Tag Archives: Data Control

Weathering Change and the Promise of Digital Transformation in Healthcare


Post by Neal Singh


Chief Executive Officer, Caradigm

Providers are among those most impacted by the turbulence in today’s healthcare landscape – whether it be adding facilities, covering more patients, changing leadership, providing additional services, or entering new value-based programs such as MACRA, Bundled Payments, or DSRIP. The “Quadruple Aim” was put forward to address the experience of providers in delivering care that is increasingly tied to cost and quality metrics. The so-called, second wave (post-EHR) of digital technology might be their greatest hope as providers manage this massive transformation to new value-based care and reimbursement models.

With clinicians supporting new populations, managing multiple data sources, and being tasked with additional processes, the burden of administrative tasks should be eased through the availability of resources that drive efficiency and enable a community-oriented, risk-based care approach. Paradoxically, it seems the introduction of new technology and processes can often be an added weight for clinicians to learn and adapt to. As we continue down the path of digital transformation, these tools should evolve to smoothly integrate into workflows and yield quick, measurable benefits for teams.

So how do organizations scale activities and enable their teams to deliver care more efficiently and consistently throughout this period of rapid change?

Weather the Uncertain Regulatory Environment

While lawmakers continue to battle it out we should face one fact: value-based care is here to stay.  Providers should push forward with a “no regrets” strategy. Prioritize efforts to drive more consistent, efficient and coordinated care, integrate your IT systems to support accurately forecasting patient risk, lowering cost structures, and building deeper relationships and loyalty with patients. Providers should not miss out this is an incredible time of innovation in healthcare that I believe is going to accelerate even more as healthcare organizations build off their early successes and learnings. With uncertainty in legislative direction for healthcare (ACA, Value Based Payment Reforms, etc.), providers may feel uncertain about their IT buying decisions. Rather than feel uncertain, I suggest providers should continue moving forward, with a keen focus on flexible and extensible solutions to support any outcome of legislative direction.

Quick Time to Value with an Eye for the End Game

Healthcare organizations need strong capabilities to aggregate data from across the community to connect all clinicians responsible for a targeted population. Providers should demand short implementations to ensure rapid time to value. Beyond this, seeking a flexible and configurable solution “future proofs” the organization to accommodate new programs that may be launched. This “future proofing” will provide organizational agility to rapidly configure to meet continuously evolving payment reforms and legal requirements. Selecting a population health tool should include an evaluation of the vendor’s ability to meet organizations where they are and grow with them across programs, such as Medicare Shared Savings Program, Comprehensive Primary Care Plus, Bundled Payments, etc.

Intelligent Analytics and Sophisticated Tools

Finding tailored software applications that enable clinicians to streamline workflows will drive positive results throughout your organization and help achieve scalability. Tools that facilitate targeted care management activities for prioritized patients will support care team efficiency. Interoperability is especially key in the case of mergers and acquisitions, considering the critical need to bring together data from potentially dozens of systems. Sophisticated risk stratification tools that consider clinical and claims data, financial information, social determinants, behavioral factors, and that employ predictive analytics will further help organizations determine where to focus constrained resources to achieve the highest return and greatest impact on patient outcomes. These are all factors to consider when searching for the right IT solutions to support your organization’s growth and goals, while advancing the health of the population.

Application Integration into Clinical Workflows –  They Can Only Use It if They Can Find It

While many providers recognize the value of using data and analytics to improve the quality of care and lower costs, there are many that have not yet integrated these directly into clinical workflows to realize the greatest impact and efficiency. This integration is especially important for accountable care organizations (ACOs) and clinically integrated networks (CINs). Timely access to data is critical when you are responsible for the health of a population of patients who may be geographically dispersed and receiving care from several hospitals or specialists. IT solutions should be leveraged to surface gaps in care, risk scores, and full medication histories so that a clinician can make educated care decisions while in the presence of the patient.

Value-based care initiatives should be addressed as a series of interconnected activities rather than as distinct, siloed efforts. A successful strategy takes a team-based approach and engages staff across different facilities to focus not only on individual patients with individual diagnoses, but also the health and wellness of the community. IT solutions need to create a unified user experience to support the interconnectedness that plays an integral role in an organization’s evolving strategy. ACOs and CINs should integrate an enterprise solutions portfolio encompassing the capabilities critical to success in value-based care programs, including: data control, healthcare analytics, and care coordination and engagement. Providers should also partner with vendors that have deep industry experience to provide advisory services. The pace of change in our industry continues to accelerate, and no organization should feel they are navigating these waters alone.

 

For more information on the content or author, please contact us.

When Compliance Dashboards and Annual Audits are Not Enough


Post by Christine Roecker


Senior Program Manager

Compliance officers can review data, search audit logs, and monitor areas of concern with most IAM products on the market.  In fact, in 2015 it was reported that eighty-two percent of organizations undertake enterprise-wide compliance risk assessment and two-thirds of those organizations conduct assessments annually, if not more frequent.[1]  However, risk assessment processes can be labor-intensive, complicated, and expensive, while barely breaking the surface of vulnerabilities and risk. Without the right tools in place, it would be a nearly impossible task for a compliance officer to know the intricate details of every position in the hospital and, further, every position’s dependencies on medical software applications.

Caradigm Provisioning Identity Management is more than just a compliance and identity management dashboard.  It also offers the checks and balances to manage and protect a hospital’s infrastructure, as well as the staff’s and patient’s PHI.  Using Caradigm Provisioning Identity Management’s compliance task feature, a review task can be scheduled or run ad-hoc to generate a real-time data report. The report can be assigned to managers across the organization to confirm their direct reports’ access permissions within assigned applications.  Imagine taking any set of data you wish to have reviewed – orphaned accounts, mismatched access, inactive users – and assign it.  The process is simple, intuitive, and deeply connected to the existing needs of the IT infrastructure given that it is all built into the same tool.

There is still a gap left in this periodic review process: “If access reviews are performed every six to 12 months, as is common in most organizations, what happens in-between the reviews? People change roles or leave the organization. Projects end. Yet those privileges remain longer than is necessary, even if good certifications result in accurate revocations every six months.”[2] With the ability to see user creation, modification and removal, review tasks can be created and assigned to managers to confirm inaccurate or lingering permissions and accounts that are no longer necessary. If a manager forgets to complete their task, reminder emails can be automatically sent. If a manager cannot review all tasks at one time, he or she can simply save their progress and come back to complete it at a more convenient time.  Further, the compliance task administrative view will let IT and compliance staff quickly determine which managers are out of compliance on their review.  Tasks can easily be reassigned and escalated if necessary to ensure all are completed in a timely manner.  In the future, if access needs to be reviewed, a manager can simply search for the review task and pull up the audit, comments, and complete access for a user.

Who has time to set aside months to prepare for auditors and their requested documents? With Caradigm Provisioning Identity Management, a compliance team can grant auditors access to read-only compliance task administrative dashboards and let them review full historic audit logs, user access reports and entitlement records, including the data output that was review, comments, timestamps and acknowledgements for the report in question.  This information can be easily shared and accessed, without any additional work by staff – allowing hospital teams to stay focused on their workloads and daily responsibilities.

Pairing the information revealed by Caradigm Provisioning Identity Management with Caradigm Single Sign-On & Context Management audit data, a user can find mismatched access privileges, unauthorized access to patient data, as well as inactive accounts. The power of an integrated identity management and access management solution allow compliance and security officers to have an easy view into potential risk areas within the organization and allow remediation with just a few clicks. Healthcare IT is rapidly changing to support continual risk assessment tasks, such as: monitoring for protocol breaches, maintaining role and application access, and facilitating frequent managerial review across the organization. A hospital’s IT compliance teams should seek and support the integration of tools that provide stronger monitoring and protection across the organization, saving them previous time in the process.

[1] https://www2.deloitte.com/content/dam/Deloitte/us/Documents/regulatory/us-aers-reg-crs-2015-compliance-trends-survey-051515.pdf

[2] http://techspective.net/2016/05/24/closing-loopholes-identity-governance-minimize-risk/

Evaluating an Identity Governance and Administration Solution for Healthcare


Post by John Lammers


Vice President and General Manager of Identity and Access Management, Caradigm

In this post, we’ll explore the unique challenges that healthcare organizations face in the arena of identity governance and administration and in a follow-up post we will review what to look for when choosing a solution for your healthcare organization.

Before we discuss challenges, let’s lay out what we mean by identity governance and administration. Gartner’s Magic Quadrant Report for Identity Governance and Administration[1] defines this as a set of identity management capabilities including: managing identity life-cycles, managing entitlements, and handling access requirements.

Accomplishing these objectives effectively requires more than just these goal-centric capabilities. There’s a set of supporting capabilities that you need to enable your organization to accomplish identity governance and administration effectively: for instance, workflow orchestration, mechanisms to certify the correctness or appropriateness of the data, and a rich set of auditing, reporting, and analytics capabilities. In the healthcare environment, where change is the norm, it is key to automate and unify as much of this as possible.

Gartner’s Magic Quadrant for Identity Governance and Administration and the Healthcare Providers Context

Many people rely on Gartner for guidance when searching for technology providers and the go-to report is Gartner’s Magic Quadrant, which ranks customers along two axes: ability to execute and completeness of vision. But did you know that the Magic Quadrant for Identity Governance and Administration only evaluates horizontal technology vendors? This means that, if you’re only looking at the Magic Quadrant, you’re missing companies that focus solely on a single vertical, such as healthcare.

Recognizing the unique needs of the healthcare vertical, Gartner has included a “Healthcare Providers Context” section in their Magic Quadrant Report for Identity Governance and Administration, and Caradigm is included as a “notable vendor”—the only one on the list that focuses exclusively on healthcare. This section of the report discusses the regulatory and integration challenges that set healthcare apart and provides guidance on what to look for when evaluating identity governance and administration solutions in a healthcare context. At Caradigm, we believe that our choice to focus solely on healthcare is our strength and one of the key differentiators of Caradigm Identity and Access Management.[2]

What Makes Healthcare Unique?

The nature of a healthcare organization’s workforce, processes, and information systems presents unique challenges. On top of this, healthcare organizations face an evolving regulatory environment, an ever-increasing threat from data breaches, and the cost of compliance and continual risk assessment.

Complex Staff and Identity Lifecycles

Change has become the new norm for healthcare organizations. In recent years, we’ve seen a 70% increase in merger and acquisition (M&A) activity.[3] Even outside of M&A activity, many healthcare organizations have staff members that come and go or change roles over time. For example, it’s common in teaching hospitals to have a large number of staff entering or leaving the organization or changing roles over a short span of time. Similar issues can be observed in the use of specialty practitioners. All of this adds up to complex identity life cycles in the healthcare space.

Flexible and Scalable Role Requirements

Healthcare isn’t an industry where you can cover your organization with a half-dozen roles. Organizations can have hundreds or even thousands of roles representing different specializations and different parts of the business. Just as M&A activity complicates identity lifecycles, it can result in an explosion of roles until the organizations involved reconciles them.

Diverse and Continuously Evolving Technology Ecosystem

Healthcare organizations are notorious for being late adopters of technology. But they’re also known for finding a way to react to emerging needs without disrupting reliable, critical systems. The result is a diverse technical landscape. A survey of accountable care organizations found that nearly 60% used multiple EHRs, and nearly 40% of medical practices have replaced or are considering replacing their existing EHR.[4] The mix of old and new systems means that your identity management solution must integrate with a wide breadth of technologies. Initiatives to standardize on large, increasingly-capable EHRs has reduced the number of applications in use, but most organizations continue to utilize many applications due to the value of specialty applications and best-of-breed approaches in areas strategic to the organization.

Proactive Risk Mitigation and Breach Defense

Healthcare continues to be hit hard by data breaches, and while incidents of hacking dominate the news, the most frequent cause of breaches is not hacking but inappropriate access by insiders.[5]

Against this backdrop, it’s critical that your organization have measures in place to guard against this. Rapid and complete de-provisioning of accounts is essential, as is conducting periodic reviews of the privileges assigned to roles or individuals and taking a proactive approach to detecting and remediating anomalies.

Selection of a Technology Partner is Key

A strong identity governance and administration strategy enables you to evolve your organization while maintaining compliance and preventing breaches. Selection of a technology partner is key, and looking to industry analyst reports and rankings can be great first step. For an industry as unique and complex as healthcare, it’s essential to read the fine print before shortlisting your vendor search. In a follow-up post, I will review some of the key features and functions of the capabilities needed to safeguard your organization and establish a quality identity governance and administration strategy for your teams.

[1] https://www.gartner.com/doc/3615131/magic-quadrant-identity-governance-administration

[2] https://www.caradigm.com/en-us/solutions-for-population-health/identity-and-access-management/

[3] http://www.beckershospitalreview.com/hospital-transactions-and-valuation/hospital-m-a-activity-jumps-70-in-5-years-8-findings.html

[4] https://www.healthcare-informatics.com/news-item/survey-acos-challenged-health-it-integration-few-use-single-ehr

[5] http://www.hipaajournal.com/largest-healthcare-data-breaches-of-2016-8631/

 

Have You Adopted Electronic Prescriptions for Controlled Substances?


Post by Jaimin Patel


Vice President IAM Program Management, Caradigm

When regulations for Electronic Prescriptions for Controlled Substances (EPCS) were introduced in 2010, more than 12 million people reported using prescription painkillers non-medically, and the number of painkillers being prescribed could have medicated every American adult for a month straight. [1] In response to the volume of both the abuse and prescribing of controlled substances, the Drug Enforcement Agency (DEA) set several regulatory requirements for healthcare practitioners and organizations that want to prescribe controlled substances by electronic means.

Initially, many providers were concerned about the strict security mandates. To be able to prescribe controlled substances electronically, the DEA requires a secure, auditable chain of trust for the entire process. In addition, the financial and IT resources required to implement the appropriate solutions for EPCS can be challenging for smaller organizations.

With only 1% of e-prescribers being enabled for EPCS as of December 2013, adoption was a concern as prescription abuse remained a prominent societal issue. [2] In 2014, almost 50,000 people died of drug-induced causes in the United States. [3] In 2015, opioids alone killed more than 33,000 people. [4] The unavoidable reality of opioid abuse in society led to additional state laws and regulations following the DEA mandate in 2010, which resulted in broader EPCS adoption. As of September 2016, 20.2% of e-prescribing providers were enabled for EPCS. [5]

Caradigm offers an integrated and comprehensive solution for EPCS workflows that is a seamless extension of our industry-leading Identity and Access Management (IAM) portfolio. Caradigm’s Multi-Factor Authentication (MFA) solution for EPCS offers a variety of integrated authentication options ranging from biometric fingerprints, hard & soft token authentication, as well as mobile authentication. These options allow your organization to implement the best authentication solution to meet your prescribers’ needs.

The DEA requires identity proofing for prescribers that access EPCS controls within an electronic medical record (EMR). Caradigm Provisioning Identity Management ensures that appropriate checks and balances are applied for an organization before granting a prescriber EPCS rights within an EMR. Further, when the prescriber no longer needs EPCS privileges, Caradigm Provisioning Identity Management can seamlessly update these permissions in the EMR while notifying appropriate members in the organization. This integrated solution ensures that no unauthorized access is granted for prescribers.

Caradigm’s EPCS solution has been deployed at number of sites where users are benefiting from integrated Single Sign-On for fast and efficient access into their applications and MFA for EPCS workflows.

Overall, it’s hard to argue that EPCS is anything but a positive for the healthcare industry, and any organizations that have not adopted a solution for EPCS should act now. E-prescribing is a tool that increases efficiency, prevents the likelihood of fraud, and reduces the risk of controlled prescription errors. For additional information, please visit our EPCS page.

[1] http://www.cdc.gov/VitalSigns/PainkillerOverdoses/index.html

[2] http://www.ajmc.com/journals/issue/2014/2014-11-vol20-sp/adoption-of-electronic-prescribing-for-controlled-substances-among-providers-and-pharmacies

[3] https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf

[4] https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

[5] https://www.healthit.gov/opioids/epcs

 

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.

 

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. 

Payer Pic1

Siloed Data Challenges

Payer Pic2 v3

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

Payer Pic3

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

Payer Pic5

 

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.

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.