Skip to main content

Advertisement

Log in

A Cost-Benefit Analysis of Automated Physiological Data Acquisition Systems Using Data-Driven Modeling

  • Research Article
  • Published:
Journal of Healthcare Informatics Research Aims and scope Submit manuscript

A Correction to this article was published on 21 March 2019

This article has been updated

Abstract

Precision medicine and the continuous analysis of “Big data” promises to improve patient outcomes dramatically in the near future. Very recently, healthcare facilities have started to explore automatic collection of patient-specific physiological data with the aim of reducing nursing workload and decreasing manual data entry errors. In addition to those purposes, continuous physiological data can be used for the early detection and prevention of common, and possibly fatal, diseases. For instance, poor patient outcomes from sepsis, a leading cause of mortality in healthcare facilities and a major driver of hospital costs in the USA, can be mitigated when detected early using screening tools that monitor the changing dynamics of physiological data. However, the potential cost of collecting continuous physiological data remains a barrier to the widespread adoption of automated high-frequency data collection systems. In this paper, we perform cost-benefit analysis (CBA) of machine learning applied to various types of acquisition systems (with different collection intervals) to determine if the benefits of such systems will outweigh their implementation costs. Although such systems can be used in the detection of various complications, in order to showcase the immediate benefits, we focus on the early detection of sepsis, one of the major challenges of hospital systems. We present a general approach to conduct such analysis for a wide range of hospitals and highlight its applicability using a case study for a small hospital with 150 beds and 3000 annual patients where the acquisition system would collect data at 1-min intervals. Lastly, we discuss how the analysis may help guide incentives/policies with regard to adopting automated data acquisition systems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Change history

  • 21 March 2019

    In the original version of this article, the incorrect version of Fig. 3 was published. Following is the correct figure.

References

  1. Jameson JL, Longo DL (2015) Precision medicine—personalized, problematic, and promising. Obstet Gynecol Surv 70(10):612–614

    Article  Google Scholar 

  2. Hong MK, Yao HH, Pedersen JS, Peters JS, Costello AJ, Murphy DG, Hovens CM, Corcoran NM (2013) Error rates in a clinical data repository: lessons from the transition to electronic data transfer—a descriptive study. BMJ Open 3(5):e002406

    Article  Google Scholar 

  3. Sawyer AM, Deal EN, Labelle AJ, Witt C, Thiel SW, Heard K, Reichley RM, Micek ST, Kollef MH (2011) Implementation of a real-time computerized sepsis alert in nonintensive care unit patients. Crit Care Med 39(3):469–473

    Article  Google Scholar 

  4. Nguyen SQ, Mwakalindile E, Booth JS, Hogan V, Morgan J, Prickett CT, Donnelly JP, Wang HE (2014) Automated electronic medical record sepsis detection in the emergency department. PeerJ 2:e343

    Article  Google Scholar 

  5. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE et al (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39(2):165–228

    Article  Google Scholar 

  6. Upperman JS et al. (2017) Specific etiologies associated with the multiple organ dysfunction syndrome in children. Pediatr Crit Care Med

  7. Jawad I, Lukšić I, Rafnsson SB (2012) Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality. J Glob Health 2(1)

  8. Shashikumar SP, Stanley MD, Sadiq I, Li Q, Holder A, Clifford GD, Nemati S (2017) Early sepsis detection in critical care patients using multiscale blood pressure and heart rate dynamics. J Electrocardiol

  9. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29(7):1303–1310

    Article  Google Scholar 

  10. Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Statistical Brief No. 204 (2016) National inpatient hospital costs: the most expensive conditions by payer, 2013

  11. Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy collaborative group: early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377

    Article  Google Scholar 

  12. Levy MM, Dellinger RP, Townsend SR et al (2012) Surviving sepsis campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med 38:367–374

    Article  Google Scholar 

  13. Marik PE, Taeb AM (2017) SIRS, qSOFA and new sepsis definition. J Thorac Dis 943

  14. Henry KE, Hager DN, Pronovost PJ, Saria S (2015) A targeted real-time early warning score (TREWScore) for septic shock. Sci Transl Med 7(299):299ra122–299ra122

    Article  Google Scholar 

  15. Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, Iwashyna TJ, Kadri SS et al (2017) Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA 318:1241–1249

    Article  Google Scholar 

  16. Carlbom D, Kelly MJ (2014) 966: Sepsis: An innovative electronic warning system for in-hospital screening of sepsis. Crit Care Med 42.12:A1593

    Article  Google Scholar 

  17. Vincent JL, Moreno R (2010) Clinical review: scoring systems in the critically ill. Crit Care 14(2):207

    Article  Google Scholar 

  18. McGregor C (2013) Big data in neonatal intensive care. Computer (Long Beach Calif) 46(6):54–59

    Google Scholar 

  19. Raghupathi W, Raghupathi V (2014) Big data analytics in healthcare: promise and potential. Health Inf Sci Syst 2(1):3

    Article  Google Scholar 

  20. De Georgia MA, Kaffashi F, Jacono FJ, Loparo KA (2015) Information technology in critical care: review of monitoring and data acquisition systems for patient care and research. Sci World J 2015:727694

    Article  Google Scholar 

  21. Choi JS, Lee WB, Rhee PL (2013) Cost-benefit analysis of electronic medical record system at a tertiary care hospital. Healthc Inform Res 19(3):205–214

    Article  Google Scholar 

  22. Wang SJ, Middleton B, Prosser LA, Bardon CG, Spurr CD, Carchidi PJ, Kittler AF et al (2003) A cost-benefit analysis of electronic medical records in primary care. Am J Med 114(5):397–403

    Article  Google Scholar 

  23. Jones C, Gannon B, Wakai A, O’Sullivan R (2015) A systematic review of the cost of data collection for performance monitoring in hospitals. Syst Rev 4(1):38

    Article  Google Scholar 

  24. Encinosa WE, Bae J (2013) Will meaningful use electronic medical records reduce hospital costs? Am J Manag Care 19(10 Spec):eSP19–eSP25

    Google Scholar 

  25. Hillestad R, Bigelow J, Bower A, Girosi F, Meili R, Scoville R, Taylor R (2005) Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff 24(5):1103–1117

    Article  Google Scholar 

  26. Hall JH, Williams SN, DeFrances CJ, Golosinskiy A (2014) Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS Data Brief 2011; No. 62

  27. Torion C, Moore B National inpatient hospital costs: the most expensive conditions by Payer, 2013. HCUP Statistical Brief #204. May 2016. Agency for Healthcare Research and Quality, Rockville http://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.pdf

  28. Nguyen K, Cook L, Greenlee EP (2014) Mortality reduction in patients with severe sepsis and septic shock through a comprehensive sepsis initiative. Crit Care 18(2):P28

    Article  Google Scholar 

  29. Walkey AJ, Wiener RS (2014) Hospital case volume and outcomes among patients hospitalized with severe sepsis. Am J Respir Crit Care Med 189(5):548–555

    Article  Google Scholar 

  30. Patient deaths in hospitals cost nearly $20 billion: AHRQ news and numbers, November 4, 2009. November 2009. Agency for Healthcare Research and Quality, Rockville, MD. https://archive.ahrq.gov/news/newsroom/news-and-numbers/110409.html

  31. Torsvik M, Gustad LT, Mehl A, Bangstad IL, Vinje LJ, Damås JK, Solligård E (2016) Early identification of sepsis in hospital inpatients by ward nurses increases 30-day survival. Crit Care 20(1):244

    Article  Google Scholar 

  32. Viscusi WK, Aldy JE (2003) The value of a statistical life: a critical review of market estimates throughout the world. J Risk Uncertain 27(1):5–76

    Article  MATH  Google Scholar 

  33. Hirth RA, Chernew ME, Miller E, Mark Fendrick A, Weissert WG (2000) Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Mak 20(3):332–342

    Article  Google Scholar 

  34. Xu J, Kochanek KD, Murphy SL, Tejada-Vera B (2016) Deaths: final data for 2014

  35. Rabin RC (2014) Wide range of hospital charges for blood tests called ‘irrational’. Available online at https://www.npr.org/sections/health-shots/2014/08/15/340637076/wide-range-of-hospital-charges-for-blood-tests-called-irrational

  36. Phillips (2013). Alarm-systems-management: just-a-Nuisance? Available online at https://www.usa.philips.com/c-dam/b2bhc/us/whitepapers/alarm-systems-management/Just-a-Nuisance.pdf

  37. ECRI Intitute (2014) In depth low-acuity continuous monitoring. Available online from: https://www.ecri.org/Resources/In_the_News/Low_Acuity_Continuous_Monitoring_(TechNation).pdf

  38. ECRI Institute’s Healthcare Product Comparison System, “Monitoring System, Physiologic” (2011) Available online from: http://www.who.int/medical_devices/innovation/monitor_physiologic.pdf?ua=1

  39. Helfand M, Christensen V, Anderson J (2016) Technology assessment: early sense for monitoring vital signs in hospitalized patients

  40. Halamka JD (2011) The cost of storing patient records. Available online from: https://geekdoctor.blogspot.com/2011/04/cost-of-storing-patient-records.html

  41. Lebedev AV, Westman E, Van Westen GJP, Kramberger MG, Lundervold A, Aarsland D, Soininen H et al (2014) Random forest ensembles for detection and prediction of Alzheimer’s disease with a good between-cohort robustness. NeuroImage: Clin 6:115–125

    Article  Google Scholar 

  42. Emir B, Masters ET, Mardekian J, Clair A, Kuhn M, Silverman SL (2015) Identification of a potential fibromyalgia diagnosis using random forest modeling applied to electronic medical records. J Pain Res 8:277

    Google Scholar 

  43. Subasi A, Alickovic E, Kevric J (2017) Diagnosis of chronic kidney disease by using random forest. In: CMBEBIH 2017. Springer, Singapore, pp 589–594

  44. Van Wyk F, Khojandi A, Kamaleswaran R, Akbilgic O, Nemati S, Davis RL (2017) How much data should we collect? A case study in sepsis detection using deep learning. In: IEEE NIH Special Topics Conference on Healthcare Innovations and Point-of-Care Technologies

  45. Lipton ZC, Kale DC, Elkan C, Wetzell R (2015) Learning to diagnose with LSTM recurrent neural networks. In: ICLR

  46. Breiman L (2001) Random forests. Mach Learn 45(1):5–32

    Article  MATH  Google Scholar 

  47. Ho TK (1995) Random decision forests (PDF). In: Proceedings of the 3rd International Conference on Document Analysis and Recognition, Montreal, QC, 14–16, pp 278–282

  48. Hassoun MH. (1995) Fundamentals of artificial neural networks. MIT press

  49. LeCun Y, Bengio Y, Hinton G (2015) Deep learning. Nature 521(7553):436–444

    Article  Google Scholar 

  50. Gordon AD, Breiman L, Friedman JH, Olshen RA, Stone CJ (1984) Classification and regression trees. Biometrics 40(3):874

    Article  MATH  Google Scholar 

  51. Breiman L (1996) Bagging predictors. Mach Learn 24(2):123–140

    MATH  Google Scholar 

  52. Miljanovic M (2012) Comparative analysis of recurrent and finite impulse response neural networks in time series prediction. Indian J Comput Sci Eng 180–191

  53. Orhan U, Hekim M, Ozer M (2011) EEG signals classification using the K-means clustering and a multilayer perceptron neural network model. Expert Syst Appl 38(10):13475–13481

    Article  Google Scholar 

  54. Seidel P, Seidel A, Herbarth O (2007) Multilayer perceptron tumour diagnosis based on chromatography analysis of urinary nucleosides. Neural Netw 20(5):646–651

    Article  Google Scholar 

  55. Young SR, Rose DC, Karnowski TP, Lim SH, Patton RM (2015) Optimizing deep learning hyper-parameters through an evolutionary algorithm. In: Proceedings of the Workshop on Machine Learning in High-Performance Computing Environments (p. 4). ACM

  56. Daubechies I (1992) Ten lectures on wavelets. Society for industrial and applied mathematics

  57. Centers for Disease Control and Prevention (2011) Table 116. Hospitals, beds, and occupancy rates, by type of ownership and size of hospital: United States, selected years 1975–2009. Available online at http://www.cdc.gov/nchs/data/hus/2011/116.pdf

  58. Carbonite (2018) Available online at https://www.carbonite.com

  59. Nesseler N, Defontaine A, Launey Y, Morcet J, Mallédant Y, Seguin P (2013) Long-term mortality and quality of life after septic shock: a follow-up observational study. Intensive Care Med 39(5):881–888

    Article  Google Scholar 

  60. Perl TM, Dvorak LA, Hwang T, Wenzel RP (1995) Long-term survival and function after suspected gram-negative sepsis. JAMA 274(4):338–345

    Article  Google Scholar 

  61. Sasse KC, Nauenberg E, Long A, Anton B, Tucker HJ, Teh-wei H (1995) Long-term survival after intensive care unit admission with sepsis. Crit Care Med 23(6):1040–1047

    Article  Google Scholar 

  62. Wang T, Derhovanessian A, De Cruz S, Belperio JA, Deng JC, Hoo GS (2014) Subsequent infections in survivors of sepsis: epidemiology and outcomes. J Intensive Care Med 29(2):87–95

    Article  Google Scholar 

  63. Prescott HC, Langa KM, Liu V, Escobar GJ, Iwashyna TJ (2014) Increased 1-year healthcare use in survivors of severe sepsis. Am J Respir Crit Care Med 190(1):62–69

    Article  Google Scholar 

  64. Prescott HC, Langa KM, Iwashyna TJ (2015) Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions. JAMA 313(10):1055–1057

    Article  Google Scholar 

  65. Jones TK, Fuchs BD, Small DS, Halpern SD, Hanish A, Umscheid CA, Baillie CA, Kerlin MP, Gaieski DF, Mikkelsen ME (2015) Post–acute care use and hospital readmission after sepsis. Ann Am Thorac Soc 12(6):904–913

    Article  Google Scholar 

  66. Prescott HC, Osterholzer JJ, Langa KM, Angus DC, Iwashyna TJ (2016) Late mortality after sepsis: propensity matched cohort study. BMJ 353:i2375

    Article  Google Scholar 

  67. Ou S-M, Chu H, Chao P-W, Lee Y-J, Kuo S-C, Chen T-J, Tseng C-M, Shih C-J, Chen Y-T (2016) Long-term mortality and major adverse cardiovascular events in sepsis survivors. A nationwide population-based study. Am J Respir Crit Care Med 194(2):209–217

    Article  Google Scholar 

  68. Neviere R, Parsons PE, Finlay G (2016) Sepsis syndromes in adults: epidemiology, definitions, clinical presentation, diagnosis, and prognosis

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anahita Khojandi.

Ethics declarations

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Disclaimer

This manuscript has been co-authored by UT-Battelle, LLC, under contract DE-AC05-00OR22725 with the US Department of Energy (DOE). The US government retains and the publisher, by accepting the article for publication, acknowledges that the US government retains a nonexclusive, paid-up, irrevocable, worldwide license to publish or reproduce the published form of this manuscript, or allow others to do so, for US government purposes. DOE will provide public access to these results of federally sponsored research in accordance with the DOE Public Access Plan (http://energy.gov/downloads/doe-public-access-plan).

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original version of this article was revised: The incorrect version of Figure 3 appeared in the original version of this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Wyk, F., Khojandi, A., Williams, B. et al. A Cost-Benefit Analysis of Automated Physiological Data Acquisition Systems Using Data-Driven Modeling. J Healthc Inform Res 3, 245–263 (2019). https://doi.org/10.1007/s41666-018-0040-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41666-018-0040-y

Keywords

Navigation