2. Clinical Decision Support moves into the world of Prescriptive Analytics and finally takes root
The delivery of scalable, patient centered, evidence based clinical decision support (CDS) to entire populations has been viewed as one of the “Holy Grails” of health tech. This promise has led to a score of CDS companies being built on the way to creating a $500M market for CDS solutions. But given the universal appeal for CDS in the addressable market of providers and payers, some would argue that the opportunity has been largely undershot. In the following paragraphs, I’ll attempt to make the case for why 2017 is the year that CDS solutions begin to overcome their previous barriers and finally take root in the market through incorporation of big data and cognitive commutive resources.
It is estimated that up to 50 percent of medical care for chronic conditions does not adhere to evidence-based medicine/guidelines (EBM). This statistic is compounded by the fact that 86 percent of all US healthcare costs are a result of complications of chronic disease. When analyzing the high prevalence of non-EBM in chronic conditions such as cardiac disease, diabetes, and renal disease, its generally accepted that systematic adoption of patient centered EBM portends improved outcomes and potential cost savings.
CDS 1.0 saw the health tech industry simply digitize long lists of clinical guidelines into workflow tools. A common tech manifestation of this trend was the “order set.” Order sets are essentially checklists or protocols that direct a clinician to order certain tests and medicines when they encounter a patient with a certain clinical condition (e.g. A CHF or COPD order set). A notable company from this era was Zynx Health, co-founded by CDS Veteran and Cedars Sinai Chief Clinical Transformation Officer Dr. Scott Weingarten. Zynx was ultimately bought and sold twice, first by Cerner, and then subsequently to Hearst Media. Criticisms of this first wave of CDS companies was a lack of patient-centeredness. The guideline-based recommendations did not change from unique patient to the next, which led to providers decrying one-size fits all “Cookbook” medicine.
I would contend we are starting to see CDS 2.0 with early stage companies pioneering the relative new trend of Prescriptive Analytics. These new entrants are combining predictive population health analytics with that of evidence based guidelines and compiling these data sets to make patient-centric recommended interventions pertinent to a patient’s current condition. This new wave of CDS companies are using virtual data warehousing, natural language processing, and Cognitive computing to incorporate disparate data sets, determine causative factors and predict outcomes.
There are a handful of next generation CDS companies that are attacking varying elements of the care spectrum using the prescriptive analytics strategy. In the Care Management space, an exciting early entrant is the stealthy, NYC-based HealthReveal, founded by Dr. Lonny Reisman. Prior to seeding and starting HealthReveal, Lonny served as chief medical officer of Aetna after his start-up Active Health was acquired by Aetna for $400M. HealthReveal is predicated on the ability to identify individuals in a population who are not receiving evidence-based care, then recommending evidence-based interventions, called “Reveals,” to the responsible clinician or care manager. Two other notable players in the care management space are venture-backed Lumiata (Khosla, Intel, Sandbox) and Atlanta based Jvion (Eastside). Led by CEO Ash Damle, an MIT trained data scientist, Lumiata company is pioneering the use of AI to identify populations that are at highest risk of adverse clinical outcomes, and directing care management through the codification of the world of clinical evidence. Jvion is harnessing their cognitive clinical success machine to serve a variety of use cases from preventing readmissions to driving success in value-based payments.
Two companies that are exclusively focused on CDS at the patient bedside through integration with Providers’ EHR and ordering systems are Stanson Health and PeraHealth. Stanson Health (Cedars Sinai), co-founded by previously mentioned Scott Weingarten is a continuation of his work at Zynx. Stanson attempts to reduce low value and unnecessary care by pinging clinicians with context-driven alerts and prompts at the point of care. PeraHealth (Mainsail) provides real-time CDS tools that are based on the Rothman Index: a validated clinical measure of patient condition/stability based on 26 independent variables. With an installed base of 80 hospitals, PeraHealth helps clinicians better predict and anticipate transitions in care, readmissions, and morality.
There are a host of large legacy players who will continue to speak to the opportunity in clinical decision support, most notably the large EHR Vendors (EPIC, Cerner, Allscripts, Athenahealth) as well as HCIT stalwarts (IBM/Watson, Optum). Given the platform nature of these companies, it is likely that they will be acquirers of these next gen CDS models that will continue to come to market in 2017.