Healthcare is one of the fastest growing segments of the U.S. economy, yet it’s one of the slowest moving in regards to innovation. The Translational Pulmonary & Immunology Research Center (TPIRC) is aiming to change that, employing process automation and data analytics in order to develop new treatment protocols for patients suffering from rare and orphan diseases, and using document management technology to scale their practice.
TPIRC founder and Chief Medical Officer Dr. Inderpal Randhawa spent the early part of his career working in intensive care units, where he saw enough children die from anaphylactic reactions to food allergens that he began to question conventional treatment protocols. He decided to dedicate his career to changing how healthcare operates. To help the medical team continue to innovate on behalf of patients, TPIRC and its second division, the Southern California Food Allergy Institute, began automating treatment plans, reducing the time practitioners spend on paperwork, and sharing information between clinical and research divisions.
In addition to regular treatments, at the onset of the COVID-19 pandemic the clinic rapidly rolled out a key electronic form and automated business process, which were used to schedule COVID-19 testing for high-risk patients, ensuring continuity of care.
Innovation fueled by data analytics
TPIRC’s mission is to close the innovation gap by developing new treatment protocols for conditions other physicians no longer try to treat or cure, a category known as orphan diseases. To advance its mission, TPIRC relies on complex clinical processes and huge amounts of data that must be shared efficiently between practitioners.
“What separates us from other physicians who are attempting to do any type of food allergy treatment is data analytics,” said Herman Sandhu, medical liaison at TPIRC. TPIRC physicians compare the results of lab tests to over 1 trillion data points TPIRC has gathered over the years.
Previously, TPIRC managed data for each patient manually, using a spreadsheet program. The laborious process led to employee overtime and made it difficult to identify data or process bottlenecks. The center implemented a cloud enterprise content management (ECM) system, then began eliminating siloed programs and automating patient data tracking.
“Document sharing, document storage, and the ability to automate processes are important for us as we expand our program,” said Sandhu. “Finding a way to operate in an efficient manner, with processes as automated as possible, was what led us down the road to adopting an ECM system.”
TPIRC implemented a pair of automated workflow solutions to communicate the results of lab analyses and automate the development of treatment plans for food allergy patients.
Sandhu built the Lab Analysis Workflow, which automatically routes patients’ lab results to multiple physicians who can provide an assessment or extract information from the results. This allows the team to smoothly communicate their medical and data analysis, and track when each portion of the medical analysis is complete.
“Before, I would’ve had to manually check all the dates, whereas now I’m able to track time stamp data that allows me to understand how long processes are taking,” said Sandhu. “The automated process enabled me to understand where bottlenecks were occurring and how I could improve the process. And then, the amount of time being spent on each patient did speed up.”
After the Lab Workflow Process is complete, TPIRC practitioners are able to predict the level of allergens that will cause a reaction in a particular patient and develop a course of treatment that will desensitize the patient over approximately 18 months.
Before automating the workflow, Sandhu and Dr. Randhawa manually typed treatment plans to distribute to practitioners as well as to the food lab, which produced the food-based “doses” patients received during each appointment. Not only was the manual process time-consuming for the practitioners, the food lab couldn’t easily export data to understand how many doses of each food they needed to prepare for each day or each appointment. To digitally transform this process, Sandhu created a custom electronic form that included the patient’s identifying number, the type of food they would consume during each visit, the amount of each food dose, and the number of doses needed. “Now when our food lab production team needs to know the number of doses to produce, they can just pull a report,” said Sandhu.
The new form also allows TPIRC to add to their growing data set, and further increase the effectiveness of their treatments.
Testing patients for COVID-19
At the onset of the COVID-19 pandemic, the TPIRC team knew they couldn’t interrupt their essential health services. In order to maintain continuity of care while preventing the spread of the disease, TPIRC began testing patients for COVID-19, assisted by an automated business process.
Over two days, Sandhu quickly built a business process to receive COVID test requests. The process begins with patients filling out an electronic form, providing information including their exposure history, their distance from the TPIRC clinic, and their age.
“With everyone scared and unsure what was going on, everyone wanted to get tested, but certain patients needed to be tested sooner than others,” said Sandhu. “Automating the process helped us to prioritize patients and keep track of them.”
Through an automated process, TPIRC emailed patients consent forms and invoices prior to testing. Following the test, results were uploaded and routed to the diagnostic manager, who performed a medical analysis then marked the test results as either positive, negative, or invalid. The process then branched off into multiple flows depending on the results: Patients who received negative tests were sent an email, while results that were marked positive received a second look from one of TPIRC’s main providers. If the provider confirmed a positive result, the automated process prompted a member of the provider team to reach out to the effected family to offer guidance. All results were saved to the repository.
“We’ve tested over 500 patients now,” said Sandhu. “Our patients needed to feel like when they were showing up to a clinic, they were in a safe environment. If we don’t have trust, we can’t offer them treatment.”
Maximizing efficiency to provide care for more patients
After implementing automated workflows, TPIRC immediately saw a reduction in the amount of practitioner overtime. Rather than spending two to three hours of overtime per week manually completing essential documentation, providers were able to regain some work-life balance.
At the same time, TPIRC has seen an improvement in the flow of information and data between the center’s divisions. In the healthcare industry, clinical practitioners, medical researchers, and patient advocates generally operate independently of one another, even though their work influences each other’s results. In an effort to realign this disjointed system, TPIRC houses not only clinical providers, but their own research and diagnostic lab, as well as an advocacy center.
“We can push all of our patient data to the researchers, and start to discover new bio-markers that we can use to test patients,” Sandhu said. “This increases our efficiency rate and the scope we’re operating within.”
Future expansion: Adding locations and researching new treatment protocols
The majority of healthcare organizations or physicians that treat food allergies advance patients to what they call “bite-proof protection,” meaning that if the child eats something they are allergic to, they may still have an allergic reaction, but won’t go into life-threatening anaphylaxis. TPIRC advances their patients to a level they call “food freedom,” meaning the patients can consume as much of their previously-anaphylactic allergen as they want without fear of allergic reaction.
Because of this huge difference in outcomes, patients visit TPIRC from all over the country. To provide more convenient access for remote patients, the facility plans to use its ECM system to help open satellite treatment centers, initially in Los Angeles and Carlsbad, California, then ultimately to every major metropolitan city. Their system will allow Dr. Randhawa and Sandhu to efficiently communicate their complex treatment plans to practitioners at the satellite clinics.
As the footprint of the organization expands, so will the number of orphan and rare diseases that TPIRC treats as well as the efficacy of the treatments already in place. Dr. Randhawa’s research has already increased the life expectancy of patients suffering from cystic fibrosis from about 15 years to about 25-30, which they consider a good starting point.
Sandhu plans to organize TPIRC’s future research processes, data, and analyzed results using an automated workflow. Plans also include getting the organization on Microsoft 365, so TPIRC can take advantage of integration into their new system and expanded workflow automations.
“I’m in the process of developing an automated research workflow, which will include all of our research project timelines as well as our process for entering research manuscripts and submitting them to medical journals,” said Sandhu. By publishing the center’s results in medical journals, TPIRC’s treatment protocols can begin to benefit anyone who suffers from diseases otherwise left behind by the medical community.