It’s been a big year in healthcare technology. Healthcare Analytics News^™ reached out to experts across our 8 coverage areas to determine which companies, people, and projects made the biggest waves. The winners of 2017 ushered in advances that have turned heads, resulted in measurable improvements, and given reason to believe that this high-speed sector is not built on hype alone.

Big Data: Montefiore Medical Center

Numbers can save lives. The traditional relational database in place at Montefiore Medical Center, Albert Einstein College of Medicine, in Bronx, New York, has been dredged out and filled in with the center’s innovative semantic data lake project, to plumb the depths of predictive analytics.

Parsa Mirhaji, MD, PhD, associate professor of systems and computational biology and the director of clinical research informatics, Albert Einstein College of Medicine and Harold and Muriel Block–Institute for Clinical Translational Research, described the new approach to HCA. “This is a collaboration between Montefiore, Intel AI, and healthcare groups to purpose-build scalable data management platforms for AI [artificial intelligence] in healthcare,” he said. “The data lake—big data technology—is being built from the ground up using AI to support AI in healthcare at scale.”

Semantic Data Lake uses deep learning and machine learning to move from prediction to the prevention of hospital conditions like sepsis and respiratory failure, Mirhaji explained. The technology can help target interventions to ward off heart failure and spinal cord compression, he added.

The first pilot project to use the new data architecture for  automated predictive and preventive approaches was conducted in 2017. That effort identified high-risk patients in need of critical, time-sensitive intervention. Automated assessment of the continuous monitoring of patients on prolonged ventilation alerted clinicians to those patients with a 70% or greater likelihood of suffering an adverse ventilation event, and it did so 48 hours before a fatal episode or respiratory failure.

Mirhaji said the new capacity for accessing and deriving actionable information from vast amounts of data will not only expedite monitoring and treating patients but also facilitate the logistics of providing care in complex healthcare settings. These areas include, he said, “optimizing appointments and [emergency department] utilization, malpractice, clinical errors, and a wide spectrum of financial system optimizations.”

Cybersecurity: Scripps Health and Risk Manager Scot Copeland

The medical information technology (IT) network at Scripps Health, in San Diego, California, has hardened security around its networked medical devices through collaborative solutions facilitated by the network risk manager, Scot Copeland. The scale of the challenge is daunting: With 10 to 15 networked medical devices such as physiologic monitors and infusion pumps per bed, a typical 500-bed hospital could have 7500 linked devices.

In June 2017, a month after the global WannaCry ransomware attack, Copeland addressed the Association for the Advancement of Medical Instrumentation’s annual conference, describing the need to foster teamwork between IT and information security, in addition to the importance of eliciting business associate  agreements with vendors, developing computerized maintenance management software for asset tracking, and establishing access control policies.

In his presentation, Copeland emphasized the importance of  establishing relationships between medical device managers and IT. “They own the network, and a lot of the things that we need to do to manage the security of our medical devices has to be done  by them,” he said.

At Scripps Health, Copeland has ensured that IT knows the networked, electronic, protected health-information capabilities of the medical devices. His department involves IT in the due diligence and technical reviews on new medical equipment and systems for vulnerability, privacy issues, and other risks—including work with the Center for Medical Interoperability in an ongoing assessment of the capabilities of Scripps Health to implement the voluntary consensus 80001-X standards.

David Jamison, executive director, Health Devices Group, ECRI Institute, told HCA that Scripps is renowned for its cybersecurity efforts, sharing his experiences in the trenches. “Scripps Health has promoted the inclusion of clinical engineering in dealing with medical device cybersecurity, and they have been pioneers of early adoption of the IEC 80001 standards,” Jamison said.

Precision Medicine: Oncology Center of Excellence 

The Oncology Center of Excellence (OCE) was established within the FDA’s Center for Drug Evaluation and Research in 2016 in response to Vice President Joe Biden’s national Cancer Moonshot initiative.

Richard Pazdur, MD, director of the OCE, said the group  emulates both academia and cancer care centers, “which are increasingly organized in multidisciplinary models to enhance collaboration, which is so essential when confronting a complex disease like cancer.”

In May 2017, the FDA acted on the data review by OCE-affiliated staff through both its Priority Review and Accelerated Approval procedures to grant the first approval of a cancer treatment based on a common biomarker rather than the location in the body where the tumor originated, Barbara Parker, MD, professor of medicine and medical director, University of California,  San Diego, Moores Cancer Center, told HCA.

The approval is supplemental to the previous approval of the product for treating several specific cancer types. Sanjeeve Bala, MD, an oncologist and acting clinical  team leader at the FDA, further characterized the new approved indication: “This is the first approval in what we’re calling a tissue-agnostic setting. That is, the indicated population is chosen by prior treatment history and a set of molecular markers instead of the conventional approach of using the histological tissue of origin.”

The Accelerated Approval procedure applied to the first approval, pembrolizumab, was established for drugs to treat serious conditions for which there is an unmet medical need.  Bala indicated that clinicians now have a tool to consider for patients with microsatellite instability-high and mismatch repair-deficient tumors. “These patients should have disease progression following standard therapies known to confer clinical benefit for their disease,” he said.

Telehealth: Avera eCARE and Mercy Virtual Care Center

Communication technologies and mobile assessment and intervention tools are increasingly being used to provide a range of healthcare services, including preventive and lifesaving treatments for patients who live far from their healthcare center.  

Of the many organizations now embracing telemedicine and mobile health technologies, 2 are notable for their scale and innovative approaches, which extend the expertise of their multidisciplinary teams to patients across large geographic regions: Avera eCARE in Sioux Falls, South Dakota, and Mercy Virtual Care Center in St. Louis, Missouri.

Peter Yellowlees, MBBS, MD, a professor of psychiatry at the University of California, Davis, and president of the American Telemedicine Association, described the particular contributions of these centers.

“In the world of telemedicine, a major issue is integrating and scaling telemedicine and the use of other clinical health technologies into routine care,” he said. “Many health systems around the [United States] are starting to move in this direction, [but the 2 winners are] outstanding examples of large multistate health systems that have really committed to virtual care and the provision of online consultations and remote monitoring as a core component of routine clinical care.”

Avera eCARE’s services extend beyond the Avera Health system locations in South Dakota, North Dakota, Minnesota, Iowa, and Nebraska to reach patients in Montana, Wyoming, and Kansas. The centralized virtual hospital hub, called the eHELM, is staffed around-the-clock with telehealth responsive physicians, pharmacists, and nurses.

Current pilot projects include telehealth suites within business facilities to allow employee  access to urgent care and within schools to expand the traditional “school nurse” capabilities and presence. In another project, consumers can access Avera providers 24 hours a day for live, online video visits through their mobile device.

The Mercy Virtual Care Center opened in 2015 to extend telehealth services throughout the 4-state region of Arkansas, Kansas, Missouri, and Oklahoma. The 4-story, 125,000-square-foot building has been described as a hospital without beds, as the staff monitors, treats, and interacts with patients who  often remain out of a hospital because of the program. One  component of its outreach, an “engagement at home” program, emphasizes ongoing monitoring and timely interventions to avoid inpatient care.

“Both health systems are aiming to have 10% to 20% of all patient consultations conducted in a virtual environment and are developing a number of fascinating novel models of care that they predict will ultimately provide better care and overall value,” Yellowlees said.

Artificial Intelligence: Arterys

AI has not had a bad year yet. Between breakthrough technologies and soaring funding rounds, there was no shortage of strong candidates to choose from in 2017.

Ambra Health CEO Morris Panner, JD, gave the nod to Arterys. The 10-year-old San Francisco, California, company both started and ended 2017 in style. In January, it received a first-of-its-kind FDA approval for its cloud-based technology, which applies AI and deep learning to medical imaging analysis. Its cardiac magnetic resonance imaging tool is now an officially approved diagnostic support application. 

The self-teaching software allows for constant improvement, and the company has been cosigned by GE, which includes  Arterys software in its new magnetic resonance imaging scanners. 

And in November, Arterys announced a $30-million Series B financing round, led by Temasek, Northwell Health, and GE Ventures. The funding should help the company commercialize its technology and develop new radiological support tools. 

“Futurists have long wondered how man and machine will coexist, and we are seeing an early preview in imaging deep learning,” Panner said. He doesn’t think artificial intelligence will replace the work of radiologists, but technologies like the ones Arterys is developing will serve as “force multipliers” for the profession.

Besides Arterys, Panner said major medical centers are emerging as leaders in the AI field. “Not since the innovation of the first CT [computed tomography] scanner has it made such a difference what medical care and center of excellence you are availing yourself of as a patient,” he said. One of the institutions he mentioned, NewYork-Presbyterian, also contributed to the recent Arterys funding round.

Population Health Management: Optum and Evolent Health

Amit Phull, MD, said population health management technologies have increasingly shifted to the front of healthcare’s collective conscience. “Being able to seamlessly inject yourself into a workflow, from a healthcare provider’s perspective, is key,” the Doximity medical director said. He pointed to Evolent Health and Optum as companies that have done just that. 

Both companies had huge financial years, and their paths may be intertwined. In mid-August, Evolent announced it had sold 8.8 million shares at nearly $20 apiece, bringing in an additional $167 million in funding. Just 2 weeks later, Optum (a UnitedHealth company) bought the Advisory Board Company’s healthcare arm for $1.3 billion. That sale included Advisory Board’s 7.6% stake in Evolent.

“Less is more when it comes to additional tasks that physicians have to do, and I think those guys have done a pretty good job with how they dovetail into decision making,” Phull said. He credited the endorsement to his colleagues throughout different health systems, who champion the ease with which Optum and Evolent integrate their decision support tools into offerings from major electronic medical record (EMR) companies.

“The trick is being able to aggregate data up into usable  dashboards. [EMR providers] have the opportunity to basically leverage the clinical data that they have stored within them.  Physicians have become accustomed to doing about 90% of their work in the [EMR] in real time,” he said. In addition to praising the 2  analytics companies, he highlighted work being done by major EMR providers to facilitate that integration. 

Interoperability: Epic

The past year was, unfortunately, a big year for disasters. In the wake of tragedies, EMR providers had the opportunity to rise to the occasion and break down interoperability barriers. Allscripts and Surescripts, for example, did that when they paired to make patient-specific history and data more available to pharmacists in devastated regions following hurricanes Irma and Harvey.

American patients might be the true winners. But Epic takes the company crown.

Asked about Kaiser Permanente’s response to wildfires that forced it to evacuate one of its facilities, the Permanente Federation’s chief information officer, Patricia Conolly, MD, praised Epic for its Happy Together feature. Introduced last year, the component consolidates a patient’s history at Epic and certain non-Epic providers onto a single interface. The resulting efficiency is especially useful for emergency departments receiving someone for the first time. 

Furthering those efforts, Epic released another feature called Share Everywhere in September. The program allows patients to grant any provider access to their data, and it enables them to view and share their Epic charts on their smartphones. Outside providers who are granted access to patient records via Share Everywhere can also send progress notes back to the patient’s original provider to inform better care. 

Doximity’s Amit Phull also touted Epic’s work in 2017. He said the company created a simple, to-the-point user dashboard. “Epic has done a great job of simplifying workflow aspects as it pertains to the [EMR],” Phull added. Having worked with the top 3 EMR provider companies throughout his career, he said all have pros and cons, but Epic has taken the “documentation lead,” taking users down a more intuitive path to accurately and capturing patient  interactions.

Value-based care: Online Pulmonary Rehabilitation

Patients with chronic obstructive pulmonary disease (COPD) spend about $27,000 every year to manage the debilitating lung condition, often entering the hospital as the problem worsens. They find it difficult to breathe and expend energy. The debilitating nature of the illness causes social isolation. The irony? “COPD is the easiest disease to not necessarily cure but to improve and work with that patient on,” said  Michael Skolnik, MS, CEO and senior consultant at the Value Based Health Care Institute. It takes exercise, socialization, and pulmonary rehabilitation.

The expenses and effort required of patients with COPD to travel mean that is easier said than done. But online pulmonary rehab has shown great promise in reducing costs—by more than $4000 a month—and increasing access. ModoSpira, where Skolnik holds a vice presidency, made noticeable strides in this area in 2017.

A clinical trial led by Northwestern University in Chicago, Illinois, found that 54% of participants stuck with the program, despite the average age being 72. For brick-and-mortar rehabs, that number hovers around 15%, he said. The digital rehab program helped them run up their 6-minute walking distance by 25%, and the trial yielded 68% fewer unscheduled hospital visits.

“Those kinds of things are major,” Skolnik added. “If you cut back on hospitalization, and you give people a chance to feel a sense of dignity—that they’re not just being thrown an inhaler—you actually give them a life, and that’s what’s important.” Value-based care, he said, must focus on more than cost containment, and this tech-centric push represents just that.

Since its inception, the online program has expanded to the University of Michigan and beyond. What’s more, studies performed in the United Kingdom and Norway have buttressed the potential of online pulmonary rehab for patients with COPD.