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Doctor writing notes on top of the ORHub

Orthopedic hospital tests cloud-based cure for healthcare costs

By Microsoft on July 13, 2017

Filed under Health

The Hoag Orthopedic Institute (HOI) is using a new digital tool to advance orthopedic care. Called ORHub, this surgical resource management solution runs on the Microsoft Azure platform and is accessed in the operating room on a Microsoft Surface device. With ORHub, HOI is improving teamwork, automating manual processes, and better understanding resource allocation in its spinal surgeries. By analyzing resource allocation with hopes of seeing correlation to outcomes, HOI is well on its way to enabling value-based healthcare.

When implanting takes places in major orthopedic surgery procedures, the operating room gets very busy. Everyone in the operating room (OR)—the surgeon, the nursing staff, and the medical device representative assisting from the sidelines—is 100 percent focused on documenting the implants that the surgeon puts into the patient. Implants range from biological tissue and bone graft material to titanium rods. Whether it’s a one-hour procedure that calls for a single tube of tissue sealant or a 10-hour surgery that requires 50 implants along a patient’s spine, an accurate record of the implants used is just the tip of the iceberg in surgical data collection and analysis.

The rest of the story lies in trying to unravel the challenging coordination effort that occurs when multiple hospital departments and external healthcare companies work together to deliver surgical and medical care. From external vendors’ shipping and billing departments to hospitals’ sterile processing departments to surgery departments, numerous steps take place that require data registration and information cataloging. With so many procedural steps in scheduling, procuring, billing, and implant record keeping, the opportunities are rife for manual error, duplication of effort, and communication gaps.

“We have to ask ourselves why the cost of healthcare in the United States is the highest in the world,” says Richard Lee, MD, an orthopedic surgeon at Hoag Orthopedic Institute (HOI). “Without understanding resource allocation, we cannot effectively transition from an unsustainable fee-for-service system to a value-based healthcare system. At some point, we need the ability to objectively compare treatment options with patient outcomes to determine the most effective method of managing a given diagnosis.”

That’s why HOI has taken an interest in using an innovative cloud-based surgical resource management solution—a new category of software in the health IT market—called ORHub. It’s built on the Microsoft Azure cloud platform, and the solution comes to life in the OR when it’s accessed on a Microsoft Surface device. “I joined HOI because the entire organization is focused on one common theme: ‘How do we optimize patient outcomes?’” says Dr. Lee. “Our participation with the ORHub project, from concept to launch, helps us proactively address nationwide healthcare challenges and deliver leading-edge treatment in a value-based system.”

“Healthcare is a Microsoft world”

The story starts in February 2015, when Wesley Mitchell, Chief Technology Officer at ORHub, was approached by the Microsoft for Startups Program about helping a surgeon who wanted to develop a software program to help analyze resource allocation for surgical procedures. “This project piqued my interest,” says Mitchell. “Value-based healthcare is a hot topic, and surgical procedures are at the heart of the issue. According to our research, most hospitals spend between 48 and 50 percent of their overall revenue on surgery.”

Mitchell and his colleagues spent two months interviewing clinical and administrative healthcare professionals before applying for BizSpark Plus credit from the Microsoft for Startups Program to develop ORHub. The development team at ORHub and Microsoft conducted a pilot program at Hoag Orthopedic Institute, where Dr. Lee and Sarah Coulter, a registered nurse trained in orthopedic surgical care, provided important feedback to fine-tune the functionality.

“We consider the ORHub and Microsoft software developers part of the team at HOI,” says Dr. Lee. “Many hospitals across the nation still use pen and paper to track ordering, sterilizing, implants, and vendor invoicing. We hope ORHub and Microsoft can help the healthcare system advance into the digital age.”

“I knew from the get-go that I wanted to develop this solution on the Azure platform,” says Mitchell. “Healthcare is a Microsoft world. Unlike Amazon Web Services, almost everything that’s offered in Azure is already encrypted and built with HIPAA [Health Insurance Portability and Accountability Act] in mind. It was a simple process to acquire a HIPAA-compliant business associate agreement with Azure. The whole platform is incredibly well suited for a fast-moving technology startup. We went from concept to production in less than a year in institutional medicine. We couldn’t have done that without help from Microsoft. They handled all the platform complexity so we could focus on delivering value to our customers.”

Enhancing care team productivity

On the frontlines of healthcare delivery, the teams responsible for spinal surgery cases at HOI use the ORHub digital platform in the OR to help decrease manual paperwork. On the back end, hospital administrators use ORHub to analyze data.

Mitchell sees surgical care delivery as a collaborative, multiuser, multidepartment effort that can benefit from a cloud-based solution to enhance efficiency. When a surgeon schedules a surgery, a medical device rep uses an app to select the implants required for the procedure and schedule them for delivery to the hospital sterilizing department, where they’re prepared for the OR. At HOI, a number of Surface devices are charged in a specially designed station outside the OR, ready for use. In the OR, the surgical nurse opens the ORHub app on her computer and provides a medical device rep with a PIN number generated by the program, so the vendor can sign in to the Surface and access the data on the surgical procedure in progress.

“For security reasons, my password won’t work on its own until the nurse invites me into the system,” explains Ted Viveros, a medical device rep. “During the surgery, the nurse and I collaborate across the sterile field, each on our own devices. We document all the materials, right as they are being used, to generate an accurate implant record.”

Adds Coulter, “I used to write out the records by hand for every implant in each case, which was time-consuming and stressful. With ORHub, I just sign in to the system, and the implants are already all there, so I can verify that the rep has given me the right materials. Now at the end of the surgery when we are getting ready to close, I can focus more on my patient than on my implant record. ORHub frees up my time to provide better care.”

Once the surgery is completed, a hospital can produce an accurate implant record with rapid digital reconciliation. Members of the healthcare team can review their screens, sign off on the record using the touch functionality, and reconcile the case simultaneously, in real time.

After the case is closed, ORHub delivers highly secure and tailored information electronically to multiple entities such as medical device companies, hospital procurement, billing departments, and materials management. “I no longer manually create purchase orders and PDF files, send emails, and visit hospital departments to drop off invoices,” says Viveros.

Improved understanding of costs

Hospitals such as HOI can use ORHub as an actionable resource analytics tool for its spinal surgeries. In addition, hospital administrators can use Microsoft Power BI for easy-to-read dashboards that compare procedures completed by department, surgeon, and OR, improving their understanding of resource allocation. Instead of waiting for the tedious generation of inventory reports, an administrator can sign in to ORHub and analyze the materials used in a surgery in real time, even during the procedure.

Mitchell and his colleagues plan to add Azure intelligence and analytics functionality to the solution’s capabilities. “We’ll be enabling Azure Machine Learning and HDInsight to assess variables such as implant usage, device cost, and patterns,” he says. “When we have 50,000 procedures in the system, we can start to effect change in the healthcare world. That includes introducing predictive analysis that hospitals can use to anticipate what resources are necessary for a given type of procedure. This can also help healthcare providers and payers coordinate fair pricing on bundled payments.”

Improved understanding of resource allocation is only the first step. A key goal is to measure outcomes objectively. When correlations are made between treatment strategy versus outcome, it becomes clearer which pathway delivers the best result. This understanding will be essential as the United States works to provide more healthcare coverage for its citizens with budget constraints and resource limitations. As national emphasis is put on transitioning to value-based models of healthcare, this understanding is more essential than ever.

These objectives drive Mitchell and his team at ORHub. They are excited to be in the vanguard of streamlining healthcare delivery through new software solutions. “We’ve seen from research that the common result of value-based institutions is a cost reduction of between 20 and 40 percent. If we can achieve that with the cost of surgeries across the US health system, that equates to USD250 to 350 billion saved every year. That’s greater than the gross domestic product of Finland.”

To reach that point, institutions need a new kind of solution—cloud-based, agile, mobile, and scalable—that breaks down the silos in evidence throughout today’s healthcare systems. “To get into the modern era, you need to rethink how healthcare software enables a better world. We think Hoag Orthopedic Institute and ORHub are at the forefront of that,” concludes Mitchell. “And Microsoft helped us all get there.”

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