Featured Blog Archives – PCCI

27 October 2020

PCCI’s Vulnerability Index observes uptick COVID-19 risk in Dallas County, as hot spots re-emerge




DALLAS – As of October, Parkland Center of Clinical Innovations’ (PCCI) Vulnerability Index continues to observe increases in vulnerability to COVID-19 infection in Dallas County, with several hot-spots showing a significant increase in their Vulnerability Index (VI) .

 

Figure 1: Dallas County ZIP codes with the highest vulnerability values.

Launched in June, PCCI’s Vulnerability Index determines communities at risk by examining comorbidity rates, including chronic illnesses such as hypertension, cancer, diabetes and heart disease; areas with high density of populations over the age of 65; and increased social deprivation such as lack of access to food, medicine, employment and transportation. These factors are combined with dynamic mobility rates and confirmed COVID-19 cases where a vulnerability index value is scaled relative to July 2020’s COVID-19 peak value.

The Vulnerability Index reports that in early October (See Table 1), the ZIP Code with the highest vulnerability value continued to be 75211, around Cockrell Hill. This area has been a high-risk area since the launch of PCCI’s Vulnerability Index.

Other ZIP codes of note include the area in 75228, which has risen from the sixth most at risk zone in July to the second most as of October. The ZIP code, 75204, is now the seventh most at-risk zone, after being outside the top ten in July. Additionally, the ZIP codes, 75240 and 75243 both dropped out of the top ten most vulnerable ZIP codes as of October.

PCCI’s Vulnerability Index also found that the top five most vulnerable ZIP codes showed the most extreme increases (See Table 2); the next five had growth but remain at a moderate Vulnerability Index levels. Contributing to vulnerability rating for all ten ZIP codes was increased year-over-year mobility that was detected. COVID-19 case counts have also increased generally across the county.

“The ways to fight this virus remain the same as prior months – limit outside visits,

wash your hands regularly and thoroughly with soap, wear a mask when travel is required outside the home, and continue social distancing,” said Thomas Roderick, PhD, Senior Data and Applied Scientist at PCCI.  “Also, be sure to listen to public health authorities, such as the Dallas County HHS, Texas DSHS, and CDC. Working together we can push back against the recent increase in cases.”

Figure 2: Dallas County ZIP codes by increase in Vulnerability Ranking change.

The PCCI COVID-19 Vulnerability Index can be found on its COVID-19 Hub for Dallas County at: https://covid-analytics-pccinnovation.hub.arcgis.com/.

Data Sources:

To build Vulnerability Index, PCCI relied on data from Parkland Health & Hospital System, Dallas County Health and Human Services Department, the Dallas-Fort Worth Hospital Council, U.S. Census, and SafeGraph.

About Parkland Center for Clinical Innovation

Parkland Center for Clinical Innovation (PCCI) is an independent, not-for-profit, healthcare intelligence organization affiliated with Parkland Health & Hospital System. PCCI leverages clinical expertise, data science and social determinants of health to address the needs of vulnerable populations. We believe that data, done right, has the power to galvanize communities, inform leaders, and empower people.

 

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27 October 2020

PCCI’s COVID-19 Animated Heat map Shows Dallas County’s Infection Evolution




Below is the PCCI’s COVID-19 animated heat map that shows the infection spread in Dallas County beginning on March 9, 2020 and ending on October 18, 2020, using Dallas County Health & Human Services Department’s COVID-19 confirmed and presumed case data. The animated geomap includes hot spots, indicated in orange, of cases over 14-day periods.

The underlying map (purple highlights) is PCCI’s Vulnerability Index updated with COVID-19 cases and SafeGraph mobility data as of October 19, 2020. Dallas County Jail and Federal Bureau of Prison locations excluded from the visualization.

Go to PCCI’s COVID-19 Hub to track cases, see the new Vulnerability Index and heat maps in Dallas County at: https://covid-analytics-pccinnovation.hub.arcgis.com/

26 October 2020

PCCI Recognition: CEO Steve Miff honored as a Most Inspiring Leader by Dallas Business Journal




As a reflection of the outstanding efforts PCCI has conducted battling the COVID-19 outbreak in Dallas, the Dallas Business Journal has honored Steve Miff, as a representative of PCCI, for its “2020 Most Inspiring Leaders” award. The awards honor companies and corporate leaders from the North Texas-area representing different sized companies from a number of industries who helped lead efforts to combat the pandemic.

Click this link to see a slide show of all DBJ’s honorees:

https://www.bizjournals.com/dallas/gallery/472954

PCCI’s efforts will be recognized at a virtual reception on Thursday, November 19th from 4:00 – 5:15 p.m.

21 October 2020

In The News: PCCI’s Kieth Kosel Authors Column in Electronic Health Reporter




Keith Kosel, PCCI’s VP of Corporate Relations and co-author of “Building Connected Communities of Care,” published an article in Electronic Health Reporter. The article, “Governance: The Glue That Holds Connected Communities of Care Together,” discusses the importance of governance in the PCCI connected community of care model that brings together community, government and healthcare organizations together in order to help under-served communities. To read the article, please click on the image below:

21 October 2020

In The News: HealthIT Analytics on how PCCI Leverages Data Analytics Tools to Address Health Disparities




In this story from HealthIT Analytics, how PCCI is using data analytics technologies to identify at-risk individuals and alleviate health disparities during the COVID-19 pandemic is examined. Please click on the image below to read the whole story.

 

 

19 October 2020

Xtelligent Podcast: Steve Miff On Addressing Health Disparities, Social Determinants Through Data Analytics




Steve Miff, president and chief executive officer of Parkland Center for Clinical Innovation, shares how to use data analytics to identify at-risk individuals. He describes how the center’s proximity risk index can help physicians decide when to direct patients to telehealth, identify patients facing social determinants of health and health disparities, and provide evidence to guide policy measures.

Click on the image below to listen to the podcast for healthcare professionals seeking solutions to today’s and tomorrow’s top challenges.

15 October 2020

PCCI Publishes Paper on Trauma Mortality Prediction




PCCI data science and clinical experts, along with team leaders at Parkland Health and Hospital System,  have published a new paper about the Parkland Trauma Index of Mortality* on arXiv®. arVix is an open archive for scholarly articles maintained and operated by Cornell University. The paper “Parkland Trauma Index of Mortality (PTIM): Real-time Predictive Model for PolyTrauma Patients” explores how a machine learning algorithm that uses electronic medical record data to predict 48−hour mortality during the first 72 hours of hospitalization.

“This project is an outstanding collaboration between PCCI and Parkland and probably first of its kind dynamic and real-time predictive model for polytrauma patients,” said Manjula Julka, MD, MBA, Vice President, Clinical Innovation at PCCI. “Dr. Adam Starr, distinguished ortho trauma surgeon at Parkland, is a key leader in this project. Parkland’s trauma center is committed to providing state-of-the-art innovative, high quality care for best health outcomes. This paper outlines how we were able to leverage machine learning to help predict mortality for trauma patients in a way where surgery and critical care teams are able to use this, along with other clinical decision support tools, as a way to help save lives.”

To view and download the paper, click on the image below:

 

*The Parkland Trauma Index of Mortality model is a free software and is distributed under the terms of the GNU Lesser General Public License (LGPL).

15 October 2020

Blog: Is Your Community Ready to be Connected?




By Keith C. Kosel, PhD, MHSA, MBA

Parkland Center for Clinical Innovation

 This question initially brings to mind many possibilities such as connection to the latest 5G cellular service, a new super-fast internet provider, or maybe one of the many new energy suppliers jockeying for market share from traditional utility companies. While all of these might represent legitimate opportunities to improve one’s community, here we are talking about a different concept; specifically, whether your community is ready to have a Connected Community of Care (CCC) to advance whole person health.

The image of a CCC may seem obvious. After all, we all live in communities where we have some connections between hospitals, physician practices, ambulatory care centers, and pharmacies to name just a few. But here we are talking about a broader sense of connected community that includes not just health care organizations, but social service organizations, such as schools and civic organizations and community-based organizations (CBOs) like neighborhood food pantries and temporary housing facilities. A true CCC links together local healthcare providers along with a wide array of CBOs, faith-based organizations and civic entities to help address those social factors, such as education, income security, food access, and behavioral support networks, which can influence a population’s risk for illness or disease. Addressing these factors in connection with traditional medical care can reduce disease risk and advance whole person care. Such is the case in Dallas Texas, where the Dallas CCC information exchange platform has been operating since 2012. Designed to electronically bring together local healthcare systems, clinicians, and ancillary providers with over a hundred CBOs, the Dallas CCC provides a real-time referral and communication platform with a sophisticated care management system designed and built by the Parkland Center for Clinical Innovation (PCCI) and Pieces Technologies, Inc.

Long before this information exchange platform was implemented, the framers of the Dallas CCC came together to consider whether Dallas needed such a network and whether the potential partners in the community were truly ready to make the commitments needed to bring this idea to fruition. As more and more communities and healthcare provider entities realize the tremendous potential of addressing the social determinants of health by bringing together healthcare entities and CBOs and other social-service organizations, the question of community readiness for a CCC is being asked much more often. But how do you know what the right answer is?

Before looking at the details of how we might answer this, let’s remember that a CCC doesn’t don’t just happen in a vacuum. It requires belief, vision, commitment― and above all― alignment among the key stakeholders. Every CCC that has formed, including the Dallas CCC, begins with a vision for a healthier community and its citizens. This vision is typically shared by two or more large and influential key community stakeholders, such as a   large healthcare system, school district, civic entity, or social- service organization like the United Way or Salvation Army. Leaders from these organizations often initially connect at informal social gatherings and advance the idea of what if? These informal exchanges soon lead to a more formal meeting where the topic is more fully discussed and each of the participants articulates their vision for a healthier community and what that might look like going forward. This stage in the evolution of a CCC is perhaps the key step in the transformation process, as while all stakeholders will have a vision, achieving alignment among those visions is no small feat. Many hopeful CCCs never pass this stage, as the stakeholders cannot come to agreement on a common vision that each can support. For the fortunate few, intrinsic organizational differences can be successfully set aside to allow the CCC to move forward.

It’s at this point in the CCC’s evolution that details begin to matter in truthfully answering the question, “Is this community ready to be connected?” While there may be agreement among the key stakeholders on a vision, the details around readiness may still divert or delay the best-laid plans. It is safe to say that the key to understanding a community’s readiness to form a CCC lies in the completion of a formal, comprehensive, and transparent readiness assessment. A readiness assessment is a process to collect, analyze, and evaluate critical information gathered from the community to help identify actual clinical and socio-economic needs, current capabilities and resources (including technology), and community interest and engagement. Taken together, a comprehensive readiness assessment can help identify a community’s strengths and weaknesses in preparation for establishing a CCC. A readiness assessment is not a tactical plan for building a CCC, nor is it a governance document that provides how all members of the CCC will relate to each other. Instead, the readiness assessment provides communities interested in establishing a CCC with an honest and unbiased yardstick to measure preparedness. Conducting and using the results of the readiness assessment is one of the best ways to ensure a successful CCC deployment.

A typical CCC readiness assessment covers five areas: (1) community demographics; (2) clinical areas of need (including trends); (3) social areas of need (including trends); (4) technology competency (e.g., what percent of the potential network participants are computer literate?), availability (e.g., what percent of the potential network participants have internet access?), and suitability (e.g., is the internet access, high speed?); and (5) what are the needs of potential network participants and can these be modeled as use cases for the information exchange network? This information is essential to help key stakeholder decision-makers decide to move forward with establishing a CCC and to know what specific challenges may lie ahead.

The collection of this essential information can be done in a number of ways, such as making use of existing publicly reported data or conducting surveys, interviews, focus groups and townhall meetings with community leaders and residents and clinical and CBO leaders and staff. Experience conducting the readiness assessment that provided the foundation for the Dallas CCC showed that no single information-collection method was sufficient to collect the necessary level and robustness of the data. In Dallas, we utilized all five approaches but found that in addition to researching publicly available data, initial surveys, followed by interviews and focus groups, yielded the most voluminous and reliable information to chart the course ahead.

In addition to the various methods to collect this essential information, the key to obtaining useful and reliable information requires a sufficient number of respondents/participants who are drawn from various organizations and organizational levels. Simply put, you must have a large enough sample and you must have diversity within the sample. It’s not enough to just interview leaders of potential network participants, as their understanding of the needs, trends, and capabilities may look very different from that of frontline staff. Similarly, surveying only one category of potential network participants may not provide enough information to  fully understand the socio-economic needs in the community or even the perspectives surrounding the prevalence of chronic conditions. Beyond the qualitative methods involved, it is important to note that if done right, this process takes a lot of time to complete. Cutting corners by reducing the sample size, for example, or doing selective sampling to speed the readiness assessment process along will only cause problems later when this insufficient information results in erroneous decision-making.

Once the data has been collected, it is important to carefully analyze what the data is trying to tell you. Results of the readiness assessment must be shared openly and honestly with all key stakeholders, particularly those serving in a governance capacity. The governance group (a topic for another day) that has formed in parallel with the readiness assessment must be able to evaluate and understand the main messages from the readiness assessment to make an informed decision as to whether to move forward with establishing a CCC. Like the need for alignment around the key stakeholder’s vision for the CCC, there must be universal agreement by the key stakeholders as to the message of the readiness assessment and its implications for the road ahead. As with the vision alignment stage, substantive disagreements among the group at this stage are a sign of trouble ahead unless differences can be resolved.

At this point you might be thinking that this all seems very complicated and fraught with potential land mines waiting to derail your effort to answer the original question “Is your community ready to be connected?” Again, I would emphasize the importance of unwavering commitment and alignment to achieve the vision. But I would also offer advice gleaned from working in the CCC space for the last eight years, which is to get help early and don’t wait until the horse is out of the barn! We have seen first-hand many communities and consultants approach the conduct of a readiness assessment with a cavalier attitude, often exemplified by the statement, “we already know all of this,” only later to have to backtrack their pronouncements at substantial additional cost in time and resources. Fortunately, today there are a number of excellent organizations, including PCCI, with the experience, credibility, and integrity in the CCC space to help you on this journey. Don’t be afraid to seek them out. It will be a wise investment that you will not regret, particularly when you begin to see the results of improved whole person health and well-being in your community.

About the author

Dr. Keith Kosel is a Vice President at Parkland Center for Clinical Innovation (PCCI) and is author of “Building Connected Communities of Care: The Playbook for Streamlining Effective Coordination Between Medical and Community-Based Organizations,” a guide that brings together communities to support our most vulnerable. At PCCI, Keith is leveraging his passion for – and extensive experience in – patient safety, quality, and population health by focusing on understanding social determinants of health and the impact of community-based interventions in improving the health of vulnerable and underserved populations.

 

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14 October 2020

D CEO & Dallas Innovates names Steve Miff as finalist Innovation Awards




D CEO and Dallas Innovates have announced that Steve Miff, CEO of PCCI, is a finalist in its second annual Innovation Awards. The program honors companies, CEOs, CIOS, CTOs, entrepreneurs, and other leaders who are helping to make Dallas-Fort Worth a hub for innovation. Steve is finalist in the “Innovation in Healthcare” category.

All finalists will be recognized in the January/February issue of D CEO magazine and online at DallasInnovates.com; winners will be revealed at an exclusive awards event in January.

Click on the image below for more information:

1 October 2020

Proximity Matters: Using machine learning and geospatial analytics to reduce COVID-19 exposure risk




By Manjula Julka, MD, MBA, PCCI’s Vice President, Clinical Innovation

By Albert Karam, MS, PCCI’s Director of Data Governance and Analytics

Since the earliest days of the COVID-19 pandemic, one of the biggest challenges for health systems has been to gain an understanding of the community spread of this virus and to determine how likely is it that a person walking through the doors of a facility is at a higher risk of being COVID-19 positive.

Without adequate access to testing data, health systems early-on were often forced to rely on individuals to answer questions such as whether they had traveled to certain high-risk regions. Even that unreliable method of assessing risk started becoming meaningless as local community spread took hold.

Parkland Health & Hospital System (the safety net health system for Dallas County, TX) and PCCI (a Dallas, TX based non-profit with expertise in the practical applications of advanced data science and social determinants of health) had a better idea. Community spread of an infectious disease is made possible through physical proximity and density of active carriers and non-infected individuals. Thus, to understand the risk of an individual contracting the disease (exposure risk), it was necessary to assess their proximity to confirmed COVID-19 cases based on their address and population density of those locations. If an “exposure risk” index could be created, then Parkland could use it to minimize exposure for their patients and health workers and provide targeted educational outreach in highly vulnerable zip codes.

PCCI’s data science and clinical team worked diligently in collaboration with the Parkland Informatics team to develop an innovative machine learning driven predictive model called Proximity Index. Proximity Index predicts for an individual’s COVID-19 exposure risk, based on their proximity to test positive cases and the population density. This model was put into action at Parkland through PCCI’s cloud-based advanced analytics and machine learning platform called Isthmus. PCCI’s machine learning engineering team generated geospatial analysis for the model and, with support from the Parkland IT team, integrated it with their Electronic Health Record system.

Since April 22, Parkland’s population health team has utilized the Proximity Index for four key system-wide initiatives to triage more than 100,000 patient encounters and to assess needs, proactively:

  1. Patients most at risk, with appointments in 1-2 days, were screened ahead of their visit to prevent spread within hospital
  2. Patients identified as vulnerable, were offered additional medical (i.e. virtual visit, medication refill assistance) and social support
  3. Communities, by zip-code, most at-risk were sent targeted messaging and focused outreach on COVID-19 prevention, staying safe, monitoring for symptoms, and resources for where to get tested and medical help.
  4. High exposure risk patients who had an appointment at one of Parkland’s community clinics in the next couple of days were offered a telehealth appointment instead of a physical appointment if that was appropriate based on the type of appointment.

5. Proximity Index to other organizations in the community – schools, employers etc., as well as to individuals to provide them with a data driven tool to help in decision making around reopening the economy and society in a safe, thoughtful manner.

Figure 1 PCCI’s Proximity Index Process

In the future, PCCI is planning on offering

Many teams across the Parkland family collaborated on this project, including the IT team led by Brett Moran, MD, Senior Vice President, Associate Chief Medical Officer and Chief Medical Information Officer at Parkland Health and Hospital System.

About the Authors

Manjula Julka, MD, FAAFP, MBA, is the Vice President of Clinical Innovation at PCCI. She brings more than 15 years of experience in healthcare delivery transformation, leading a strong and consistent track record of enabling meaningful outcomes.

Albert Karam is a data scientist at PCCI with experience building predictive models in healthcare. While working at PCCI, Albert has researched, identified, managed, modeled, and deployed predictive models for Parkland Hospital and the Parkland Community Health Plan. He is diverse in understanding modelling workflows and implementation of real time models.

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