Monthly Archives: January 2015

What is an Enterprise Data Warehouse for Healthcare?


Post by Neal Singh


Chief Executive 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.