Mathematical Modeling Meets Disease Prevention

5 Key Elements For Clinical Decision Support Systems

Intermountain Healthcare, based in Salt Lake City, will use Archimedes' IndiGO decision support tool to help reduce patients' risk of developing serious chronic diseases and to pick the best interventions to head off major events like a heart attack or a stroke. Intermountain joins several other healthcare organizations, including Kaiser Permanente, which piloted IndiGO, in using the mathematical modeling approach to prevention.

IndiGO will be among an array of applications, some homegrown and others acquired from outside vendors, that Intermountain will use to reengineer its healthcare delivery system with the help of a $9.7 million government grant. This is one of 107 Health Care Innovation grants, totalling $896 million, that the Department of Health and Human Services recently announced.

One of the largest healthcare organizations in the West, Intermountain includes 23 hospitals and 185 clinics in Utah and southern Idaho, as well as a health plan that covers nearly a third of its patients. Over the years, it has gained a reputation for innovative approaches to quality improvement and has been a pioneer in health IT.

Intermountain received the HHS award to "test a new care delivery and payment model" that relies heavily on IT. The project, which will incorporate a shared savings model and, possibly, some downside financial risk, is expected to save Medicare and Medicaid more than $67 million by 2015.

Intermountain is very confident it can achieve this seven-fold return on investment, said Lucy Savitz, MD, director of research and education at Intermountain's Institute for Healthcare Delivery Research, in an interview with InformationWeek Healthcare.

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"If you're more effectively treating patients in outpatient settings because of shared decision making and other tools you have in place, you'll prevent unnecessary ED visits and hospital admissions," she pointed out. In addition, she said, the new approach will help Intermountain revamp its care processes so it can do a better job of managing population health.

The IndiGO tool from San Francisco-based Archimedes derives its power from algorithms based on mathematical modeling of large public databases. These include Kaiser Permanente data and information from the National Institutes of Health and long-running studies such as the Framingham Heart Study.

When a patient comes to a physician office, IndiGO is applied to the information in his or her electronic record. Based on that data, IndiGO can assess the risk of a patient having a heart attack or a stroke, developing diabetes, or acquiring some other chronic disease over the next five years. It also ranks the interventions that could be used to reduce that risk in order of their potential benefit to the patient.

Intermountain will use some of its grant money to expand IndiGO to include depression, Savitz said. The reason is the strong correlation that Intermountain's research and other studies have found between depression and other chronic conditions. Patients with congestive heart failure and diabetes, for instance, are often depressed, she noted.

"We try to treat patients holistically, and if you want to effectively treat patients and have them be compliant with the care for their medical condition, if you're not treating the mental health condition, you're not treating the patient," she said.

Intermountain's tightly integrated system and advanced EHR, which was internally developed, are what makes it possible to undertake this project, Savitz added. "We're not starting de novo. We're building on a strong track record and on strong information systems that will allow us to monitor and track effectively what's happening." Intermountain's bold experiment, she said, "can serve as an important model for the country in terms of being able to show what's possible."

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