News and Events

Why technology will replace doctors.

Don’t worry. It won’t. 

by Steve Lefar, CEO of Applied Pathways

Artificial intelligence (AI) or machine learning is the latest buzzword and investment theme in healthcare. Because the term AI is used to encompass everything from expert systems, to recommendation engines, to machine or deep learning, to real sentient AI, most of us interact with AI systems on a daily basis. “AI is transforming Google search. The rest of the Web is next,” says Cade Metz of Wired. “This approach, called deep learning, is rapidly reinventing so many of the Internet’s most popular services, from Facebook to Twitter to Skype.”

The places where AI is having the most day-to-day impact – search, online shopping, connecting with friends, and certain machine learning uses in industrial settings – are nothing like healthcare where a singular definitive answer to an often moderately specific question with limited data is required for true AI. In healthcare, it’s still in the early days of the hype cycle with vendors making all sorts of claims that are not yet supported with peer-reviewed, evidence-based research.

Many organizations are working hard to bring forms of AI to healthcare. IBM’s Watson, numerous startups like Enlitic* (full disclosure: I’m an investor), Arterys, Zebra, and iRhythm are focused on supervised (learning to recognize patterns in multi-week cardiac monitoring) and unsupervised (finding lung nodules on images) AI. The real focus is shifting to augmenting physicians via a recommendation engine approach versus the initial approach many took of being the soothsaying Magic 8 ball answer machine. Computers will dramatically enhance the diagnosis of disease, pattern recognition and recommendation of treatment options and identification of gaps in care better than clinicians flying solo with only the knowledge base in their brains. 

The problem is we have a new batch of startups trying to raise the next billion-dollar valuation by making wild claims of instant diagnoses via chat bots and online interviews. We must temper the hype or we will suffer yet another “AI nuclear winter” as we saw all the way back in 1984 during the American Association of Artificial Intelligence meeting.

 

The Wizard of Oz in Healthcare?

Read the fine print right now. Every one of these new startups disclaims their results as being for informational purposes only and not diagnostics. They want to have investors buy into HAL 2001 or Star Trek M5 (1968!). What they are really signing up for is the Wizard of Oz model – “pay no heed to the man behind the curtain”.

The real challenges are deep, especially in unsupervised machine learning where we don’t even know why the computer gives us the answer it does. Are we to presume it is accurate? That’s fine for a recommendation to buy a coffee mug but not to determine a singular choice of treatment without human concurrence.  Nowhere is this more real than in autonomous driving where the behavioral, legal, social, and technical challenges of the technology are becoming more and more public.

Recently, people have started to express concern that, since computers are taught by humans, they absorb all of our implicit and explicit biases.  According to this recent article by Brian Resnick, computers are just as likely to be racist as we are. With AI’s entrance into healthcare, the possibilities become potentially alarming. Brian notes, “It’s long been known that women get surgery at lower rates than men (One reason is that women, as primary caregivers, have fewer people to take care of them post-surgery.) Might AI then recommend surgery at a lower rate for women?”.

Others are talking about how the vast majority of the peer-reviewed journal articles that are consumed by AI engines to create these models retain the implicit bias of the researcher which skews what we believe to be the latest and greatest research. This opens up the opportunity for abuse by corporations around the globe that want their drugs, devices or procedures to be the next great thing regardless of their efficacy.

 

Are we ready for the Star Trek M5 (season 2 Episode 24 1968)!? 

In 1968 when the starship enterprise was turned over to a black box, Gene Rodenberry envisioned a computer declaring Kirk and Bones non-essential personnel. it went downhill from there and the AI engine misunderstood what humans would do. This black box approach – where we see the end result, potentially after catastrophic damage, without seeing or understanding the path taken to get there — simply doesn’t work in healthcare. Doctors and patients alike need to understand WHY an illness was diagnosed or a treatment path was recommended.  And we need to be assured that the implicit and explicit biases that plague us as humans aren’t determining our healthcare fate as decided by a computer.

Until AI can do that and eliminate learning our own human frailties it will likely remain a tool to augment us not replace us. In healthcare, augmentation of the experts will be the answer for the foreseeable future. Investors, consumers and providers should take heed and not believe the great and mighty Oz just yet!

Read MoreWhy technology will replace doctors.

Visit us at the AHIP Institute & Expo in June

Applied Pathways is exhibiting at AHIP’s Institute and Expo in Austin from June 7-9. Come and visit us in booth 1414.

AHIP is the national association whose members provide coverage and health‐related services that improve and protect the health and financial security of consumers, families, businesses, communities and the nation.

AHIP and its members create and accelerate positive change and innovation across the Health care system for consumers through market‐based solutions and public‐private partnerships that advance affordability, value, access and well‐being.

Read MoreVisit us at the AHIP Institute & Expo in June

Quantum Leap: Revolutionizing Healthcare Through Knowledge Management

What Knowledge Management is and how it will improve quality.

By John Feldman, Founder and Chairman of Applied Pathways

When it comes to healthcare, all the knowledge mankind has accumulated since the dawn of recorded time could be described as the foundation upon which contemporary medicine has been built. Over the past several years, great leaps in technology have allowed for the unprecedented collection of massive amounts of data. This data, when properly harnessed through machine learning or other analytic processes, is capable of hugely augmenting our existing knowledge base, extending the foundation while also laying the cornerstone for precision medicine and truly revolutionary healthcare delivery.

Therein, however, lies the rub. For although we now excel at collecting data, healthcare often and infamously lags behind other industries in effectively translating that data into knowledge to improve quality. This is where knowledge management comes in. And with the proper solution in place, it is capable of evoking a sea change in healthcare, fomenting no less than a knowledge revolution that will grow exponentially and continue to drive quality.

So what exactly is knowledge management, and how can it help us? To begin, let’s focus on the knowledge management pyramid.

Augmenting the DIKW model 

The traditional knowledge pyramid is also known as the DIKW pyramid. Each letter in the acronym represents a different level. From the bottom up, these are:

1. Data;

2. Information;

3. Knowledge; and 

4. Wisdom.

Source: Clinical Knowledge Management, Opportunities and Challenges, Rajeev K. Bali

Delving further into these concepts, we can see the components comprising each step of the pyramid and how they relate to the traditional model (again, from the bottom up):

Collecting and Organizing – Parts of the lower pyramid’s data level, caregivers have gotten quite good at these imperative tasks, especially in recent years as technology advances have hugely aided in the data collection process.

Summarizing and Analyzing – These more advanced ventures occupy the second level of the pyramid: information. Technology again is a driving force here, with significant investments and advances in data analytics software allowing practitioners to finally begin to use collected data to its fullest potential.

Synthesizing and Decision Making – Occupying the pyramid’s apex at the third and fourth levels of knowledge and wisdom are, respectively, synthesizing and — most importantly — decision making. While the decision-making process remains solely with caregivers, knowledge-management technology is a powerful, cutting-edge tool to aid in synthesizing data, correlating it with all related information to suggest a hierarchy of importance (Ex: appropriate study or intervention), pointing out further information that should be gathered, and even listing possible causes.

Properly utilized, effective knowledge management is a robust tool capable of transmuting medical data into clinically relevant information, and making that information universally available to caregivers whenever and wherever they require it.

Proper knowledge management increases quality of service

Established in other industries in the early 1990s, effective knowledge management has been shown to encourage the sharing of information. This environment fosters innovation, providing that the knowledge management solution is a living, malleable entity capable of change and incorporating new learning as it is accumulated.

From the decades of data collected from those other industries that began incorporating knowledge management long ago, there is a demonstrable link between effective knowledge management and improvement in quality. By putting best practices into the practice of medicine, we can deliver tools to help caregivers perform at the highest level possible.

Knowledge management works best when it’s used across all continuums of healthcare. With contemporary technologies, contextually relevant knowledge or expertise can be delivered anywhere a patient seeks care. As the industry demands more performance from practitioners, there must be adequate tools in place to help them achieve their goals, including the Triple Aim. A proper knowledge management solution lays the foundation for rigorous quality control enabling improved workflow, efficiency and accuracy in diagnoses.

Raw data becomes information. Information becomes knowledge. Knowledge produces quality when enforced and consistently applied. The trick is to connect the people who produce knowledge with those who apply it. We now have a handle on data storage. Determining what to do with the data? That’s knowledge management.

Read MoreQuantum Leap: Revolutionizing Healthcare Through Knowledge Management

The Enemy of Quality

Why variance management is key to improving healthcare.

By John Feldman, Founder and Chairman of Applied Pathways

How do you know you are successful if you don’t set goals? In healthcare — and everywhere else, for that matter — quality is defined as achieving your desired outcomes.

But just what is “variance,” and how does it impact quality?

In statistics, variance calculates how data is distributed about the mean or expected value. In other words, variance measures quality by letting you know how close you are to meeting the goals you intended to achieve. Higher variance means lower quality.

In manufacturing, quality is determined by how closely the final product matches the desired specifications.

To understand just how variance management can impact healthcare, let’s first take a look at how quality control experts in other industries elucidate the relationship between quality and variance.

That’s nice, but can you do it again?

Engineer and statistician W. Edwards Deming, credited with helping Japan improve the quality of its manufacturing industry after World War II, defined quality as “predictability,” and called variance “the enemy of quality.” To achieve an intended outcome, Deming thought it was important to plan for common-cause variation, which can be predicted, and special-cause variation, which cannot.

Harold F. Dodge, one of the principal architects of the science of statistical quality control, said, “You cannot inspect quality into a product.” In other words, once the inspection takes place, it’s too late. Rather, data from the quality inspection needs to be utilized to continually improve the process.

Management consultant Joseph Juran, who focused on management training and the human element of quality control for a variety of businesses, stated that quality is “a fitness for use.” Juran said that resistance to change often causes a reduction in quality, and insisted that high-performance quality management systems must contain planning, control and improvement (known as the “Juran Trilogy”).

Businessman Philip B. Crosby, who developed the concept of Zero Defects while working as senior quality engineer at aircraft manufacturer The Martin Company, defined quality as “a conformance to requirements.” He warned against the high cost of nonconformance, and said that the desired performance standard of zero defects could only be achieved through the proper management system.

Historically, healthcare has been a late adopter of established practices shown to work in other industries. But what if healthcare managed quality and variance in the same way other industries do?

Making a list, checking it twice

The National Academies’ Health and Medicine Division (HMD), formerly The Institute of Medicine (IOM), defines quality as, “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

Author and expert on the challenges of modern medicine Atul Gawande makes the case that something as simple as a checklist can substantially improve healthcare outcomes (“The Checklist Manifesto: How to Get Things Right”).

To that end, the HMD outlines six specific aims that a healthcare system must fulfill to deliver quality care:

Safe: Care should be as safe for patients in healthcare facilities as in their homes;

Effective: The science and evidence behind health care should be applied and serve as the standard in the delivery of care;

Efficient: Care and service should be cost effective, and waste should be removed from the system;

Timely: Patients should experience no waits or delays in receiving care and service;

Patient centered: The system of care should revolve around the patient, respect patient preferences, and put the patient in control;

Equitable: Unequal treatment should be a fact of the past; disparities in care should be eradicated.

Knowledge is power

The knowledge underpinning evidence-based medicine (EBM), which optimizes decision making by emphasizing the use of evidence, is evolving so rapidly that clinicians cannot keep pace. As sophisticated analytics, deep learning, machine learning and big data accelerate learning, the challenge for healthcare organizations will be to determine how to close the ignorance gap — the delta between evidence and awareness. A knowledge management ecosystem will bridge the gap between knowledge and ignorance, enabling healthcare organizations to reproducibly achieve their intended outcomes by keeping variance low.

The objective of EBM is to apply best practices to achieve intended outcomes. The purpose of knowledge management is to deliver wisdom to those who need to apply it. As medical knowledge advances, so should the care delivered to patients.

What do you think? Are you working to reduce variance in your organization? If so, let us know what steps you are taking and we’ll write about the responses we get.

Read MoreThe Enemy of Quality

Applied Pathways Names Steve Lefar Chief Executive Officer

SCHAUMBURG, Ill., June 16, 2016 /PRNewswire/ — Applied Pathways LLC, a leader in Enterprise Knowledge Management for healthcare, today announced that healthcare industry veteran Steve Lefar has assumed the role of Chief Executive Officer and will join its Board of Directors.  Founder and current CEO John Feldman will continue in an operating role as Chairman of the Board.

Lefar, 49, is an accomplished C-level executive with more than 25 years of leadership experience in the healthcare information technology industry and a reputation for building companies that become a part of the fabric of the industry.  Lefar comes to Applied Pathways following his 4-year tenure as President and CEO of analytics firm Sg2, which was acquired by MedAssets in 2015.

Lefar’s experience in the healthcare IT industry will accelerate Applied Pathways’ mission to improve healthcare delivery effectiveness through an interoperable and system-agnostic platform for curating, managing and integrating best practices and evidence into complex clinical and operational workflow.  Healthcare organizations across the country use Applied Pathways Enterprise Knowledge Management today to improve the efficiency and accuracy of telehealth, nurse triage, case and utilization management, point-of-care decision support, self-help portals and scheduling, as well as new technologies such as chat bots and interactive devices.

“Steve is a highly respected industry leader and an ideal fit for Applied Pathways as we seek to build upon a period of incredible growth,” said Feldman.  “He has an impeccable track record of accelerating and scaling businesses while delivering impactful, patient-centric solutions for healthcare.  I am thrilled to have him on our team.”

Lefar’s 25-year career demonstrates proven expertise across critical healthcare information technology specialties including analytics, content management, consulting, strategy, and developing software-as-a-service (SAAS) solutions.  At Sg2, Lefar led a transformation of the company into a recurring-revenue analytics and content firm while driving dramatic returns prior to its sale to MedAssets.  Before joining Sg2, he was President of MediRegs, a pioneer in SAAS applications and content for the healthcare compliance space that was acquired by WoltersKluwer.

“We provided growth capital to Applied Pathways because of John’s vision and success,”  said Ezra Mehlman at Health Enterprise Partners, the company’s first institutional investor. “Steve’s track record of repeatedly building great franchises with founders is simply unique.”

Lefar stated, “I share John’s vision for helping the industry achieve the Triple AIM of healthcare- improving experience of care; improving the health of populations; and reducing the per capita cost.  John and his team have shown we can integrate best- and enterprise-specific practices into algorithms and workflows that help our clients improve the care of hundreds of millions of consumers and create value for healthcare organizations across the country.  I look forward to building upon that proven success and taking Applied Pathways to the next level.”

 

About Applied Pathways

Applied Pathways’ cloud-based clinical rules modeling and Enterprise Knowledge Management for Healthcare technology facilitates the development and distribution of interoperable, EMR-agnostic decision support and quality management solutions. Applied Pathways’ Curion Platform enables clinicians and business users to centrally develop, manage, and curate institutional knowledge and clinical best practices, for integration in third-party systems or Applied Pathways’ suite of applications. For more information, visit www.AppliedPathways.com.

 

MEDIA CONTACT:

Michael Previti

Applied Pathway, LLC

Michael.previti@appliedpathways.com

Phone: (877) 309-7284 x130

 

INVESTOR CONTACT:

Steve Lefar

Applied Pathways, LLC

Steve.Lefar@appliedpathways.com

Phone: (877) 309-7284

Read MoreApplied Pathways Names Steve Lefar Chief Executive Officer

Applied Pathways Receives $6 Million Investment from Health Enterprise Partners

Series A funding will drive continued market growth and commercialization

Applied Pathways, a leader in Enterprise Knowledge Management for healthcare, announced today that it has received $6 million in series A funding from Health Enterprise Partners (HEP), a New York-based equity firm focused on healthcare and information technology, whose investors include many of the largest hospital systems and health plans. The investment will enable Applied Pathways’ continued market expansion.

Applied Pathways’ cloud-based clinical rules modeling and Enterprise Clinical Knowledge Management facilitates the development and distribution of interoperable, EMR-agnostic clinical decision support and quality management solutions. Applied Pathways’ Curion Platform enables clinicians and business users to centrally develop, manage, and curate institutional knowledge and clinical best practices. The intuitive and visual workflow modeling can be integrated with third-party systems or Applied Pathways’ suite of applications, supporting the industry’s shift to fee for value by enabling standardized processes with centralized management. This is the first clinical decision support investment HEP has made.

“We are honored to have earned the trust and financial support of HEP as a strategic partner,” said John Feldman, CEO of Applied Pathways. “This investment further validates the strength of our offering, which has already been proven through our partnerships with some of the country’s most respected healthcare organizations. Through this new relationship, we aim to accelerate our clients’ ability to drive a new level of clinical and financial returns.”

“Applied Pathways is one of the rising stars in healthcare,” said Ezra Mehlman, Vice President of Health Enterprise Partners. “They’re a unique partner for us—one with the capability to drive better outcomes for payers and providers. The enterprise knowledge platform provides an unmatched ease of use for the end user, which provides a heightened level of adoption. John Feldman’s proven, career-spanning record of driving innovation is a great asset in our affiliation with Applied Pathways; we look forward to a productive collaboration.” In conjunction with the investment, Ezra Mehlman and Bob Schulz have joined Applied Pathways’ board of directors.

 

About Health Enterprise Partners 

Health Enterprise Partners invests primarily in privately held, middle market companies in health care services and health care information technology. Central to HEP’s strategy is its unique and extensive hospital system and health plan network, 26 members of which are investors in HEP’s funds. HEP seeks to invest in companies that improve the quality of the patient experience, expand access, and reduce the cost of health care.

For more information, please visit http://www.hepfund.com

 

About Applied Pathways

Applied Pathways’ cloud-based clinical rules modeling and Enterprise Clinical Knowledge Management for Healthcare technology facilitates the development and distribution of interoperable, EMR-agnostic clinical decision support and quality management solutions. Applied Pathways’ Curion Platform enables clinicians and business users to centrally develop, manage, and curate institutional knowledge and clinical best practices, for integration in third-party systems or Applied Pathways’ suite of applications.

Clients include McKesson, Anthem, Mayo Clinic, Healthwise, Medicalis, and others that use Applied Pathways technology as a framework to expand and syndicate their intellectual capital. We support healthcare use cases encompassing point of care, call centers, web portals, and mobile applications to provide simple results to complex issues.

Media Contact

Boh Hatter

(410) 790.9570

bhatter@sage-growth.com

Read MoreApplied Pathways Receives $6 Million Investment from Health Enterprise Partners