Timothy G. Buchman, M.D., Ph.D. Director, Emory Critical Care Center, Emory University School of Medicine

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1 Timothy G. Buchman, M.D., Ph.D. Director, Emory Critical Care Center, Emory University School of Medicine

2 What makes hospitals smarter, What makes patients safer, What makes outcomes better? Emory Critical Care Center Tim Buchman 2 APR

3 Disclosures Relevant To This Presentation Emory Healthcare is a customer of various vendors that supply electronic medical record software (Cerner Corp.), patient management systems (Philips Corp.), data archiving software (Excel Medical Corp.), data analytic software (IBM). I periodically attend user group meetings representing Emory Healthcare and Emory University at Emory expense. I serve as an advisor to federal (e.g. NIH) and to not-for-profit nongovernmental organizations (e.g. The Moore Foundation and The James S. McDonnell Foundation). In this advisory capacity, I review grant applications and counsel directors and senior staff on trends in critical care medicine. Honoraria, if offered, are either declined or contributed to Emory University. Some work discussed in this presentation has been funded by federal agencies including CMS (as part of the Healthcare Innovation Award program, 1C1CMS331041) and the Department of Defense (through the Surgical Critical Care Initiative [SC2i]). 3

4 Disclaimers The opinions expressed are strictly personal. They may or may not represent the opinions and views of any organization or publication with which I am affiliated. The contents of this presentation are solely the responsibility of the presenter and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The data presented here are based on analysis conducted by colleagues at Emory. Except where noted, findings might or might not be consistent with or confirmed by the independent evaluation contractor. 4

5 The care of human life and happiness, and not their destruction, is the first and only object of good government. --Thomas Jefferson, 3 rd President of the USA 5

6 Not smart 6

7 Potentially Smarter 7

8 Big Data and Real-Time Analytics 8

9 Stream Computing in Intensive Care Computing across dozens of streams per patient, dozens of patients per ICU, multiple ICUs within a single hospital, multiple hospitals within a healthcare system, and referencing archived (reference) data. 9

10 Visual detection of anomalies 10 10

11 Smarter->Predictive Critical Care (BAASiC) 11

12 Making patients safer 12

13 Data -> Analysis -> Alerting 13

failure to comprehend data; failure to accurately project the

14 Cognitive Error: Situational Level Situational cognitive errors are data based and come in three general types: failure to receive/perceive data; failure to comprehend data; failure to accurately project the consequences of decisions based on the data. Air Traffic Control eicu (telehealth) 14

15 Safer through presentation simplification Present all information, options, outcomes in readily interpretable form 15

16 Better Outcomes Conceived with a population as the focus of concern Distance from perspective of patients and families 16

17 Emory eicu Results: Community-Centered Hospital erns emds emoryhealthcare.org

18 emoryhealthcare.org Emory eicu Results: Community-Centered Hospital

19 emoryhealthcare.org Emory eicu Results: Community-Centered Hospital

President Franklin D. Roosevelt, 6 JAN 1941 In the future days, which we seek to make secure, we look forward to a world founded upon four essential human freedoms.

The third is freedom from want which, translated into world terms, means economic understandings which will secure to every nation a healthy peacetime life for its inhabitants-everywhere in the world.

20 President Franklin D. Roosevelt, 6 JAN 1941 In the future days, which we seek to make secure, we look forward to a world founded upon four essential human freedoms. The first is freedom of speech and expression everywhere in the world. The second is freedom of every person to worship God in his own way everywhere in the world. The third is freedom from want which, translated into world terms, means economic understandings which will secure to every nation a healthy peacetime life for its inhabitants-everywhere in the world. The fourth is freedom from fear which, translated into world terms, means a world-wide reduction of armaments to such a point and in such a thorough fashion that no nation will be in a position to commit an act of physical aggression against any neighbor anywhere in the world. That is no vision of a distant millennium.it is a definite basis for a kind of world attainable in our own time and generation. 20

21 1. Freedom from harms no patient or family should fear an error that will culminate in a preventable harm 21

22 2. Freedom from suffering no patient or family should experience unnecessary pain or misery 22

23 3. Freedom from disability no patient or family should experience unnecessary disability and the burdens of dependence on self and loved ones 23

24 4. Freedom from healthcare impoverishment no patient or family should fear impoverishment related to the cost of care and treatment 24

25 Where do we go from here? 25

New healthcare delivery models: Interprofessional, regional, international

New healthcare delivery models: Interprofessional, regional, international Cheryl Hiddleson MSN, RN, CCRN-E Director, Emory eicu Center Timothy G. Buchman PhD, MD, FACS, FCCP, MCCM Founding Director, Emory