.

Example – UI Cont.

Example – UI Cont.

Example – UI Cont.

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Example – UI Cont.

Example – UI Cont.

Example – UI Cont.

Example – UI Cont.

Example – UI Cont.

Use case - Rules Created in RTS

The challenge

•  Creation of multiple rules automatically in RTS without any human interaction

•  External Access to ILog vocabulary

•  Guided Editor for Rule Creation

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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

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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

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.

Sample Rule Template

Sample Evaluation Rule Template

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

Example Cont. - Rules Created in RTS

Example Cont. - Rules Created in RTS

Example Cont. - Rules Created in RTS

Example Cont. - Rules Created in RTS

Example Cont. - Rules Created in RTS

Projected Volumes – Clarified – add current events + projected number of events

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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

Event Detection

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Q&A

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