The COVID-19 pandemic has widened the income gap which has long existed between US hospitals. A few conglomerates rake in profits and grow, while hundreds of frontline and critical access hospitals lose money while treating most of the poor and vulnerable. In today’s surrealistic crisis–where hospitals and clinics cut wages and teeter on bankruptcy even while they emerge as the most critical institutions in society–it becomes more important than ever to identify areas of high expenditures and forecast future needs. A health IT start-up named Innovar Healthcare is trying to cull the crucial information hospitals and clinics need.
I talked about Innovar’s approach to highlighting needed changes with founder and CEO Loyd Bittle at his Montgomery, Alabama headquarters. The service is currently in beta testing in two locations.
The thrust of Innovar’s service is to present health care administrators with dashboards based on real-time data that help planning. These dashboards might show which departments are spending the most, where utilization of resources is inefficient, and where the demands on the institution are increasing or shrinking. The following figure shows a typical chart.
The service takes place in two stages. The first is Lightswitch, which Bittle calls a cloud-based message clearinghouse. Despite the term “clearinghouse,” Lightswitch is nothing like the unlamented Health Information Exchange (HIE) of earlier decades. It doesn’t try to slurp up and store all the information from a hospital, but to monitor new information and extract only what it needs to run its calculations.
The relatively recent FHIR standard, being a modern API, allows Lightswitch to request particular fields from EHRs and financial systems. However, Lightswitch can also handle systems that stick to older formats such as CDAs, HL7 version 2.X, and even simple comma-separated value (CSV) files. Hospitals have many disparate systems, but Lightswitch can take relevant data from each and store it in an internal format that makes cross-comparisons possible.
The second stage is an analytical engine named Illuminate, which create the charts. The number-crunching required here is pretty simple: sums, averages, and so forth. It’s nice to see a company that finds value in simple operations and doesn’t boast about the use of machine learning. Bittle explains that because their calculations are so simple, they can present real-time data, whereas many analytical engines require many hours to produce ouput. A manager can check the dashboards once or more a day on their cell phone and start to make changes to the organization based on the most recent insights.
I asked Bittle whether clients could design their own dashboards. He said that they don’t currently allow that, but have identified graphs that will be valuable to a wide range of institutions and offer those in the dashboards. Typical statistics shown include census (number of patients in beds at the time), average length of stay, the volume of medications ordered, and the number of outpatients seen. They can even geolocate patients to provide insights through heat map visualizations.
Innovar is working toward a statistical model that will predict what will happen and what the hospital will need 30 to 90 days out. It occurred to me that such a service could be useful when a sudden change hits the environment. As hospitals grappled with COVID-19, for example, they made major adjustments like converting hospital wings for COVID-19 patients, setting up screening facilities in their parking lots, and of course moving to telemedicine. A good prediction tool could be invaluable for such needs.
An even more sophisticated service Innovar is planning to develop would compare different health care systems. If your cardiology patients are taking three days longer to recover than the average in nearby hospitals, you’d like to know that.
Bittle expressed some frustration at information that current hospital systems don’t provide. For instance, Innovar could think of useful charts that bring nurse utilization into the calculations, but hospital systems don’t provide that information in a way a service such as Innovar can consume.
Innovar runs on Amazon.com’s AWS cloud, but bases its service on open source software, such as the PostgreSQL database. Bittle developed a respect for open source software back in the 1980s and worked for a long time at Mirth, an open source provider of Health Exchange software. He still feels that free and open source software are the most trustworthy foundation for a service.
Pricing for Innovar will be simple. You pay a flat monthly fee based the number of endpoints from which the service collects data. All upgrades and new services are included in this fee for the life of the contract.
Normally, I prefer to write about services that improve patient experience and care, rather than services that focus on financial changes. Innovar, although focusing on financial issues at the start, has the potential to improve with patient care as well. And right now, as we’re all reminded that hospitals are businesses (something the administrators have always known, even at non-profits), I’m happy to see the prospect of financial help as well.
This article is part of the #HealthIT100in100