Dedalus offers integrated response to healthcare journey
by David Pare
DC4H Platform delivers evidence-based insights and interoperability
The healthcare journey is never linear, and the information needs of each part of the journey vary based on the situation and the stakeholder. What doesn’t change is the need for clear, complete, integrated and coordinated healthcare data that transcends the walls of individual institutions.
To best support the healthcare journey, a digital platform must understand the different needs of each stakeholder. Doctors are looking to make decisions on future treatments for their patients. Researchers want to identify patients for a clinical trial. Hospital CEOs or chiefs of medicine want to predict and anticipate which patients are more likely to be readmitted so they can act accordingly to prevent that from occurring. A nurse working in a care coordination centre wants to be notified if a patient at home with a serious condition such as congestive heart failure has encountered an adverse event so she/he can act and prevent an emergency. Patients and carers want clear oversight of their data and records for greater engagement in their own care.
To achieve these objectives and provide patients with a cohesive care experience, healthcare organisations are increasingly leveraging digital tools and services as they seek real-time visibility into the wider health system to meet the needs of their patients.
Meeting the needs of patients and providers
The needs of the healthcare industry, providers, and patients are at the heart of what Dedalus is about. The DC4H platform is built with clear objectives in mind – to enable users to integrate and ingest data across disparate applications, to link datasets, to gain evidence-based insights about populations, and to support clinical workflows across organisations.
Dedalus’ vision for integrated healthcare is best represented by a six-pillar approach that connects and builds on the capabilities delivered by one another, while also functioning independently so the organisation can start where maximum value can be delivered.
HOW DO I GET TO THE PATIENT DATA I NEED?
DC4H Pillar One: Integrate
Healthcare stakeholders need access to data about their patients in order to make the right decisions. The challenge, however, is that the data required to support decision-making is not easily accessible, does not use common terminology, and is held in disparate systems.
DC4H’s Integrate pillar connects fragmented data across disparate applications, making it easier to manage high volumes of complex data. It does this by mapping data items using industry standards, including HL7 version 2 and Fast Healthcare Interoperability Resources (FHIR) to allow users to integrate multiple systems and hundreds of different sources of data. This approach enables the organisation to continue to use existing systems and evolve their application landscape rather than carrying out a rip-and-replace strategy.
Integrate pillar in action
During the COVID-19 outbreak in March 2020, Dedalus was asked by several hospital systems to set up and implement a primary care process dedicated to COVID-19 assessment and follow-up. This meant gathering, connecting and integrating data from different systems and workflows. The result was a control centre dashboard to provide physicians with an overview of their patients’ status, progress, and conditions.
HOW DO I COMBINE AND VIEW ALL RELEVANT DATA FOR MY PATIENTS?
DC4H Pillar Two: Ingest
The next big challenge for healthcare stakeholders is how to ingest data about the patient from multiple source systems – provider, payer, IoT-sourced data, etc. – into the integrated care record. DC4H’s Ingest pillar provides a single source for storing ingested data, creating an integrated and coordinated care record that provides a full picture of patients’ clinical and administrative data.
Having a single store to hold data ingested from multiple source systems and normalised to an industry standard provides users with a full picture of the patient’s clinical and administrative data. A terminology engine supports coding and terminology normalisation during data ingestion. The data quality is also assessed to ensure anything ingested from other sources is of value to the end user. The platform uses FHIR as the canonical data format and uses standardised terminology sets such as SNOMED-CT, ICD and LOINC for mapping. The aggregated data can be securely shared with other internal and external systems and applications, for example Apple Health, via standard APIs.
Ingest pillar in action
A region in Italy with a population of 5.8 million people asked Dedalus to set up a primary care process to assess and follow up COVID-19. Assessment information was collected from patients, primary care physicians and other sources and ingested into a control centre dashboard providing an overview of patients’ health status. The result was regional longitudinal integrated care records that enabled physicians to manage cohorts of patients beyond the walls of the hospital.
HOW DO I MAKE SENSE OF THE DATA?
DC4H Pillar Three: Index
Having a single source for capturing integrated care records is just one step in the journey to making sense of the patient record. The next is to make sense of the data. Through “semantic linking” of the datasets, clinicians can ask relevant questions and extract specific data – for example, users can find all the data on male patients over age 55 with both COPD and hypertension in a specific city, region or country.
This addresses the longstanding challenge for healthcare data analysts caused by data being organised and coded in different ways depending on the system from which it originated – for example, the hospital EMR may use SNOMED-CT to code a health condition while a GP system may use an ICD-10 code.
Index pillar in action
Dedalus worked with a hospital in China to not only integrate with systems from different vendors and transfer data between systems, but to provide decision-makers with a holistic view of clinical documents, with different encounters and episodes related to one patient displayed on a single page. Furthermore, by putting all aggregated data into a single standard repository (i.e. the integrated care record), then analysing and offering visual presentations of the data, users were able to gather insights for better decision-making.
HOW DO I USE RELEVANT DATA TO TRACK TRENDS AND PREDICT FUTURE RISKS?
DC4H Pillar Four: Insight
Healthcare decision makers want data not only to support point-of-care decision making but also to find information that will help them support their patients’ healthcare journey or predict health outcomes, such as which patients are most likely to be readmitted to hospital.
The DC4H Insight pillar provides analytics and evidence-based insights about populations as well as the health of individuals to support care planning. Components including an insights workbench, analytics workbench and analytics hub support visual investigative analysis of data for the generation of actionable insights and care planning. Organisations can use the hub to execute their own AI models while the adapters allow data to be taken from the integrated record for use in third-party machine learning solutions. Results from multiple machine learning or AI models can be integrated into a common dataset for analysis.
Insight pillar in action
During the COVID-19 pandemic, it became important to be able to safely and securely connect patients with primary care physicians, while ensuring patients with COVID symptoms self-isolated to contain the outbreak. A large region in southern Italy turned to Dedalus to develop a solution that would enable primary carers to connect with patient via telemonitoring to assist them with self-care and self-assessment. In less than a month, Dedalus rolled up the customised DC4H platform for COVID-19 assessment and follow-up, integrated with the existing regional health infrastructure. Through the solution, primary care physicians now have access to a control centre dashboard where they receive an overview of their patients’ status, progress, and conditions as well as COVID-19 test results for their patients.
HOW DO I NAVIGATE THE DATA TO MAKE DECISIONS ?
DC4H Pillar Five: Inform
To improve decision-making, healthcare stakeholders need to be able to more easily navigate the relevant data. DC4H’s Inform pillar provides evidence-based insights about populations and individual health, enabling investigative intelligence on the data in the longitudinal patient record through navigable dashboards and visualisations.
The inform pillar of DC4H allows any healthcare professionals to access and visualize a patient’s clinical information via a powerful “optical layer” to display clinical information available on DC4H, either in the form of clinical documents or finer-grained clinical data sets from ingested resources.
Inform pillar in action
A hospital system needed a solution to monitor patient demand by specialty and turned to Dedalus’ DC4H platform for assistance. The result is a solution that allows the hospital system to gather data from different sources, enabling administrators to see bottlenecks in the system, such as longer-than-expected lengths of stay, an increase in the number of patients who left without treatment, staffing mismatches and more. This has helped the hospital system to determine the most critical areas on which to focus service improvement efforts.
HOW CAN I TAKE ACTION WHEN THERE IS CRITICAL INFORMATION ABOUT MY PATIENTS?
DC4H Pillar Six: Intervene
To bring healthcare decision-makers full circle with the objectives to improve outcomes, one last piece of the journey is knowing when action needs to be taken. Stakeholders, therefore, need a solution to alert them or notify them when to act.
DC4H’s Intervene pillar uses a set of defined business rules and automated processes, through notifications or alerts, to offer an action based on what is actually happening. Examples include a large influx of patients in the emergency department or a crisis with a heart patient in another ward. Automated workflows, carried out by the Insights pillar, monitor real-time data coming into the integrated record and can alert or notify clinicians when interventions are required or overdue.
Also integral to enabling healthcare intervention is the ability to connect third-party applications through an open application ecosystem using DC4H Public APIs (based on HL7 FHIR). This, combined with automated workflows, puts actionable and real-time insights directly into the hands of the clinicians or hospital staff, notifying them to go and do something.
Intervene allows clinicians to visualise an event and provides them with an intervention based on clinical decision support best practices. For example, in the case of a patient with chronic heart failure, the Intervene Pillar could be leveraged to monitor if a patient’s weight increases by more than a X kilograms on the same day with a rule that triggers an alert to a clinician or care coordinator to act and prevent an unnecessary hospital admission.
Intervene pillar in action
A UK mental health organisation that acts as a hub for referrals to tier 2 and child and adolescent mental health services (CAMHS) faced challenges with incomplete referrals. Clinician time was being wasted gathering missing information in order to assess referrals while demand for services was continuing to rise. The organisation needed an integrated digital solution that could be tied to local liaison work to best target CAHMS resources.
Dedalus provided the organisation with a portal that was built in conjunction with service users and local schools, including a differentiated interface to provide additional information for parents, teachers and care professionals. The solution also enables the organisation to expand its liaison with local schools to reach more at-risk young people. The solution also includes an online referrals, analytics and recommendations engine and self-help app, which is now being expanded to adults.
As the healthcare industry looks to gain more real-time access to and insights from the vast stores of data and information about patient care, the ability to integrate data from a wide range of healthcare sources, to aggregate that data, and create an open, interoperable, agile platform environment that connects assets will become increasingly important.
Clinicians need to be able to clearly view and interpret data that helps them understand their patients and how they interact with a healthcare provider or organisation; they need to be able to collaborate with other providers to ensure their patients receive the best, integrated care across the healthcare ecosystem; and they need to ensure the data captured beyond a healthcare practice – data from internet of things, wearable medical devices and more – are incorporated into the discussion for a truly patient-centric engagement.
About David Pare:
David Pare is an innovative thinker with 20 years of experience in business and technology management consulting, helping organizations through their digital transformation. At Dedalus, David is the global portfolio director for the ConnectedCare solution. Previously, he was the chief technology officer for DXC Technology’s Healthcare and Life Sciences in Australia and New Zealand.