Healthcare. White Paper. Extracting Value from Healthcare Data: An Analysis of Industry Leading Data Models

Transcription

1 Healthcare White Paper Extractig Value from Healthcare Data: A Aalysis of Idustry Leadig Data Models

2 About the Authors Pakaj Siha Pratice Head - Iformatio Maagemet, Big Data & Aalytics, Tata Cosultacy Services Pakaj has 20+ years of experiece i Iformatio Techology with expertise i Strategy, Plaig, Architecture ad implemetatio of busiess systems across various idustry verticals ad techology platforms. Over the years he has led several strategic ad large scale egagemets i Iformatio Maagemet, CRM, Eterprise Applicatio Developmet & Trasformatio areas. Curretly, Pakaj heads up the Iformatio Maagemet, Big Data & Aalytics Practice for TCS Isurace & Healthcare uit. Aupam Kumar Techology Excellece Group, Healthcare Aupam Kumar is part of the Techology Excellece Group of the Healthcare ad Isurace Idustry Solutios Uit at Tata Cosultacy Services (TCS) where he focuses o aalytics ad data maagemet. Aupam has a Ph.D i Statistics ad over 18 years of idustry experiece, which spas techology, solutio desig, ad cosultig across the healthcare, isurace, ad bakig domais. He has worked with leadig cliet orgaizatios i the U.S. ad Europe. Aupam also coceptualizes strategic solutios ad platforms for healthcare ad isurace customers icludig payers, itegrated payer-providers, specialty providers, ad pharmacy beefit maagemet compaies. Aatha Ramakrisha Solutio Architect, Healthcare As part of the Techology Excellece Group, Aatha Ramakrisha is resposible for iformatio maagemet solutios ad data architecture desig for healthcare cliets i North America. He has 20 years of experiece i defiig ad implemetig comprehesive, large-scale data architecture ad maagemet solutios. Rajaram Narasimha Busiess Itelligece Solutio Architect, Healthcare Rajaram Narasimha works with the Healthcare Techology Practice, ad is resposible for providig iformatio maagemet solutios to healthcare cliets. He specializes i data architecture, busiess itelligece, ad aalytics. Narasimha has 10 years of experiece i the healthcare domai at TCS.

3 Abstract The lack of data is ot a problem today. The advet of Electroic Health Records (EHR) ad regulatios such as the Affordable Care Act (ACA) has resulted i billios of terabytes of data for payers ad providers. Makig effective use of this data however ca be a huge challege. The data deluge has opeed up may challeges related to orgaizig, maagig, ad sharig healthcare data across the care cotiuum. Much of the critical iformatio is fragmeted ad spread across differet departmets ad systems i multiple formats. This makes it difficult to itegrate cliical data with fiacial ad operatioal data to gai a holistic picture. Trasitioig to data-cetric healthcare requires a strog focus o buildig the foudatio for a robust iformatio maagemet ifrastructure. Data models serve as blueprits to idetify the structures ecessary to desig a operatioal data store, data ware house, or data marts. They also facilitate data services, itegratio, ad exchage as well as developmet of aalytics platforms that cater to the uique eeds of the healthcare eviromet. They eable the extractio of actioable itelligece from data to improve stakeholder outcomes through a more cost efficiet ad higher quality healthcare delivery system. This white paper reviews three idustry leadig data models from IBM, Oracle, ad Teradata, that ca be used by payers, providers, ad Pharmacy Beefit Maagemet (PBM) compaies i their data modelig iitiatives. These models have bee reviewed i the cotext of the Federal Health Architecture (FHA), the Federal Health Iformatio Maagemet (FHIM) model, ad the Domai-Drive Desig (DDD) cocept. Choosig the right data model ca help healthcare orgaizatios obtai deeper strategic ad operatioal isights to realize data drive healthcare improvemets ad further their cost optimizatio efforts.

4 Cotets Desigig data models: A blueprit for healthcare itelligece 5 Aligig data models with idustry stadards ad best practices 6 IBM Healthcare Provider Data Model 8 Teradata Healthcare Logical Data Model 9 Oracle Healthcare Data Model 10 How the Healthcare Data Models Help Idustry Players 11 Data model decisios 12 Turig the data oslaught ito competitive advatage 13

5 Desigig data models: A blueprit for healthcare itelligece Today, there is a compellig eed to use the available healthcare data i better ways to drive superior patiet ad busiess outcomes. However, the iformatio flow i the healthcare ecosystem is turig icreasigly complex, as show i Figure 1. The growig flood of ustructured iformatio further complicates the matter, makig extractio ad maagemet of iformatio a top priority. Is there a simple ad cost effective way to eable seamless iformatio flow betwee stakeholders to help healthcare orgaizatios move to a patiet cetric ad collaborative busiess model? Medical Research Cosumer (Patiet / Member) Explaatio of Beefits Prescriptio Registratio (Demographics) Research EMRs Govermet Regulatory Body Payer Beefits & Eligibility Network Mgmt. Pricig Acc. Payable Receivable Morbidity, Mortality Statistics Poit of Care Pre-Authorizatio Claims Treatmet Prevetio Claims Recovery Quality of Care Data Diagosis Health Promotios Disease Prevetio Educatio Pharmacy Provider Stadard Reportig Stadard Reportig Eligibility & TRR Membership Moitorig & Aalysis Surveillace Paymets Sales Geomics TPA / Clearig House Like HEDIS Wholesaler Formulary Data PBM Rebate Ifo Pharmaceutical Figure 1: Iformatio flow i the healthcare ladscape 5

6 Sophisticated data models offer idustry players precisely this optio. They simplify the iformatio ladscape by capturig the crucial data elemets ad structure eeded for effective decisio makig. They ca represet a sigle fuctioal area or provide a big picture of the healthcare orgaizatio i the form of a Eterprise Data Model (EDM). A EDM aims to establish trust ad cofidece i the orgaizatioal data assets. It plays a crucial role i defiig the data architecture as well as maitaiig data quality, cosistecy, security, ad accessibility. It also Pre-built idustry data models provide faster time supports data goverace, metadata maagemet ad master data to value, ad eable maagemet. superior decisio makig Sigificat skills ad resources are required to build a EDM from scratch. ad compliace. Pre-built idustry data models eable uderstadig of the varied uses of data, their relatioships ad attributes, ad provide faster time to value. I additio, they reduce operatioal expeditures by elimiatig the eed for skilled data modelers ad itegrators. Servig as the foudatio of actioable itelligece, they help healthcare leaders maage budgets, prioritize techology ivestmets, ad esure regulatory compliace. Aligig data models with idustry stadards ad best practices Electroic Health Record Persoal Health Record Quality Measures Cliical Research Public Health Patiet Populatio Practice Public Health Policy Cliical Decisio Support Natioal & Iteratioal Health Aalytics Health Iformatio Exchage Public Cliical Guidelies Source: HealthIT.gov Itegrated Care Persoalizatio of Care Care Coordiatio Outcomes Patiet Egagemet Patiet Satisfactio Cost Cotaimet Patiet Safety Persoal Health Record Welless Iitiatives Geomics Simplificatio of Busiess & IT Operatios is essetial to achieve the Idustry Visio Figure 2: Drivig efficiet data exchage across healthcare stakeholders 6

7 With icreasig emphasis o providig itegrated ad persoalized care, healthcare data models have become key to drivig efficiet data exchage ad iteroperability across the healthcare commuity ad govermet healthcare programs (see figure 2). Several idustry stadards support the overarchig visio of creatig a iteroperable ecosystem to improve the exchage of health data amog stakeholders. The Federal Health Architecture (FHA) started i 2004 is oe such iitiative. It ecompasses stakeholders such as the federal govermet, private sector healthcare providers, ad others. The FHA is curretly maaged by the Office of the Natioal Coordiator for Health IT (ONC) withi the Departmet of Health ad Huma Services (HHS). FHA aims to improve access to ad quality of care while reducig overall healthcare costs by focusig o the followig1: Supportig federal efforts to deploy stadardized health IT systems ad measure health IT stadard adoptio. Esurig that federal agecies ca seamlessly exchage health data amog themselves as well as with the state, local, ad tribal govermets, ad private-sector parters. Providig guidace to federal agecies o how best to maage ad maitai health IT ivestmets. The Federal Health Iformatio Model: A stadard for supportig healthcare iteroperability The Federal Health Iformatio Model (FHIM) is a iformatio model of healthcare data developed for the FHA parter agecies. The FHIM seeks to support health iteroperability by harmoizig iformatio from federal parters ad stadards developmet orgaizatios (SDOs) ito a uified, logical, health iformatio model. This logical model uses the HL7 Referece Iformatio Model (RIM) as its referece poit. It is desiged to support multiple Office of Iteroperability ad Stadards iitiatives, icludig CONNECT ad the Stadards ad Iteroperability (S&I) Framework2. The FHIM is a Iformatio model ad ot a data model. Usually, data models are meat to be implemeted, whereas iformatio models are higher level specificatios. A iformatio model is like a buildig blueprit. It defies metadata types that are stored i a repository database ad used by tools ad applicatios. The FHIM is desiged to eable meaigful iformatio exchage amog the parter agecies as well as exterally, with the broader health commuity. Its key features iclude: Itegratio with Model Drive Health Tools (MDHT) to support a Model Drive Architecture (MDA) approach for the developmet of health iformatio exchage iteroperability specificatios. Use of the Uified Modelig Laguage (UML) - that describes the health-related iformatio eeded by the FHA federal parter orgaizatios - for model developmet A sematic iformatio base for iformatio exchage, traceability, ad aligmet with idustry iformatio models ad stadards. Suitability as a Logical Iformatio Model to guide the eterprise architecture of the federal parter orgaizatios. 1] Healthit.gov, Federal Health Architecture, accessed, Jue 2015, 2] Healthit.gov, Federal Health Architecture, accessed, Jue 2015, 7

8 Domai Drive Desig: A best practice for emphasizig core domai cocepts A domai is a sphere of kowledge, ifluece or activity. With respect to FHIM, it is a subject area i healthcare such as allergies, vitals, or orders. Domai-Drive Desig (DDD) is a coceptual model of a domai of iterest that describes the various etities, their attributes, roles ad relatioships. Data models ecompass etities ad their relatioships, while domai models idetify how these etities iteract with each other to make these actios a itegral part of etities behavioral specificatios. It also describes the costraits that gover the itegrity of the model elemets comprisig that problem domai. As a approach to developig software for complex eeds, DDD places the project's primary focus o the core domai ad domai logic. It supports collaboratio betwee techical ad domai experts to get closer to the coceptual heart of the busiess challege i this case - providig health iformatio isights. I the followig sectio, we look at three idustry-leadig data models that eable the seamless flow of iformatio betwee stakeholders i the healthcare ecosystem to deliver patiet-cetric ad accoutable care. What is uique about the IBM model? Itegratio across products to support all four major data warehouse use cases Cotiuous ivestmet i product iovatio to meet emergig customer ad market demads, icludig a data warehouse PaaS offerig- dashdb that offers i-memory columar capabilities Itegratio with the Cloudat NoSQL databases as well as PureData for idatabase aalytics Deployable with techologies such as BigIsights BigSQl, DB2 with BLU Acceleratio ad IBM PureData powered by Netezza (which supports high performace for complex aalytic workloads) IBM Healthcare Provider Data Model The IBM Healthcare Provider Data model is part of the IBM IfoSphere software portfolio. It itegrates cliical, admiistrative, ad fiacial data to support real time aalytical eeds. By leveragig this data model, healthcare delivery orgaizatios ca remai resposive to cliet ad marketplace requiremets, ad the evolvig healthcare regulatory eviromet. The data model builds a strog foudatio for iformatio maagemet ifrastructure, ad helps drive evidece based, patiet cetric, accoutable care. It supports Cliical Care ad Research, Supply Chai, Service Lie Aalytics, Model Extesios ad Busiess Glossary Ehacemets. The key compoets³ ad features⁴ of the IBM s Healthcare Provider Data Model are give below: 3] IBM Europe Sales Maual, November 2013, IBM Healthcare Provider Data Model V8.8, Accessed Jue 2015, 4] IBM Software, Accessed Jue 2015, 8

9 Compoets Busiess terms: Eterprise-wide vocabulary of busiess cocepts that provide a view of itself ad the idustry. Busiess data model: Coceptual data model that specifies the third ormal form (3NF) data structures required to represet cocepts defied i busiess terms. Features Atomic warehouse model: Desig-level data model that represets a eterprise-wide repository of atomic data used for iformatio processig. Dimesioal warehouse model: Eterprise-wide repository for aalytical data. It cotais star schema-style dimesioal data structures orgaized aroud fact etities. Busiess solutio templates: Set of idustry-relevat aalytical reportig requiremets orgaized aroud busiess focus areas. Extesibility ad scalability: Offers a robust set of busiess ad techical data models that are extesible ad scalable to address curret as well as future eeds. Cross fuctioal eterprise views: Itegrates busiess model, atomic warehouse model, ad dimesioal warehouse model to support cross-fuctioal eterprise views, aalytics, ad applicatios. Comprehesive aalytics: Addresses the aalytical busiess requiremets coverig cliical research, fiacial, ad operatioal data itegrated across the eterprise. Cotet delivery: Supports quality aalysis, shared savigs programs, patiet safety iitiatives, ad other idustry-wide stadards. Beefits IBM s Healthcare Provider Data Model helps correlate cliical, fiacial, operatioal, ad payer data i a cohesive ad flexible maer. This helps accelerate the uderstadig of populatio-level health, maage ad quatify risk, ad idetify opportuities for trasformatio ad iovatio. It also offers the followig beefits : Operatioal isight: Provides a comprehesive, aalytical reportig framework Risk ad compliace reportig: Supports the reportig for a series of regulatory requiremets Eterprise architecture: Offers structure ad cotet to support the busiess ad applicatio layers of a eterprise architecture Teradata Healthcare Logical Data Model The Teradata Healthcare Logical Data Model (HC-LDM) offers cross-fuctioal coverage ad a sigle view of data across the eterprise. It provides a holistic view of healthcare isurers, providers, maaged care orgaizatios, healthcare data admiistrators, vedors, ad cosultats. I additio, the HC-LDM ca be easily exteded as the busiess grows by leveragig the Teradata ildm uificatio. Key compoets ad features of the Teradata Healthcare Logical Data Model are give below⁶: Compoets Features Coceptual, busiess high-level, subject area data model. Busiess LDM Third Normal Form (3NF), fully attributed data model. Prelimiary Physical Database Desig, populated with techical ames ad/or abbreviatios. A database, data warehouse costructio, or implemetatio data model cofigured to maximize throughput. Icludes structures which capture data elemets ad busiess rules that gover day-to-day operatios. Built usig the process of ormalizatio ad completely idepedet of both applicatio ad techology. Offers extesibility which allows healthcare orgaizatios to add ew structures ad elimiate uecessary existig structures. Cosists of data elemets i third ormal form 3NF that support a umber of idustry stadards. 6] The Teradata Healthcare Idustry Logical Data Model, Accessed Jue 2015, 9

10 Beefits The Oracle Healthcare Data Model itegrates data from electroic medical records, cliical departmetal systems, patiet accoutig, back office, research, ad various other source systems. It supports diverse aalytical requiremets to ulock value from cliical ad operatioal data quickly ad cost-effectively ad provides: Query ad reportig for iformatio: Supports the extractio of detailed ad summary data OLAP for data aalysis: Provides summaries, treds, ad forecasts Data miig for isight ad predictio: Ucovers hidde patters ad isights How the Healthcare Data Models Help Idustry Players The models discussed here are desiged by idustry experts ad supported by best-i-class techologies. They help healthcare orgaizatios avoid the pitfalls of complex itegratio requiremets ad reduce the total cost of owership. These models also offer fast ad predictable implemetatio, acceleratig the retur o ivestmet while reducig deploymet risks. Healthcare data models: Key busiess outcomes Improved access to iformatio across the healthcare ecosystem Better isights from cliical ad operatioal data through data miig Fast ad precise, cliical ad o-cliical decisio makig through better aalytics Improved data goverace ad stadardizatio Predictable healthcare outcomes through accurate forecastig Improved risk ad compliace reportig Idetificatio ad prioritizatio of key areas of improvemets across service lies The IBM Healthcare Data Model allows healthcare orgaizatios lookig for ehaced data goverace ad stadardizatio to defie a corporate set of Better scalability to meet stadard best practices related to their data. This eables IT to eforce future growth stadards as well as use data profilig techiques for compliace requiremets moitorig ad exceptio alertig. I additio, the solutio provides service lie aalytics through a eterprise framework to create visibility across the orgaizatio ad gai isight ito re-admissio rates, quality idicators, operatig margis ad cliical outcomes. The Oracle Healthcare Data Model is a good fit for healthcare orgaizatios iterested i workig with a sigle vedor solutio to miimize compatibility issues, ad accelerate deploymet ad traiig. The solutio also eables data miig to idetify iefficiecies ad best practices, ad supports forecastig to predict ad maage healthcare outcomes. The Teradata Healthcare Model is a party (orgaizatio, idividual) cetric model which is derived from Teradata s extesive experiece i the payer idustry. This model itegrates the fiacial etities such as claims, paymets etc. Moreover, sice the party is defied as a commo subject, the data model supports seamless itegratio ad offers icreased flexibility for aalysis. 11

11 Beefits The Teradata HC-LDM provides a itegrated base of strategic busiess ad cliical iformatio. It supports the creatio of a ideal framework for a wide rage of kowledge applicatios as well as ew paymet models. It helps healthcare orgaizatios lauch ew lies of busiess ad meet evolvig govermet madates. I additio, the Teradata HC-LDM offers the followig beefits⁷: Itegrated base of iformatio: Offers a sigle source of cliical ad busiess iformatio, more seamless care maagemet, tighter customer ad supplier relatioships, ad more accurate pricig Operatioal isights: Provides additioal isight to egotiate more favorable cotracts, segmet customers better, or idetify greater cost savig opportuities Scalable model: Establishes a base for addig more applicatios ad capabilities to exploit data Modular architecture: Allows users to desig ad implemet a data warehouse strategy oe fuctioal area at a time What is uique about the Teradata model? Demostrates cotiuous techology ehacemets to meet productio demads Has a broad user type support Ca be combied with the Teradata Healthcare Data Itegratio Roadmap (DIR) which is a visual referece model that helps alig strategic orgaizatioal objectives with the supportig data i the itegrated data warehouse. Oracle Healthcare Data Model The Oracle Healthcare Data Model provides a itegrated view of eterprise-wide cliical ad operatioal data for better decisio makig. It icludes both logical ad physical data models that are desiged to support Oracle data warehouses, icludig the Oracle Exadata Database Machie⁸. It supports commo etities such as party ad care site, core cliical activities such as observatio, itervetio ad order, ad fiacial ad billig activities for accoutig, equipmet, HR, ad payroll. The key compoets ad features of the Oracle Healthcare Data Model are give below: Compoets Physical model: Physical maifestatio of the logical data model ito database tables ad relatioships. Partitios, idexes, parallel defiitios, ad Cube Views aid performace. Itra-ETL database packages: Pre-built ETL compoet which loads the iformatio preset i the foudatio layer (3NF tables) ito the Oracle Healthcare Data Model Aalytical Layer. Oracle Iteractive Dashboard: Sample reports ad dashboards usig Oracle Busiess Itelligece Suite Eterprise Editio. Features Embedded aalytics: Offers embedded advaced aalytics, usig pre-built data miig, Oracle Olie Aalytical Processig (Oracle OLAP), ad dimesioal models. Query ad reportig: Eables extractio of detailed ad summary data. 3NF data warehouse model: Provides a solid base for a healthcare data warehouse, while the derived layer provides the ifrastructure for creatig KPI's, cube views, ad reports. Robust ifrastructure: Supports the creatio of a rage of reports. 7] Teradata Healthcare Data Model, Accessed Jue 2015, 8] Oracle Healthcare Data Model Referece, Accessed Jue 2015, 10

12 A detailed aalysis is provided i figure 3. Features IBM Healthcare Data Model Oracle Healthcare Data Model Teradata Healthcare Data Model Caters complex ad fluid aalytical eeds Scalability Cross fuctioal eterprise views Hadles Data goverace ad Stadardizatio Logical Data Model Support Physical Data Model Support Sigle vedor solutio package Provides metrics & isights Embedded Advaced Aalytics OLAP Data Miig & Forecasts BI Itegrated Data Warehouse Itegrated Strategy Supports Ÿ Cliical care ad research Ÿ Service-lie aalytics Ÿ Supply chai Ÿ Platform Figure 3: A comparative aalysis of the healthcare data models Data model decisios The move towards patiet-cetric ad collaborative care delivery requires the seamless flow of iformatio across the healthcare ecosystem. Several programs such as the Federal Health Architecture ad Federal Health Iformatio Model (FHIM) establish stadards for creatig a iteroperable ecosystem to improve the exchage of health data amog stakeholders. Itegratig cliical, admiistrative, ad fiacial data ca help healthcare orgaizatios aswer complex strategic ad tactical busiess questios faster ad more accurately. This is made possible by data models that serve as blueprits for healthcare itelligece. They play a crucial role i defiig the data architecture, ad capturig data elemets ad structures. 12

13 As opposed to proprietary eterprise data models, pre-built idustry models ca help reduce the time ad resources required to build a proprietary eterprise data model. The IBM Healthcare Data Model facilitates ehaced data goverace ad stadardizatio to defie a corporate set of stadard best practices related to healthcare data. It also offers service lie aalytics. Healthcare orgaizatios lookig for a sigle vedor solutio ca leverage Oracle s Healthcare Data Model. It eables data miig ad supports forecastig to predict ad maage healthcare outcomes. The Teradata Healthcare Model is a party cetric model, which itegrates the fiacial etities such as claims ad paymets. It supports seamless itegratio ad provides icreased flexibility for aalysis. All of these models offer predictable implemetatio, reduced deploymet risks ad faster time to value, while eablig a cost efficiet ad higher quality healthcare delivery system. Turig the data oslaught ito competitive advatage Deliverig high quality healthcare is a iformatio itesive effort, ad orgaizatios must evolve their data maagemet approach to match the chagig ad complex eeds of the idustry. Moreover, with healthcare data growig i volume, velocity, ad variety, the ability to leverage Big Data to derive isights has become a importat competitive differetiator. The chose data model must therefore be robust eough to support the curret eeds while beig scalable to address future requiremets. Healthcare orgaizatios that idetify the right data model for their uique eeds will gai a truly comprehesive approach to healthcare itelligece, resultig i competitive advatage. 13

14 About TCS' Healthcare Busiess Uit TCS parters with leadig health payers, providers ad PBMs globally to eable busiess model trasformatios to address healthcare reforms, improve quality of care, icrease customer egagemet ad reduce overheads. By streamliig ad moderizig busiess processes ad systems, TCS helps healthcare orgaizatios realize operatioal efficiecies ad reduce operatig costs. We work closely with healthcare players to empower them to meet their cosumers' demads for higher levels of service, quality of care, ad ew ways of iteractig ad egagig. Our advaced data solutios, aalytics, ad cuttig edge digital techologies deliver a higher degree of customer cetricity. TCS' portfolio of services covers the etire payer value chai from Pla Defiitio, Eligibility ad Erollmet, Policy Servicig, Billig, Claims Processig, Claims Adjudicatio, Beefit Maagemet, Provider Maagemet ad Member Services. For providers, we deliver bespoke services for Provider Maagemet, Claims Maagemet, Patiet Iformatio ad Fiacial Maagemet, Cliical Data Maagemet, Pharmacy Beefit Maagemet ad Reveue Cycle Maagemet. Cotact For more iformatio about TCS Healthcare Busiess Uit, visit: healthcare.solutios@tcs.com Subscribe to TCS White Papers TCS.com RSS: Feedburer: About Tata Cosultacy Services (TCS) Tata Cosultacy Services is a IT services, cosultig ad busiess solutios orgaizatio that delivers real results to global busiess, esurig a level of certaity o other firm ca match. TCS offers a cosultig-led, itegrated portfolio of IT ad IT-eabled ifrastructure, egieerig ad assurace services. This is delivered through its uique Global Network Delivery ModelTM, recogized as the bechmark of excellece i software developmet. A part of the Tata Group, Idia s largest idustrial coglomerate, TCS has a global footprit ad is listed o the Natioal Stock Exchage ad Bombay Stock Exchage i Idia. IT Services Busiess Solutios Cosultig All cotet / iformatio preset here is the exclusive property of Tata Cosultacy Services Limited (TCS). The cotet / iformatio cotaied here is correct at the time of publishig. No material from here may be copied, modified, reproduced, republished, uploaded, trasmitted, posted or distributed i ay form without prior writte permissio from TCS. Uauthorized use of the cotet / iformatio appearig here may violate copyright, trademark ad other applicable laws, ad could result i crimial or civil pealties. Copyright 2015 Tata Cosultacy Services Limited TCS Desig Services I M I 12 I 15 For more iformatio, visit us at