What is an Enterprise Data Warehouse for Healthcare?

Post by Neal Singh

Chief Technology Officer, Caradigm

Healthcare organizations have become more aware of the need to leverage all of their data in order to support new population health management initiatives. An Enterprise Data Warehouse (EDW) is one of the key solutions many healthcare CIOs are considering to help accomplish this goal. In recent conversations that I’ve been having with CIOs, I often hear them say that they need more than what a horizontal EDW provides. The “Aha!” moment comes when CIOs realize that they need an EDW specifically designed for healthcare that has the vertical functionality needed to drive a scalable healthcare data and analytics strategy.

The first step in building an EDW for healthcare starts with choosing an enterprise EDW foundation. Caradigm has developed a deep integration with Microsoft SQL, a Leader in the 2014 Gartner BI Magic Quadrant that provides a strong horizontal EDW foundation including SSIS, SSAS, SSRS and Power BI tools. Caradigm has added an array of vertical functionality to that foundation to deliver an EDW for healthcare. Let’s explore further what distinguishes it from horizontal solutions.

A single-source of aggregated data in near real-time

Aggregating different types of data (e.g. clinical, claims, financial) from potentially dozens of systems across a health network is a core requirement for population health that horizontal EDWs are not equipped to handle efficiently.  An EDW for healthcare is different because it provides the following functionality that enables a single-source of data to be possible:

  • A healthcare data model that can automate the process of combining different data sources and data structures to create a single, longitudinal patient record.
  • Complex healthcare data aggregation parsers that automate the ingestion of data from all healthcare information technology systems and normalize disparate data to semantic healthcare terminology tailored to your enterprise.
  • The ability to use Hadoop and NLP (Natural Language Processing) to leverage and derive insights from non-structured data.
  • The ability to update and make the data available in near real-time as opposed traditional EDWs that require delayed monthly or quarterly batch processing.

Actionable and Extensible Data

An EDW for healthcare also must deliver the following functionality that enables the data to drive action:

  • The ability to write data back into source systems to surface actionable information at the point-of-care. This is a key requirement that allows you take action from insights.
  • Healthcare specific tool sets for non-technical clinical analysts that allow them to perform analysis and reporting with strong visualizations. You want to decrease the barriers for information access by bringing end users closer to data. The traditional route of requiring end users to work through IT for coding reports is slow and expensive.
  • Data exploration tools should enable insight discovery i.e. exploring data to discover hidden insights versus the traditional route of asking the questions and building rigid data marts around them.
  • Native support for predictive analytics like estimations of risk and predicted outcomes. Examples include cohort stratification, patient identification, risk modeling, readmissions management, and total cost of care.
  • Integrated out of the box analytics applications like Quality Improvement, Risk Management, and Condition Management that can leverage the EDW to perform and share analytics.
  • An open platform that can share data via web services APIs (Application Programming. Interfaces) or access via other 3rd party popular BI tools like Tableau, QlikView, and Spotfire
  • An application development platform that gives the ability to create new applications utilizing the EDW.

Security and Compliance

Lastly, but as important as any of the functionality mentioned above is the ability to provide a security model that is role-based, row based, field level redaction with auditability. This can be an important tool for HIPAA best practices.

My advice to providers is that they need to think about which tools can help them today and scale with their future needs. The overall strategy has to be extensible and simple from the customer’s point of view. Providers shouldn’t have to acquire multiple new systems, develop custom solutions, or build an internal team of developers.  Providers need a partner with a defined path forward that includes infrastructure, domain expertise, out-of-the-box functionality and tool sets that can simplify processes today while being able to adapt in the future. If you’re struggling to get out of the gate beginning with data aggregation, then that’s an indicator that there are missing fundamental capabilities. It’s unlikely that population health data capabilities can be patchworked together without delaying the timeframe for success and increasing costs.     

Caradigm is unique because we deliver a mature and comprehensive EDW designed specifically for healthcare.  We have already helped customers aggregate their data and are surfacing that information in clinician workflows to improve care. Once these core requirements are in place, providers are positioned well to succeed with their population health initiatives. I look forward to having more discussions with providers about how we can partner to help you realize the full potential of your data to support your population health efforts.

All Signs Point to Population Health Management

Post by Scott McLeod

Director of Product Marketing, Caradigm

In this recent Becker’s Hospital Review article, I found it notable that so many of the top 10 challenges and opportunities for hospitals in 2015 were related to population health management. In addition to population health, which was called out on its own, five other related trends included the shift to value-based reimbursement, M&A, system integration, the use of data, and the need to lower costs due to reimbursement rate differences. To that list, I would also add clinical integration and quality improvement as two other top challenges hospitals are facing. It’s interesting that while providers have a variety of challenges that fall into different buckets, population health is a single strategy that can help address them all.

Some providers are taking a conservative approach with population health because it is still so new, and they are trying to determine the best way to proceed. However, we’re starting to see more providers view population health as a strategy that is central to solving many of the biggest challenges they are facing. Those providers have already begun building their population health capabilities because they view them as requirements to achieve their overall long term strategy, which often falls into one or more of these broad categories:

Growth – providers seeking growth via acquisition, clinical integration, partnerships or the signing of new commercial contracts

Quality – providers that make quality their organizational focus and want to differentiate on it

Raise Margins/Lower costs – providers seeking to strengthen long-term financial performance by lowering costs and benefiting from risk-based contracts

Efficiency – providers that want to improve clinical efficiency and achieve better coordinated and consistent care

Population health solutions bring a broad set of value to organizations that allows them to solve a variety of business challenges. The core capabilities of population health are:

  • Data aggregation – merge and share all data from information systems across a health network
  • Predictive analytics – understand clinical and financial risk of a population to identify opportunities for improvement
  • Care coordination – improve coordination, efficiency and consistency of care in order to improve patient outcomes
  • Patient engagement – empower patients in self-care to modify behaviors that can improve patient outcomes 

One of the most valuable aspects of these core capabilities is that they can be applied broadly. Providers can use them to address today’s initiatives, but can expand and evolve them as new challenges emerge in the future. Whether it’s integrating the health IT systems from an acquisition, lowering the cost of care for a population in an ACO, expanding a clinically integrated network, or lowering readmissions rates, population health solutions are needed. I’m predicting that 2015 is the year that population health shifts from being perceived as a new concept to a core strategy that providers will be employing to achieve long term success.

Insider Threats Are Top of Mind for Healthcare CISOs

Post by Azam Husain

Senior Product Manager, Caradigm

I had an interesting conversation with a healthcare CISO at a recent event about what worries him the most. Even more than external malicious threats, he was most worried about employees abusing privileges and violating the trust they had been given by his organization. One of the most challenging aspects of information security is that the security perimeter keeps expanding, and now includes insider threats as well as external ones.

Recent healthcare breaches caused by insiders show that the CISO is justified in his concern. Last month, a former employee of a hospital was caught inappropriately accessing patient medical and financial records for nearly three and a half years causing a breach impacting nearly 700 records.  Also last month, a different provider received a ransom demand made by an unknown party threatening to release protected health information unless payment was received. The ransom email contained evidence of PHI from the hospital. After an investigation by external forensic experts, an internal threat became suspected because it was determined that hospital servers had not been hacked and remain secure.  Also recently, the FBI and the U.S. Department of Homeland Security (DHS) issued a warning about the increase in insider threats from disgruntled current and former employees.

These are all timely reminders about the serious risk from insider threats. External threats are already being addressed and generally understood today by security professionals, however, it’s the risk from internal threats that healthcare organizations may need to apply more focus.

The question then becomes how do you manage the trusted access you’ve already given to employees? Healthcare organizations can take control of the risk through a strong identity and access management (IAM) program. IAM is a solution that allows providers to give precise, role-based access to clinical applications that contain protected health information (PHI). That access can be granted or revoked in seconds, monitored, reported on and is easily available for audits.  IAM is a fundamental component of a good security and HIPAA compliance program, which all healthcare organizations are required to have in place.

To learn more about how providers are effectively using IAM solutions, you can sign up to view the recording of a recent webinar we hosted with Duke University Health System who talked about how they evolved their use of IAM as their business needs evolved over time.

What Could the Proposed MSSP Rules Changes Mean for ACOs

Post by Brian Drozdowicz

Vice President of Population Health, Caradigm

2014 was another year of learning for ACOs participating in the Medicare Shared Savings Program (MSSP). So far, the results have been uneven, as three out of four ACOs launched in 2012 and 2013 did not save enough to earn bonuses. Only five out of more than 300 ACOs felt confident enough to choose the option for a penalty and increased shared savings. The National Association of ACOs surveyed MSSP ACOs in October and found two-thirds were somewhat or highly unlikely to continue if they were required to accept penalties. Finally, on the Pioneer ACO program side, eight of the nine ACOs that left the program posted losses for the first performance year, and none of them earned shared savings.  

Given these results, many ACOs are understandably in agreement that they would like more time to acquire the infrastructure and expertise needed to revamp their models of care. In response to this feedback, the Center for Medicare & Medicaid Services (CMS) is proposing changes to encourage providers to stay in the program. A number of publications including Modern Health and Becker’s Hospital Review have posted good summaries about the proposed changes. I believe the key aspect of the proposed changes is that it would lessen the risk ACOs face in the short term while they gain traction in the program.

Clif Gaus, CEO of the National Association of ACOs, supports the extra time for ACOs because he said “It’s probably a decade-long process to redesign all of the care processes that lead to both better care and more appropriate care…There’s a big learning curve for many ACOs. They are almost new businesses starting from scratch.”

The proposed changes would create a much needed buffer, however, it’s also important for ACOs to realize that 2015 is the year they should accomplish the identification and implementation of technology needed to drive population health management and more shared savings. I found it interesting that CMS is also proposing to add new eligibility requirements to the program that will ask applicants to describe how they will promote the use of enabling technologies for improving care coordination as well as provide milestones and targets for the implementation of those technologies. This shows CMS has acknowledged the critical role that technology plays in the shift to population health although it is still a long ways away from making any specific recommendations.

Given our work with a variety of customers managing these challenges, I am more than willing to make recommendations about the various capabilities required to successfully support the transition to value based care and am passionate about helping others take that step. One of the most important things to focus on is to take a holistic technology approach that considers the entire organization – an enterprise population health approach. A narrow approach using point solutions can fall short because population health requires integrated technology to bring together data, analytics and workflows across the entire organization. For example, the technology requirements of a population health strategy are:

  • Aggregation, normalization and sharing of all of your data (e.g. clinical, claims, financial) in near real-time
  • Application of analytics to all of the data to stratify your population, uncover insights and enroll patients in programs  
  • Surfacing of the data, analytics and insights at the point-of-care (i.e. within care management workflows and EMRs) to make care more efficient and consistent for the targeted population

A gap in any of these requirements or a lack of integration between them creates inefficiencies that become a blocker to overall population health efforts. When there are synergies and automation between a platform, applications and workflows, that’s when tremendous efficiencies and improvements can be realized. This innovation is real, and Caradigm is the leading provider in the market delivering a comprehensive solution that enables enterprise population health. I’m anticipating that 2015 will be a pivotal year for ACOs as many adopt the technologies and strategies they will need to thrive. If you’d like to continue the discussion and learn more, send a note via this form.

DSRIP Leads to Population Health Management

Post by Vicki Harter

Clinical Product Manager, Caradigm

It’s challenging to provide care for the patients most in-need – the homeless, those with untreated, chronic health and mental illness. These patients often lack consistent primary care, and often only receive treatment when they go to the emergency room during an acute episode. It’s a lose-lose situation because the patients don’t sustain the improved health after leaving the ER, and costs are unsustainable for providers and U.S. taxpayers.  

The federal government saw the need for better coordinated care of Medicaid and uninsured patients, resulting in the creation of the Delivery System Reform Incentive Payment (DSRIP) program to help healthcare organizations transform how they deliver care to those patients. At its highest level, DSRIP is intended to advance the Institute for Healthcare Improvement “Triple Aim” of improving the health of the population, enhancing the experience and outcomes of the patient and reducing the per capita cost of care. DSRIP is also ultimately about Medicaid reform, moving to a system of care that promotes wellness rather than just manage sickness and promotes value of care over volume of care.

DSRIP points people in the right direction by emphasizing certain goals such as the “Triple Aim,” collaboration with community providers, avoiding preventable hospitalizations and clinical improvement for chronic diseases. What DSRIP does not do is specify how providers are going to accomplish those goals, which requires organizational change and new technologies. To complete the picture, healthcare organizations need a population health management strategy and solutions to enable that strategy.

Population health management solutions can reduce silos of care by sharing data and analytics across the community at the point-of-care. Patients are given a single plan of care focused on prevention and wellness that is then executed by a care team across the continuum efficiently and without redundancy. The result is an integrated community of providers that delivers better coordinated care to make patients healthier and keep them out of the ER and hospital settings.

The DSRIP program represents a great opportunity for eligible organizations to jumpstart a population health strategy. To learn more about the DSRIP program, you can watch this short video or contact us to discuss further.


Caradigm Employees Volunteer with Timmy Global Health in Ecuador

Post by Larry Nicklas

Senior Product Manager, Caradigm

Four Caradigm employees (Bryan Ferrel, Kathleen McGrow, Michele Kirkpatrick and Larry Nicklas) volunteered on a medical mission in Ecuador earlier this month. We asked Larry Nicklas, a Senior Product Manager for Caradigm, to share a few thoughts about his experience. It is a timely reminder that we have much for which to be thankful. Happy Thanksgiving!

What organization did you go with?

I went as part of a team organized by Microsoft that goes on an annual trip through Timmy Global Health (TGH) who works to strengthen local health systems and help end health disparities. We were based out of Tena, located in the Amazon Basin and would visit different villages each day that were 30 minutes to 3 hours away. Tena is the capital of Napo Province, about a 6 hour bus ride from Quito, the capital of Ecuador where we flew into.

What is healthcare like in Napo Province?

There’s a lot of health issues for the villagers that we visited with. Virtually everyone had a fever, cough, runny nose, and many had fleas and rotting teeth. Chronic conditions such as hypertension and diabetes were also common. In terms of healthcare resources, it’s pretty barren. A ”brigade” from TGH tries to visit 2-4 times a year. Usually, the nearest hospital is many hours away, but the locals don’t have transportation. If you can hitch a ride to the hospital, it’s like being in a facility from the 1920s.

What was the goal of the medical mission?

Each day, we set up temporary clinics in various villages to help as many people as possible get treatment, education and basic tools to improve health. It was pretty hectic as we were seeing as much as 125 people a day at a single clinic, from newborns to people in their 60s. Folks that need treatment beyond what we can provide on the ground are referred to other facilities, and TGH pays for these services.

What was the process like for patients?

The process was very similar to what patients experience here, although the setting and facilities were obviously quite different. Patients would be registered in a rudimentary EMR, then move on to different stations where they would explain why they need care, get basic vitals, can get blood and urinalysis work done, consult with a clinician, then get meds from the Pharmacy station, which was basically two dozen suitcases and plastic bins broken out by different drug categories. Most volunteers were assigned to different stations each day.

Did it change your perspectives on healthcare in the U.S.?

It made me think about how we have easy access to healthcare, but too often don’t bother to use it   compared to people who desperately need it, but don’t have a means to receive it. It also made me think about how easy it should be for us to maintain a healthy lifestyle and take care of ourselves better given the environment we live in.

Did you have a favorite moment from the trip?

I’d have to say it was a tie between interacting with the children and forming relationships with the incredible volunteer team. It was really eye opening for me to see people with so many medical and socio-economic problems who could still find it so easy to smile, laugh and play. There was also a deep camaraderie that developed within the team because of the unique experience we went through together – living in shacks in the jungle; seeing heartbreaking things in the villages, rallying each other to do our best to help. It was an amazing and emotional trip. I went to learn about a different culture and wound up also learning a lot about myself. We are truly lucky and blessed to live where we do. 


Pic 1

Kathleen, Bryan, and Larry with a new friend




Five Essentials of a Population Health Management Strategy Webinar

Post by Sandy Murti

VP of Partnerships and Alliances, Caradigm

In a relatively short amount of time, population health management has become one of the most talked about topics in healthcare. As more healthcare organizations take on risk for populations of patients, they need a strategy to transition away from episodic, single patient care. Many are considering population health as the answer to improve quality, lower costs and succeed with risk.  

Some organizations can stall in their journey to population health when they get bogged down by the volume of information they need to synthesize to successfully execute population health management programs. Furthermore, the magnitude of organizational change management required can be considerable for a large health network embarking on this journey. This requirement for population health advisory services along with an investment in the right technologies is one of the primary reasons Caradigm has formed an alliance with a leading healthcare consulting services provider like Beacon Partners.  The alliance brings together Caradigm’s population health software and the population health consulting expertise of Beacon Partners.   

This Friday, Wendy Vincent, National Practice Director Strategic Advisory Services, Beacon Partners and Ed Barthell, MD, Medical Director, Americas, Caradigm will present a webinar about the essential components of a population health strategy for provider organizations.  On the webinar they will cover the core components of a strategy such as:

  • How to identify populations to manage
  • How to coordinate care through partnerships and technology
  • How to engage your organization
  • How to optimize your current technology investment
  • How to measure success

I hope you can join us. You can register for the webinar here.


The Importance of Patient Motivation in Population Health Management

Post by Steve Shihadeh

Senior VP, Sales & Customer Operations, Caradigm

As healthcare organizations take on more financial risk for patient populations, they must gain a much deeper understanding of their patient population in order to drive better outcomes. Realizing the full potential of population health management is limited by finite care management resources as well as each patient’s willingness to participate in his or her own outcomes. By stratifying your patient population based upon predicted future risk that considers patient motivation, providers can identify and prioritize patients most likely to be positively impacted by targeted care planning and interventions.

Factoring patient motivation into the risk stratification of a patient population is one of the exciting ways that Caradigm is helping innovate population health management. Consider the following example of two patients that I have a deep understanding of – my mom and my dad.  Both have chronic conditions, and would be identified by most providers as patients that are high risk or could potentially move to a high risk stratification. Inside of an EMR, the two patients look very similar, but the truth is they should be viewed very differently by providers.

My mom is the ideal patient. She follows her physician’s instructions, fills her prescriptions promptly, schedules her follow-ups, and takes exercise classes as recommended. On the other hand, my dad presents as a more problematic patient because he doesn’t follow his doctor’s recommendations. He’s the opposite of my mom in terms of participating in self-care even though he also has a chronic condition that needs ongoing management.

For a provider, it is extremely valuable to factor in patient motivation when stratifying populations to identify and prioritize patients like my parents. Providers are more likely to have much better outcomes from interventions with motivated patients. Care teams can better assess which patients will benefit most from certain types of interventions, so that they can manage their limited time in order to receive the highest return on intervention.  I am not saying “only focus on motivated patients” but I am saying “working with motivated patients can have the biggest positive impact for all”.

I have been asked, “How in the world do you measure patient motivation?” It starts with being able to aggregate and leverage all of a provider’s data (e.g. clinical, claims, financial). Next, Caradigm applies sophisticated analytics to that data with help of our partner LexisNexis with MEDai Science who has been refining and perfecting the accuracy of how they calculate patient motivation for many years. The data plus analytics then enables deep population stratification and providers can use that information to streamline care management workflows as well as surface it at the point-of-care to guide decisions.

I’ll be participating on the Data Analytics and Practical Uses panel at the Becker’s Hospital Review CEO Strategy Roundtable on November 4th in Chicago, and would happy to continue the discussion at the event or after.

Top 3 Myths About Population Health Management Data

Post by Bill Howard

VP of Solution Architecture, Caradigm

According to this recent survey of Accountable Care Organizations (ACOs) reported in a Healthcare IT News article, an astounding 88 percent report significant obstacles in integrating data from disparate sources and 83 percent say they have a hard time fitting analytics tools into their workflows. Keith J. Figlioli, Premier’s senior vice president of healthcare informatics says that the survey results suggest interoperability is a “pervasive problem among ACOs, and it could stymie the long-term vision for ACO cost and quality improvements if not addressed.” The cost of interoperability was cited as a factor preventing interoperability for many organizations.

The survey responses above are significant in that nearly all ACOs are unnecessarily struggling with core capabilities of population health that will hinder their ability to succeed as ACOs. The responses also reveal that there are misconceptions about population health data that need to be cleared up.

Myth #1: A lack of interoperability prevents the aggregation of data

Even if your hospital network uses dozens of non-interoperable systems to store clinical, claims, financial and other data, that does not prevent you from obtaining a single source of “truth.” Enterprise population health solutions include a data aggregation platform and specialized team that can aggregate and normalize all data from across your community. Closed-system vendors as well as point pop health solution providers struggle with this requirement because they don’t have the data aggregation domain expertise nor enterprise platform infrastructure to bridge the gap between non-interoperable systems.

Myth #2: The cost of interoperability is prohibitive

As described above, interoperability can be achieved through an enterprise data aggregation platform, however, costs should not be prohibitive. Costs and implementation complexity are controlled by leveraging standards, pre-built interface connectors, repeatable mapping and normalization processes, along with options for cloud-based deployments. Compared to the amount of revenue at risk for a typical ACO, interoperability has high ROI potential. Costs can be much higher with solution providers that do not have data management domain expertise and infrastructure because they cannot efficiently connect non-interoperable systems.

Myth #3: Analytics cannot be easily surfaced in workflows

Surfacing analytics at the point-of-care is one of the core value propositions of population health management. Workflow solution vendors often have trouble meeting this requirement because they don’t provide the analytics to integrate into a complete solution set. Many analytics vendors often cannot surface results at the point of care because they don’t integrate with EMRs or offer workflow solutions.  Enterprise population health vendors are able to deliver data and analytics at the point-of-care in near-real time because they provide a data platform, analytics engine and apps designed to work together.

To learn more about how Caradigm can help with your population health initiatives, check out the resources page on our website at www.caradigm.com.

How Population Health Management is Changing CFO Perspectives

Post by Matt Wood

Chief Financial Officer, Caradigm

As healthcare moves from fee-for-service to pay-for-performance, population health management is changing how Chief Financial Officers (CFOs) of health systems approach their roles. Population health aligns quality with revenue, which then aligns the goals of CFOs with Chief Medical Officers (CMO) and Chief Quality Officers (CQO) more closely than ever before. Mark Bogen, CFO and senior vice president of finance of South Nassau Communities Hospital in Oceanside, N.Y. describes the shift for CFOs in this recent Becker’s Hospital Review article:

“I think the biggest thing is CFOs…they’re going to have to continue to get out of their comfort zone with the traditional financial indicators that predict revenue, that predict cash flow, and be more aware of where we’re headed, how many lives are we covering and the utilization and the outcomes attached to the clinical pathways that we’re allowing access to,” he says. “I know that’s a tough thing to get used to, but quality and outcomes are where it’s at, so you’ve got to be in that loop.”  

Population health presents an opportunity for CFOs to increase margins through lower costs, shared savings and bundled payment programs, and increase revenue through the addition of other risk-based agreements. To realize those benefits, CFOs should understand the key requirements of population health solutions as much as the CMO and CQO and participate in the evaluation process as a key stakeholder. For population health to successfully increase margins and revenue, providers need solutions that can:

1) Aggregate and normalize all data (e.g, clinical, claims, financial) across all systems.

2) Apply analytics to that data to stratify populations down to an actionable number of patients with the highest ROI.

3) Surface data and analytics at the point-of care in near real-time to guide decisions and improve productivity.

Without these capabilities, investments in population health solutions run the risk of underperforming on quality improvement and therefore, not delivering ROI. As the internal subject matter expert on ROI and the owner of financial performance, CFOs should play an important role in population health as it can help pave a stronger financial path for their organizations. I believe that having more stakeholders aligned around quality is the first step to drive better patient outcomes, so I look forward to having more conversations with CFOs about population health.