Novel interoperable platform at Intermountain Health provides real-time clinical decision support to help providers make better diagnoses and treatment plans for patients
Medical informaticists at Intermountain Health have developed and implemented a novel and interoperable technology platform that hosts real-time clinical decision support tools to help medical providers use evidence-based medicine, algorithms, and artificial intelligence (AI) apps which aid them in making more precise diagnoses and treatment plans for patients at the bedside.
“This advanced approach to using data builds on the strong culture of innovation we foster at Intermountain Health. Patient care is often complex and very personal. This gives providers another tool to help them give patients the best, individualized care possible and helps ensure the right decision is being made at the right time,” said Craig Richardville, chief digital and information officer at Intermountain Health.
The first application that Intermountain Health is using on this new platform is an updated version of the ePneumonia app, which was first used in 2011. This updated app is currently being used to help emergency department clinicians enhance the diagnosis and treatment of pneumonia patients at Intermountain Medical Center in Murray, Utah.
The benefits of how the Intermountain ePneumonia app has already significantly helped save patients’ lives by getting them the right antibiotics sooner and ensuring they receive the appropriate level of care, was shared in a series of studies in peer-reviewed papers.
“In the studies, we demonstrated a 36% relative decrease in 30-day mortality for pneumonia patients, which is more than 100 lives saved annually. We observed 17% increase in outpatient disposition from the emergency department and increased the use of antibiotic best practices,” said Nathan Dean, MD, section chief of pulmonary and critical care medicine at Intermountain Medical Center and principal investigator of the studies.
Intermountain Health has other apps for other medical specialties and diagnoses planned that will also run on the new platform. The platform is unique in the way it was developed and versatile in its capabilities and potential uses.
This real-time, FHIR-enabled platform is truly interoperable; it can be used with the major vendors of electronic health records (EHRs), and it allows clinicians to securely read from and write directly to the medical record in real-time. It does this by operating outside of the EHR and using a common standard healthcare language called Fast Healthcare Interoperability Resources or FHIR.
“The platform has the capability to effectively perform and represent complex clinical processes and enables more rapid development of both clinical and business workflows. This will help create a more seamless experience for patients,” said Kathryn Kuttler, PhD, FAMIA, advanced decision support director at Intermountain Health.
“This ePneumonia app is one of the most complicated apps to build, as there are more than 50 data elements that go into diagnosis, assessment of illness severity, and decision making for patients with pneumonia,” said Dr. Dean. “Published pneumonia care guidelines have been historically difficult to follow at the bedside and have a complex workflow.”
According to Dr. Kuttler, the foundation of the platform is a standards-based, workflow engine that integrates a variety of services including:
FHIR-based read and write services which securely read from and write to the EHR in real-time
Publish and subscribe event processing, which continuously updates the workflow engine as new test results are added to the patient’s medical record
Imaging services — chest images are interpreted by an AI, deep neural network
Diagnostic services are executed by an AI, Bayesian network
“Every Intermountain Health hospital or urgent care in seven states will eventually be able to access this platform and this app and future apps. And both technologies could be used by other health systems as well,” said Richardville.
“Our user-friendly ePneumonia app identifies and displays critical data for clinicians to help them make complex decisions. It calculates the patient’s likelihood of pneumonia and objective severity of illness measures. It recommends microbiology tests, guides the choice of antibiotic treatment, and recommends if the patient would be best treated in a hospital, clinic, or is well enough that they would rest and recover best at home,” said Dr. Dean.
Clinicians use the data from the app – along with the information and nuances they’ve gathered during their visit with the patient – to help them determine the best course of treatment. The ePneumonia app alone, has broad applications.
“There are an estimated six million cases of pneumonia in the United States each year and 4.2 million emergency department visits. At Intermountain Health there are approximately 5,000 pneumonia cases seen in our emergency department every year and 6,500 cases in our urgent care locations,” said Dr. Dean.
“At Intermountain, we have always innovated, and we are ahead in many ways, especially in the transition to value-based care. This novel platform and the ePneumonia app are both tools that really align with what we’re doing generally in value-based care: to diagnose people earlier, improve patient safety and quality of care, with the simultaneous goal to reduce healthcare costs,” said Diego Ize-Ludlow, MD, chief health information officer at Intermountain Health.
About Intermountain Health
Headquartered in Utah with locations in seven states and additional operations across the western U.S., www.intermountainhealth.org is a nonprofit system of 33 hospitals, 385 clinics, medical groups with some 3,900 employed physicians and advanced care providers, a health plans division called SelectHealth with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs. For more information or updates, see https://intermountainhealthcare.org/news.