Predictive modeling shapes the future at Boston Children's

CMIO Marvin Harper: 'This data has been very powerful already in the care of children nationwide'

Hospitals nationwide are turning to informatics to streamline care processes, improving both the efficiency and safety of patient care. One facility that appears to be ahead of the curve, however, is Children's Hospital Boston, which, according to CIO Dan Nigrin saves roughly $1.4 million annually by using informatics in its medication delivery system.

"The pharmacy is made aware of changes much more expeditiously than when we were paper based," Nigrin told FierceHealthIT in an exclusive interview. "The pharmacy has gotten to essentially be much more of a just-in-time delivery model, where they're continuously delivering medications to the floor, every hour or every two hours, as opposed to every 12. If a medication has changed, the amount of potential waste that occurs because the medication was, for instance, discontinued, has dropped dramatically."

Nigrin and colleagues Jonathan Bickel, director of clinical research informatics at the hospital, and Marvin Harper, the facility's chief medical information officer, recently spoke with FierceHealthIT about those and other ways in which they currently are using informatics.

FierceHealthIT: How is Boston Children's currently using predictive models?

Dan Nigrin (right): One of the main ways in which we get at that data is using a technology that's been developed locally here in a joint effort between Children's Hospital and Partners HealthCare on a platform called I2B2 (Informatics for Integrating Biology and the Bedside). In short, I2B2 is an application that allows end users to be able to look for cohorts of patients that meet a certain criteria. For example, I could be looking for all of the patients seen within the last year at Children's who have diabetes and who have hypertension, and this thing crunches away for a few seconds and then I'm given that de-identified cohort of patients.

Jonathan Bickel (left): We've had the technology around for the last four years, and it's been in constant development for at least seven or eight. It's also installed at about 60 academic medical centers across the country.

The thing that's most innovative is we're starting to connect up individual I2B2 instances together in a network called the Shared Health Research Information Network (SHRINE). It's essentially a group of I2B2 instances where the data lives still within the firewall of the home institution, but yet we here at Children's can initiate a query and ask those same kind of cohort questions previously mentioned across this network and get the same information; we're really starting to develop national cohorts.

FHIT: How fast can you get results from SHRINE compared to I2B2?

JB: It maybe takes 150 seconds as opposed to 20 seconds within your own hospital to get your number. We're talking you don't have time to get up and get a cup of coffee.

DN: With respect to these tools, though, they're not yet to the point where if you've got a new patient in front of you, you can query the database to find out how other similar patients have been managed or how they fared on a certain system; the system is not yet essentially real time for us. It's not informing care at the point of care. Currently, we're using the system in a research mode.

I think over the next few years, however, that could change.