Life expectancy in the US is falling, according to the National Center for Health Statistics. Multiple sources of data also reveal growing gaps in mortality according to race. White Americans live more than five years longer on average than Black Americans, for example. Such disparities are especially stark in Chicago, where residents on the city’s West Side face a life expectancy 16 years shorter than those in the wealthier loop. And the gaps are widening.
A founding member of the Healthcare Anchor Network, dedicated to promoting inclusive local economies, Chicago’s Rush University System for Health (RUSH) recognizes that patient outcomes are tied not only to the health care people receive but also to conditions in the communities where they live. However, hospitals’ traditional data systems keep community-level information from being easily available to doctors and clinicians.
“Many social and environmental factors, such as how easily a person can access fresh, healthy food, adequate housing, and transportation, contribute to these disparities,” says Dr. Abdul Shaikh, global lead for population health, Amazon Web Services (AWS). “Cloud technology can make it easier to link disparate data for advanced analytics, such as machine learning, to inform meaningful interventions—helping us close these gaps by identifying the drivers that lead to poor health and guiding patient and provider decision making,”
With a grant from the Robert Wood Johnson Foundation and support in the form of AWS credits, professional services support, and technical expertise from the AWS Health Equity Initiative, RUSH set out on a mission to build its own Health Equity Care & Analytics Platform (HECAP) to aggregate this critical data and create a more complete patient profile for clinical and community intervention.
Says Dr. David Ansell, RUSH’s senior vice president for community health equity, “In order to build trust with the community and improve health outcomes, we have to build technology that adequately addresses the challenges [patients] face.”
Developing Technology to Improve Lives
With HECAP, RUSH aimed to help clinicians and patients make better decisions to address health inequities and improve outcomes. Its goal was to create a platform that could transform, aggregate, and harmonize data from different sources to reflect the complex interplay of clinical and social factors on patient health.
“It's health equity, not health equality,” says Dr. Michael Cui, RUSH associate chief medical informatics officer. “We're not trying to give everyone the same care. We want to achieve the same outcome no matter the patient's circumstances or differences.”
RUSH created the foundation for the platform during the Covid-19 pandemic, when it worked with AWS and Chicago’s Department of Public Health to create a public health analytics hub in the cloud. This hub aggregated and analyzed multi-hospital data so that care providers could quickly identify where beds were available across Chicago’s hospitals and help ensure that people throughout the city had access to care.
Although this effort meant RUSH wasn’t starting from scratch, the organization did face challenges in creating HECAP. First, it needed to move quickly—lives were at stake—yet securely, without compromising patient data and confidence. “Trust is the cornerstone of any of our health equity work,” Cui says.
Second, like the Covid-19 analytics hub, the expanded platform needed to harness many kinds of data from different sources. With HECAP, the hub would aggregate not just clinical data from electronic health record (EHR) systems but also patient surveys, blood pressure device data, public data (such as from the US Centers for Disease Control and Prevention), and other information to get a holistic picture of each patient.
Finally, it had to build a solution that could scale easily as more data was added and would drive RUSH’s goals for making HECAP available to other organizations and communities.
The Cloud Brings the Vision to Life
RUSH worked with AWS to overcome these challenges. The organization was able to build HECAP in less than 18 months using AWS services, such as serverless technology, which the RUSH development team used to move quickly and securely. Serverless technology helps companies eliminate infrastructure management tasks, such as capacity provisioning and patching, so they can focus more on their customers and patients.
To solve the second challenge of aggregating disparate data, both structured and unstructured, RUSH is using AWS HealthLake, a HIPAA-eligible service that uses Fast Healthcare Interoperability Resources-standard (FHIR) APIs (including SMART on FHIR support, patient access API, and FHIR bulk data access) to securely store, transform, and prepare health data to inform analysis and intervention at scale. HealthLake makes it easier for RUSH to use the harmonized data with AWS machine learning and decision support tools.
“When we make data from multiple sources interoperable, we can do more effective risk prediction and intervention,” Cui says. “For instance, using machine learning models and data visualization for decision support at the point of care can help our clinicians identify patients who are both at higher risk for cardiovascular disease and will benefit from medical, lifestyle, or community support, such as food banks. This results in more equitable and tailored interventions to enhance patient outcomes.”
HealthLake also supports Amazon Comprehend Medical, a HIPAA-eligible natural language processing (NLP) service that extracts key information from text such as a physician’s notes and discharge summaries in a patient’s EHR. Using this service, RUSH can transcribe and link important data, such as medications and procedures, to standardized medical terminologies such as ICD-10-CM (diagnostic codes) and RxNorm (drug names). HECAP can then extract relevant information from this data to derive further insights.
RUSH also ensured its new system would be scalable by using AWS, with which it can add or remove capacity at the click of a button. “The data infrastructure needs to grow as the data comes in,” says Anil Saldanha, chief innovation officer at RUSH. “You can turn the knob to the right or to the left, depending on how much you need, and AWS will instantly provide you with those facilities to scale the infrastructure up or down.”
Looking to the Future
RUSH is continuing to build out HECAP by adding more functionality to the provider dashboard, such as enhancing risk-prediction modeling and implementing additional tools to enhance care for underserved populations.
“We have a great opportunity to bring in more data from different sources and use the power of AWS to scale massively across our system, significantly benefiting the care of our patients in Chicago,” Cui says.
Using the methodology and architecture that it developed on AWS, RUSH hopes to share what it has learned in developing HECAP to support other health care organizations and improve outcomes for patients everywhere. Although RUSH is now focused on mitigating social and structural conditions—like structural racism, poverty, and economic deprivation—on the West Side of Chicago, these are global problems.
The hope, says Ansell, is “to make HECAP a blueprint for other organizations to use to advance health equity across the United States and around the world.”
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This story was produced by AWS and edited by WIRED Brand Lab.
