Reducing hospital readmissions by 40% with predictive ML models.
A regional hospital network was struggling with a 22% 30-day readmission rate — significantly above the national average and triggering Medicare financial penalties. Clinical staff had no tools to proactively identify high-risk patients before discharge. The challenge was building a HIPAA-compliant, real-time prediction system that integrated with existing EHR systems without disrupting clinical workflows.
Built FHIR-compliant data connectors to ingest structured patient data from the hospital's Epic EHR system, normalizing and anonymizing records across 2.5M patient histories.
Trained an ensemble ML model (XGBoost + deep learning) on 3 years of patient data, achieving 92% prediction accuracy in identifying patients at high risk of 30-day readmission.
Built a React-based clinical dashboard surfacing real-time risk scores, key risk factors, and recommended interventions for every patient — integrated directly into the nursing workflow.
Deployed the model on AWS SageMaker with automated retraining pipelines, drift detection, and performance monitoring — ensuring the model remains accurate as patient populations evolve.
The platform gives clinical teams a real-time view of patient risk before discharge, enabling targeted interventions that have measurably reduced readmissions. The system is HIPAA-compliant, processes patient records in under 2 seconds, and has been adopted across all six hospitals in the network. The readmission rate dropped from 22% to 13.2% within the first year.
The readmission prediction model has fundamentally changed how our care teams work. We now have clear, actionable risk signals for every patient at discharge. The Qodeon Labs team navigated the HIPAA complexity and EHR integration challenges better than any vendor we've worked with.