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Improving Patient Health with Business Intelligence: A Q&A with Sergio Carbone of Vree Health

Originally published October 26, 2015

This BeyeNETWORK article features Ron Powellís interview with Sergio Carbone, the Chief Information Officer (CIO) for Vree Health. Sergio and Ron discuss Vree Healthís business intelligence needs and solutions.

For those who are not familiar with Vree Health, could you give us a little background on the company?

Sergio Carbone: Vree Health closes a very special gap in healthcare. We work with the patients after theyíre discharged from the hospital to see that the patients have the best chance of recovery and not being readmitted. Weíre very concerned about the patientsí well being and how well the patients are carrying out the discharge instructions as well as their health during their 30-day post-discharge period.

I bet you find that a number of patients donít follow the discharge orders.

Sergio Carbone:
Many patients who are readmitted are found to not have followed their discharge instructions. Predominantly, they donít get back to their primary care provider, they donít comply with their daily regimens, they donít comply with their medications, or they continue to participate in unhealthy lifestyle choices Ė such as poor diet or lack of activity. Vree Health tries to reach the patients and motivate the patients to close the loop on these items.

As the CIO, what are the biggest challenges youíre facing from an information perspective?

Sergio Carbone: There are a few ways Vree Health uses information to address this problem. Information comes when a patient is discharged, integrating with the electronic medical record and pulling data directly from that record. We understand what the patientís discharge instructions are, and we understand what medications or allergies this patient may have. However, thatís the starting point for information and our ability to manage that patient. A lot of the information we collect along the way with the patient is done through the course of actual person-to-person conversation between our care liaison and the patient. This is where a lot of factors that affect whether or not the patient is able to comply with his or her discharge instructions gets surfaced Ė things that are important to individuals every day, such as do they have a lifestyle support mechanism that would be able to get them to the doctors, can they afford their medication, do they have any personal goals that theyíre trying to achieve. Interestingly enough, when people are recovering, a lot of times theyíll focus on a particular goal and that will really help those patients strive to comply with what will make them better. That goal could be something along the lines of going to a grandchildís wedding. The goal could be seeing the next holiday season, seeing their son graduate or coming back from service in the military. These are all things that are very important, and all of that is data to Vree Health. All of that data is collected during the conversations that the patient has. What we do with that data is we pull it into the system, and we supplement the patientís medical record with it. That way, if we can tell that this person is starting to appear a little depressed or that theyíre kind of falling off of their recovery plan, we can make sure that patient is escalated properly. We can reach out and notify people who care about the patient. A third source of information that we use is actual observation data that the patient or the patientís loved ones take on the patientís health state. These measurements could be something as simple as blood pressure, weight, temperature, or whether or not theyíve complied with their medications. All of that observation data is also brought in.

Again, to revisit it Ė we have data coming in from three different directions. We have data coming in from the electronic medical record. We have data coming in from discussions with the patients about their lifestyle and state of mental health. We have their goals coming in during those conversations. And then we have more measurement or metric data that is observed by what we call a health check.

How do you store the information? Is it in the cloud?

Sergio Carbone: All of this data is stored in a private cloud that Vree Health runs. When we take a look at how we use this data for business intelligence (BI), we use it in a number of different ways. First, as we take this data in, it goes through and is continually reviewed from a notification and alert mechanism. So we combine the data in ways to understand whether or not this person could have some type of drug-to-drug interaction, whether or not this person is going outside of some type of norm for weight gain or weight loss to determine whether or not we really need to escalate this patient more to the top of an observation list. One of the ways we use this information is to notify caregivers about this patientís recovery, about whether or not this patient has crossed specific key milestones Ė like their day 12 in the program. For many reasons day 12 is sign of whether or not that patient is going to successfully complete the program. Itís all contained on a completely virtual environment with high availability. Itís actually hosted by a company called Rackspace. They do an excellent job of running a professional data center.

I would imagine that mobile is a trend thatís key for accessing that information.

Sergio Carbone: When you start talking about self-service and mobile, there is an interesting thing about this. Even though our service is sold to a healthcare provider like a hospital, we think of the patient as the main focal point. What we do is we do patient centricity. We keep the patient in focus all the time. But this is an aged population. These are people who are very ill. They donít typically use the Web. They donít typically use mobile devices. Even though this is available to them to use, what we find is itís used by people surrounding them. I like to say that patients sit at the center of healthcare, and healthcare takes place surrounding them. The people who use more of the self-service application sets are the care team or the providers such as their children, grandchildren or spouses. These are people who have a vested interest in the recovery of the patient. These are people who continually collaborate about the health and current state of the patient. Our online tools make it available for these care teams to come together, share information, see what happened to mom or dad last in their medical recovery, see whether or not theyíre complying with their health checks and medications, and what their mental state is. They can access all that information online and know how their loved one is doing. This is also extended back to the discharging hospital. The discharging hospital has members who can also come in and see how the patient is doing as well as the primary care provider.

Could you tell us a little about your BI infrastructure?

Sergio Carbone: We really rely a lot on Information Builders iWay product suite. One of the interesting things about Vree Health and care plans and care management in general is there is a marked advantage to rule-based processing as well as some master data management techniques that you have to use. iWay is delivering us our capabilities. They are helping us handle all of our rule-based processing. They are enabling us to standardize and improve data quality coming in, whether or not that is data quality coming in from electronic medical records or from something somebody has observed. For us to be able to do any type of analytics, we need to be sure the data is corrected in structure and form. Of course, Information Builders iWay suite goes a very long way in giving us those capabilities. Outside of the iWay suite, as I said earlier we are hosted at Rackspace. We use VMware to run all of our virtual environments. We run a very high availability environment. Behind that, we use SharePoint for a lot of our user interface work Ė a lot of SharePoint web parts. We run SQL server from a database engine perspective. We have a lot of technology coming to bear.

What do you feel gives you an edge in the marketplace today?

Sergio Carbone: What gives Vree Health an edge is that we have an ability to still treat the patient as an individual and scale. One of the things that is a core advantage is that every patient is different, every patientís disease state is going to be slightly different than what happened to another patient, and their compliance in their recovery is going to be different. We have an ability to handle en masse multiple disease states for many customers, completely independently. So we can assure that if a particular patient needs a particular care because of their discharge, we can see that we can accommodate that. Many companies canít do that. Along with this, we have a human touch to Vree Health. Itís very important. Itís in our core beliefs that we reach out and directly talk and contact the patients. So our client services group is really excellent. Theyíre all experts in behavioral coaching, and theyíre all highly trained individuals. They go out and talk with the patient via the phone and really become part of that patientís life. We donít run call centers in a classic fashion where you donít know who youíre going to get when youíre calling. Unless a patientís care liaison is on vacation, they are going to continue their relationship with that care liaison through their time in the program. This builds familiarity and inter-person empathy. It builds a clear understanding of whatís important to that patient and how to best motivate that patient along in their recovery.

By managing all of these discharge instructions, you are reducing the number of patients who get readmitted to the hospital.

Sergio Carbone: Quite correct.

Is it just hospitals?

Sergio Carbone: Weíre doing it for hospitals, and weíre also doing chronic disease management for physician groups as well. Itís a slightly different service that we have to deliver for chronic care management. We have to remember that with a discharge there is an ending point. It is a 30-day program. With chronic care, it stays with the patient. Itís not something theyíre expected to recover from. So in those cases, the relationship we build with a patient can be many months long.

Sergio, itís been a pleasure talking to you about how Vree Health uses data to improve patient health.

  • Ron PowellRon Powell
    Ron is an independent analyst, consultant and editorial expert with extensive knowledge and experience in business intelligence, big data, analytics and data warehousing. Currently president of Powell Interactive Media, which specializes in consulting and podcast services, he is also Executive Producer of The World Transformed Fast Forward series. In 2004, Ron founded the BeyeNETWORK, which was acquired by Tech Target in 2010.† Prior to the founding of the BeyeNETWORK, Ron was cofounder, publisher and editorial director of DM Review (now Information Management). He maintains an expert channel and blog on the BeyeNETWORK and may be contacted by email at†rpowell@powellinteractivemedia.com.

    More articles and Ron's blog can be found in his BeyeNETWORK expert channel.

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