Monthly Archives: April 2014

Observations from iHT² Atlanta

Post by Sameer Bade, MD

Vice President of Clinical Solutions, Caradigm

The 2014 iHT² Health IT Summit in Atlanta was a great opportunity to share / learn about the current state of population health management experiences from a number of amazing health systems and their leaders in the southeast US.  Below are a few of my observations and take-aways:

Focused on delivering the Triple Aim, the participating organizations are managing risk in different ways (ranging from pay for performance, bundled payments, shared savings, ACO arrangements and capitated risk). Represented at the meeting were Integrated Delivery Networks, post-acute care organizations, telehealth service providers, the CDC, CMMS, and vendors providing various software, infrastructure, and consulting services supporting population health. Dr. Kevin Fickenscher’s keynote set the tone of the meeting, declaring ‘Profession-Centric’ (the ‘guild’) healthcare delivery is being replaced by a systems-centric approach to healthcare delivery. Clearly, a new era of multi-disciplinary teams managing the care and wellness of populations (‘Team-Based Care Continuum’) is emerging as a replacement.

Some key observations presented during the panels, talks, and group discussions reflect the increasing experience of healthcare organizations as they deliver on the objectives of the Triple Aim:

1. Analytics are necessary (gaps in care, prospective, predictive, risk, etc.), come from many different sources (several are external to the EMR), and need to be easily accessible. Some analytics are based on claims, others are purely based on clinical EMR data, and a few are emerging from combined data sets. Unfortunately, with all of these different sources, there is not a single analytical view of a patient. Furthermore, to access these analytics, providers and care managers have to examine multiple ‘lists’ from multiple different analytic and reporting tools. Health system leaders from Carilion, BayCare and Carolinas, all expressed a requirement that gaps in care, risk, and cost data need to be easily accessible by clinicians. Dr. Kristyn Greifer, VP of Population Health Management for WellStar, also observed that access to real time analytics are a necessary part of care delivery.

2. Patient Centered Medical Homes have been deployed to ensure the best care is being delivered to patients with single or multiple chronic diseases. However, there is an experience that the use of registry tools in conjunction with the EMR can lead to increased utilization without major changes in clinical outcomes. To achieve the necessary outcomes, health systems need to identify patients who need/can benefit from comprehensive plans of care coordinated by care managers. Carilion Clinic has invested extensively in EMR infrastructure, registries, an EDW, and multiple analytic tools. Dr. Stephen Morgan, Sr. Vice President and CMIO, shared their approach of investing in more care managers and the arduous task of crafting care plans within the EMR. An interesting discussion with the audience explored that pursuing population health activities can have a definite impact on hospital volumes and profitability. Clear challenges exist in the transition from fee for service to fee for value, but one thing is clear, Carilion Clinic is working to deliver on their Triple Aim oriented Vision 2017 of “We are committed to a Common Purpose of Better Patient Care, Better Community Health and Lower Cost.”

3. Traditional patient portals are good, but there is a need for deeper engagement. Groups of patients are wanting to understand their plan of care, message their providers, and participate in programs to monitor their chronic conditions. The adoption of “Blue Button” is increasing and there is a need for shared decision-making tools, patient reported outcomes, and access to specific types of analytics. These types of tools could help to increase patient engagement. Another key issue identified was ‘portal sprawl’ or ‘portal fatigue.’ Some health systems are now just saying ‘no’ to the portals that health plans wish to deploy as part of an ACO arrangement and prefer to stick with a single portal experience for their patients.

4. Health Information Exchanges are evolving. Some of the organizations are now in their second and third rounds of participating in health information exchanges. Baptist Pensacola is participating in a truly unique exchange with a local competitor, the military, the VA (opt-in), and a local Skilled Nursing Facility. The Baptist CIO, Steve Sorros, shared that the exchange is helping ambulatory clinics deliver more informed care to our uniformed personnel and veterans. Future business drivers to create sustainability for local exchanges will leverage the ‘last mile connectivity’ created as a result of this exchange (results delivery, sharing care plans within a clinically integrated network, payer participation for sharing data, alerts, etc.).

5. Telehealth – One provider of remote care services, the Global Partnership for Tele-health, provided more than 140,000 remote encounters last year (focused in Georgia and Alabama) and is anticipating that number to exceed 200,000 this year. That’s starting to approach the number of in-person ambulatory encounters seen by smaller health systems. Cleveland Clinic has integrated home monitoring devices with traditional care programs, and is considering further expansion using Microsoft HealthVault-connected devices. In a note of caution during his presentation on ‘big data,’ Dr. Ryan Uitti, Deputy Director of the Mayo Clinic Kern Center for the Science of Health Care Delivery, shared findings from a 2012 study of 205 elderly patients with multiple co-morbidities which showed “no difference in combined hospitalizations and ED visits between patients receiving tele-monitoring vs. usual care.”1 He also shared information on a new application Mayo has developed called “AWARE” to support active surveillance and situational awareness of critical care patients. The initial evaluation of the application indicates a decrease in cognitive overload for clinicians, a decrease in errors, and a decrease in the amount of time spent looking for data or performing tasks. These varied experiences indicate that additional technologies (and services) need to be applied to the right populations, at the right time, and with the right supporting clinical programs.

6. Retooling your People – West Georgia Health’s CIO, Sonya Christian, their CFO, Paul Perrotti, and Director of Nursing, Tracy Gynther, made one thing very clear: Their people (employees, nurses, and doctors) are their most important asset as they improve and evolve their services. Despite providing 85% of the care in their market, the health system is investing in re-tooling their staff, increasing staff participation, promoting new efficiencies through the application of lean production methods, a system-wide focus on patient safety and multi-disciplinary teams.  Five years without a single Ventilator Acquired Pneumonia episode required a relentless multi-disciplinary collaboration between physicians, nurses, and respiratory therapists. As health systems prepare to embark on increasing population health activities, the engagement (and collaborative ownership) of all staff across multiple settings of care is required for success.

What has your organization done in these areas? Are you integrating external analytics into your EMR? What types of tools are you using for performing care coordination and care management? In future blog posts, we’ll explore each of these areas in more detail.

iHT2 Cropped

(1) Takahashi, Paul; Pecina, Jennifer; et al, “A Randomized Controlled Trial of Telemonitoring in Older Adults With Multiple Health Issues to Prevent Hospitalizations and Emergency Department Visits.” Arch Intern Med. 2012;172(10):773-779.

Leveraging Big Data in Healthcare

Post by Hamid Al-Azzawe

Vice President of Engineering, Caradigm

“Big Data” has become as prevalent a term as “EMR” and “HIE” in the healthcare industry. Is it the new technology that holds the promise to revolutionize healthcare? Should a CIO consider adopting it? What are the real benefits? What are some of the key factors to consider when reviewing the multitude of options available?

While carrying out the Monitoring and Diagnostics mission of the Microsoft Autopilot team, we had to process petabytes of data on a daily basis. Big Data was not science fiction; it was a fact of our daily lives. Our customers, and our own infrastructure team, demanded fast and efficient processing of huge amounts of data to facilitate operational, business, and engineering decisions critical to their success. Many of the insights gleaned from this data relied on Cosmos, Microsoft’s internal big data store.

In healthcare, as I outlined in my earlier blog and whitepaper, we are witnessing an explosion of digital data collected from cell phones, voice, images, notes, EMRs, HIEs, and even social media, coupled with an ever increasing number of medical devices that generate large amounts of healthcare tests and diagnostics data. Hospitals of all sizes are finding themselves overwhelmed with this growing data asset. As a result, this data asset may go unused or worse be purged periodically due to a lack of perceived value or the assumed complexity and cost of archival storage!

One way to tackle this data explosion problem is big data. So what is big data? Big data refers to the collection and management of very large data sets and storage facilities. Big data can offer solutions for data that is described as high in:

• Volume – the large amounts of data,
• Velocity – the speed of growth of data, and
• Variety – the mix of structured and unstructured data.

Some organizations also add Veracity, the quality of data, as a challenge because more often than not, data requires cleansing before use. Some of the key advantages of adopting big data stores in your IT infrastructure include:

Cost & Reliability – Low cost archival storage of historical data that can be retrieved as new applications are developed. Low cost does not equate to low availability or complexity as most big data stores offer triple storage redundancy and a host of management and monitoring tools to track your data.

Scalability & Elasticity – Big data is not just about storage; rather, it entails efficient data processing that can scale up or down based on your needs without requiring costly dedicated or upfront investment in expensive SAN (storage area network) or data processing servers in your data centers.

Performance – Processing large amounts of data—whether it is structured, semi-structured, or unstructured,—requires a massive amount of storage bandwidth and a considerable amount of processing power. Most big data engines support distributed redundant storage and some form of MapReduce distributed processing job execution engine, delivering unprecedented performance that can scale up or down based on an organization’s changing needs.

Flexibility – Multiple offerings exist today that emphasize one or more areas spanning performance, atomicity, read vs write, and data query flexibility based on an organization’s specific needs. These solutions range from publicly available open source libraries to more professional SaaS (software as a service) based commercial offerings.

Caradigm was able to recently leverage Microsoft’s HDInsight, a service that deploys and provisions Apache Hadoop clusters in the cloud, to establish a software framework designed to manage, analyze, and report on big data – see the illustrative diagram below. Caradigm’s population health and analytics solutions, with the power of HDInsight and other complementary big data solutions, can now be configured to allow for archival storage, unstructured data queries using your choice of NLP (natural language processing), and data analytics capabilities that allow care managers to glean actionable insights from volumes of data.

Caradigm Intelligence Platform Diagram

Make no mistake, big data alone will not be sufficient to address all of the data storage and data management needs of healthcare organizations. Caradigm uses a hybrid model that enables us to augment our near real time transactional and analytics data store with a big data store to deliver the most value to healthcare IT, providers, and patients.

Houston Methodist Addresses Operational Challenges

Post by Azam Husain

Senior Product Manager, Caradigm

Recently, Houston Methodist gave a great webinar on how the organization was able to address core operational challenges in their environment by using the Caradigm™ Provisioning solution. Methodist is a mid-sized provider serving the Houston area.  With 17,000 employees and 4,500 affiliated physicians, the Methodist IT organization had significant operational challenges in managing the lifecycle of user access to clinical systems. Kevin Conway, the Security Infrastructure Manager at Houston Methodist, explained that the operational benefit of Houston Methodist using the Provisioning solution comes down to four key tenants:

  • Lifecycle management of all types of clinician accounts
  • Account standardization and creation/removal consistency
  • IT oversight and data control
  • IT efficiency

Kevin articulated three key scenarios that enabled Houston Methodist to be successful with the implementation:

    1. Clinician Onboarding – Student/resident onboarding events. Before using Provisioning, help desk analysts would struggle to build Active Directory accounts in a reasonable timeframe and application accounts would not be complete for weeks. After implementing Provisioning, students and residents would have the appropriate access on day one.


    1. Hospital Acquisition – Methodist acquired a new hospital. As part of the integration, Methodist needed to create 1,100 accounts for all acquired employees for all target systems. Caradigm Provisioning was used to create this access within one day.


    1. Terminations – Terminating employees from Methodist’s systems was previously inconsistent, and accounts often remained active in key clinical systems inappropriately, creating a compliance problem. After implementing Provisioning, HR would provide a daily feed of inactive users, and Provisioning would immediately de-provision these users from network access and all key clinical systems.


View the webinar to learn more about how Houston Methodist addressed their operational challenges with Caradigm Provisioning.

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