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1 Global Headquarters: 5 Speen Street Framingham, MA USA P F L e v e raging Big Data to Build a F o undation f o r Accountable Healthcare C U S T O M I N D U S T R Y B R I E F Sponsored by: Hitachi Data Systems Judy Hanover June 2012 I D C H E A L T H I N S I G H T S O P I N I O N Provider organizations have invested years and millions of dollars to build an application portfolio (foundational applications) to run their business. Some of this investment has been driven by regulatory requirements such as ARRA's HITECH Act, which created incentives and eventual penalties around the adoption of electronic health records (EHRs) and computerized physician order entry (CPOE). These applications generate mountains of valuable data, but provider organizations have yet to explore their full potential. With the introduction of new big data technology, provider organizations have the opportunity and the imperative to turn their big data problems into solutions that will provide the information required to improve care delivery, outcomes, and costs in the accountable delivery environment. Healthcare clearly presents a challenge and an opportunity for big data technology. Successful participation in accountable care requires provider organizations to have a full understanding of their costs, clinical care patterns, risks, and patient population, and analytics will play a critical role in developing this capability. The scale and the complexity of analytics in most healthcare organizations, particularly advanced analytics techniques such as aggregation of data from multiple systems and analysis of unstructured data, indicate a significant role for big data technology in provider organizations. The long life cycle of data in the healthcare organization, driven by both regulatory requirements and the longitudinal nature of the health record, presents additional complexities for providers. S I T U A T I O N A L O V E R V I E W IDC defines big data as having four key attributes: volume, velocity, variety, and value. These attributes are clearly demonstrated in the provider organization: Volume. The escalating number of medical records that are captured and stored electronically, as well as free text, images, and scanning from historical paper records, creates a volume of data that is clearly consistent with a big data problem. June 2012, IDC Health Insights #HI235672

2 Velocity. If data is to impact care delivery and help improve outcomes for patients, it needs to be captured and analyzed, and the results need to be presented rapidly, in real time, creating the necessity for velocity in the delivery of analytics. Variety. The data from clinical applications includes structured data as well as a large amount of unstructured data and images. The number of data types, formats, and unstructured elements clearly constitutes variety. Value. The effective use of analytics will allow providers to successfully manage risk and meet the goals of accountable delivery business models. The potential for generating value from big data and analytics makes the healthcare provider setting an ideal proving ground for big data technology. It is clear that healthcare providers faced with the challenges of healthcare reform need to optimize the use of data in the organization to drive decisions, improve care and quality, and meet cost containment goals. Big data technology presents providers with the tools for storage, search, and analytical capabilities to help meet these challenges. It is particularly well suited to tackle the challenges of extracting information from unstructured data, such as free text and transcribed clinical notes and discharge summaries resident within the EHR, which is critical to assembling a full picture of a patient for use in analytics efforts. Implementing appropriate infrastructures, such as a clinical content repository, to ensure that an agile analytics environment is in place is among the most important investments that healthcare providers need to make going forward. T h e P r o v i d e r L a n d s c a p e U.S. healthcare providers are faced with massive changes to regulatory requirements and business objectives, and providers must consider those now in implementation and those to come. Regardless of the future of U.S. public reform legislation, reform is clearly necessary and already under way in the private sector. Whether in the public or private sector, the cost structure associated with care delivery is not sustainable, and providers understand the need to manage costs aggressively to remain competitive. Patients are increasingly involved in care and are demanding higher-quality services and better outcomes. Providers are increasingly capturing data electronically, and data volumes are growing exponentially. With the availability of electronic data, providers acknowledge that a responsibility has been created to exploit the data and garner the information necessary to deliver the highest possible quality care while minimizing the costs associated with substandard and excessive services. The move toward healthcare reform has begun, and we can expect it to proceed along a continuum that will require advanced Page 2 #HI IDC Health Insights

3 analytics facilitated by big data (and big data infrastructure) to execute. This continuum is illustrated in Figure 1. F I G U R E 1 M e a n i n g f u l U s e / H e a l t h c a r e R e f o r m C o n t i n u u m Early EMR and HIE Adopters and beyond ARRA Signed EHRs Deployed Connecting Healthcare Data aggregation Push pull strategies Meaningful Use Single sign-on Electronic Physician and medical and patient portals health records Clinical (EMRs/EHRs) messaging erx and CPOE Syntactic and Health semantic information interoperability exchange (HIE) Virtualization Service-based delivery of applications and storage Accountable Care Care management Population health Care team collaboration Care coordination and management Transitions in care management Clinical decision support Connected health technologies (RPM, mhealth) Analytics Big data applications Source: IDC Health Insights, 2012 Although EHRs have been in existence for upwards of 20 years, adoption by providers began in earnest with CPOE implementations following the Institute of Medicine's groundbreaking 1999 report, To Err is Human: Building a Safer Health System (http://www.iom.edu/reports/1999/to-erris-human-building-a-safer-health-system.aspx). The implementation of EHRs broadened beyond CPOE to include additional functionality, such as the capture of clinical documentation, with the 2009 signing of ARRA's HITECH Act, which put incentives in place for physicians to implement EHRs. The HITECH Act created incentives for the meaningful use of EHRs, which required not only implementation of a certified EHR product, electronic order entry, and health information exchange (HIE) but also analytics to determine the performance of providers on specific quality measures. The reporting on these quality measures required some form of analytics for efficient reporting and started providers on a path toward 2012 IDC Health Insights #HI Page 3

4 wider demands for analytics and business intelligence technology. EHR adoption is expected to reach the majority of providers by the end of HIEs further advance the ability to execute accountable delivery and measure quality and outcomes by connecting healthcare providers and allowing the aggregation and analysis of data across multiple organizations, thus enabling care coordination among providers. However, EHR and HIE are only the enabling technologies for healthcare reform and simply create the electronic data that needs to be exploited fully to meet the goals of accountable care: better understand and improve healthcare business models, optimize the delivery of care, and improve outcomes for patients. In an individual healthcare organization or in multiple healthcare organizations aggregated via an HIE, the ability to manage, manipulate, and analyze healthcare data is the foundation for successfully moving toward the new business models and paradigms of accountable care. As the continuum of healthcare reform proceeds mercilessly, IT budgets continue to grow more slowly than data volumes and the demand for applications and analytics to support the business. The role of the IT organization is expanding and changing as a result of healthcare reform, as electronic data capture puts technology at the forefront of care, and a successful IT strategy has become a critical competency for healthcare provider organizations. The foundational changes in IT requirements necessitate IT portfolio rationalization, software consolidation, centralization of infrastructure, and preparation to fully utilize big data technology, including new types of hardware, storage, and appliances that help optimize storage and processing of data while reducing datacenter costs. C h a l l e n g e s o f B i g D a t a f o r P r o v i d e r s Challenges for healthcare organizations approaching big data include: Siloed data/applications. The vast volumes of data that need to be considered in big data installations come from a variety of legacy operational and clinical systems. These legacy systems present challenges for big data projects, as database structures and integration options are often limited. Nascent data standards. While healthcare has many established data standards on the operational side, such as HL7, clinical data standards such as the continuity of care document (CCD) are still evolving and present issues when aggregating data from multiple systems. Multiple systems. Clinical and operational data needs to be sourced from multiple departmental and process-oriented systems. These systems often have limited data extract and integration capabilities, complex data structures, and problems with inconsistent data definitions across applications. Lack of interoperability when it comes to the consolidation and aggregation of data hinders the Page 4 #HI IDC Health Insights

5 formation of a longitudinal patient record, a capability that is pivotal to big data efforts. Master data management strategies are required to link patient records and multiple patient identifiers across the enterprise's clinical and financial applications. Lack of real-time data and limitations of near-real-time data from applications. Real-time data feeds are not readily available from many legacy clinical and operational applications, and nearreal-time batched approaches may not meet the eventual goals of big data, requiring deeper integration efforts to arrive at real-time data. Limited decision support infrastructure. In order for the information that results from big data efforts to be actionable, it needs to be fed into a decision support infrastructure that is active at the point of care for providers. In many cases, this infrastructure is limited and needs to be extended to offer the richer information set that will be created by big data information feeds. The goals of providers making investments in big data are to create actionable, real-time solutions that work to support intervention and solve problems at the point of care. The objectives of a big data platform in healthcare are to address the goals of improving safety, outcomes, and quality of care while lowering the cost to deliver care and increasing patient satisfaction. While there are many obstacles to achieving these goals, new big data technologies have the potential to allow providers to meet these goals more efficiently and with lower costs in the datacenter. F U T U R E O U T L O O K As healthcare providers move forward and implementation of clinical systems continues, volumes of clinical data will continue to grow. Demographic changes in our communities, such as growing access to services for patients under healthcare reform, aging populations, and the growing chronic disease burden, will only add to these data volumes. Not only are data sets growing, but healthcare organizations are required to preserve information for extended and sometimes indefinite periods. Decisions about storing and managing this data will live longer than any storage application or piece of infrastructure. The storage environment must provide for retention, security, and integrity requirements without putting data in silos, as access will be required to support production and compliance efforts. Over its life cycle, data needs to be able to easily move between data capture, analytic, and research environments and efficient, regulatory-compliant, massive-scale content repositories many times. Large amounts of data will make data migrations and traditional protection practices untenable. Organizations will need dynamic, virtualized storage infrastructures that can work with structured and 2012 IDC Health Insights #HI Page 5

6 unstructured data types and store them separately from source applications to allow for movement among storage tiers and to allow the data to be repurposed for new applications and securely shared among physicians, patients, payers, researchers, and other stakeholders. Search and ediscovery are also critical to finding the right content in this growing and disparate set of information. Physicians need immediate access to patient histories, patients want access to their medical records, regulators need to be able to audit systems, and lawyers may need to find relevant information across the entire organization. Searching the consolidated storage environment rather than searching each siloed application provides a comprehensive view that spans multiple content sources, leading to faster, more accurate search results and better patient outcomes. The big data problem is not going away; it's only growing in urgency and complexity. Providers need agile, adaptable solutions and infrastructure that will meet their goals now and help them prepare to compete in the future under new business models. Key considerations for healthcare providers approaching big data include: Begin consolidating silos into a dynamic storage infrastructure that will support the billions of objects and petabytes of data on the horizon. Standardize on storage that supports all data types, and automate data capture, storage, and tiering practices and management. Create organizationwide consensus on content handling and data ownership to remove data access hurdles without creating compliance risk. Use point-of-care decision support to leverage actionable information in the organization. Seek out technologies that can search, tier, and automatically manage the life cycle of data across existing silos according to content and rich metadata. Proactively build effective data sharing with patients, physicians, researchers, educators, external vendors, and partners into your data strategy. Ensure that appropriate retention, content integrity, and data security exist from both an organizational standpoint and an IT standpoint. Leverage emerging big data technologies to optimize the infrastructure to support data handling, storage, and advanced analytics. Page 6 #HI IDC Health Insights

7 A B O U T I D C H E A L T H I N S I G H T S IDC Health Insights provides research-based advisory and consulting services that enable healthcare and life science executives to: Maximize the business value of their technology investments Minimize technology risk through accurate planning Benchmark themselves against industry peers Adopt industry best practices for business/technology alignment Make more informed technology decisions and drive technologyenabled business innovation IDC Health Insights provides full coverage of the health industry value chain and closely follows the payer, provider, and life science segments. Its particular focus is on developing and employing strategies that leverage IT investments to maximize organizational performance. Staffed by senior analysts with significant technology experience in the healthcare industry, IDC Health Insights provides a portfolio of offerings that are relevant to both IT and business needs. C o p y r i g h t N o t i c e Copyright 2012 IDC Health Insights. Reproduction without written permission is completely forbidden. External Publication of IDC Health Insights Information and Data: Any IDC Health Insights information that is to be used in advertising, press releases, or promotional materials requires prior written approval from the appropriate IDC Health Insights Vice President. A draft of the proposed document should accompany any such request. IDC Health Insights reserves the right to deny approval of external usage for any reason IDC Health Insights #HI Page 7

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