There are not many private healthcare providers around the world who serve an urban population of 11 million people but Northwell Health is one of them.
New York’s largest health system is leveraging technology to deliver personalised patient experiences across its 23 hospitals and more than 830 outpatient facilities in order to outpace the accelerating digital landscape created by the COVID-19 pandemic.
The numbers and sheer scale of Northwell Health, which also includes medical research at the Feinstein Institutes as well as medical and nursing education through the Zucker School of Medicine, does not detract from its aim to transform the health of every unique patient with their mantra ‘be better tomorrow than we are today’ — a goal which has stood the test of time since they were founded nearly 25 years ago.
Today, it has never been more important for the 76,000-strong team to focus on a future driven by a digital transformation, which includes data lake solutions used to effectively ‘supercharge the data’. Northwell is focused on delivering connected digital patient experiences that complement their physical experiences inside and outside the Northwell system.
With more than five million patient engagements every year, this digital transformation has accelerated the ease in which patients can access their electronic health records (EHR) and consult physicians through virtual consultations, which was vital at a time when the state of New York imposed new visitation policies.
Serving one of the biggest and most diverse populations on the planet could be perceived as a challenge but according to Marc d. Paradis, Vice President, Data Strategy for Northwell Holdings and Ventures, this provides a unique opportunity to “apply representative data and balanced analytics to real world clinical scenarios”.
As a data scientist who combines the best of academia and industry know-how to drive the data strategy for Northwell Health, Paradis is responsible for targeted investments, joint ventures and innovations that support Northwell’s clinical and social missions by leveraging Northwell's data assets, intellectual expertise and clinical platforms. He also focuses on data strategy, predictive algorithms and digital partnerships.
“My role is to empower our patients, augment our providers, support their families and to improve the health of all of the communities we serve through the use of innovative data solutions,” said Paradis who joined Northwell in January of 2020, just before COVID-19 was declared a global pandemic.
“I have the privilege to help the system as a whole think through data strategy, looking at how we can enrich and leverage our differentiable and defensible assets. We have a decade of data on 11 million lives covering all of Long Island, the five New York City Boroughs and Westchester County which is probably the most genetically, culturally and demographically diverse population and clinical data set in the world. This is a tremendous resource to have,” he said.
Paradis pointed out that the data set they are working with is unique and allows them to produce predictive models which can be validated on real world data in diverse clinical scenarios, which gives Northwell a competitive advantage. He also said that having such a vast platform of hospitals, ambulatory surgery centres and outpatient facilities enables them to rigorously test new technologies in the context of the full care continuum.
“It gives us this fantastic platform to test new ideas, new technologies and put them through their paces. We use evidence-based best practices to ensure that they are actually delivering clinically relevant hard outcomes on the basis of changes in people’s behavior at specific points of intervention in the clinical workflow. These model-driven interventions are then packaged in solutions that lead to measurable value and clinical impact,” he said.
Northwell has a vast network of collaborators from research pioneers to entrepreneurs and educators who are all dedicated on their ‘mission to serve’ and are committed to providing:
- The highest quality clinical care
- Educating the current and future generations of healthcare professionals
- Searching for new advances in medicine through the conduct of biomedical research Promoting health education and caring for the community regardless of the ability to pay
Response to the pandemic
Northwell has been on their digital transformation journey for several years but what the pandemic emphasised was the crucial role of cross-functional teams in which everyone across the organisation worked together to achieve a common goal. They quickly rolled out devices that enabled audio and video connections with patients.
“When COVID hit it demonstrated to us the priority to move this digital transformation to the very top of the list and we moved rapidly — today we are in a place which would have probably taken years to achieve pre-pandemic,” said Paradis who pointed out it only took weeks to implement the entire telemedicine infrastructure for over 8,000 clinicians, including physicians in training and medical students.
“People had been talking about telehealth for over a decade prior to COVID, and the foundational technology had been ready several years prior to the pandemic, but it required the pandemic to jump start the change management and adoption.
“Even though we are over the peak of the pandemic we still expect to see a portion of care in a telehealth format to give patients the flexibility and choice to see their care providers at more convenient times and with less interruption to their daily lives. Telehealth visits also have the additional advantage of helping with sustainability and reducing the carbon footprint in NYS.”
Paradis pointed out it was one small step at a time when it comes to changes in healthcare. “The way we solve complex problems is not with one expansive technology or one big application. We solve it by lots of little improvements which might only make it better for one per cent of the population. But if you do a hundred of those improvements, pretty soon you make it better for close to 100 per cent of the population.”
But Paradis pointed out that although the technological changes were rapidly altering the way Northwell delivered their healthcare, the patient is always put first. “We have to remember we’re dealing with people at the most sensitive and vulnerable points in their lives it's a real privilege to be a caring part of those moments and to help them in their journey to achieve their health and wellness goals.”
‘Supercharged’ data lakes
Data lakes are next-generation data management solutions that help data scientists meet big data challenges and drive new levels of real-time analytics and are being used at Northwell Health for EHR and laboratory data.
Their highly scalable environment supports large data volumes, collecting petabytes of structured, semi-structured and unstructured data in its native format from a variety of sources, including those previously untapped such as Internet of Things (IoT) devices.
“Part of our strategy over the coming years is continuing to build out that data Lake infrastructure and architecture,” said Paradis. “It's not just focused on EHR data. There are separate systems for lab data and radiology data, among others. The point of the data lake is to bring all of that data together in one place for a complete and personalized view of each patient that will supercharge Northwell’s data and analytics.
“This will build the connections between those disparate data sets, while ensuring the appropriate data quality work resulting in datasets that, in a much more effective and efficient way, really follow and track the care journey within Northwell.
“Our health information exchange is done through InterSystems and they do a fantastic job of giving us a single view of the patients, at the time of care and the point of care — even if they’ve been to multiple different hospitals and touchpoints across Northwell.
“Bringing together our data lake and our health information exchange at an analytical level really empowers new kinds of analytics and applications that address each unique patient as a whole, not just limited to snapshots at points of time,” he said.
Commenting on the road ahead for a more digitised healthcare, Paradis said the dynamics of care are changing rapidly — using the analogy of cars merging onto a highway where drivers respond dynamically to each other’s actions. “We make choices to deliver particular kinds of treatment or care and those choices impact the system, creating these interesting feedback loops. We're building out systems, machine learning systems and AI systems to understand and to track and to be able to intervene in these loops in a positive way that creates virtuous cycles of care. In effect we're learning how to merge onto these incredibly complex highways of health successfully and safely.”
Importance of partnership with Health Catalyst
Commenting on the foundational importance to Northwell’s ecosystem, Paradis pointed out the value Health Catalyst, Athena, Sutherland and Allscripts.
“Health Catalyst is our data lake, they were very smart when they started by recognising that if you can’t efficiently and reliably connect to your data sources and move that data in a repeatable, scalable, high quality way, it doesn't matter what you build downstream. It’s garbage in, garbage out. Health Catalyst built out these connectors that allow us to pull in data from all of our transactional and operational systems, and to write directly into a data lake that then feeds into their Data Operating System (DOS™), a canonical healthcare data model that includes clinical, claims, administrative and other data. Downstream from that Data Operating System, Health Catalyst has a whole series of pre-built applications to support clinical workflows, patient flow, finance and regulatory issues, among many others.
“Health Catalyst is a fantastic partner from that standpoint and they also give us a world-class infrastructure that empowers us to generate our own insights in less time and with fewer resources.
Paradis pointed out that Northwell’s partnerships with Athena, Sutherland and Allscripts were also essential for the correct functioning of the transactional and operational systems that feed the data lake.
Sutherland’s robotic process automation automates outreach to payer websites for claim status updates, coding validations for bundled denials and electronic submission of clinical medical records data to the payers. These intelligent process automations have driven efficiencies of scale, increased productivity and accuracy across silos. In addition to RPA, Sutherland’s Health Analytics portal capabilities delivers actionable and prescriptive insights to end users via interactive dashboards, self-service BI and real-time business alerts.
Athena has been a crucial revenue cycle partner for many years with respect to administering physician billing, accounts receivable management and associated analytics. All told Sutherland and Athena help to ensure the accuracy, timeliness and impact of data from the administrative source systems that feed the Health Catalyst data lake.
“Of course, Paradis made sure to emphasise, none of this would be possible without the incredible partnership Northwell has with Allscripts. The Allscripts EHR powers everything that we are able to do for our patients and providers. The openness, scalability and extensibility of Allscripts are unique differentiators of their EHR.
Other essential partners for the Northwell ecosystem include:
- Tableau - an interface which helps to visualise and analyse data
- Microsoft - provide the IT infrastructure
- Microsoft Azure - platform for cloud, AI and ML
- Google and Fitbit - wearables are being worked into the process of healthcare
“Having a tool like Fitbit, which has wearables that can track heart rhythms to identify silent arrhythmias and atrial fibrillation, when tied to a user-interface, can empower a person, in partnership with their care team, to change behaviours and prevent adverse outcomes,” said Paradis who pointed out that in the next couple of years streaming data sources such as wearables will revolutionise medicine.
Predicting the future of healthcare Paradis said there will be a focus on the genome which will help cancer care. “That's been driven by an understanding of the specific mutations in a patient tumors and designing drugs targeted at those. I think we can expect to see similar types of drugs, similar types of interventions and procedures in other areas along with a change in protocol linked to a more personalised care.
“My dream is that we begin to move the healthcare system from this episodic interventional system that we have now to fix a problem that's already occurred towards a continuous preventive maintenance and care model where the data from all aspects of your life is in full view of you and your care team in order to empower you to achieve your ideal health outcomes as you define them,” he said.
Top 10 facts about Northwell Health
- Pioneering bioelectronic medicine research at the Feinstein Institutes, which includes trial sites for treating lupus, rheumatoid arthritis and paralysis
- Treats more New Yorkers for cancer than any other health care provider
- One of the largest medical residency programs in the US, with 1,900+ residents and fellows
- Sandra Atlas Bass Heart Hospital — one of top two cardiac surgery programs in US and Canada
- Named a Best Place to Work by both Fortune and Glassdoor
- Only hospital-based helicopter emergency transport service in the tri-state area
- Largest hospital-based laboratory in North America
- Lenox Hill Hospital the first on the East Coast to use the 3D video exoscope for neurosurgery
- Created New York State’s first Centre for Cancer, Pregnancy and Reproduction
- Cohen Children’s Medical Centre treats more paediatric cancer cases than any other children’s hospital in New York
Vaccine cloud technology
Northwell Health responded to the COVID-19 pandemic by leveraging Salesforce’s Vaccine Cloud technology.
When the pandemic hit New York, the city’s biggest healthcare provider was already using Health Cloud so they extended that to include Salesforce’s new suite for vaccine management.
Vaccine Cloud is part of Salesforce’s COVID-19 response technology solutions, which include vaccine inventory management, appointment scheduling, outcome monitoring, and public health outreach.
At the beginning of the pandemic, Northwell started using Experience Cloud to allow self-service appointment-booking for patients to schedule COVID-19 PCR testing. They customised workflows for call centres to automate incoming calls and added live chat on the website and built another patient self-scheduling application for vaccine appointments.
The use of Marketing Cloud also helped them to communicate with patients through email and text messaging rounding off the patient experience.
Life-changing benefits from Northwell’s 3D printing
Northwell's automated 3D printing laboratory is creating state-of-the-art, personalised treatments which will change the life for their patients. By uniting world class resources in prosthetics, aerospace and 3D printing, Northwell created a first-of-its-kind prosthetic known as the Fin.
The Fin allows an amputee to enter and exit the water without changing prosthetics. It uses state-of-the-art carbon fibre materials and an ergonomic shape to ensure durable and efficient movement.
The Fin is printed using a carbon fibre enhanced nylon to provide strength and flexibility. The result is a durable solution that is highly functional on land and in the water.
3D printing is technology that produces a three-dimensional object from a digital 3D file, such as a computer-aided design (CAD) drawing or a CT/MRI scan. This creates a device that is matched to a patient’s anatomy and is used in the following:
- Tumor resection models - used to highlight a tumor and surrounding tissue
- Orthopedic models - built from bone-like materials used for pre-surgery measuring
- Vascular models - These can be printed to identify abnormalities in the organ, tumors, blood flow, sliced chambers, valves, muscle tissue and calcified tissue
- Dentistry - digital dentistry in the form of 3D printed dental appliances
How Northwell is reaching out to New Yorkers
The image of a simple bubble travelling on the breeze through the Big Apple is used by Northwell Healthcare as a symbol of life’s resilience and fragility and is part of their Raise Health awareness campaign.
The advert released in February 2021 challenges New Yorkers to collectively raise their expectations when it comes to healthcare - a year after the city became the epicentre of the COVID-19 pandemic in the US.
As Northwell continues to roll-out the COVID-19 vaccines to millions of people, the healthcare provider has vowed to make public health their biggest priority.
Katz Institute for Women’s Health
Northwell created the Katz Institute for Women’s Health, the only network of experts devoted to every aspect of women’s care as part of Northwell’s commitment to #RaiseHealth for all.
Paradis pointed out much of medicine over the last 200 years has been defined by the simplistic research construct of the “75 kilogram spherical man”.
“So much of the research, so much of the drug testing for so long has been based around adult males, sidelining women and minorities. We recently started an initiative to recognise what is different and unique about women’s health and how we can make sure that we address those appropriately,” he said.