Category Archives: Data Control

Progressing with Population Health and Big Data


Post by Neal Singh


Chief Executive Officer, Caradigm

Last year, I wrote this blog post about the great potential of big data to drive innovation in healthcare. With the rapid progress organizations are making with their population health strategies, I thought it would be a good time to revisit this topic because of its importance to the industry. To be honest, healthcare organizations are still in the early adoption phases of big data.  Only a few organizations are dealing with petabytes of data, which is typically the threshold people think of when it comes to big data. However, I do see significant progress. Big data is in the process of transitioning from a research-oriented activity to a main stream agenda item that enables multiple population health scenarios. Let’s explore why.

Population health is driving the data explosion

Whether healthcare organizations are ready for big data or not, many are faced with exploding amounts of data at their disposal as they embark on new population health strategies. Within a single health system, it is not unusual to have several hundred IT systems and applications in the portfolio, and to have 50-75 that are actually exchanging data. Population health often requires a better understanding of your patient population, utilization, costs, quality, and chronic conditions across multiple systems and or with many partner organizations. This likely involves extending beyond your EMR to other disparate EMRs and IT systems outside your enterprise. Therefore, one needs to aggregate, normalize and share clinical, operational and financial data from many IT systems across the community—including EMRs, billing systems, payers, pharmacy systems, labs, and HIEs. Also consider that today, most of the data sets in the industry tend to be structured. We are now beginning to see early use of unstructured data (i.e. clinician notes), which can contain highly valuable patient information (e.g. ejection fraction for patients with congestive heart failure). Additionally, I see increasing interest in other new data sets such as consumer, genomic, demographic and social data (e.g. fitness devices, purchasing history, Twitter, Facebook) integrated into scenarios for population health. There is no end in sight for the growth of data in healthcare, which I find incredibly exciting because of the ability to draw new value from it.

The mechanics of big data are being established

In order to realize the full value of their data, organizations have been establishing the mechanics of how that data needs to be aggregated, transformed and stored. It’s important to have the right population health data platform in place that can automate numerous processes, or else big data efforts can struggle to get off the ground. Healthcare organizations leading the way in big data have been adopting data platforms for healthcare that have the following capabilities:

  • Automated data ingestion from any originating source in any format in real-time that has existing pre-defined configurations or parsers for a variety of data formats, e.g. HL7, CCD and CCLF, and unstructured.
  • Automated transformation of data regardless if data is in different terminology code sets or structures that includes semantic mapping for code conversion and pre-built tooling that facilitates normalization and deduping of data from pre-defined and custom sources.
  • Automated modeling of data that uses pre-defined healthcare entities that can accommodate most clinical and claims data as well as custom entities to accommodate customer-specific data.
  • Open data sharing APIs that provide untethered read and write access with source systems and the ability to share data with analytics and self-service reporting solutions.
  • Role-based security with auditing.

Initial population health scenarios are being explored

The scenarios for big data are limitless and I believe that one day they will expand to untapped data sources such as social media, consumer purchasing, and even things like smart clothing. Until that day arrives, big data can still have a significant impact on how you manage a population at an aggregate as well an individual level. Here are a few initial scenarios that organizations are already exploring today:

  • Build and share a true longitudinal patient record to see all relevant patient data (e.g. labs, pharmacy, claims, analytics) that covers the full continuum of care.
  • Employ predictive models (i.e. risk stratification), which are especially effective with large data sets so that you can focus your resources where they will have the greatest impact.
  • Expand the scope of your analytics to new areas such as measuring the quality and financial performance of individual clinicians as well as overall organizational financial and utilization analytics.

It’s fantastic to see that healthcare is innovating through big data and population health. The organizations that have built their infrastructure strategically should be in great position to keep refining what they’re doing today while scaling and building new use cases. If you’d like to discuss how Caradigm can help with your big data strategies, then leave us a note here.

 

HIMSS16 Day 1: Seeking Interoperability in Population Health


Post by Neal Singh


Chief Executive Officer, Caradigm

The healthcare world assembled in Las Vegas with the kick-off of the Health Information Management Systems Society (HIMSS) Annual Conference. An issue that I expect to have many conversations about at HIMSS16 is the ongoing challenge of interoperability. Organizations engaging in population health continue to be frustrated by disparate information systems that result in outdated and incomplete patient information. This greatly hinders organizations’ ability to effectively coordinate care between providers in different settings, close gaps in care, and manage overall utilization and financial risk. The demand for interoperability has reached a crescendo as it is now a must-have in order to succeed with population health.

As I noted in this recent blog post about the Fast Healthcare Interoperability Resources (FHIR) standard, while FHIR is part of the discussion around interoperability, it is not a cure-all for all data challenges. An ideal solution starts with the foundation of an enterprise data warehouse (EDW) that can support a multitude of data standards and is designed specifically to model healthcare data and share it with other applications. This piece of the solution aggregates, normalizes and models your data, creating a rich data asset that can be used to drive action in any native or third-party application. True interoperability also requires bi-directional integration with any EMR in your community to enable the exchange of electronic care plans, care summaries, and other clinical data within the community.

There has not been an enterprise data platform like this in our industry, until now. At HIMSS16, Caradigm  announced Open Exchange, which works in conjunction with the Caradigm Intelligence Platform (CIP), an EDW for healthcare. The HIMSS ConCert certified solution is unique in our industry for its ability to enable interoperability of EHRs and other data source systems needed for population health. Caradigm is demonstrating its capabilities this week as part of the HIMSS16 Interoperability Showcase, which is the culmination of our participation in several collaboration events with other health IT solution providers.

We are extremely proud of our team’s efforts with Open Exchange and CIP that underscores Caradigm’s industry leadership in innovating healthcare data exchange. If you are attending HIMMS16, then we invite you to stop by the Caradigm booth #5427 or the Interoperability Showcase to discuss your interoperability needs and learn more about how Caradigm can help. Also, don’t miss my colleague, Vicki Harter, who is speaking tomorrow in the Population Health Knowledge Center about how providers can approach different value-based strategies in a presentation entitled – ACOs and CINs and DSRIP, oh my!

 

Neal Accepting HIMSS Award

I was very proud to accept Caradigm’s award for the HIMSS ConCert Certification of Open Exchange

Expanding Your Population Health Data Foundation to Claims and Beyond


Post by Niranjan Sharma


Director of Engineering for Healthcare Analytics Platform & Applications, Caradigm

Healthcare is traditionally thought of as the care of patients by healthcare providers. Clinical data is generated during that care, and payers reimburse providers for the services rendered based on submitted claims. For providers engaging in population health, working solely with clinical data only tells part of the population health story. Most healthcare organizations are striving to derive more value and population insight by including claims and other types of data so that they can better stratify their populations, drive other analytics efforts, and improve care coordination among many activities. 

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Siloed Data Challenges

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The challenge is that it is complicated to ingest, normalize and model different types of healthcare data. Healthcare organizations often have many disparate information systems, and many work with partners who in turn also have many disparate systems. Most providers are still working towards harmonizing all of their data so they can view a single picture of their populations and make the best use of it in a timely manner to meet their clinical and financial goals.

 

Harmonize Data, Analyze & Compute

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One of Caradigm’s hallmarks as an enterprise population health company is that we are experts in healthcare data management infrastructure and processes. We help our customers remove the complexity and manual processes associated with data management through the Caradigm Intelligence Platform (CIP), an enterprise data warehouse designed specifically for healthcare. CIP enables organizations to harmonize their data, and then perform a rich array of analysis (e.g. predictive risk stratification, utilization), as well as computations on data (e.g. quality compliance, gaps in care, display last glucose results, display last PCP visit for a patient, etc.).

 

Modeling Claims Data Using Entities

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Caradigm has a proprietary methodology that structures data as specific healthcare entities. On the outer ring in the diagram above are examples of core payer entities that we can introduce with our customers. Seeing payer data organized in this fashion is often eye opening because it provides a harmonious view of the care delivered to patients. What is even more exciting is when payer data is combined with clinical and other data to show a complete picture that can then feed other integrated applications.

 

Lighting Up Applications With Payer Data

  • Risk Management Analytics
  • Accountable Care Organization compliance
  • Gaps in Care
  • Gaps in Billing
  • Network Utilization Analytics
  • LOS Analytics
  • Post-Acute Care Analytics
  • PMPM Analytics
  • In-Patient Analytics
  • ED Visit Analytics
  • Ambulatory Visit Analytics
  • Drug Utilization Analytics
  • Conditions Analytics
  • Bundled Payments Analytics
  • EMR Only Analytics
  • Claims Only Analytics
  • Harmonized Data Analytics

The beauty of a complete and reusable data asset is that it can light up all kinds of analytics applications. You can forecast clinical and financial risk, identify gaps in care, and analyze utilization or network steerage in order to uncover opportunities for financial improvement.

The amount of data available in our industry is growing exponentially. It is time for healthcare organizations to augment their ability to harness all of that data and realize more value. If you would like to discuss how your organization can harmonize its data and better leverage claims data as part of population health efforts, then please send us a note here.

FHIR Up Population Health


Post by Neal Singh


Chief Executive Officer, Caradigm

It’s a fantastic sign for the healthcare industry that the Fast Healthcare Interoperability Resources (FHIR) standard is garnering a lot of recent attention. I’ve had conversations with several CIOs who are hearing that FHIR could be the next-generation standards framework that can help innovate data sharing at their organizations. I can understand why they’re excited. EMRs have been closed systems for a long time, which creates major challenges for organizations wanting to share data between disparate systems. The challenge is even greater for organizations engaging in population health initiatives because the open sharing of data between different systems and providers is a must. Provider organizations want to learn more about FHIR because it has the potential to help overcome these interoperability challenges.

Let’s explore FHIR a little deeper. There are a few important details to know in order to understand its potential to help:

FHIR is an evolving standard

Up until September 2015, there were two active versions – DSTU1 & DSTU2. DSTU2 is the new version, but some technology vendors are still using DSTU1. HL7, the creator of FHIR, is still working on a final standard expected to be released in 2017. Once the final standard is in place, it will likely take a few years for broader adoption.

Vendor approaches vary

Solution vendors are in the early stages of developing FHIR strategies. Some EMR vendors are prototyping the use of FHIR APIs to enable read access of certain resources from patient charts. Others are working on the ability to read and write data back into systems. The types of data models that can be accessed using FHIR APIs also vary. For example, one vendor may support Patient, Allergy and Medication data models, but may not support Family History, Immunization, CareTeam or PlanofCare data models. Vendors can also vary whether they enable just read or read and write for each of the data models.

The use case is discrete data sharing

FHIR was designed for discrete data sharing, i.e., sharing of small batches of patient data. If you need to share one or two or ten bits of data, then FHIR can help. It is not intended for high volume data ingestion required for large scale aggregation.

FHIR is not the only game in town

Web services with REST-based APIs can already accomplish what FHIR seeks to achieve. Our customers don’t have to wait for FHIR, they can solve their data sharing challenges today using our rich and open web services data connectors that include role-based security controls and auditability. Caradigm has built unique applications like Knowledge Hub that can share real-time data and information from third-party applications directly within clinician workflows in their EMR. In the UK population health market, we have built mobile applications using REST-based APIs that can share patient data pulled from multiple sources to a mobile application at the point-of-care.

Caradigm fundamentally believes in open standards, data sharing, and in democratizing information to drive innovation in healthcare. That’s why we support an extensive number of data models, and have always been on the cutting edge of supporting emerging models such as NLP, unstructured models and now FHIR. We are able to engage services for FHIR API integrations, and will continue to build access to entities in the Caradigm Intelligence Platform including deeper integrations with specific EMRs. Caradigm also collaborates with other industry leaders on emerging standards by participating annually in events such as the IHE North American Connectathon Week (see this post about last year’s event). We look forward to participating in the next Connectathon in January.

Ultimately, there are many ways to approach population health, and Caradigm partners closely with our customers to understand their goals and challenges in order to help them develop strategies. We’re excited at the prospect of FHIR being part of the solution for our customers. If you’d like to discuss FHIR more and how it fits into your population health strategies, then please reach out to us here.

The Future of Big Data in Healthcare


Post by Neal Singh


Chief Executive Officer, Caradigm

The idea that there could be undiscovered insights residing in large data sets that can be used to drive innovation is fascinating. That’s why Big Data has so many people excited, including myself. In healthcare, Big Data is essentially a core component of population health management, a strategy that is helping healthcare organizations transform to value-based care. Although most healthcare organizations are still in the early stages of both strategies, there is no question that Big Data and population health will play major roles in shaping the future of healthcare. Let’s explore this issue further to better understand what steps healthcare organizations can take to realize the full promise of Big Data.

Getting to Big Data

The traditional healthcare organization is evolving beyond the walls of the hospital. Providers must now coordinate care across a broader health network that can include a large number of clinical partners often using a variety of technology systems. Although it can be a challenge to bring data together, it is the first required step towards gathering large quantities of data. It is also important to consider that clinical data is only the starting point. Where Big Data in healthcare starts to get really innovative is when clinical data is combined with other types of information such as claims, financial, lab, pharmacy, unstructured data (e.g. clinical notes), etc.  Providers that can establish the processes and tools to automate the aggregation and normalization of data regardless of the system or structure they reside in will be set up for Big Data success.

From Data to Insights

After an organization achieves data aggregation, it should celebrate because that is a major accomplishment. However, that is only step one in the journey because the data has to be turned into insights that can drive improvement. One of the most powerful uses of healthcare data is in predictive modeling, which helps providers understand their patient populations and anticipate where they can have the highest return on intervention. For example, providers can measure patient motivation, and use it to predict which patients will follow physician instructions and benefit most from targeted interventions. They can also predict which patients will become the sickest next, i.e. those that are most likely to transition from low to high clinical and financial risk over the next 12 months, so they can intervene proactively. As risk has shifted from payers to providers, this ability to understand the risk in a population has become essential.

From Insights to Action

The last, but most important, step is to surface insights and information within clinician workflows in real-time so that they can take action and improve outcomes. For example, a physician can see gaps in care for patients and close those gaps while still in their presence. A care manager can be alerted when a high-risk patient is admitted to the emergency department to ensure proper transition of care. A clinical analyst can monitor patient data on a large number of patients who have had catheters inserted, and alert a nurse when the data shows that a patient is showing signs of a potential infection.  

Most exciting is that all of the above use cases are not hypothetical or years away from becoming reality. They are all possible with today’s health information technology. These innovations stemming from Big Data are starting to take hold, but it will take time for them to truly become the norm in healthcare. There is no doubt, however, that momentum is building for both Big Data as well as population health, and that they will play leading roles in healthcare’s future.

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.

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.