Now Mehra’s company, IllumiCare, has come out with software that displays a panel of real-time data to help physicians make better informed choices when prescribing medications or choosing labs. “It empowers clinicians to provide clinically and financially efficient care, and provides hospitals with measurable, hard-dollar reductions in the lab, medication, radiology and observational expenses,” he says.
The idea for the Smart Ribbon came to Mehra when he was treating a 39-year-old nurse with Crohn’s disease. She had visited multiple hospitals throughout Central Alabama in the previous past three years. He gathered her records from all the facilities and discovered she’d undergone 18 CAT scans. “It’s amazing that we worry about radiation through airport security or dental x-rays, but we’re not tracking radiation ordered through CT scans in ERs,” Mehra says.
The number alarmed him. He spent weeks analyzing atomic bomb data and calculated that the nurse’s estimated risk of radiation exposure from the multitude of CT scans equaled 238 millisieverts. “Her risk from radiation exposure was 2.3 times the risk if she’d lived a mile from ground zero,” Mehra says.
He told her to tell any future ER physicians ordering a CT scan about his radiation numbers. “If they knew, they’d think twice about ordering one. She has not had another CT since,” he says.
Besides showing radiation data, IllumiCare displays ribbons on labs, medications and hospital costs. It took more than two years to compile the data and another 18 months to devise the algorithms to populate the panels.
In September, IllumiCare won the Alabama Launchpad, a competition for business start-ups sponsored by the Economic Partnership Development of Alabama.
St. Vincent’s East in Trussville was the first hospital to implement IllumiCare when the product rolled out in November, with St. Vincent’s Birmingham, Blount and St. Clair adopting the software soon after. IllumiCare has recently formed a partnership with the Texas Medical Association and signed contracts with several Texas hospitals.
“Feedback has been really good,” Mehra says. “We want to fill in the gaps and help patient and health systems concurrently.”
The stand-alone ribbon hovers on top of any EMR and requires no additional sign-ins. If the physician does not interact with it, the ribbon fades away a few seconds later. It can be recalled at any time.
The look of the panel resembles a cockpit with segmented areas of graphs, lists and gauges. The visual display allows for quick synthesizing of essential data about risks, costs and effectiveness of treatment and medications. Hovering over or clicking parts of the ribbon reveals additional data.
With healthcare transitioning toward bundled payments, cost factors are becoming tantamount. Yet physicians have no access to real-time costs at the point of care. “It’s fascinating to me,” Mehra says. “Physicians see the prices when ordering cars, football tickets, even milk. Healthcare is the only facet in life where they don’t see the costs.”
Despite popular belief, studies show that physicians need not be rewarded to make cost-effective choices, only informed. Mehra tested that while directing endoscopy at St. Vincent’s hospital. He posted the cost for tools used in endoscopic retrograde cholangiopancreatograms (ERCPs). Stent pushers ran $100 each. “They realized you could push it up in other ways, that it was a frivolous cost, and the demand dropped to zero, so we quit ordering it,” he says. “Physicians in general choose what’s best for a patient and don’t pick an expensive thing because they think it’s better.”
Mehra says no physician will say they love EMRs, because they were designed for reasons other than helping physicians with healthcare decisions. “But this is the information that physicians have been missing,” he says.
Escalating medication quantities is one of those missing data points. Mehra once manually tracked a man’s prescriptions in the hospital over seven days. Initially, he was on seven medications. By day seven, he was on 24. “That happens everywhere. You put out fires. You prescribe meds,” he says. So one graph of the Medication Smart Ribbon shows the quantity of meds over the span of a week, along with the risk data.
The panels are customizable and flexible. One healthcare system requested real-time data on cost and outcomes on two antibiotics on a certain bacterium within their facility. Another requested data appear on the timespan catheters were in use and the resulting infections. “We can do a lot of things that hospitals and physicians want to do that are difficult in hard-coded EMRs. If you want alert bulletins and NFL scores, we can do that.”
The future of the IllumiCare Smart Ribbon lies in genetics, says Mehra. For instance, using data on the variance in metabolizing of drugs by gender and race, the panel could compare a patient’s genetic testing with current drugs chosen by physician and point out any non-optimal matches. “That’s the kind of patient specificity that’s coming,” he says.
