The problem we solve: Health information exchanges (HIEs) aggregate patient data across health organizations within a given geographic region. Information in HIEs can be incredibly helpful to a physician providing care for a patient, because it often adds important data that are not available in the physician's electronic health record (EHR). However, the physician typically must access these data using a separate workflow outside of the usual process of reviewing patient data in their EHR, without assurance that any meaningful data will actually be found. This makes trying to retrieve HIE data inefficient and cumbersome.
About our solution: Using the Fast Healthcare Interoperability Resources (FHIR) standard, our innovation retrieves and aggregates the most clinically relevant data (in our first implementation regarding chest pain) from an HIE, and presents it to the clinician within their EHR (in our case, Cerner) in an easily consumable and efficient format.Progress to date:
The initial target audience for our innovation in emergency medicine are physicians who treat patients with chest pain. Because time is a precious resource in the emergency department (ED), enabling the timely and efficient review of the most pertinent data available is highly valued. When pitching the software to emergency physicians, we have received overwhelmingly positive feedback. Currently we are building the product in collaboration with the Indiana Health Information Exchange (IHIE), and we will be starting a pilot of the software for emergency physicians in December with Indiana University Health. They are the largest healthcare organization in Indiana and our pilot location is Methodist Hospital which boasts one of the busiest emergency departments in the state.
Creator: Matthias Kochmann
Bio: Dr. Matthias Kochmann is a pediatrician and clinical informatics fellow at the Regenstrief Institute in Indianapolis, IN.
Title: Clinical Informatics Fellow, Pediatrician
Advanced Degree(s): DMD, PhD
Clinical Informatics Fellow, Emergency Medicine Physician, MD
Biography: Dan Seitz, MD, is an emergency medicine physician and clinical informatics fellow at the Regenstrief Institute in Indianapolis, IN. He received his MD from Washington University in St. Louis and is a proud graduate of the Indiana University Department of Emergency Medicine residency program.
Title: Clinical Informatics Fellow, Emergency Medicine Physician
Advanced Degree(s): MD
Research Scientist, Regenstrief Institute, DMD, PhD
Biography: Titus Schleyer, DMD, PhD, is Professor of Biomedical Informatics and a Research Scientist at the Center for Biomedical Informatics at the Regenstrief Institute (http://www.regenstrief.org), as well as Professor of Medicine, Department of Medicine, Indiana University School of Medicine. He holds DMD degrees from the University of Frankfurt, Germany, and Temple University, Philadelphia, as well as a PhD degree in molecular biology from the University of Frankfurt and an MBA degree in Health Administration from Temple University. Dr. Schleyer has been active in biomedical informatics research since 1989, conducting seminal research on electronic dental records and Internet applications, and workflow and human-computer interaction in dentistry. Dr. Schleyer was a co-director of the Biomedical Informatics Training Program of the School of Medicine, University of Pittsburgh. He founded the Department of Dental Informatics at Temple University, as well as the Center for Dental Informatics at the University of Pittsburgh. Dr. Schleyer's informatics research is primarily funded by the National Institutes of Health. He co-directs (with Dr. Brian Dixon) the Public & Population Health Informatics (PHI) Fellowship at Indiana University.
Title: Research Scientist, Regenstrief Institute
Advanced Degree(s): DMD, PhD
Our innovation will help patients by beginning to tear down barriers to efficient patient data access across healthcare facilities. By allowing physicians to access health information exchange data in addition to a patient's hospital-specific chart, our product enables patients to feel less constrained to a single healthcare system for all of their care. Additionally, patients can feel more at ease that the most important parts of their medical record are readily available to any physician delivering their care.
Physician satisfaction with electronic health systems is at an all-time low, and a key contributor to this is a sense that the physician spends more time sitting in front of her computer than she does talking face-to-face with her patients. Our innovation amplifies the signal over the noise in reviewing a patient's medical history and past results, allowing the physician to have more time with the patient, and improving the odds of seeing that test result in the history that changes the clinical workup or clinches the diagnosis.
Hospital systems are constantly challenged to balance quality of care, patient safety, patient and clinician satisfaction, and the responsible use of resources. Our innovation leverages existing patient data to give clinicians in a healthcare institution more useful data in a shorter amount of time to allow them to make more informed decisions about appropriate patient care. It saves clinician time and effort, and thus makes healthcare institutions more efficient. In addition, it reduces the waste of resources on repeat or unwarranted testing; mitigates unnecessary admissions that stem from lack of data; improves provider satisfaction; and, most importantly, improves patient safety by enabling access to a more complete medical history.
MedStartr and its partners are focused on healthcare, and our innovation offers the opportunity is to support a truly transformational approach to healthcare interoperability. While healthcare interoperability has been a focus of the healthcare system for a long time, we have not mastered its challenges. Our implementation of the Fast Healthcare Interoperability standard to "knit together" granular information from multiple health IT systems in order to support clinical care and workflow in a provider-centric way offers a truly new approach for how physicians work. Plus, it has the potential to improve information access across the spectrum of healthcare.
Key Milestones Achieved and Planned
We have been working on the conceptualization of our project for several years. In April 2017 we launched a software development pilot project with three partners: the Regenstrief Institute, the Indiana Health Information Exchange and Indiana University Health (IUH). A 15-person team is currently working on the implementation of a minimum viable product, with rollout scheduled for December 4, 2017. Concurrently, Dr. Schleyer is working with a postdoctoral fellow in public and population health informatics on designing and executing an evaluation study. After December 4, 2017, the project will go into Phase II, in which we will develop a robust production application during the subsequent 12 month. This application will be rolled out to all 20 emergency departments with in IUH and increase the number of clinical conditions which we support.
Our Competitive Advantages
Our innovation benefits from a competitive advantage that is not easily duplicated: a FHIR interface to the country's oldest health information exchange, the Indiana Network for Patient Care, which has significant population coverage (66.7% of all Indiana citizens are represented in the INPC). We also have significant software engineering expertise in building FHIR interfaces and applications, as well as biomedical research and evaluation expertise. At the moment, commercial competitive projects (such as Commonwell and Careeverywhere) are far less granular and much more cumbersome to use than our app.
Barriers to Entry
Our technology is currently proprietary and we are deploying it in a setting that is not easily duplicated. The expertise for design, engineering and deployment that we have accumulated is fairly unique and not easily replicated.
Traction, Funding and Partners
Dr. Schleyer has been funding this work in part from discretionary research support funds. Other partner organizations, such as the Indiana Health Information Exchange and Indiana University Health, are making in-kind contributions. At the moment, we have not received any outside funds.