These increased costs are a detriment to hospital margins and drive up patient bills, which is a problem when 530,000 families turn to bankruptcy each year because of medical issues and bills. 30% of medical debt is due to the costs of a recent inpatient stay. Also, a previous eReport found that these specific wasteful behaviors predict 47% of provider spending variation. Clinicians now must care for their patients clinically and attend to the financial consequences, a new modern day iatrogenic sequela of clinical decision making.

Avoiding Alert Fatigue

Founded by numerous physicians and healthcare leaders, IllumiCare is grounded with great empathy for provider cognitive load, bandwidth and autonomy. While we have valuable proprietary content, much of our technical work has gone into what not to say and when not to say it. With about 100,000 clinical users and having real-time analysis of over 5 million hospital admissions, we have tracked user responses when we “nudge” in their workflow with our content. This dataset has allowed us to build models to predict the context of patient attributes, provider attributes and other circumstances when it is most impactful to present our content to a user (and also to avoid the interruption if less likely to spark a behavior change).

Clinical Specificity

Clinicians respond to our guidance because IllumiCare monitors many real-time clinical indicators for appropriateness. Consider the sodium bicarb example above, where we filter on the latest pH value (<7.2), creatinine (>1.5) and/or a diagnosis of acute kidney injury. There are times when the use of expensive tests or medicines is clinically warranted. We emphasize when expensive options are used outside their clinical indication (which happens too frequently).

While hospitals have existing programs for pharmacy and lab review, it is very laborious for humans to review every order’s appropriateness. Instead, IllumiCare collaborates with key stakeholders so they can review and modify our rules and then allow our technology to intervene at the point of decision. Our data analytics (and peer comparison dataset) facilitate upstream changes (formulary, orderset, etc.), and our nudges drive downstream behavior change.

CDS Hooks as the Delivery Mechanism

The “5 rights” of clinical decision support (CDS) are: the right information, to the right person, in the right format, through the right channel, at the right time in the workflow. Over the past 18 months, we have developed and launched an optimal way to deliver our content - using a CDS Hook invoked OurPractice Advisory (OPA) when a user signs an order in Epic. The app is now available in Epic Connection Hub.

There is an Implementation Guide and Turbocharger to ease implementation. It uses a grouper (VCG) that establishes which medications or services initiate the external CDS web service call. IllumiCare has separate real-time data feeds and knows the diagnoses, lab results, imaging results, clinical notes, medications, indwelling devices, dietary status, etc. of every patient in the hospital. IllumiCare also knows every provider, their specialty, their historical utilization and spend on every medication and service (compared to peer benchmarks), their propensity to order send-out labs, advanced imaging on day of discharge, etc.

From this body of knowledge about the patient, the ordering provider and the circumstances, IllumiCare decides whether to present an OurPractice Advisory in the ordering process. If an alternative is presented, it uses a preference list (LPF) to populate the options. All of the content undergoes prior approval by the health system. A sample: