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Advanced Lab Analytics for Patient Blood Management Programs
L. Eleanor Herriman, MD, MBAMarch 23, 2016
L. Eleanor J. Herriman, M.D.,M.B.A.
• Physician executive with 20 years of varied healthcare experience• Former faculty member at Harvard Business School’s Institute for
Strategy and Competitiveness • Market research and strategy services to the pathology and
laboratory industries at G2 Intelligence• Healthcare strategy consulting at Bain & Company
Education• Pathology training at UCSF• Doctor of Medicine degree from Baylor College of Medicine• Presidents Scholarship with honors in Neurology, Psychiatry and Neuropathology• Masters in Business Administration from Harvard University Graduate School of Business
Administration as a Baker Scholar
Chief Medical Informatics Officer
Agenda
• The Blood Utilization Problem
• Blood Management Programs
• Role of Analytics in Blood Management
• Viewics Insights for Blood Management™
The Blood Utilization Problem
“Blood transfusion is far riskier than what people believe, and is responsible for billions in wasted healthcare dollars every year.”
- Aryeh Shander MD, Clinical Professor of Anesthesiology, Medicine and Surgery, Icahn School of Medicine at Mt Sinai, New York
The Blood Transfusion Problem
Transfusion Utilization Opportunity
Past Guidelines Wrong
Wide Variation in Ordering
Over-utilization
Creates Harm and Costs
• Higher Hemoglobin (Hgb) triggers
• 2 Units +
Slow adoption of new guidelines
Harm beyond transfusion reactions
Overutilization Problem
Inappropriate Transfusions
Appropriate52%
Inappropriate 48%
U.S. Units Transfused (millions annually)
Appropriate Inappropriate
Morbidity and Mortality Impact
26%
20%
36%
56%52%
14%
0%
10%
20%
30%
40%
50%
60%
Hospital Mortality
Total Mortality
Rebleeding Acute Cor Syn
Pulmonary Edema
Bacterial Infections
Source: National Blood Collection and Utilization Survey Report, DHHS;; and Tim Hannon and Rishi Sikka, Wall Street Journal, Jan 15, 2015. Source: Salpeter SR et al. The Am J of Med 127(2), Feb 2014
Variation in Transfusion Usage – 345 Hospitals
8
$1M in savings per hospital for joint replacement transfusions
Blood Management Programs
“A Restrictive Blood Transfusion Approach is Best Practice”- Society for the Advancement of Blood Management
Standard guidelines transfusion trigger = 6-7 g/dl
Higher threshold guidelines for transfusion = 7-10 g/dl
The American Board of Internal Medicine’s Choosing Wisely campaign had every organization submit five “do nots” Number (3) states:
“Avoid transfusion of red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms of active coronary disease, heart failure or stroke.”
3 Types of Blood Management Programs
• Multidisciplinary Team• Decision support• Feedback/reports
• Cross-facility• Anemia and hemostasis management• Transfusion management• Informatics• Patient-centered
1. Restrictive Guidelines
• Hgb of 7• “One & Done”
2. Restrictive Blood Program
3.Patient Blood Management
Joint Commission PBM Certification
What’s in it for my hospital?
• Risk reduction in fewer adverse events and incidents• Improved patient outcomes• Reduced hospital stays, readmissions, and lengths of
stay• Ensuring blood availability for those most in need• Optimized care for those who may need transfusion• Fostering collaboration throughout the hospital• Providing a competitive edge in the marketplace• Enhanced staff recruitment and development • Cost savings
Blood Management Program Success
• Implementation of an anemia management program that resulted in a reduction of red blood cell transfusion by 62%
• A 25% reduction in hospital stays for non-transfused vs. transfused patients
• A 47% reduction in the odds of death and 50%reduction decrease in total hospitalization costs after cardiac surgery
• A hospital’s first year of implementation expenses for blood decreased $510,000
Benefits of Reducing Transfusion Overutilization
Cost Savings from 30% Reduction in Transfusion of Blood Products
Improved Outcomes from 30% Reduction in Transfusion of Blood Products
Source: National Blood Collection and Utilization Survey Report, DHHS;; and Tim Hannon and Rishi Sikka, Wall Street Journal, Jan 15, 2015.
0
0.5
1
1.5
2
2.5
3
Low End Estimate of Savings High End Estimate of Savings
U.S. Savings from Blood Costs ($B annually)
50,000 lives saved200,000 wound complications averted
8M fewer patient in-hospital days
$1.5B
$2.5B
Transfusion Savings for Hospitals
$250
$1,000
$7,055
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
Costs per Unit Additional Hospital Costs for Transfused vs. Nontransfused Patient
Acquisition Transfusion LOS, Hospital-acquired complications, Mortality
Source: G2 Intelligence
Adverse EventDecrease in AE Dueto New Guidelines
Rebleeding 36%
Acute Coronary Syndrome 56%
Pulmonary Edema 52%
Bacterial Infections 14%
Decrease in % of AE’s Resulting from New Restrictive Transfusion Guidelines
Hospital Size 400-500 Beds Cost Savings $$
Rebleeding $131,721 $60,592
Acute CoronarySyndrome $455,544 $255,105
Pulmonary Edema $1,101,120 $572,582
Bacterial Infection $989,333 $138,507
Total $2,677,719 $1,026,786
Costs and Savings Per AE for Mid-Size Hospitals in 2011
Premier Healthcare’s Recommendations
Source: “Best Practices in Blood Utilization.” October 2012. Premier Healthcare Alliance.
1. Using a multi-disciplinary blood stewardship team2. Working collaboratively with clinicians and supply chain
executives to explore alternative products and procedures3. Establishing and implementing evidence-based transfusion
guidelines4. Providing education and clinical decision support tools to inform
clinicians of guidelines in real time5. Developing processes to monitor adherence to guidelines and
provide feedback to clinicians6. Monitoring utilization on an ongoing basis while measuring the
impact of improvement
requires analytics
Department Position/Specialty Total No. Representatives
Hospital Administrator Chief Medical Officer 1
Blood Bank Director Laboratory Manager 2
Blood Vendor Director 1
Pathology Director 1
Pathology Residents 1+
Biomedical Engineering 1
Pharmacy 1
Risk Management 1
Clinical Services 14
(1 Physician + 1 Nurse from each specialty)
Anesthesia
Emergency Medicine
Surgery
Cardiothoracic
Intensive Care Units
Trauma
Medicine/Hematology
Pediatrics/Neonatology
Nursing Nursing 3
Perioperative Nursing
Nursing Education
Total 26+
Model for Transfusion Committee Membership
Case Study: UPMC’s Total Blood Management Program
Implement Evidence-based Transfusion Triggers
Clinician CPOE Alerts
Monthly Utilization Reports
Minimize Preop Autologous Donation
Preop Anemia Optimization
Intraop POC Hgb Testing
Role of Analytics in Blood Management
Analytics for Blood Management – Key Uses
Blood Bank Operations
• Inventory management• Productivity • Acquisition and waste
Clinical Utilization Analytics
• Peer comparisons / reports• Pattern and outlier detection• Manager dashboards
Decision Support / Alerts
• Link transfusion decisions to prior Hgb levels
• More complex rules by clinical setting
• Early identification of anemic patients before elective surgeries
Monitor Blood Use
• By patient, clinician or service line• Real-time and by any time range • Measure impact of programs
Blood Program Analytics Capabilities
1. Link required data sources – blood, lab, clinical
2. Automates analytics with minimal labor
3. Supports multi-disciplinary program / users
4. Delivers in real–time
Case Study: UPMC’s Total Blood Management Program
Analytics for Pre-op Anemia Management
• When patient is scheduled in the system for elective surgery, computer searches for most recent hemoglobin
• If patient is anemic, preoperative anemia alert goes to surgeon and PCP• Identifies anemic patients before surgery & sends automated email or fax to surgeon/PCP
• Allows physician to treat anemia before surgery• Shown to reduce transfusion rates
Viewics Insights for Blood Management™
Viewics Insights for Blood Management ™
Analytic Visualizations, Dashboards, Alerts
Blood Bank Operations
• Inventory management• Productivity • Acquisition and waste
Clinical Utilization Analytics
• Peer comparisons / reports• Pattern and outlier detection• Manager dashboards
Decision Support / Alerts
• Link transfusion decisions to prior Hgb levels
• More complex rules by clinical setting
• Early identification of anemic patients before elective surgeries
Monitor Blood Use
• By patient, clinician or service line• Real-time and by any time range • Measure impact of programs
Viewics Blood Product Waste Management
Inventory Management – Track Product Availability
Blood Bank Supply Management
Physician Variation in Blood Utilization Within One Medical Unit
Percent of PatientsWith Transfused RBCs(# Units / Patients)
Physician Variation in Blood Utilization Across Hospital Units
Percent of PatientsWith Transfused RBCsby Hospital Unit
Physician Blood Utilization Variation Over Time
Percent of Patientswith Transfused RBCs
Utilization Management by Hemoglobin Guidelines
Summary
• Excessive transfusion utilization is a widespread problem, associated with high rates of morbidity, mortality and avoidable spending
• Evidence-based restrictive guidelines and blood programs can change clinician usage patterns and generate significant clinical value
• Analytics systems employing blood bank, lab and clinical data are critical to successfully implementing these blood programs
• Viewics Insights for Blood Management™ represents one such solution– Optimization of blood bank resources– Interventions for physician utilization
Want to follow up?
Contact Dr. Eleanor Herriman
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