Innovative Mission At the University of Pittsburgh Medical Center

Far-sighted facilities and healthcare systems are learning how to harness technology to buttress their fiscal health. The University of Pittsburgh Medical Center (UPMC) is taking that concept to an entrepreneurial level, partnering with industry to develop cost-saving, care-enhancing technologies and commercializing those technologies for profit.

As a major system with multiple facilities affiliated with the University of Pittsburgh Schools of the Health Sciences and with the resources of Western Pennsylvania to draw upon, UPMC always has been quick to adopt and implement new technologies. The provider has been named one of the “most wired” hospitals for 13 consecutive years. But, in recent years, UPMC has focused on leveraging its tech savvy not only to support high-level, cost-efficient care, but also to support its bottom line. UPMC established an international services division that commercializes its technologies and sells these technologies to other facilities and healthcare systems outside the U.S.

The system’s response to a common procurement problem is one example. UPMC found that approximately 80 percent of supply purchases were “maverick buys,” or purchases that were not compliant with the system’s purchasing contracts. UPMC had an electronic purchasing system in place, but it limited purchasers to searching local catalogs or leaving the system to search vendor databases.

“The ROI for e-procurement solutions is predicated on end-users actually using the solution. If [end-users] find other ways to buy, if they plug in a price off an 8x10 piece of paper taped to a filing cabinet, if they call the vendor directly, they’re usually getting an incorrect price, and that’s [money that is] usually going out to the vendor,” says Michael DeLuca, senior director of supply chain solutions and consulting services for UPMC.

The provider set about constructing a more user-friendly platform—“an Amazon.com-like shopping experience,” DeLuca explains, which has achieved great results. It developed a virtual marketplace shoppers can easily search. UPMC’s supply spends are now more than 80 percent compliant systemwide, resulting in savings that DeLuca estimates at $3.5 million per year, and increasing as the marketplace adds new vendors. In addition, enhanced back-office efficiency has allowed UPMC to reassign 25 full-time employees from buying support positions to sourcing.

UPMC then leveraged the success of the virtual marketplace by creating Prodigo Solutions, and launching it as a commercial enterprise in 2008. DeLuca simultaneously holds the title of vice president of technology and client services at Prodigo. The company sells its commercial marketplace platform, as well as electronic exchange systems and web-based requisition technologies, to healthcare facilities and systems across the U.S. The company broke even in 2012, DeLuca reports, and hopes to turn a profit in 2013.

While Prodigo is a home-grown enterprise, UPMC emphasizes partnering with large vendors to develop, test and sell healthcare technologies. By positioning itself as a healthcare delivery system with entrepreneurial verve, the provider serves as a beta test lab for new  technologies that are developed, offering the credibility of a provider known for quality care.

Much of the work of identifying technological needs and appropriate partners is done through UPMC’s Technology Development Center (TDC), a group tasked with creating innovation in health IT. UPMC’s industry partners contribute to the costs of technology development. According to TDC President Rebecca Kaul, the group focuses on “building technology for the future, that doesn’t already exist in the marketplace, and then making these technologies commercially available through strategic partnerships with large industry vendors. That’s really our business model.”

 The TDC’s mission is to transform the way healthcare is delivered by using innovative technology, including:

• Advanced analytics and decision support systems;
• Machine learning and data mining;
• Computer vision and image data handling;
• Mobile healthcare;
• Computer-aided diagnosis systems; and
• Telemedicine.

When it partners with a technology vendor to develop a new innovation, TDC provides reality-based advice and experience to design a product that is feasible, useful and therefore, more likely to be successful in the commercial marketplace. UPMC also serves as a testing ground, providing opportunities to pilot the technology in a real-world setting.

Currently, TDC has several projects in development. In 2011, it entered into a multi-year agreement with Nuance Healthcare to develop speech and clinical language understanding (CLU) technologies, as well as others that focus on quality and clinical decision support. The goal is to transform clinical data from the EHR and other sources into actionable information, not only obviating the need for time-consuming review and analysis but also creating rich analytics that will improve the quality and efficiency of care throughout the system. The initial focus of the project is on creating a technology that will help clinicians improve the accuracy of what is captured in the EHR while applying analytics to improve patient care. By improving clinical records in this way, the developers expect to see improvements in billing and coding accuracy and Meaningful Use compliance, as well. Eventually, the partners hope to offer the product on the commercial market.  
TDC also is working with Optum on a technology seeking to improve clinical record-keeping through clinical documentation improvement (CDI). Currently underway for less than a year, the project is in its pilot phase. Again using natural language processing technologies, this system will mine the clinical record and pose electronic queries to the clinician about the patient or the care the patient received. A CDI specialist reviews the proposed query for appropriateness and accuracy before it is sent to the physician or other clinician for response.

Although ICD-10 adoption and compliance is a driving force behind the development of the CDI technology, it also will be a critical component of UPMC’s move to concurrent billing. Presley Kelleher, senior product manager at TDC, notes that UPMC typically bills a patient an average of 30 days post-discharge. He hopes that when the system is fully implemented, coding will occur concurrently with the hospital stay, reducing the discharge-to-bill time to four to seven days.

The CDI technology that Optum and UPMC are developing seeks to shrink the time gap between dictation and queries. The technology also will seek to generate a query when information seems to be inaccurate or missing, electronically sending the query to the physician as soon as a CDI specialist has reviewed it. The physician then can respond to the query electronically.

“Currently, at discharge and post-discharge, there’s a lot of running around, tracking the physician down, trying to get a response to queries,” Kelleher says. “Sometimes these queries come 15 to 20 days after discharge, and the physician needs to locate the record, go back and reconstruct. The new system will eliminate the need for manual responses, because the coder will see something in yesterday’s records and can query the physician while [he or she is] still actively caring for that patient. The physician has more accurate information available, instead of two or three weeks after the fact.”

To assess the new system, TDC collected 500 randomly selected discharge records and evaluated the records for potential gains. If the system identified potential gains, any necessary additional information was obtained and the cases were rebilled. The result was $69,000 in additional revenue, an average of $138 per case. Extrapolated to all of UPMC’s DRG discharges for FY2012, Kaul says the technology could produce an additional $21.5 million in revenue, without factoring in the cost savings of greater efficiency and enhanced compliance.

A pilot program introducing the CDI product began in December 2012, and Kaul expects that it will become commercially available in the second or third quarter of 2013, after a six-month trial.

The development of new technologies is the core mission of TDC and using them to maintain and enhance the financial well-being of the entire UPMC system is critical. But Kaul emphasizes that there is a larger purpose.

The goal is for more accurate documentation to improve quality of care in the long run because it will enable more meaningful analytics that offers better understanding of the patient population. “We’ll gain a better level of detail about them, and we’ll be able to understand what drives variation in care and what drives different treatment paths based on the specifics of the patient and the care plan,” says Kaul. “All of this is giving us a financial benefit now and it’s very substantial and we’re very excited about it. But it’s really about capturing more valid information about our patients to drive better care.”