Temporal Analytics and IntegratedReal-time Predictive Modeling for

Value-Based Care

How to Effectively Create and Apply Actionable Intelligence

Becker’s Hospital Review July 28, 2016

Business Intelligence ≠ Big Data

• Actionable insights • Timely• Measurable• Demonstrably Predictive

(‘looks around the corner’)

Business Intelligence Requirements

Temporal Analytics(Temporalytics™)

Temporal Analytics(Temporalytics™)

• What?• How? • Where?• Why?• WHEN?

Temporal Clinical Response Profiles

GMP = 12 hrs

Temporalytic Methodology

Time

0

Act

ivat

ion

Clinical Issue

• Leverages metadata derived from actions and outcomes

• Provides tighter cause and effect analysis to determine optimal outcomes & cost effective care

• Approach is versatile, can be used on financial, clinical and operational outcomes

Goal: GMP = 6 hrs

New GMP = 6 hrs

LOS: -1.2 DaysSavings: $6M

Prior GMP = 12 hrs

Time

• Narrows variability of clinical response times, and moves the response mean up the curve

• Approach is versatile, can be used on financial, clinical and operational outcomes

Temporalytic Methodology-Meaningful Outcomes

Organism-Antibiotic Mismatch Rule Analysis

VigiLanz BI Temporalytics® Analytics

Organism-Antibiotic Mismatch Rule

• The Organism-Antibiotic Mismatch rules identify potential organism-antibiotic mismatches

• The first discovery of an organism for a patient will trigger an activation of this rule. The rule engine will monitor the activation to ensure that the patient is on an antibiotic to which the organism had tested susceptible.

• An alert will be delivered after 24 hours (GMP) has elapsed following the rule activation if an appropriate antibiotic order has not been seen

• Period: 15 months

Rule Acknowledgement Rates

Activations

acknowledged

Activations not

acknowledged

Total

activations Acknowledged %

Site 1 2,098 482 2,580 81.3%

Site 2 1,108 1,920 3,028 36.6%

Site 3 676 845 1,521 44.4%

Site 4 398 558 956 41.6%

Site 5 632 366 998 63.3%

Site 6 547 395 942 58.1%

Total 5,459 4,566 10,025 54.5%

Responsiveness to activations

0

10

20

30

40

50

60

70

Site 1 Site 2 Site 3 Site 4 Site 5 Site 6

Perc

ent

of

tota

l act

ivat

ion

s

Acknowledgements occurring more than 24 hrs after rule activation

Day of week effect

0

12

24

36

48

60

72

Sun Mon Tue Wed Thu Fri Sat

Ho

urs

ela

pse

d: a

ctiv

atio

n t

o a

ckn

ow

led

gme

nt

Average time between rule activation and acknowledgment

All acknowledged cases Cases acknowledged within 72 hours

Day of week effect, by site

Median LOS vs acknowledgment delay

Median LOS vs acknowledgment delay, by site

Work Shift Effects: Hour of Day Activations

Acknowledged > 24 hr: 1,467 x $23601 x 1.5 = $5,193,180 Not acknowledged, > 24 hr: 4,710 x $23601 x 1.5 = $16,673,400

1. Becker’s Hospital CFO, May 19, 2015 (adjusted to 2016 USD)

Financial Impact

Temporal Analytics

• Universally applicable• Actionable• Timely• Measurable

Real-Time Predictive Modeling

Sepsis Use Case

Sepsis:

It has been repeatedly proven that theearlier the intervention and treatment,the better the clinical and financialoutcomes.

Temporalytics® Predictive Model: Sepsis

Admission Severe Sepsis Dx(Infx + Organ Dysf)

ICU admit ICU discharge

T0 = 0 Tsepsis= Max(Tinfx, Torgan dysfn)

Discharged/

Expired

Age, BMI, History,

Comorbidities

Vitals & Labs

Goal: Predict before

onset of Severe

Sepsis

General Models (SIRS, qSOFA)

SIRS Criteria vs. VI Prediction

SIR2 (-) SIRS2 (+) Total

Severe Sepsis (-) 1,954 730 2,684

Severe Sepsis (+) 20 139 159

Model (-) Model (+) Total

Severe Sepsis (-) 2,410 274 2,684

Severe Sepsis (+) 18 141 159

• Sensitivity: 87%

• Specificity: 73%

• Sensitivity: 89%

• Specificity: 90%

B

B

A

A

B

C

C

C

C

Patient

Hour 1

Hour 4

Hour 8

16%

PPV

34%

PPV

VigiLanz Temporalytics®SIRS Criteria

Pat

ien

t C

are

Op

tim

izat

ion

ClinicalInsights

OutcomeAssurance

Actio

nab

le In

tellige

nce

Insigh

ts

OperationalInsights

New Insights for Sepsis ID & Tx

Sepsis Prediction Model

Data

+

AdvisoryServices

VL Clinical Intelligence

Business Intelligence

EHR

- Claims- Discharge- Billing- Unstructured Data

- Patient Info- VigiLanz Mobile- Social

Sepsis Early Warning

Model

Dx Rules

At risk Population

Identification Refinement

TherapeuticRules

Real-TimeReassessmentResponse to

Tx

Clinical Intelligence

Sepsis: Real Time Predictive Modeling

Real Time Sepsis Predictive Modeling

Positive Predictive Value: 48.5%

4-6 hours in advance of SIRS/qSOFA