Beyond health

information exchange
as we know it: From
disease to health
Titus Schleyer, DMD, PhD
Presented by:

Hosted by:

What well cover

Does the health care system keep us
healthy?
How could a learning health system
keep us healthier?
How can we work together to
achieve this vision?

What health care used to look like

http://www.ancient-origins.net/history-ancient-traditions/ayurvedic-medicine-traditional-knowledge-life-india-has-enduredpassage-020647

 and what it looks like

today:

Copyrighted image

Does this system keep us

healthy?
We spend $3+
trillion on
healthcare
(2014).

Does this system keep us

healthy?
We spend $3+
trillion on
healthcare
(2014).
Our health
indicators are
worse than in
much of
developed world.

Does this system keep us

healthy?
We spend $3+
trillion on
healthcare (2014).
Our health
indicators are
worse than in
much of developed
world.
Hoosiers rank at
the bottom.

Indiana is #41
low per capita public health
funding (#48)
high levels of air pollution (#47)
high prevalence of smoking (#44)
high levels of obesity (#44)
cancer deaths (#42)
child immunizations (#42)
preventable hospitalizations (#42)
physical inactivity (#41)
substance abuse challenges

What makes us healthy

Medical care
influences 10% of
our health.
Clinicians know
very little about
your behavior,
environment or
genetics.
But, we spend a
lot on medical
services.

How can we use big data

to make and/or keep us
healthier?

How medicine treats you

George Hripcsak et al. PNAS 2016;113:7329-7336

Facts per Decision

The end of the brilliant

physician
1000
Proteomics and
other
effector molecules
100

Functional
Genetics:
Gene expression
profiles

10

Structural Genetics:
e.g. SNPs, haplotypes

Human
Cognitive 5
Capacity

Decisions by Clinical
Phenotype
1990

2000

2010

2020

Stead&Starmer, Beyond expert-based practice, IOM 2008

The Learning Health System

is

one in which progress in science,

informatics, and care culture align to
generate new knowledge as an
ongoing, natural by-product of the care
experience, and seamlessly refine and
deliver best practices for continuous
improvement in health and health
care. (Institute of Medicine, 2011)

Care
improved

Clinical
questions
answered

Clinical encounter
generates patient data

Learning
Health
System

Data captured in
EHR

Data extracted
Copyright T. Schleyer 2016

How can we work together

to achieve this vision?

The
Indiana
Network
for Patient
Care
(INPC)

Thank you!

and many others.

Health Data Sources

Value-Added Services

What is HIE?
Hospitals

Hospitals

Physician
Offices

Physicia
n Offices

Physician

Health Information Exchange

Labs / Imaging
Centers
Patient

Labs / Imaging
Centers

Physician
Public Health

Physician

Payors

Outpatient Rx

Data
Repository

Applications

Public Health

Payors

Data
Stewardship

Researchers
Copyright 2015 Indiana Health Information Exchange, Inc

www.ihie.org

The INPC by the numbers

> 13m unique patients (over time)
Answer questions like:
27.5m registration events

Who is sick from

> 4b discrete results
what?
> 1.7b clinical observations
Where are they?
> 840m encounter events
Why are people
> 580m claims observations
sick?
(procedures, prescriptions, etc.)
What interventions
118m text reports
have worked and
> 2.5m emergency department
visits per
how well?
year from over 100 Indiana hospitals
> 2m new transactions/day

IT
IS
!
G
I
B

INPC content

Case study 1
Maximizing the utility of
precision medicine at the
population level using EHR
data

Case study 2: Population EHR Data for Assessment at the Local Level
(PEDAL)

Case study 3: Improving

population and clinical health
with integrated services and
advanced analytics
Data included in most
prediction models

What we are adding

Social Determinants of Health Model by Braveman et al (2011) Annu. Rev. Public Health, 32:381-398

Traditional risk prediction modeling.

Individual risk score

Claims &
EHR
Diagnoses & Utilization

(high utilization)

ith m
Algor

Support for this presentation was

provided by the Robert Wood Johnson
Foundation through the Systems for
Action National Coordinating Center, ID
73485.

Our project expands to the social determinants of health

Claims &
EHR

ith
Algor

Diagnoses & Utilization

Financial assist.
referral risk score
Behavioral health
referral risk score
Dietician
referral risk score
Social work
referral risk score

www.citygalleryindy.org

Area resources
Living conditions
Social context
Safety
Transport

Additional health behaviors

Utilization at other providers

nationswell.com

Neighborhood risk behaviors

Chronic diseases

Thank you! Questions, comments?

Thanks to Chuck Friedman (UMich), John Kansky (IHIE),

Josh Vest (FSPH) and Brian Dixon (RI) for help with the

Regenstrief Institute
@titusschleyer, @RCBMI
schleyer@regenstrief.org

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