1. Medstreaming/M2S Development Update
June 12, 2019
Jack L. Cronenwett, M.D.
Chief Medical Officer

2. Major Technology Releases - Past Year
New Architecture implemented for all registries
Save incomplete follow-up forms, tabs show completion, download data as text
Mandatory fields highlighted on registry follow-up forms
Registry-specific rules for “credit” for follow-up, excluding irrelevant cases
30-Day follow-up forms for all relevant registries
PVI “Basic” form released, with ability to turn on comprehensive form
GUDID integration for PVI balloons, atherectomy devices
Quarterly update of new devices
Help text revisions, variable option updates, Medicare Beneficiary Number
© 2017  M2S, All Rights Reserved Confidential and Proprietary

3. Major New Technology Releases Scheduled for 2018
Hemodialysis Access registry revision (August 30th)
Varicose Vein registry revision (September 10th)
New Venous Stent registry (September 20th )
New Vascular Medicine registry (September 30th)

4. EMR Integration – M2S Abstraction App
Location of data highlighted in source document
User Report shows data captured and links to source for QA

5. EMR Integration – M2S Abstraction App
Challenges
Requires some local IT support and structured note use by providers
Progress to Date
Epic Pilot Sites:
UMASS - extracted JSON file of common data elements, transferred to MS/M2S where Abstraction App was able to auto-populate registry data
Cleveland Clinic - configured IT infrastructure to house the Abstraction App on site, expects data transfer to begin this summer
Cerner Pilot Sites:
Emory - transferred structured procedure note to MS/M2S where Abstraction App was able to auto-populate registry data (now awaiting more local IT support)
UAB – created structured notes, will use Cerner Direct Message to transfer clinical notes to MS/M2S Abstraction App, expects data transfer this summer
Office-based EMRs:
Midwest Institute for Minimally Invasive Therapies has Abstraction App fully deployed and operational, transmitting data to VQI

6. Vascular Ultrasound Registry Project
VQI project with Society for Vascular Ultrasound
Auto-populate carotid duplex images and associated velocity data into a new Vascular Ultrasound Registry (VUR)
Co-Chairs: David Dawson, MD, Greg Moneta, MD; Steering Committee from pilot sites
Method
Initial pilot project to show feasibility with centers using Medstreaming vascular laboratory software that has been configured to upload data to the VUR in VQI
VUR created in Pathways to receive carotid duplex data
Goal
Match VUR data with VQI patients in CEA and CAS registries (later Vascular Medicine)
Analyze variation across labs, QI reports to labs, machine learning from imaging
Progress
11 Centers selected, many required internal software updates, delayed progress
1 Center has now successfully uploaded images, several more expected soon
Committee meeting Thursday at VAM to evaluate progress and plan next steps

7. Medstreaming Image Viewer – Big Data Hadoop Platform
Images for First Study Uploaded to VUR

8. Using VQI to Analyze and Reduce Costs
EVAR Cost Project in 18 VQI Centers (2017)
Collaboration with Vizient to estimate hospital costs based on charges (with individual cost categories)
Used VQI data to define standard EVAR cases without complications
Showed 2 fold-variation in cost across 18 centers for similar type cases
Largest variation: implant costs
Comparison allowed centers to identify opportunities to reduce cost
Average EVAR Cost, Categories and Reimbursement
$54K
$22K
Average EVAR Implant + MedSurg Supply Cost
n=434 EVAR Cases
$31K
$7.5K
18 VQI Centers
- Lemmon et al J Vasc Surg 2017

9. Using VQI to Analyze and Reduce Costs
2018: Ron Dalman, MD
Stanford used the EVAR Cost Pilot comparative data to focus cost reduction efforts
Analyzed detailed hospital costs, developed care pathways and new device purchasing agreements
Reduce costs significantly across multiple dimensions:
Devices - 31%; Bed utilization - 50%; Inpatient imaging – 93%; Medications – 38%
Reducing costs requires drill down into hospital accounting system
Each hospital has its own proprietary system NOT linked to clinical data or VQI
Ideal solution: Link VQI clinical data with each hospital’s cost system, provide benchmarking
New VQI-Medstreaming Cost Analysis Pilot Project
Medstreaming partnership with Biome, for hospital cost analysis linked to VQI clinical data
Hospitals transfer detailed cost file to SVS PSO for linkage with clinical data and reporting
Similar reports for cardiac surgery have created substantial hospital cost saving
-Itoga et al, J Vasc Surg, 22019

10. PVI Cost Calculator: Average Center Costs per Year
Report Filters Based on VQI Clinical Variables
Total Mean Cost/ N Procedures
Cost Categories
Year
Note: All Data Simulated for Demonstration
Mean Cost for each Cost Category

11. PVI Cost Calculator: Average Center Costs per Year
Select Dimension for Comparison
View by Patient Symptom Severity
Note: All Data Simulated for Demonstration
Mean Cost for each Cost Category

12. PVI Cost Calculator: Compare Claudication vs. CLI
All Treated Patients
$13,000
CLI: Much higher cost, due to Med/Surg bed
Procedure
Med/Surg
$29,000
Note: All Data Simulated for Demonstration
Mean Cost for each Cost Category

13. PVI Cost Calculator: Compare by Artery Treated
All Treated Patients
Note: All Data Simulated for Demonstration
Mean Cost for each Cost Category

14. PVI Cost Calculator: Compare Inpatient vs. Outpatient
All Treated Patients
Same procedure and stent cost, but Inpatient-related costs much higher
Note: All Data Simulated for Demonstration
Mean Cost for each Cost Category

15. PVI Cost Calculator: Compare Claudication vs. CLI
Inpatients Only
Filters Inpatients Only
$17,000
$35,000
Note: All Data Simulated for Demonstration
Mean Cost for each Cost Category

16. PVI Cost Calculator: Compare Claudication vs. CLI
Outpatients Only
Filters Outpatients Only
$11,000
$10,500
Note: All Data Simulated for Demonstration
Mean Cost for each Cost Category

17. PVI Cost Calculator: Average Center Costs per Year
Select Dimension for Comparison
View by Physician
Note: All Data Simulated for Demonstration
Mean Cost for each Cost Category

18. PVI Cost Calculator: Average Costs per Physician
All Cases in Selected Time Period
Physician with higher costs
Mean Cost for each Cost Category
Note: All Data Simulated for Demonstration

19. PVI Cost Calculator: Average Costs per Physician
Only Outpatient Treated Claudicants
MD with Low Procedure Cost
But High Stent Cost
Mean Cost for each Cost Category
Note: All Data Simulated for Demonstration

20. PVI Cost Calculator: Drill Down to Individual Items
Select “Stents”
Shows Summary for this Physician:
Drill Down to each stent used
Note: All Data Simulated for Demonstration

21. PVI Cost Calculator: Drill Down to Individual Items
Show Pharmacy Charges by Year
Select Details to Display
Select Highest Cost Item: Alteplase
Drill Down to examine procedure details for each case used
Case Drilldown
Note: All Data Simulated for Demonstration

23. Using VQI to Analyze and Reduce Costs
VQI-Medstreaming Cost Analysis Pilot Project
Currently in development for PVI and EVAR in 2 VQI centers
Expected general availability in Q1, 2020 (with additional subscription cost)
Opportunity for other centers to join pilot project for other registries
Provide input for report format and clinical variables to be included
Live demonstration available at the M2S/Medstreaming booth, Thursday and Friday in exhibit hall.