Innovation in Health
Care Delivery
Jonathan Wilt
AVP, Center for Innovation
Ochsner Health System

Ochsner Center for Innovation
 Created in 2013
 Tasked with going above and beyond
the typical, incremental optimization
of software systems and clinical
workflows
 Use the newest technologies to
innovate care delivery models
 Solve core business problems that
can be scaled system-wide

Ochsner Center for Innovation
New Orleans based Ochsner Health System, announced it is the first
Epic Systems client to successfully integrate its electronic health
record (EHR) with the new Apple HealthKit. Approximately 53 percent
of Americans have their medical records within the Epic EHR, and its
MyChart application is the most used patient portal in the United
States.
“In the past, we relied on patients to log information, bring it to us,
and then we would input the data and decide a course of action,”
said Robert Bober, MD, Director of Cardiac Molecular Imaging,
Ochsner Medical Center. “Now we can share information seamlessly
between patient and physician to allow real-time, accurate analysis of
a patient’s health status. This is ideal for patients with chronic
diseases such as heart failure, hypertension and diabetes.”
Ochsner Health System First Epic Client to Fully
Integrate with Apple HealthKit

innovationOchsner

innovationOchsner
• Our focus is to develop entirely new ways for healthcare providers to
dramatically improve the quality of care by managing patient
conditions more effectively
• We do this by innovating health care delivery models and partnering
with companies looking to revolutionize patient-centered care
http://www.innovationochsner.com/

But before we can innovate…..
• Ochsner is a growing health
system, and must be diligent
in designing a sustainable IT
infrastructure
• System-wide standardization
is critical to our ability to
innovate
Innovation
Speed and
Flexibility
System-wide
Standards

Integration is key
• Integration trumps best-of-
breed
• New products must able to
integrate seamlessly with
our hub EHR system, Epic

Maximizing our EHR
• We don’t want to spend
millions on add-ons when
our EHR can already do it
A scorecard of how effectively you’re using the system
Ochsner Health System
Ranked #1 in the nation

Where do we begin?

Necessity is the mother of invention.
The Republic, Book II, 369BC, Plato
& innovation

Healthcare Spending as a Percent of
Gross Domestic Product
17.7%
11.9%
11.6%
11.2%
9.6%
9.4%
9.3%
9.0%
7.9%
7.7%
7.4%0% 9% 18%
United States
Netherlands
France
Canada
Japan
United Kingdom
OECD Average
Finland
Hungary
Israel
South Korea
Source: OECD. http://www.vox.com/cards/how-doctors-are-paid/how-else-could-the-us-bring-down-health-care-costs#E5744046

3 6 4 1 5 2 7
4 7 5 2 1 3 6
2 7 6 3 5 1 4
6 5 3 1 4 2 7
4 5 7 2 1 3 6
2 5 3 6 1 7 4
6.5 5 3 1 4 2 6.5
6 3.5 3.5 2 5 1 7
6 7 2 1 3 4 5
2 6 5 3 4 1 7
4 5 3 1 6 2 7
1 2 3 4 5 6 7
$3,357 $3,895 $3,588 $3,837 $2,454 $2,992 $7,290
AUS CAN GER NETH NZ UK US
OVERALL RANKING (2010)
Quality Care
Access
Efficiency
Equity
Long, Healthy, Productive Lives
Health Expenditures/Capita, 2007
Cost-Related Problem
Timeliness of Care
Effective Care
Safe Care
Coordinated Care
Patient-Centered Care
Source: The Commonwealth Fund: Mirror Mirror On The Wall: How the Performance of
the U.S. Health Care System Compares Internationally 2010 Update
How the US Health Care System Compares Internationally

600,000
700,000
800,000
900,000
2008 2010 2015 2020
Demand Supply
Projected Supply and Demand,
Physicians (all specialties)
Physician supply not keeping pace with increasing demand for healthcare services
91,500
62,900
Source: AAMC Center for Workforce Studies, June 2010 Analysis

Major Epidemics in History

Bubonic Plague
1347-1350
>25 Million deaths
30-70% of the Population
Cholera
1817-1860 1865-1900
>50 Million deaths
10% of the Population
Influenza
1918-1919
>75 Million deaths
30-70% of the Population

CHRONIC
DISEASE
Today
75% of all Deaths
50% of the Population
CHRONIC
DISEASES
ACCOUNT FOR
3 4
DEATHS
OUT
OF

Chronic Disease
 75% of U.S. health care dollars goes to treatment of
chronic disease.
 Nation’s leading cause of death and disability causing
70% of all deaths.
 50% of all adult American have at least one chronic
disease.
 90% of seniors have at least one chronic disease, and
77% have two or more chronic conditions.
Median outpatient visit length is < 15 minutes covering a median of 6 topics
Source: Centers for Disease Control and Prevention. http://www.cdc.gov/chronicdisease/index.htm
BMJ 2013;346:f2614. http://transformativehealth.info/a-c-suite-view/patient-engagement-a-strategic-imperative-for-preventing-readmissions/
Tai-Seale M, et al. Health Serv Res. 2007;42:1871-1894. Gottschalk A, et al. Ann Fam Med. 2005;3:488-493.

Four Common Causes of
Chronic Disease
Health Behaviors
 Lack of physical activity
 Poor nutrition
 Tobacco use
 Excessive alcohol consumption
obesity
• diabetes
• hypertension
• heart failure
• coronary heart disease
• stroke
• cancer
• OSA
• atrial fibrillation
• hyperlipidemia
• gallstones
• back pain
• infertility
• skin infections
• gastric ulcers
Source: http://www.cdc.gov/chronicdisease/overview/index.htm

Projected Growth in Population with Chronic Conditions
2013-2025
Dall TM, et al Health Affairs 2013;32:2013-2020.

Adherence to Quality Indicators in Chronic Disease
Condition No. of Indicators
% of Recommended
Care Received
Overall Care 439 54.9%
Hypertension 27 64.7%
Heart Failure 36 63.9%
COPD 20 58.0%
Asthma 25 53.5%
Hyperlipidemia 7 48.6%
Diabetes mellitus 13 45.4%
Peptic ulcer disease 8 32.7%
Atrial fibrillation 10 24.7%
McGlynn EA, et al. N Engl J Med 2003;348:2635-45.

Last
Costs too high Poor quality
Modern day epidemic Receiving recommended care
Demand outpacing supply
What’s the Necessity?What’s the Necessity?

Factors Influencing Health Status
40%
15%
30%
5%
10%
Schroeder SA. N Engl J Med 2007;357:1221-8.
Environmental
exposure
Genetic predisposition

Factors Influencing Health Status
 Electronic Health Records
 Meaningful Use
 Core Measures
 Transparency
 HCAHPS, CAHPS
 HEDIS, SCIP
 Pay for Performance
 PACS
 Joint Commission, Leapfrog
40%
15%
30%
5%
10%
Health care
Health care
Schroeder SA. N Engl J Med 2007;357:1221-8.

Factors Influencing Health Status
Social Circumstances
 Living conditions (live alone)
 Transportation
 Access to care
 Medication affordability
 Social network support
 Education level
40%
15%
30%
5%
10%
Social
Circumstances
Health care
Schroeder SA. N Engl J Med 2007;357:1221-8.

Factors Influencing Health Status
40%
15%
10%
Schroeder SA. N Engl J Med 2007;357:1221-8.
Behavioral patterns
Social
Circumstances
Health care
Behavioral patterns
 Depression
 Medication adherence
 Social network influence
 Physician/Health-System perception
 Lifestyle: diet, activity
 Patient activation

Last
Costs too high Poor quality
Modern day epidemic Receiving recommended care
Demand outpacing supply
Not effectively targeting
behavioral patterns
What’s the Necessity?What’s the Necessity?

Focus on Chronic Disease Management
 Focus in 2014 and 2015 is chronic disease management
 Using the newest technologies available, target the 65% of contributing factors we
have control over – not just 10%
40%
15%
30%
5%
10%

Prioritizing Diseases
 Inpatient Readmissions - CHF
Elixhauser A (AHRQ), Steiner C (AHRQ). Readmissions to U.S. Hospitals by Diagnosis, 2010. HCUP Statistical Brief #153. April
2013. Agency for Healthcare Research and Quality, Rockville, MD.
26.1 25.7
24.2
0
5
10
15
20
25
30
18-44 45-64 65+
All-cause 30-day readmission rates for
congestive heart failure
Age

Prioritizing Diseases
 Outpatient diagnoses - Hypertension
Chronic Condition % of outpatient visits
Hypertension 27.0
Hyperlipidemia 15.7
Diabetes 15.1
Depression 12.4
Arthritis 10.2
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Congestive Heart Failure
 Targeted approach for all heart failure
patients including detailed screening
(i.e. depression, med adherence, etc.)
with dedicated HF nurses.
 Comprehensive OP monitoring with
HF care team
 Monitors daily weight for changes and
reaches out to patient to provide real-
time guidance and treatment.

Level 1: Guided Decision Support

Level 2: Assessments
 Affordability of meds
 Medication adherence
 Drug-drug, drug-condition interactions
 HF Quality of Life
 Depression screen
 Family / Caregiver support
 Transportation issues
 Education level / level of HF understanding
 Alcohol / drug use
 Dietary sodium quantification
In-depth evaluation and quantification of patient specific characteristics

Level 2: Interactive Assessments
Everything is completed by the patient on Windows tablets
 Patient scores high on sodium consumption
• “Who shops for your groceries”?
• “Who prepares your meals”?
 Patient views video on what high sodium
means and why it is important; shown what
foods are high in sodium and which foods
make better choices
 Individual(s) who shops for and prepares
meals sent email with literature and video
link

Level 2: Inpatient Intervention
 Pharmacy consulted for adherence/affordability
(+/- social worker). If unaffordable, 30-day supply
of meds provided at discharge.
 Psychiatry consulted for depression, drug/alcohol
addiction.
 Nutrition consulted for high dietary sodium intake.
 Social services for transportation, caregiver
support, home health services.
 Educated in heart failure disease state; use of
monitoring scale; cause and effect relationships.

Level 3: Outpatient home monitoring
metrics
scrubbed
thru
condition
specific
algorithms
patients
stratified
by risk
status
high risk
patients
intervened
by
medication
adjustment
and/or
outpatient
visit
X
potential
readmission
avoided

Relationship betweenImproved Care Coordination andReadmission in
Heart FailurePatients
0
5
10
15
20
25
30
35
40
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
%Readmissions
2012 2013 2014
14%
25%
Program

Hypertension
 Hypertension is the most common diagnosis made at primary care office visits.
 Most common chronic condition, affecting about 30% of US adults, with estimated
annual costs > $50 billion.
 Only half of patients with hypertension achieve BP control; the leading cause of
which is “therapeutic inertia” (86.9%).
Ranking Prevalence State
47 39.8% LA
48 40.2% MS
49 40.3% AL
50 41.0% W.Va
Roger VL, et al. Circulation. 2012;125(1):e2-e220.
Hsiao C, et al. National Ambulatory Medical Care Survey: 2007 Summary. Hyattsville, MD: National Center for Health Statiastics; 2010.
Margolis KL. JAMA 2013;310(1): 46-56.
Milani RV, et al. J Am Coll Cardiol 2013;62:2185-7.

Just as banking can be done outside the confines of a bank,
BP monitoring and management can and should be done at
home and in other nonclinical settings such as pharmacies
and community and senior centers. Out-of-clinic BP
monitoring with team care should largely replace
traditional office-based BP management for most patients.
Absent a contraindication to home monitoring, patients
should be provided with a validated BP monitor and BP
measurements should be transmitted to each patient’s
clinician, with follow-up patient-clinician communication
by telephone or by electronic visits, if necessary. If home
BP monitoring and team-based care were implemented
broadly, hypertension management would be easier for
patients, and the magnitude of BP reductions brought about
by this change could lead to substantial reductions in
cardiovascular events and mortality, which is something
patients, clinicians, and policy makers can take to the bank.

“Health Care 2020: Reengineering Health Care Delivery to Combat Chronic Disease,” by Richard V. Milani, MD, and Carl J. Lavie, MD (DOI:
http://dx.doi.org/10.1016/j.amjmed.2014.10.047). It appears in The American Journal of Medicine, Volume 128, Issue 4 (April 2015) published by
Elsevier

Home BP Telemonitoring: HyperLink Study
Proportion of Patients with Controlled Blood Pressure
Follow-up Telemonitoring Usual Care p-value
6 months 71.8% 45.2% <0.001
12 months 71.2% 52.8% 0.001
18 months 71.8% 57.1% 0.003
Margolis KL. JAMA 2013;310(1): 46-56.

Innovative Model for Care Delivery Going Forward
1. Utilizes non-physician providers of care that supports
physicians
2. Works in a “focused-factory” that can keep up with an ever
expanding knowledge-base and growing set of quality
measures
3. Assess, characterize, and potentially modify social
circumstances and behavioral patterns to enhance overall
health status
4. Exploit technology to its fullest in order to manage large
populations of patients efficiently (i.e. decision-support tools)
5. Monitor and “touch” patients remotely (just-in-time) resulting
in faster cycle-times for meeting goals and enhanced patient
satisfaction

Apple HealthKit, Withings, Fitbit
 HealthKit provides a standardized
platform for a variety of in-home
devices
 We can concentrate on the largest few
manufacturers for Android users
 Withings
 Fitbit
 This standardization is critical to remain
agile – we want more data but can’t
build custom interfaces to every future
device

 New data points from home
 Increased patient engagement
 Medication adherence
 Quality of Life
 Family engagement
 Level of understanding of diseases
 Dietary issues
What we look for in new technologies

New wearables
 Apple Watch may be able to facilitate
frequent, meaningful communications
between patients and care team
 Huge opportunity to create the next
wearable technology
 National Innovation Challenge: 2015
challenge involves wearable technology
concepts and/or mobile applications
that take a proactive and improved
approach to transforming healthcare
outcomes

Data integrity
 Hypertension Digital Medicine users are
required to have their own smartphone
 Devices cannot be linked to patients –
must initiate BP measurement from
your smartphone

Remember… Integration is key
• Integration trumps best-of-
breed at Ochsner
• New products must able to
integrate seamlessly with
our hub EHR system, Epic
• Open.epic.com

Questions??
Open Positions:
 User Support Specialist
 RN Clinical Care Coordinator
 Mobile App Developer
 Entry level analyst
www.Ochsner.org/careers