Director, Emory Critical Care Center, Emory University

Timothy G. Buchman, M.D., Ph.D.

Director, Emory Critical Care Center,

Emory University School of Medicine

22

What makes hospitals “smarter”, What makes

patients “safer”, What makes outcomes “better”?

Emory Critical Care Center

Tim Buchman

2 APR 2015

33

● Emory Healthcare is a customer of various vendors that supply electronic

medical record software (Cerner Corp.), patient management systems (Philips

Corp.), data archiving software (Excel Medical Corp.), data analytic software

(IBM). I periodically attend user group meetings representing Emory

Healthcare and Emory University at Emory expense.

● I serve as an advisor to federal (e.g. NIH) and to not-for-profit non-

governmental organizations (e.g. The Moore Foundation and The James S.

McDonnell Foundation). In this advisory capacity, I review grant applications

and counsel directors and senior staff on trends in critical care medicine.

Honoraria, if offered, are either declined or contributed to Emory University.

● Some work discussed in this presentation has been funded by federal

agencies including CMS (as part of the Healthcare Innovation Award

program, 1C1CMS331041) and the Department of Defense (through the

Surgical Critical Care Initiative [SC2i]).

Disclosures Relevant To This Presentation

44

● The opinions expressed are strictly personal. They may or may not

represent the opinions and views of any organization or publication with which

I am affiliated.

● The contents of this presentation are solely the responsibility of the

presenter and do not necessarily represent the official views of the U.S.

Department of Health and Human Services or any of its agencies.

● The data presented here are based on analysis conducted by colleagues at

Emory. Except where noted, findings might or might not be consistent

with or confirmed by the independent evaluation contractor.

Disclaimers

55

The care of human life and happiness, and not their destruction, is the first and only object of good government.

--Thomas Jefferson,

3rd President of the USA

66

Not “smart”

77

Potentially Smarter

88

“Big” Data and Real-Time Analytics

99

Stream Computing in Intensive Care

Computing across dozens of streams per patient, dozens of patients

per ICU, multiple ICUs within a single hospital, multiple hospitals

within a healthcare system, and referencing archived (reference)

data.

1010

Visual detection of anomalies

10

1111

Smarter->Predictive Critical Care (BAASiC)

1212

Making patients safer

1313

Data -> Analysis -> Alerting

1414

Situational cognitive

errors are data based

and come in three

general types:

failure to receive/perceive

data;

failure to comprehend

data;

failure to accurately

project the

consequences of

decisions based on the

data.

Cognitive Error: Situational Level

Air Traffic

Control

eICU

(telehealth)

1515

• Present all information, options, outcomes in readily interpretable

form

Safer through presentation simplification

1616

● Conceived with a

population as the

focus of concern

● Distance from

perspective of

patients and families

“Better” Outcomes

emoryhealthcare.org

Emory eICU Results:Community-Centered Hospital

eRNs

eMDs

emoryhealthcare.org

Emory eICU Results:Community-Centered Hospital

emoryhealthcare.org

Emory eICU Results:Community-Centered Hospital

2020

President Franklin D. Roosevelt, 6 JAN 1941

In the future days, which we seek to make secure, we look forward to a world founded upon four essential human

freedoms.

• The first is freedom of speech and expression—everywhere in the world.

• The second is freedom of every person to worship God in his own way—everywhere in the world.

• The third is freedom from want—which, translated into world terms, means economic understandings which will

secure to every nation a healthy peacetime life for its inhabitants-everywhere in the world.

• The fourth is freedom from fear—which, translated into world terms, means a world-wide reduction of armaments to

such a point and in such a thorough fashion that no nation will be in a position to commit an act of physical

aggression against any neighbor—anywhere in the world.

That is no vision of a distant millennium.It is a definite basis for a kind of world attainable in our own time and generation.

2121

no patient or family

should fear an

error that will

culminate in a

preventable harm

1. Freedom from harms

2222

no patient or family

should experience

unnecessary pain

or misery

2. Freedom from suffering

2323

no patient or family

should experience

unnecessary

disability and the

burdens of

dependence on

self and loved

ones

3. Freedom from disability

2424

no patient or family

should fear

impoverishment

related to the cost

of care and

treatment

4. Freedom from healthcare impoverishment

2525

Where do we go from here?