25 February 2020

HIMSS20: PCCI experts to launch book, deliver program presentations

The experts at Parkland Center for Clinical Innovation (PCCI) will be out in force at the HIMSS20 Convention in Orlando in March. At the event, PCCI will launch its new book, “Building Connected Communities of Care,” which is currently available in pre-sale. There will be several events where show attendees can meet with the authors and learn more about the book. These events include  book signings and presentations (see below).

Additionally, PCCI experts will deliver presentations on their cutting-edge programs at HIMSS20. See below for all of the PCCI activities.

If you are attending HIMSS20 and would like to meet with PCCI’s experts, please contact us HERE.


  • Author Meet & Greet, Book Signing
    • CEO Steve Miff and VP Keith Kosel (book authors)
    • Tuesday, March 10, 10:30 a.m. to 11 a.m.
    • Orlando – Orange County Convention Center, Level 2 – Lobby B



  • Building Connected Communities of Care Book Release Reception
    • Tuesday, March 10, 3-4 p.m.
    • Exhibit Floor, Hall B, Booth #2731 (Healthbox)
  • Author Meet & Greet, Book Signing
    • CEO Steve Miff and VP Keith Kosel (book authors)
    • Wednesday, March 11, 9:30 a.m. to 10 a.m.
    • Orlando – Orange County Convention Center, Level 2 – Lobby B




21 February 2020

PCCI Experts Share How Predictive Models Help Improve Healthcare at UT Dallas

In mid-February, the University of Texas at Dallas’s Computer Science Department hosted presentations by PCCI experts Akshay Arora and Priyanka Kharat at their weekly Community Outreach program. The presentations were delivered to UT-Dallas students, clinicians, health data scientists and technology officers from different companies interested in PCCI’s predictive models and healthcare research.

Priyanka presented “Harnessing Healthcare Data using AI/ML”; and Akshay presented on “Using Natural Language Processing in Clinical Applications.”

The audience was engaged and asked insightful questions about Sepsis prediction and post model deployment feedback from clinicians noted in Priyanka’s presentation. The design of PCCI’s cloud platform (Isthmus) and the way the company created a healthcare domain specific platform for machine learning was very well received.

During Akshay’s presentation, he discussed how PCCI leveraged clinical NLP for understanding the VTE prophylaxis and SDOH to understand our patient cohorts.  The audience was particularly inquisitive about the extension and the generalization of PCCI’s clinical NLP models for multiple hospitals.

17 February 2020

PCCI News: Parkland Center for Clinical Innovation’s New Book, ‘Building Connected Communities of Care,’ a Critical Tool to Improve HealthCare

DALLAS – Parkland Center for Clinical Innovation (PCCI), which improves healthcare for vulnerable populations using advanced data science and clinical experts, is releasing “Building Connected Communities of Care: The Playbook for Streamlining Effective Coordination Between Medical and Community-Based Organizations” a new book available starting March 9.

The book is a practical, how-to guide for health systems, payers, communities, philanthropic agencies, foundations, and federal and local policymakers desiring to streamline coordination and assistance efforts between medical and social services to reduce costs and improve the health, safety, and well-being of a community’s most vulnerable residents, especially those  with chronic diseases and complex social needs.


“This playbook candidly articulates how to build a connected community and shares practical lessons learned.”

– Richard (Dick) Daniels, CIO Kaiser Permanente


The PCCI book authors, Dr. Steve Miff, President and CEO and Dr. Keith Kosel, Vice President Enterprise Relationships, each have long careers leveraging advanced data science, clinical expertise, and social determinants of health insights to better support population health and at-risk populations.

In this book, the authors propose a novel approach to the coordination of medicine and social services through the use of people, process, and technology, to promote true cross-sector patient and client engagement.

“Building Connected Communities of Care” is based on the experience of Dallas, Texas, which was one of the first metropolitan regions to develop at scale a comprehensive foundation for partnership between a community’s clinical and social sectors using web-based information exchange. In the five years since the initial launch, the authors with their teams and partners have been able to provide digital connection, communication, and coordination between healthcare providers and a wide array of community-based social service organizations.

“As an organization, PCCI is dedicated to helping pioneer new ways to health by creating and deploying frameworks to bring community and healthcare organization together to personalize and move interventions upstream,” said Dr. Miff. “This book shares our experiences, insights and recommendations in creating connected communities of care that can help change how we approach healthcare and drive collective impact.”

PCCI’S “Building Connected Communities of Care” can be reserved now in pre-release at HIMSS Publishing and on Amazon. The book will be available in hardback, softback and electronic editions at release on March 9.

PCCI will hold several book-release events at the healthcare technology conference, HIMSS20, in Orlando, Fla., including:


  • Author Meet & Greet, Book Signing
    • Tuesday, March 10, 10:30 a.m. to 11 a.m.
    • Orlando – Orange County Convention Center, Level 2 – Lobby B



  • Author Meet & Greet, Book Signing
    • Wednesday, March 11, 9:30 a.m. to 10 a.m.
    • Orlando – Orange County Convention Center, Level 2 – Lobby B

About Parkland Center for Clinical Innovation

Parkland Center for Clinical Innovation (PCCI) is an independent, not-for-profit, healthcare intelligence organization affiliated with Parkland Health & Hospital System. PCCI leverages clinical expertise, data science and social determinants of health to address the needs of vulnerable populations. We believe that data, done right, has the power to galvanize communities, inform leaders, and empower people.



11 February 2020

PCCI at HIMSS20 – AI-Powered Early Prediction of Post-Acute Care Need

PCCI’s Medical Director, Jacqueline Naeem, MD, will be presenting at HIMSS20 on Friday, March 13 at 10:45 a.m., in Room W414A. Her presentation “AI-Powered Early Prediction of Post-Acute Care Need” offers her expert insights on early identification of patients who require post-acute care upon discharge. She will discuss how through the early identification, transition care team productivity is increased, medically unnecessary length of stay and likelihood of readmission is reduced. Click the image below for all the details:

6 February 2020

In The News: The Power of Personal Determinants of Health

PCCI’s Chief Analytics and Information Officer, Vikas Chowdhry, MBA, is featured in Healthcare Innovation as a guest author, where he shares his perspective on evolution of the social determinants of health. Click on the image below to read the full story:

5 February 2020

The Future of SDoH: The Power of Personal Determinants of Health

It is encouraging to see many healthcare systems and payors focusing on the impact of social determinants of health (SDoH) and looking for ways to partner with community-based organizations to address and improve these issues locally. Although this is a necessary step, I believe that providing access or referrals to community organizations is not the full answer. While healthcare systems can provide referrals and connect patients to resources such as food banks or employment resources, it may not be enough to create individual engagement and empowerment to use those resources. We more fully need to appreciate the role played by the environment in which we grow up and the choices available to us in shaping how we respond toSDoH factors as individuals.

As part of an innovation center where we align data science withSDoH to help systematically disadvantaged individuals, I’ve been witness to projects and research that point to the theory of individual resiliency as part of the equation. The American Psychological Association defines individual-level resilience as the process of adapting well in the face of adversity, trauma, tragedy or threats.[1] A review of the research on

resilience by the WHO found that an individual’s ability to successfully cope in the face of significant adversity develops and changes over time, and that interventions to strengthen resilience are more effective when supported by environments that promote and protect population health and well-being. Further, supportive environments are essential for people to increase control over the determinants of their health.[2]

Also, in addition to traditional resilience methods, the emergence of methods to assess an individual’s capacity for self-care are adding significant insights into personal determinants of health. In particular, the needs of the growing population of complex patients with multiple chronic conditions calls for a different approach to care. Clinical teams need to acknowledge, respect and support the work that patients do and the capacity they mobilize to enact this work, and to adapt and self-manage. Further, clinical teams need to ensure that social and community workers and public health policy advocates are part of the proposed solution. Researchers at the Mayo Knowledge and Evaluation Research (KER) Unit and the Minimally Disruptive Medicine (MDM) program led by Dr. Kasey Boehmer are developing qualitative methods and measures of capacity and individual’s ability for self-care.

Take post-traumatic stress disorder (PTSD), as an example. It has been estimated that around 50-60 percent of people in the US will experience severe trauma at some time in their lives. Around one in 10 goes on to develop PTSD, which is permanent in a third of cases. But some people who have lived through major traumatic events display an astonishing capacity to recover.[3] A complex set of factors can be attributed increasing an individual’s resiliency to trauma including their personality, their individual biology, childhood experiences and parental responses, their economic and social environment as shaped by public policy, and support from family and friends.

I could apply this to patient engagement as well. In any given population we may be able to determine which factors cause one individual to not only take a referral to a food bank but continue to receive services to improve their food insecurity versus another individual from the same neighborhood and population who did not. Perhaps the first individual connected with a case manager at the food bank who did regular check ins. Maybe they had family or friends who drove them to the food bank weekly or attended nutrition classes at the center that provided them with regular group support.

What might social determinants of health look like in 2025 if we could capture, analyze and use these “resiliency” factors or personal determinants of health? In 2025, SDoH will evolve to:

    • SDoH will evolve and morph intoPDoH – Personal Determinants of Health
    • Policy makers at local, state and federal levels will recognize the role that these factors play toward health and well-being of people and will enact policies to provide support for prevention versus late stage clinical intervention
    • PDoH will be broadly integrated into Cognitive Health Records and built into AI-based risk predictive models
    • Bridging isolation (mental and physical) will be a key focus: Transportation-driven access challenges will be addressed through co-location of services and broadly through digital technology, tele-consults (at non-traditional location such as food pantries) and drone deliveries (everyone loves drones)
    • PDoH will evolve to integrate pharmacogenetic/genetic based data and measures of self-care capacity
    • From my perspective, we will be better at understanding “who are our patients” beyond clinical diagnoses through both AI driven deep neural network analyses of PDoH data and qualitative studies leveraging discrete choice methodologies and other consumer choice and segmentation research methods


In a collaboration between Parkland Health & Hospital System and North Texas food pantries, the partners wanted to test their ability through connected data share and cross-organizational care coordination using a social-to-health Dallas Information Exchange Portal (IEP) to impact the health care experience of food-insecure individuals with diabetes and/or hypertension.

Individuals who sought services at one of the food bank locations and reported to have diabetes/hypertension and seeking care at Parkland were flagged for participation in the program, through coordination with Parkland. At their next visit to the food pantry, they received prescription and appointment reminders, access to healthy food options conducive to their medical condition and any barriers they had to care were identified and recorded in the IEP system.  Parkland providers can see and use the information to proactively address any barriers to care (e.g., prescription refill assistance or transportation assistance to next appointment).

Individuals who were enrolled in the program had a significantly higher outpatient appointment attendance and a near significant decrease in no-show/same day cancellation of appointments versus a control group. In addition, satisfaction surveys showed that 93% of respondents either agree or strongly agree that the program has made them more likely to go to their doctor’s visit. These results seem to strengthen the idea that those individuals with adequate social supports, and connectedness between the health system and community providers increases individual engagement in health and well-being.

About Vikas Chowdhry

Vikas Chowdhry, MS, MBA, is PCCI’s Chief Analytics and Information Officer with more than 15 years of healthcare experience. He works closely with data science and clinical teams at PCCI to develop machine learning driven technologies and products that can empower clinical and social services providers and individuals to create communities that are healthier and more productive. Vikas would like to thank the teams at Parkland and PCCI who helped him understand the nuances and impact ofSDoH on the people served by Parkland. Vikas would also like to thank NatashaGoburdhun from NDGB Advisors who contributed to this post.

[1]https://www.apa.org/helpcenter/road-resilience; accessed on July 19, 2019

[2] Strengthening resilience: a priority shared by Health 2020 and the Sustainable Development Goals; World Health Organization, Regional Office for Europe; http://www.euro.who.int/__data/assets/pdf_file/0005/351284/resilience-report-20171004-h1635.pdf, accessed July 18, 2019

[3]https://www.theguardian.com/science/blog/2014/dec/19/unbroken-resilience-louis-zamperini-post-traumatic-stress-disorder; accessed on July 18, 2019


4 February 2020

HIMSS20: A can’t miss SDOH talk with PCCI’s Steve Miff & Neil Patel, President of Healthbox


On Monday, March 9 at 11:55 a.m. in the Rosen Centre Junior Ballroom G, Healthbox President Neil Patel sits down with Steve Miff, president and CEO of Parkland Center for Clinical Innovation to discuss the launch of the center’s Building Connected Communities of Care: A Playbook at HIMSS20 this year.

The CCC Playbook is based on the experience of Dallas, Texas, one of the first metropolitan regions to develop a comprehensive foundation for partnerships between a community’s clinical and social sectors using web-based information exchange.

Click on the image below to get all the details:

28 January 2020

PCCI Expert: What to expect at HIMSS20

In this week’s edition of Healthcare Innovation, Leslie Wainwright was interviewed for her expert perspective on what to look for at the upcoming HIMSS20 event in March. She also discusses the new Playbook set to be released at HIMSS20. Click on the image below to read the whole story.

27 January 2020

Steve Miff Webcast on Artificial Intelligence for Social Determinants of Health

Recently, PCCI’s CEO & President, Steve Miff participated on a webcast hosted by the University of South Florida for the Florida Medicaid Drug Therapy Management Program for Behavioral Health. His presentation “Artificial Intelligence for SDOH” discussed how social determinants of health and AI can work together to help improve care for under-served populations. Click on the image below to see the video webcast:




22 January 2020

PCCI at HIMSS20: Yolande M. Pengetnze, MD

At HIMSS20 in Orlando on March 10, PCCI’s Senior Medical Director, Yolande M. Pengetnze, MD, will present on how machine-learning and artificial intelligence-driven algorithms guide targeted and tailored educational for high-risk Medicaid children with asthma and Medicaid pregnant women at risk for preterm delivery. Click on the image below for all the details.