Friday, April 24, 2015

Very Cool New Product: Choosing Wisely with Stanson Health

I recently gave a presentation to a regional HIMSS meeting in Austin, Texas and in that lecture, I talked about "closed loop analytics"-- that is, presenting data in the workflow of decision making, such that the data optimizes the outcome of the decision. Amazon.com does it all the time to influenc our decisions when buying their products. I was lamenting our lack of closed loop analytics in EHRs to help inform and influence physicians and patients at the point of care.

In the audience of that HIMSS meeting was Kimberly Denney, Vice President at a company Stanson Health. She called me afterwards and said, "Hey, I think we have what you're talking about. I think we have closed loop analytics."  And so began my familiarity with Stanson Health.  I soon found out that Stanson was founded by Dr. Scott Weingarten, one of the most respected, nice, humble CMIOs in healthcare, and also the founder of Zynx. Cedars-Sinai is the development lab for Stanson Health, much the same as it was for Zynx before being sold to Cerner.

Stanson Health provides Epic health system users with targeted, real-time clinical decision support that notifies physicians when and where they need guidance most: at the point of care.  Using closed-loop analytics, Stanson informs clinical and technical stakeholders about specific provider ordering behaviors because monitoring provider adherence to evidence based guidelines is crucial in helping organizations reduce variation in care, reduce overutilization of high cost interventions, and safely improve care quality over time. 

Studies have shown that EHRs alone, without clinical decision support, have minimal impact on quality and cost of care. EHRs with the appropriate forms of clinical decision support, however, can have a substantial impact.  Imagine the power of having intelligent clinical logic embedded in the EHR that helps physicians make appropriate decisions at the point of care while substantially reducing waste from inappropriate or unnecessary care.  Physicians are 15 times more likely to adjust their decisions if presented with evidence-based data at the point of care, compared to seeing the same data off-line, in a clinical quality improvement meeting.

Leveraging the American Board of Internal Medicine’s Choosing Wisely® campaign, Stanson has transformed static societal guidelines into real-time, actionable CDS. What sets Stanson apart from other CDS vendors has been their dedicated approach to testing and refining each new piece of CDS in a live EHR environment. As part of a quality improvement initiative at Cedars-Sinai Health, Stanson clinicians have audited patient charts to validate the accuracy and positive predictive value of their rules.  Designed to be “fatigue proof” the Stanson alerts when triggered to a provider in the ordering workflow represent a patient-specific, evidence-based recommendation. With over a year’s experience at Cedars, Stanson has validated $4M in savings from reductions in ordering volume and cancelled orders for a number of imaging tests, labs, procedures, and medications. Reducing overutilization of Benzodiazepines in the elderly, for example, also translates into reducing patient harm by reducing the risk for falls, hospitalization, long-term care or possibly death.  

Stanson’s closed-loop analytics enable important insights for C-suite stakeholders on where their focus may deliver the greatest benefit and savings. Stanson knows every dollar invested in a provider using their CDS will be returned a minimum of 3-4X. As health systems move from fee for service to outcomes, Stanson Health’s solutions provide much needed guidance for that journey by enabling crucial conversations and the transparency needed to support physicians as they begin to compare their practice with their peers.

Stanson Health is providing specific and measurable ROI from their Choosing Wisely CDS, but they are also providing a general role model example of closed loop analytics at the point of care. Choosing Wisely is just the beginning.

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