THE REAL TIME HEALTHCARE PODCAST · Jan 11 · 17:16 min

#48 - Using Command Center Technology For Statewide Capacity Management

In this Episode:

Leveraging technology already in place at Oregon Science & Health University, Apprise Health Insights partnered with GE Healthcare to launch an automated, near real-time capacity management system in Oregon.

That has allowed hospitals throughout the state to manage COVID-19 patient surges and other natural disasters collaboratively. Discover how the new system was stood up with 80% of Oregon hospitals in just 2-3 weeks, and is now in place at every hospital in the state.

Apprise’s CEO Andy Van Pelt also shares how driving consensus across the state’s hospital association members is creating more possibilities to use the system to improve healthcare delivery for all of Oregon.

Jeff Terry
Hello and welcome. I'm Jeff Terry, delighted to be joined today by Andy Van Pelt, who is the CEO of Apprise Health Insights. Hi, Andy.

Andy Van Pelt
Hi. Thanks for having me.

Jeff Terry
Yes, sir. Brilliant. So, Apprise Health Insights, maybe to start there, what is Apprise, and how do you serve the hospitals in Oregon?

Andy Van Pelt
Sure. Apprise Health Insights is a subsidiary of the Oregon Association of Hospitals and Health Systems. That organization represents 62 community hospitals in the State of Oregon. Every state has a hospital association of that effect.

And, at Apprise, we set up ourselves to assist all the hospitals in Oregon on data collection and analytics. So, we do a series of reports, and we collect around seven million records a year on an annualized basis, inpatient, outpatient, emergency discharge data, financial and utilization data.

And we have a relationship with the State of Oregon to collect on their behalf and normalize the data and then provide it to the state for their use too.

Jeff Terry
And are those data products... So, some of those are used for reporting of certain things and others, I would guess, are used by the hospitals themselves to do-

Andy Van Pelt
Correct.

Jeff Terry
... analysis or, yeah, maybe talk-

Andy Van Pelt
Yeah.

Jeff Terry
... a bit more about it.

Andy Van Pelt
So we also offer the services. We have this principle of, if you're providing data, you can see the data, and we're really big into transparency. So, everybody can see everybody's data, because they're participating in that. A lot of it's used for strategic planning, market share, and just demographics of their patient community.

We do hotspoting and emergency tracking for emergency room visits. So, it's pretty powerful tool to provide, and we're happy to do it.

Jeff Terry
And I know we got to know you through COVID. And we're going to talk more about that work, but, I mean, data and analytics, I'm sure, in many areas, became even more important. So it must have been a busy couple years.

Andy Van Pelt
Yeah. So it was March of 2020 when COVID first started, and we realized, as a state and an industry, we don't know what's coming our way, in terms of resource management, in terms of bed space, and just the real time nature of this, of COVID. And Oregon doesn't have a real time or automated system to track that stuff statewide.

It's all very manual and very, well, non-consistent. So, we needed to find an opportunity in terms of trying to fill some of these data gaps for decision making as COVID was basically starting to pick up steam.

Jeff Terry
And that's what became the Oregon Capacity System.

Andy Van Pelt
Yeah, it's actually a really unique story. So, Oregon Health Sciences University, our academic medical center here in the state, had deployed the GE command center previously to this.

So, we inserted ourselves with OHSU to say, okay, I've seen mission control, I've been there, it's pretty amazing, how can we leverage that beyond your health system to the entire state?

And so, we just started brainstorming, and we also then pulled all the health executives together on a Saturday morning in March to say, we have this problem, who's willing to participate at a voluntary basis to provide their data stream on beds to a statewide tile? And then the Oregon Capacity System was born.

And just to say, importantly, and, of course, many folks might say, well, hey, we provide bed capacity to data to the state, and have for a long time. But what was different here is automated, so-

Andy Van Pelt
Correct.

Jeff Terry
... not depending on someone to enter in near time, right?

Andy Van Pelt
It was automated and near time. In the traditional system there was a once a week requirement, once every 24 hours at 9:00 AM, but it was not consistent. And it was always somebody's job to remember to do that. And in the nature of this public health emergency, that just wasn't...

Jeff Terry
Yeah, that might be fine for a sense of, about how many more hospital beds are we going to need in the next 20 years? But if you're trying to decide right now how to manage a surge, it just can't support that.

Andy Van Pelt
It can't support that, and decisions were being made quickly on where to deploy resource, both from the federal government and the state government and within the region amongst hospitals. And we just had no way of knowing immediately how to make some of those operational decisions.

And so, in the partnership with GE we were able to stand up the statewide bed tile, but I'd say around 80% percent of the hospitals, now we're nearing 100%, in about a two to three week period. I mean, it was just amazing how flexible and quick we could deploy that.

Jeff Terry
And that was back in March, 2020?

Andy Van Pelt
Of 2020. Correct.

Jeff Terry
And, of course, it's been in continued use since then. And so maybe talk about the current state of it, and which is in the midst of moving to 2.0. So maybe lay out current state and vision a bit.

Andy Van Pelt
Yeah. So, we learned a lot in those early stages, and we all talk about COVID, but in Oregon we had another parallel use case that really supported this technology. In the fall of... so September and October of 2020 we experienced historical wildfires about 20 miles outside of Portland.

The whole southern region of the state was on fire, and that required us to evacuate up to five hospitals in a 24 hour period.

Again, the necessity for real time data was critical. We turned to the bed tile, who can take patients, who can't, and it quickly became another use case of how we can deploy this technology.

And forest fires in Oregon are going to be around for a while now. So, the development of this beyond COVID or infectious disease use is proving itself out in spades.

And so, those two experiences have said, okay, if we're going to go beyond beds, what were some other use cases that we can work with in this new system? PPE supply chain, huge issue at the beginning of it. And we're working with a steering committee of PPE folks at the various hospitals to develop a dashboard or tile for PPE inventory.

Divert, how are we going to display divert and show which facilities have limited capacity for STEMI, for stroke, for critical care, for ICU. And the audience for that is our EMS services. They're at the table helping us design a tool for divert communication. So that's critical.

Jeff Terry
To add to that, because I think what's really... One thing that's really interesting about that is we GE are providing the technology for the Oregon capacity system. And of course, you could make the case, and many states are considering us and similar systems to do similar things, but in every state there's a lot of definitional questions and a lot I don't call political or such, but it's a heck of a lot more than technology.

So, to get people to agree, what is the divert hierarchy in Oregon, I mean, that's what you guys... an example of where you need an organization like Apprise to bring everybody together and figure that out in a very detailed way.

Andy Van Pelt
Yeah. I think that's the value add for Apprise inserting itself in this conversation. While we're a data and analytics company, remember, we are also tied to a hospital association. And association work in its nature is to drive for consensus.

So, we've taken that model within Apprise to say, okay, we don't know what we don't know, I'm not a PPE expert, I am not an epic writer, I'm none of those, but what I can do is find the right people at the participating organizations to sit around a table, or a virtual table in this sense, and ask those questions. And the beauty of this is, for once, we're not being territorial.

This isn't a competitive experience, and gamesmanship happens all the time with sharing data in this way. And that's one of our core principles, is this is really for patient movement and how to get the best care or the best resource to take care of that patient population immediately. And these tables have allowed for that.

And frankly, we have two subcommittees of divert definitions, which includes EMS, and the state, by the way, I should acknowledge that. The state is a advisor to this conversation, because they're an important member of this group and use the tool as well.

So, it's really a open communication, and we just arm wrestle back and forth about what's the best. It might not be what I choose to do at my facility, but for the purposes of operationalizing a statewide, regional, or national type model that measures bed and resource capacity, this is how we should do it. And that's been a fun experience to witness.

Jeff Terry
Well, for sure. And you guys do it well. And I love that quote, the association work is to drive for consensus. And to put in a system like this you need that same approach, because everybody's got to participate for it to be valuable.

Andy Van Pelt
Correct.

Jeff Terry
And we should, I guess, underscore too that, in the end, the hospital systems control their own capacity. There's no patient data here.

There's a lot of nuances to patients that are not captured in the data, but in the moment when you're managing a surge, the teams no longer have to spend an hour on phone calls to get a report so they can start talking about what to do, which, by the time they're done compiling it, is already out of date.

Andy Van Pelt
So there's another, a great example of how... In Oregon we've just been doing things on the fly and using this technology to create value and prove our own thinking.

So, when we hit delta surge in Oregon we had a peak of about 1800 hospitalizations in the first, in September. September of 2020 we were at 91 hospitalizations. So, we were in a critical crunch.

We have about 650 ICU beds in the state. We had 1700, 1800 admissions, COVID admissions in September of this year. We had hospitals around the state making 40 to 50 phone calls, I need to transfer this patient, where can I go, what can I do? And you're wasting time. These are critical patients.

So we realized immediately we needed to do things a bit different in the bed tile to provide that insight of where the ECMO beds were, where the high acuity ICU beds were.

And so, our team came together. We standardized the definition from the journal of critical care from a white paper back in 2017. We got the hospitals to buy into that definition in terms of what is ICU one, level two, level three. And then GE, in their way, worked with the hospitals quickly to re-identify those ICU beds.

And so now, I'd say in a two week period again, we were able to break out our ICU capacity, which then allowed for us to create a statewide transfer center, or a coordination center for a one stop shop in terms of, where can we transfer in and out around the state? That clinical team used the bed tile to make those decisions. And the flexibility of this has been just amazing, and frankly, something that every state or region should really be considering.

Jeff Terry
That's amazing, and the speed of it, and thank you for acknowledging GE's role in it. And also amazing that, I guess, Apprise's role of it, the role of the hospitals, but to come together, get the information together, but to put that actual process in place where they were running a statewide transfer center for those critical resources, which had been planned in the March, April 2020 time period, but I think used most intensely during delta recently.

Andy Van Pelt
Yeah. And the state was a partner in staffing and supporting that work. But it was really the hospitals meeting daily or twice a day in the peak looking at patient lists and prioritizing patient transfers, again, coordinating with EMS as well.

And it's still up and running today. They don't meet twice a day anymore, but it proved that this tool has saved lives. And I truly, truly believe that, based on our experience.

Jeff Terry
That's amazing. Yeah. Well, and I guess it's much more difficult to run a center like that without a tool like that, right?

Andy Van Pelt
I got to give credit to the hospitals. They took a risk. They're trusting each other. They're being transparent with what's possible. And that's nice to see.

Jeff Terry
Absolutely. You and I both have been in conversations with other states who are wrestling with those same questions of transparency, and those aren't so easy, and I give a lot of credit to Oregon for getting through that pretty daggone quickly.

Andy Van Pelt
Well, it's funny you say that, because in these conversations with other states I'm always expecting them to ask super technical questions, but the questions we're getting are, well, how do you get people to agree, how do you get people to share their information?

And that's surprising me, but I'm hoping our experience at Apprise and within Oregon can be a model that we can offer to other states to consider.

Jeff Terry
Amen. I think it's both proof that it can be done and a model for how to approach getting it done.

Andy Van Pelt
Right.

Jeff Terry
Right. So you sort of mentioned some of this along the way, but maybe just to ask you, as you reflect on all of that experience, any lesson learned that you haven't mentioned that comes to mind, and how do you think the next two years will play out for Apprise?

Andy Van Pelt
A lesson learned, don't say it can't be done. I think all of us had a different mindset in March of 2020, but it required us to push the envelope, to ask questions, and look where we are today.

I mean, this is not a mandated system within the State of Oregon. People are voluntarily providing this data to support, again, critical patient care. And I think that is a tremendous lesson to continue to push. Trust the data, make actionable data or reducing the reporting burden by taking what is 300 manual fields in the existing system and automating, hopefully, 80% or more of that.

And then, also looking for opportunities to continue to create value and continue to reduce the burden of reporting requirements so that we can free up the workforce to do what they should be doing, and that's caring for the patients. For Apprise, who knows? We're writing the chapters here as we go.

We have been very successful of collecting data for a long time, very successful, have a great team of analysts to analyze the data.

This, though, I think could be a sweet spot for us, bringing this technology, based on our experience, to other states and regions that are tackling the question of resource. We're never going to get more resource than we have today, both in workforce and just the ability to run a hospital. So, how do we create efficiencies in the system, how do we know what really is out there?

Data doesn't lie, and to be able to trust that and help people work through those challenges, I think, is where we're defining our value, and hopefully we can continue to do that.

Jeff Terry
I love that point you made earlier. Data doesn't lie, but to make it true you have to do the work up front to get the definitions right and get consensus, and that's what you guys do so well. So, it really all adds up. Brilliant. Andy, thank you very much for joining today.

Andy Van Pelt
No, thanks for having me.

Jeff Terry
Yes, sir. And with that, I will close the podcast.

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