Trish.M.Doherty

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Q&A with New AHA Chair, Benjamin K. Chu, MD

chuRecently, Benjamin K. Chu, MD, MPH, MACP, group president for Kaiser Permanente Southern California and Kaiser Permanente Hawaii, spoke at his investiture as chair of the American Hospital Association.  The AHA represents America’s hospitals and health systems, and Dr. Chu is leading the organization at a key time for the health sector.

Dr. Chu was kind enough to talk with us about his new role with the AHA, what the organization is focusing on with the implementation of the Affordable Care Act, and the changing nature of patient-centered care and the patient/health care team dynamic.

CTH Blog:

Congratulations on your chairmanship with the AHA.  What will this new role within the organization mean for you?

Benjamin Chu:

The American Hospital Association represents about 5,000 hospitals across the country, and it’s governed by a 27-member board.  One of the important tasks is advocacy — largely on the federal level – both in congress and among the federal agencies that have bearing on health policy.

But I think much more important from Kaiser Permanente’s point of view is that the American Hospital Association has been moving toward shaping care transformation across the country.  For about the last half-dozen years, the AHA has focused on an effort called, “Hospitals in Pursuit of Excellence,” which tries to bring together different ideas on quality improvement and innovation and then leverage that learning across the industry.

Last year, I was involved in the committee on research reports that focused on patient and family engagement.  I was happy to be part of this effort, because one of the most important pieces of Kaiser Permanente’s Total Health agenda is much more than taking care of people during their episodes of illness; it’s trying to put into place all of the environmental changes and influences that could help people make healthier choices in their lives.

CTH Blog:

You are taking the reins at a key time in the history of health care with the implementation of the ACA.  What do you anticipate the organization will focus on under your leadership?

An Innovative Way to Engage Patients at the Point of Care

high-res-indigo-screen-shot

Last week at HIMSS in New Orleans, one of the booths that captured our attention was that of Archimedes, a company focused on bringing quantifiable analysis to health care.  The folks from Archimedes were at HIMSS to talk about their product, IndiGO – which stands for Individualized Guidelines and Outcomes.  IndiGO is a clinical decision support tool designed for doctors and other care providers to use at the point of care with their patients.  According to the Archimedes website, IndiGO calculates and displays the risk a patient has of adverse events – such as heart attacks, strokes, and onset of diabetes. IndiGO then suggests and prioritizes the medications and/or lifestyle interventions that have the greatest impact on reducing that risk.

Rishi Misra, Implementation Manager for Archimedes, was kind enough to spend some time with us to talk about IndiGO, how it works, and why it’s such a powerful tool for engaging a patient in decisions about their health care.

CTH Blog:

Why don’t you start by providing some background on Archimedes?

Rishi Misra:

Archimedes was founded by David Eddy, one of the pioneers in bringing evidence-based practices to medicine.  David recognized that many medical decisions were not being made based on the best available evidence.  He wanted to integrate a more evidenced-based approach of making medical decisions based on statistics and clinically validated data. Based on that need, he built what we call the Archimedes Model. The Archimedes Model and the data engine that powers it are the foundation from which the tools the company offers today are built.

Archimedes was established as a part of Kaiser Permanente, and in 2006 it was spun out as a Kaiser Innovation – an independent, for-profit entity.

CTH Blog:

In layman’s terms, what is IndiGO, and how is it used?

RM:

IndiGO is a clinical-decision support tool used to manage patient health at the point of care by showing patients what their risk is of certain adverse events on a five-year time horizon, and in some cases even over a lifetime. Based on the Archimedes Model, IndiGO provides suggested interventions to reduce a patient’s risk of heart attacks, strokes, and onset of diabetes.

CTH Blog:

How does it work?  Does it use data from the electronic health record?

RM:

IndiGO incorporates 27 data elements from a patient’s EHR that are critical to computing the risk and suggested benefit of a particular intervention. The physician’s office or health care organization sends us de-identified patient data on a nightly basis, so we’re always looking at the latest, most current information. The data is then analyzed by the IndiGO engine, and results are returned to the submitting office. The risk assessment is very real-time, providing up-to-date information that the physicians have available to them.

CTH Blog:

And you use that data in the EHR to make these predictions?

RM:

Yes. Exactly. The IndiGO risk assessment shows how a patient’s decisions could reduce their health risk. It also illustrates how the risk could be magnified by their choice to ignore an intervention. For example, it might show that if they cease taking a medication, their risk could increase to, say, roughly seven times the risk of a healthy patient who is the same gender and age.

CTH Blog:

What is the response you are seeing from patients?

RM:

What we found is that this tool really serves as a trigger.  Anecdotally, we know that physicians print out this screen and give it to their patients as a visual reinforcement of their conversation. The patients use the information in their risk assessment to activate them to adhere to the physician recommended intervention. We’ve heard of patients putting it up on their refrigerator as a reminder.

We’re doing a pilot with the Colorado Beacon Consortium, and we had patients come in and give testimonials.  These were unscripted patients coming in to talk about how IndiGO has benefited the management of their personal health.

One patient – a retired engineer, 71 years old — said he never cared to go see his doctor.  But once he saw IndiGO in action, he was hooked.  He loved how it visually quantified his health.  For him, this tool served as a differentiating factor, motivating him to see his doctor and stick with his plan.  We find that IndiGO is not only helping physicians manage the health of their patients, it’s also serving as a distinguishing factor for patients to choose physicians using the tool, because they are provided with a more quantitative and more visual way of looking at their health. You can see how patients react to IndiGO in a video we have on YouTube.

CTH Blog:

A picture must really be worth a thousand words.  What they see illustrated on the screen must resonate differently, because patients are told risk percentages all the time, but it doesn’t seem to have the same effect.

RM:

Right, because most risk percentages are an arbitrary number, and patients don’t know what it’s relative to.  Whereas, with IndiGO, you might say, “Look, this is your current risk, and this is where a patient at the optimal level of health is.”  And then you can show, visually, the effect their own actions can have on their health risks.   That really motivates them.  It’s powerful.

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