All that RaaS: saving lives and transforming healthcare economics
Stuart, a 66-year-old man with diabetes, felt lousy—constantly fatigued, nauseated, and short of breath after just the slightest exertion. His daughter, worried by his increasing frailty, took him to the emergency room at the local hospital. Her concern was amply justified: Stuart was suffering from heart failure. Like 5.1 million other Americans each year who suffer from heart failure, he was admitted to the hospital to treat this serious, often life-threatening condition. The caring medical team stabilized his condition, and Stuart left the hospital after 10 days, glad to be home with words of advice and a few medications. Within a month he was back, once again fatigued, and facing a second episode.
Stuart’s story is far from rare. Hospital readmissions for chronic conditions such as diabetes, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF) are both common and very costly. Studies conducted in the United States indicate that nearly 20% of Medicare patients who are hospitalized for chronic conditions are often readmitted within 30 days. Experts at Edifecs indicate that it costs Medicare—and US taxpayers—about $26 billion a year, and often a large majority of these readmissions are actually considered avoidable with accurate prioritization and personalized care protocols. Readmission-related costs have become so onerous that the Affordable Care Act includes financial rewards and penalties to deal with the readmission problem. Hospitals that reduce their readmission rates receive financial incentives; those that do not, lose reimbursement and get penalized.
Holistic tools that can reliably predict heart-failure readmissions—taking into account all aspects of each patient’s condition and risk factors—would significantly help patients and hospitals. The growth in the use of electronic patient records has recently offered the potential for such analysis, but little had been done to harness the collective intelligence contained in hospital patient records augmented with other data sources.
By introducing cloud computing technology and applying some of the latest advances in machine learning techniques, researchers are rapidly changing this situation.
One leading example of this is RaaS (Readmission Score as a Service), a platform that was developed by the University of Washington (UW) Tacoma’s Center for Data Science. RaaS compares a patient’s medical information to a database of heart-failure outcomes, using advanced machine learning techniques to arrive at a risk-of-readmission factor as well as corresponding actionable guidelines for the patient-provider team. Those patients identified with a high risk receive additional treatment: the goal is to reduce their likelihood of readmission and produce overall healthier outcomes across all stages of the patient care continuum.
The hundreds of machine learning models of RaaS are developed by using both the R machine learning language, and Microsoft Azure Machine Learning. This chronic care management predictive platform relies on historical patient data from multiple sources. These sources include anonymized electronic medical records, claims, labs, medications, and psycho-social factors, all labeled with observed outcomes that the machine learning models access and share in sync to provide continuous monitoring for personalized patient alerts.
RaaS is available as an on-premises service as well as via the cloud by using Azure Machine Learning web services and the Azure-based Zementis Adapa scoring engine to make predictions for patients. When deployed using Azure Cloud Services, RaaS performs data preparation at scale.
The UW Center for Data Science team began developing initial models in collaboration with MultiCare Health System in March 2012, using just two on-premises servers. The maintenance, frequent updates, and down times of these on-premises servers posed an ongoing problem, and scalability issues limited the scope of the project by affecting the speed of data exploration and machine learning.
About a year and a half ago, the team applied for and was awarded an Azure for Research grant, taking advantage of the Microsoft Research program that offers training and awards of computing resources to qualified institutions that use the cloud to advance scientific discovery. The award enabled the Center for Data Science team to scale up the project and create a robust prediction engine that generates a readmission risk factor score for patients at every stage of their hospital care: post-admission, pre-discharge, and post-discharge.
The RaaS platform at MultiCare Health enables the care management team to view an electronic dashboard that shows heart-failure patients’ risks of readmission. UW Medicine Cardiology is now collaborating with the Center for Data Science team to study the efficacy of predictive models for augmenting care management guidelines by using machine learning.
—Daron Green, Deputy Managing Director, Microsoft Research
—Gregory Wood, MD, UW Medicine Cardiology
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A Global Leader in Aging and Brain Health Wins Big with Blended IT
Healthcare Institutions Save Time and Reduce Development Costs by up to 90 Percent with Cloud-Based Portal
A global leader in aging and brain health, Baycrest wanted to more easily share resources with other healthcare organizations in Canada and around the world. By using a blended IT approach and working with a Microsoft Partner, Baycrest developed eHealth2Share, a cloud-based portal based on Microsoft Office 365 that allows hospital workers to share information and expertise. By reusing software applications and electronic forms, eHealth2Share will help healthcare institutions save weeks of employee labor time.
Baycrest offers a comprehensive system of care for aging patients and one of the world's top research institutes in cognitive neuroscience. The organization wanted to improve efficiency by sharing information and expertise with other hospitals in Canada and around the world. Healthcare officials realized that cloud technologies could help Baycrest develop a centralized information hub without investing a lot of time or money.
Blending forces with an award-winning Microsoft Partner, Baycrest built eHealth2Share, a centralized information portal that allows healthcare providers to share a range of information, including electronic forms, policies, software applications, training programs, and best practices. Baycrest developed the portal by using Microsoft Office 365, which provided an affordable way for organizations to access and share documents using the Microsoft Office applications that most employees are already familiar with.
With eHealth2Share, healthcare organizations can save time and lower development costs by as much as 90 percent by downloading software applications and electronic forms that other institutions have already produced. They can also improve care by more easily sharing knowledge and expertise with colleagues at other institutions. In addition, employees can save time by sharing electronic forms, policies, best practices, and employee training programs.
“It can cost [US]$10,000 to $40,000 every time a healthcare institution needs to develop an electronic form,” says Terrie Tucker, Director of eHealth at Baycrest. “By sharing standardized forms on eHealth2Share, hospitals can download forms that already exist, make the minor edits needed, and have a customized form and associated workflow ready to go, with substantially less investment in staff time and effort.”
By utilizing a blended IT workforce, developing the portal made it possible for Baycrest to create eHealth2Share quickly and at low cost. “We wouldn’t have done this if we had to maintain it internally and had to worry about security, access, and all those types of things,” Tucker says. “The fact that it’s in the cloud and someone else is managing the servers is what made it all possible.”
More and more companies are discovering the benefits of employing a blended IT workforce. This approach includes using a mix of full-time employees, independent contractors and temporary workers. A blended IT solution provides for the best possible financial and strategic business outcomes.
Already, Baycrest is seeing the benefits of eHealth2Share. Employees are saving time and labor by downloading documents developed by other institutions and then customizing these documents to meet their specific needs. Baycrest has posted several software applications to eHealth2Share for other institutions to download free of charge, potentially saving them thousands of dollars in development costs.
“By openly sharing best-in-class electronic forms and e-learning modules, healthcare institutions can save weeks—and even months—of time that it takes to create them,” says Tucker. “It’s all about sharing resources and saving public taxpayer dollars.”
To date, about 40 healthcare providers at 40 institutions have subscribed to eHealth2Share, including all the major teaching hospitals in the Toronto area. Baycrest eventually hopes to extend the portal to healthcare institutions around the world. Tucker believes the portal will be especially useful for smaller healthcare organizations and those in remote areas that don’t have the same resources as larger, urban-based institutions. “This is truly an innovative use of cloud services in the healthcare sector,” she says. “It presents a huge opportunity for knowledge exchange and relationship building. Ultimately, this has the potential to save healthcare institutions a lot of time and money.”
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Talis Clinical
Healthcare Technology Firm Launches New Perioperative Solution on Microsoft Azure
Talis Clinical wanted to make an innovative anesthesia information management system more widely available, so it redesigned the application to run in the cloud on Microsoft Azure. Called ACG-Anesthesia, the patient-centric solution provides centralized, automated visibility into patient risk factors and changing physiologic conditions from the decision to perform surgery through recovery.
In addition, built-in advanced clinical guidance and evidence-based care protocols empower physicians to more effectively manage all phases of perioperative care.
Making healthcare smarter
Sharing data quickly and accurately across multiple processes is important for all businesses, but nowhere is it more critical than in a hospital setting where the right information at the right time can mean the difference between life and death. Among the most critical events in patient care is the intraoperative episode, where the anesthesia care team must simultaneously monitor and react to multiple physiological parameters.
To address those challenges, an application was developed and implemented at Ohio’s Cleveland Clinic that integrates data from patient monitors, medical devices, and electronic health records (EHR) to provide centralized insight and multiparameter decision support. The anesthesia system was already being used in more than 270 operating rooms when the development team and an experienced medical entrepreneur decided to establish a new firm called Talis Clinical and offer the solution to other healthcare organizations.
Talis immediately began expanding the scope of the anesthesia system to include preoperative and postoperative events. In addition to improving patient care and safety, the extended solution would help healthcare providers get more value from the electronic health records (EHR) systems that many organizations had installed and augmented to satisfy recent regulations. Gary Colister, Chief Executive Officer of Talis, explains, “EHR technology alone does not provide the level of vigilance needed in perioperative care; it mostly enables the clinical team to record what happens.”
Moving to the cloud
Talis spent a year looking at an array of cloud platforms from specialized medical platforms to large commercial vendors. The new company decided that Microsoft Azure was the best choice for commercializing its application. “We went through all of these evaluations, and then we actually realized that we’re a Microsoft shop, with all of our technology built on a Microsoft platform,” says Colister. “We’re also moving very fast, and we needed to make sure that not only the individual pieces of software we deployed had the necessary robustness, but that our cloud partner had a deep awareness of our technology stack. It really came down to that support.”
Using the Microsoft Visual Studio development system, including Visual Studio Team Foundation Server, Talis redesigned its anesthesiology solution to run in the cloud on Microsoft Azure Virtual Machines. The highly scalable, flexible environment provides a range of benefits, including easy integration with virtually any endpoint including diverse EHRs and medical devices. On the back end, Talis gained similar advantages, including support for its databases, which ran on Linux operating systems.
The solution, called ACG-Anesthesia, continuously collects patient data such as heart rate and blood pressure, and provides real-time, clinical views of specific patient conditions in multiple rooms. It also includes electronic case summaries and hand-off checklists so that comprehensive information can be shared efficiently with all members of a medical team. ACG-Anesthesia automatically pulls data from Talis clinical products, medical devices, EHRs, lab systems, pharmacies, and more.
In the operating room, the anesthesia care team uses an intuitive touchscreen to access and record information. Elsewhere, the supervising physician can use a mobile device to remotely monitor multiple rooms staffed by nurses or other members of the care team. In addition to providing a way to monitor patient health through a central interface, the solution pushes real-time alerts to devices including tablets and smartphones. It can be customized for a wide range of scenarios, including general, cardiac, and pediatric care.
Built-in clinical guidance supports complex decisions by calculating multiple parameters and events. As a result, the solution can alert caregivers to potential adverse conditions and reactions. And besides providing operational and clinical guidance at the point of care, ACG-Anesthesia helps hospitals collect and report data required by healthcare reform acts and other regulations.
Talis is also migrating other clinical products to the cloud, including a portal that establishes and measures protocols for preoperative testing and image-based, documentation technology that is used for assessment before anesthesia is administered. Both products are already integrated with ACG-Anesthesia. Brought to market in just two years, the suite is available across North America.
Improving healthcare
By taking advantage of Microsoft Azure, Talis Clinical can help medical organizations throughout North America improve patient care and safety at all stages of treatment and recovery.
Provides better support for innovation
With the Microsoft cloud, Talis was able to launch an innovative product that can help hospitals improve performance. “We have determined that Microsoft Azure can help us serve clients better than other traditional platforms,” says Colister. “We want our clients to feel like we can deliver the highest level of service that they expect. To be able to provide insights that help clinicians be more vigilant and at the same time produce legal documentation for compliance—that’s a big achievement in our space.”
Improves patient outcome
By providing timely, relevant data through remote apps and devices, Talis can help clinicians improve patient care. “The perioperative surgical care model is being studied at a lot of prominent medical centers around the country, and it emphasizes continuity and measuring patient information from the preop to surgery, subsequent physical therapy, and beyond discharge” says Karen Alexander, Vice President of Business Intelligence at Talis Clinical. “With Microsoft Azure, we can build the technology to implement this new care model and improve patient outcomes.”
Increases clinical efficiency
Talis is also improving workflow for hospital staff, which frees up valuable time where it matters most. “We’re talking to clinicians who tell us that our product saves them an hour each day in documentation, and it also reduces downtime because it’s more accurate,” Colister says. “With Microsoft technology, we’re creating solutions that make physicians more productive so that they can take better care of patients.”
Read customer success stories to learn how Managed Solution helps businesses implement technology productivity solutions.
Discover how Intermountain Healthcare uses Skype for Business to connect patients with their physicians
Patients can now have face to face conversations with physicians when they normally would not be able to. The power of Skype allows patients to connect from the comfort of their home without having to make an office or hospital visit.
The new Skype Developer Platform provides opportunities to customize and extend the capabilities not only with Skype for Business but also through Skype. Developers don't have to think anymore in "silos" for business and allows for more consumer customization opportunities. Find in-depth developer resources, how-to documentation, SDKs and references, and code samples for Skype developer platform verticals. Learn more
ON-DEMAND: Office 365 in Healthcare
When: Webcast Available Until September 30, 2015 (This is an on-demand webcast event. Upon registration webcast information will be provided.)
Office 365 in Healthcare
With Microsoft Office 365, healthcare organizations can provide anywhere access to enterprise email, file sharing, online communications and productivity tools, while gaining robust security, privacy and compliance controls. In this session, we will address how the Office 365 cloud platform is enabling:
Clinicians to extend the patient care experience and improve care team collaboration
Health IT staff to expand business capabilities and realize geo-replication for disaster recovery
Finance to reduce costs and smooth budgets
Organizations to improve productivity and protect Personal Heath Information (PHI)
Watch this webcast, now on-demand, to discover the basics of Office 365, learn about the scope of the service’s capabilities, hear industry and customer use cases, and gain an understanding of our HIPAA/HITRUST compliance capabilities.
Shawn Remacle, Director of Industry Engagement, Microsoft Health and Life Sciences
Shawn, based in Reston, VA, is responsible for shaping the industry conversations for Microsoft’s health sales team, working with partners to broaden the reach of Microsoft health solutions and supporting sales engagements by helping customers understand how their business, clinical and IT objectives can be met by using the Microsoft platform. For 10 years prior to working for Microsoft, Shawn was the Chief Information Officer at a multi-hospital, integrated health provider in North Carolina.
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Healthcare Staffing Agency Given An Opportunity To Grow
Business Needs
A healthcare staffing firm with about 20 employees had been with the same independent IT consultant since they were less than half that size. While the independent consultant did a great job supporting them in the early days, he was having difficulty keeping up with their day to day needs as they continued to grow. Things became even more difficult if he was out sick or on vacation. With improved economic conditions as well as new legislation for the healthcare industry, the client felt this would be the proper climate to grow their business. Although to make this a reality they would need guidance on what technology to leverage as well as a way to support their company as the number of employees continued to increase. They also wanted to provide employees access to work remotely from the office.
Solution
Managed Solution first partnered with the healthcare staffing firm by doing an assessment of their current environment while also taking on the responsibilities of the day to day IT support. The assessment provided the client insight to what was really going on in their network. A server that was thought to be only a year old was revealed to be over 4 years old, out of warranty, and approaching capacity. Also, it was not configured and patched properly which was the cause of some their daily challenges. What was also revealed was that their back-up solution had not worked properly for over a year. This was troubling due to compliance standards they thought were being met. Managed Solution was able to design and implement a new network infrastructure that would not only help them meet their HIPAA and Joint Commission requirements but also improve the way their employees were able to work together.
Success:
Managed Solution was originally chosen to partner with the client due to their growing demands for day to day IT support that were not being met. While this was addressed, the true benefit to the client was making them aware of why they were having challenges, both known and unknown, and providing them guidance to overcoming them. What is probably more exciting were the recommendations in technology that have helped them grow their business. After 1 year of working with Managed Solution, they were able to increase their staff by 25% because they know they now have a way to support them. With their continued success, they are now anticipating further growth by an additional 200% over the next 2-3 years.
