Prism Group's first proposal for funding - v0.08

1. PRISM Group
Re-Admission Prevention agents
customize post-discharge RED Care
Plans by searching each EMR
Dan Corwin, Architect,
Lexikos Corporation

2. solution overview
High level solution –
PRISM uses a portable Daily News web app to help mine the EMR of
each patient, especially its notes. It seeks specific "clinical conditions
of interest“ cited in RAP Policies, and alerts caregivers to them.
Our challenge goals -
1. “Train" this app to alert intelligently about serious patient discharge
conditions causing poor outcomes, then help a discharge specialist to
extend a “RED Care Plan” so it custom-counters all their effects
2. Extensions should engage the patient on such condition-specific
threats, tap his external support network for help on them, and arrange
for after-discharge patient surveillance measures when required.
Healthcare and business problems addressed
Rapidly improve patient outcomes for serious discharge conditions and
quickly reduce high re-admission rates for client departments.

3. “RAP Policies” drive searches
PRISM regularly compares
all RAP Policies approved
by the hospital with the
EMR of every in-patient.
Matches suggest Chapters
of a Discharge Guideline,
customized to that patient

4. usability and design – part 1
Our PRISM search agents run 7/24 behind institutional firewalls, automatically
analyzing EMRs for all patients scheduled for certain types of departmental
medical exams or procedures.
Basically, the agents monitor each EMR for possible future problems, to be
systematically sought as part of pre-defined departmental policies.
When any authorized user reviews in PRISM’s Daily News display the EMR of
a patient scheduled for a covered procedure, that display may raise visual
warnings. If so, it also offers to “justify" those alerts by using browser-based
links to the specific medical records it noticed as relevant.
Our background EMR searches routinely save busy caregivers time, and
sometimes they point out specific medical issues or hazards which the
caregivers did not expect – a valuable RAP service.

5. Policy alerts drive Care Plans
Alerts are set
Pharmacy for the patient
Therapist support
Family network
others

6. usability and design – part 2
For pre-discharge patients with serious illnesses, optimum use of PRISM
technology may require a trained "discharge specialist“, whose patients can
get specially encouraged and motivated and trained to stay healthy.
By clicking on visual alerts from Daily News, a "discharge specialist“ can
quickly locate RED Care Plan “chapters" pre-customized to each patient’s
special conditions. Then s/he can quickly configure each such chapter by
using embedded web forms designed to help handle its specific threat.
Better patient education is a central goal of providing each RED Care Plan
chapter. PRISM lets this goal be realized more quickly and effectively by
using semi-standard EMR searches and RED Care Plan “chapters"

7. usability and design – part 3
 Executable partner applications, even if simple, can help out
enormously by making the basic Care Plan suggested by PRISM
more effective. It is shared data that helps integrate and unify
caregivers, the patient, and her external support network.
 Through NetDelivery, key external supporters and caregivers can get
copies of the Care Plan extensions to help unify patient support. To
make it seem interactive, active reminders for the patient or her
support network can be easily scheduled.
 If scheduled, HealthBotz applications can implement pro-active
patient surveillance as necessary through lab test result graphing,
tracking mobile medical devices, monitoring prescription refill, and
social media questions and alerts directed to various human
supporters.

8. development stage
PRISM’s main EMR search engine is highly functional, and its
browser-based Daily News UI works okay for simple alerting. Both
parts are being polished. So are our main partner applications.
1) NetDelivery runs as a co-process inside the hospital and
helps with EMR imports and web-based document transport
2) HealthBotz runs in the cloud. It handles remote access to
Internet services and devices, plus care plan assembly
RAP Policies and related Chapters of care plan documents for
specific discharge conditions are the main artifacts still needed.
Each is merely XHTML – a pair of web pages that effectively
summarize the “standard of care” for one condition, phrased and
configured to directly control all the other elements above
.

9. integration description
 Allscripts Care Management suite runs under the ASP model - up in the
cloud. You can already access many forms of data on each patient there,
even EMRs from competing systems.
 Your suite seems the host PRISM really needs to establish good RAP
Policies, and your Care Management suite in turn would benefit from
PRISM’s executable components – it seems an easy, two-way fit.
 Like an HIE, your suite could readily use and/or redistribute our RAP
Policies & PRISM search agents. It can also support PRISM “follow-up”
agents with medications-tracking software agents for patients.

10. Go to Market Plans – part 1
 PRISM intends to beta test our working system for improving
discharge procedures in Q2 at hospitals now using NetDelivery.
 Candidates are not yet chosen, but one major selection criteria is
that each one did poorly on a recent CMS evaluation for excess re-
admission rates in Heart Attack, Heart Failure, and/or Pneumonia
discharges. We will work with each beta department's "discharge
specialist" to quickly affect meaningful and measurable changes
 The specific RAP Policy Set we add to each departmental beta
site, plus its semi-automatic aggregation into new local executable
Care Plans, will be driven by local need, then steadily tested and
refined. Before we end beta testing, we expect each customer’s
re-admission rates to improve significantly.

11. Go to Market Plans – pt 2
Once our RAP Policy Set is better developed, we hope to find regional
groups and Health Information Exchanges who will use it as well, and who
help us to distribute our PRISM code into the regional hospitals using them.
Success seems likely, because state plans such as RARE (MN) have
already strongly advocated such systematic programs for improving
discharges. We are working with others like DHIN (DE) to refine our PRISM
design model
Post-beta pricing for RAP search agents and policies is now estimated for a
medium sized hospital at $10,000 per discharge type, plus Daily News
install fees, with a 20% annual support charge for ongoing enhancements.
If in 2013 we get even 100 hospitals buy in, every type of re-admission rate
we improve should return PRISM revenues of $1 million. This, plus the
healthcare cost savings, seems ample to financially justify development

12. Our video demo shows how
RAP Policy web pages work
http://www.youtube.com/watch?v=7W2VtkLa1F
PRISM runs 7/24 as a background “expert” system. It analyses
each scheduled EMR and suggests needed RAP Policies.
Daily News screens show visual alerts, but parts are still in
coding. So are Guideline screens, plus HealthBotz screens.
Both will come from our DataBotz UI partner, whose concurrent
proposal shows Care Plan chapters configured for “diabetes” .

13. Why select PRISM RAP agents
to lower Re-Admission rates?
 PRISM's 7x24 semantic analysis of clinical notes could offer Allscripts some
subtle new powers in Care Management. Because PRISM works from
textual notes and standard medical vocabulary, it is at core mostly EMR-
vendor-agnostic. We will search whatever notes might get imported
 By using us as a supplier of PRISM searches and related RAP Policies (just
as our HIE distributors will), Allscripts could quickly offer text mining alerts
and "executable” RAP Care Plan extensions that really succeed.
.
 But Allscripts could do all this on the national scale, not regionally. Give
PRISM a chance to move ahead by funding us; and we'll return the favor.