Case Study: Efficiently Converting Healthcare Data into Information and Intelligence by @uddenfeldt


This article was published by Mats Uddenfeldt, on his LinkedIn Pulse page [ https://www.linkedin.com/pulse/case-study-efficiently-converting-healthcare-data-mats-uddenfeldt ]. The article is republished here with the author’s permission.
Valence Health provides healthcare providers with customized solutions for value based care, helping them better manage their patient populations and accept financial responsibility for the quality of the care they provide. The company offers advisory services, health plan services and a suite of population health technology software as a service (SaaS) products that help their clients transition from a transaction-based approach to a value-based approach to healthcare. Headquartered in Chicago, Valence Health serves 85,000 physicians and 135 hospitals, helping them manage the health of 20 million patients nationwide.

The Challenge

The company’s rapid client growth and the increasing volume of data required to keep up with that growth were straining its existing technology infrastructure. “Our services have a voracious appetite for data. We use that data to inform decisions about improving both healthcare outcomes and operational processes. We knew if we continued to grow, we couldn’t sustain this,” explains Dan Blake, Valence Health Chief Technology Officer. “We had outgrown our Extract Transform and Load (ETL) infrastructure and knew we had to replace it.”
Valence Health looked at various alternative technologies. “We looked at large monolithic technologies like Informatica and point solutions like Syncsort but they did not give us the robustness and flexibility we needed in the long run,” says Blake. “We wanted something very open that would give us the flexibility to choose where to make investments over time. We were drawn to Hadoop and the capabilities those tools provided.”

MapR Solution

Valence Health is using the MapR Converged Data Platform [ https://www.mapr.com/products/mapr-converged-data-platform ] to build a data lake that is the company’s main data repository. The company consumes 3,000 inbound data feeds with 45 different types of data including lab test results, patient vitals, prescriptions, immunizations, pharmacy benefits, claims and payment, and claims from doctors and hospitals.
“NFS was a very important feature for data ingestion. It is making our migration much easier,” says Blake. In the short term, Valence is transferring data back to the SQL server database as their portal and analytics expect that format. Once they get through the ETL transformation, they plan to transition from SQL to an HBase solution.
    “We chose MapR [ https://www.mapr.com/why-hadoop/why-mapr ] because they were the easiest company to work with. They were the most receptive and answered questions quickly, honestly and efficiently. On the technology side, we’ve been very impressed with the overall ability to implement and integrate sequential data transformation.” Dan Blake, Chief Technology Officer, Valence Health

Benefits

Valence Health is already seeing many benefits from its MapR solution including increased performance, better responsiveness to customers, higher quality data and a flexible platform to sustain their growth over time.

Growth requires new data architecture that can scale the business

Valence Health has been on a steep growth path over the last several years. “In the wake of the ACA’s implementation, more and more healthcare providers and organizations like Consumer Orientated and Operated Plans (CO-Ops) are taking on risk. As a result, we have tripled the size of our business in three years and expect do the same next year,” says Kevin Weinstein, Valence Health Chief Growth Officer. “Every year we’re more than doubling the amount of data we are processing. Having a robust data architecture is integral to our success.”
The company’s growth path is tied to client growth and the growth in the data infrastructure that those clients require. “We have to use technology to scale the business. We have to be able to manage more data with the same amount of people,” says Weinstein.

Performance gains increase customer satisfaction

The reliable and high performance of the MapR Platform enables Valence to be much more responsiveness to their customers. “In the past, if we received a feed with 20 million lab records, it would take 22 hours to process that data,” says Blake. “MapR can cut that cycle time down from 22 hours to 20 minutes [ https://www.mapr.com/company/press-releases/valence-health-dramatically-improves-data-ingestion-performance-and ] . And it’s running on much less hardware.”
“MapR gives us the resource efficiency, speed and flexibility to make a huge difference in customer satisfaction. As soon as the data hits our system it’s pushed all the way through,” he says. “It gives our customers much faster feedback about what’s going on with the population they are trying to manage.”

Flexibility serves customers faster

Valence Health is also now able to answer customer requests that were very difficult to answer in the past. “It allows us to do things we could not do in our old world,” explains Blake. “For example, a customer might call and say: ‘I sent you an incorrect file three months ago and I need you to take that file out.’ That’s not something you can do in a normal ETL system on top of a relational database. It could take 3-4 weeks to get that data deleted,” he says. “But with MapR, that is naturally supported, we can just roll it back and take that file out.”
This ease of administration and maintenance means that the company can focus more resources on their core business. “I can spend less on outsourced resources and instead spend money on adding new features, analytics or visualization capabilities or acquiring new types of data. We can do things that truly matter to our customers,” says Blake.

Enriching the data lake with new data sources enhances data quality

The MapR Platform also makes it much easier for Valence Health to enrich their data lake with new data sources. “It’s not just the volume of data, we’re looking to integrate new types of data like socioeconomic and demographic information, or immunization records. With our old architecture it was painful to do so,” says Blake. “Our data scientists are looking at new sources of data. The data can tell you things you don’t even know about. If we can augment our data, we can build new types of analytics that allow our client and our company to successfully invest in areas we have not been in before.”

Data acquisition and integration capabilities enable differentiated services

Valence Health believes that their new data acquisition and integration capabilities will give them a leg up over their competitors. “Other startups are selling software solutions in spaces we operate in,” explains Blake. “But the hard part is getting the data into the system and into formats where it can be truly useful. Our twenty years of hands-on practical experience in working with provider organizations that have taken on all sorts of risk-arrangements coupled with our effective and efficient infrastructure to get data flowing and keep it flowing is hugely powerful. The data acquisition infrastructure is very important to our ongoing success and to our customers.”

Recommended Reading

Want to learn more about Big Data for the Healthcare industry? Please check out the links below:
  1. How Health Care IT Diagnoses Data Pain Points, CIO Insight – http://www.cioinsight.com/case-studies/how-health-care-it-diagnoses-data-pain-points.html
  2. Stepping Up to the Life Science Storage System Challenge, HPC wire – http://www.hpcwire.com/2015/10/05/stepping-up-to-the-life-science-storage-system-challenge/
  3. Health Care Emerges as Hadoop Use Case, Datanami – http://www.datanami.com/2015/10/08/health-care-emerges-as-hadoop-use-case/
  4. Big Data and Apache Hadoop for Healthcare and Life Sciences, MapR – https://www.mapr.com/solutions/industry/big-data-and-apache-hadoop-healthcare-and-life-sciences
Join our more than 700+ paying customers and discover why MapR [ https://www.mapr.com/ ]  is the clear market leader for production ready Big Data applications by reading about the Top 10 Reasons Customers Choose MapR [ https://www.mapr.com/top-ten-reasons ].
This article was published by Mats Uddenfeldt, on his LinkedIn Pulse page [ https://www.linkedin.com/pulse/case-study-efficiently-converting-healthcare-data-mats-uddenfeldt ] . The article is republished here with the author’s permission.
Author
Mats Uddenfeldt

Big Data Thought Leadership ♦ Enabling As-It-Happens Business
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Booking a doctor appointment online – Whats the big deal? – @AshwinNaik


This blog was first published in Dr. Ashwin Naik’s LinkedIn Pulse.  

WOW!
Now you can you book an appointment with a doctor online. I know, i know – not a big deal. 

I meant, you can now book an appointment with a doctor in a government hospital online Or in a couple of years – you can book an appointment with a doctor in any government hospital in the country – online (http://ors.gov.in/copp/appointment.jsp) !

Now that’s something. With a country of a billion+ people, mostly on mobile and with 1000s of government hospitals & clinics across the country – now this IS A BIG DEAL. 

 
The government has silently launched the Online registration system (http://ors.gov.in/copp/) on which you can book appointments with government hospitals using your aadhar card. It early days, but since July 2015, close to quarter of a million appointments have been taken online. And multiple hospitals are now using the e-hospital system (with over 2 million appointments) 

Now this is a really big deal.


+ has a mobile app. And portal to check availability of blood in the hospitals


First – how this works

If the patient provides Aadhaar number on his first visit to the hospital then he would be given same preference for online appointment as is given to the patient who stands in queue in the hospital and UHID will be provided to the patient. In future, patient would be able to print E-OPD card after making online payment.

If patient is a follow up patient with hospital, then also he should try to link his Aadhaar with existing UHID which will facilitate in maintaining Electronic Health Record (EHR) in the hospital for better treatment.

Patient’s UHID get linked to Aadhaar card so that EHR across the Hospitals can also be facilitated in future.

In case patient has aadhaar number but mobile number is not registered with it, then name of the patient appearing in aadhaar card must be known. After verification, patient needs to enter other personal details.

While this is a great technology and adoption achievement, i am excited that this has an even more incredible impact – transparency! If every government hospital data on appointment available and booked is captured in a single system along with reports from lab and pharmacy – boom – everything is out in the open. 

Doctors who dont show up as per their appointment are up for scrutiny, medicines prescribed if not in the pharmacy show up, lab test which should have been done in house – now being diverted to private labs – stick out like sore thumb. 

And that’s why i think this is a really big big big big deal.


This blog was first published in Dr. Ashwin Naik’s LinkedIn Pulse.
Author
Dr. Ashwin Naik

Founder – Vaatsalya, Ashoka Fellow & Young Global Leader of World Economic Forum

C.A.U.S.E Methodology for Healthcare Organization Change Management by @pankajguptadr

Please note: The Author of this article is Dr. Pankaj Gupta. The article was first published on Dr. Gupta’s blog.


For Boot-Strapping Healthcare Organisation Change Management, I follow my proprietary CAUSE Methodology for managing change in people, process and technology. This has emerged out of our collective experience of managing change in healthcare organisations.

Consciousness of need to change: The people must be informed by the Head of the organization again and again until they are very clear in their mind about why the change in needed. There is no over communication for this. Treat the organization like an anxious child about to undergo a surgery and will need a lot of reassurance.
Aspiration to support change: The organization must Aspire to support the changes. Since the organization is going through a transition this is an opportunity for the organization to redefine itself across the organization. The Aspiration must come from within not without.
Understanding how to change: Once the organisation is conscious of the need to change and they aspire for the change from within then they are ready to be trained. Before this stage any trainings will be futile. Now train the team on new processes and technology extensively, again and again till it becomes second nature to them. Keep Checking for gaps in knowledge between expected and achieved.
Strength to over come hurdles and implement change: It is important to realize that processes will break and problems will happen when such a major implementation is done. Trick is to recognize the problem areas before it is too late to avoid big failures. Top management should be ready to cope up with the hurdle and internal resistance and not buckle down under pressure.
Ecosystem to support, sustain and adopt change: Lot of support is required in terms of hand holding and training till the change gets adopted by the users and is irreversibly embedded into the ecosystem. Unless you support the change till it becomes an ecosystem the change will not last. It will swing back to zero as an elastic and throw the organization into chaos.

Dr. Pankaj Gupta’s experience spans Organization change management, Business transformation, Clinical transformation, Knowledge management, Transition management, eHealth Consulting, mHealth Consulting, Chronic Disease Management, Solution design, Implementations. Due to his background and experience he is interested in Healthcare Operations, Pharma, R&D Labs, Medical Devices, IoT, SMAC, next generation technology platforms for Digital Hospitals.

CAUSE Methodology is an outcome of having done organization change management over and over again. Dr. Pankaj Gupta has successfully applied this framework to many healthcare organisations in terms of IT, Process, Quality and Management changes.
Please note: The Author of this article is Dr. Pankaj Gupta. The article was first published on Dr. Gupta’s blog.

Author

Article By: Dr. Pankaj Gupta

Digital Health Influencer & SMAC / IoT Speaker | Healthcare Business Executive, Chief Medical Informatics Officer at ProMed Network AG | Managing Partner at TAURUS GLOCAL CONSULTING | Director at Taurus Globalsourcing Inc.
Additional Articles by the Author

  1. Top #DigitalHealth Trends to expect in 2016 by @pankajguptadr @AmandaShaffer14 http://ow.ly/uTSp300Bhyw
  2. New Healthcare Aggregators: SMAC and IoT by @pankajguptadr http://ow.ly/UCzO300BD7y

From Mere Health Statistics to Real Health Data by @AtulVB

The article was first published on Mr. Atul Bengeri’s – LinkedIn Pulse. The article is republished here with the authors’ permission

The Health Statistics play a major role in deciding the Health Policies of Nations, no doubt they provide the insights into the health parameters in question and health statistics such as Rates, Ratio, Incidence, Prevalence and Life Tables are needed to be formed into indicators of progress of the nation in terms of improvement of the factors in consideration.

The question is – is mere statistics enough or is there something more to it?

As we move from Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs) – this question becomes more imperative!

According to WHO, Health is defined as “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. 1

Health is also identified the state of “not well”, “ill “or “morbidity” or “sickness”. Further “death”, which is caused by illness or sickness, reflects the condition of Health. Hence measurement of “Mortality” and “Morbidity” reveals of Health condition of a community.2

Statistics definitely provide a macro-level / micro-level understanding of the situation and brings in quantitative pointer to a qualitative, exhaustive and comprehensive activity. Year-on-year the quantitative pointer is kept as the reference. Any deviation from it is representative of the growth or decline of the parameters in consideration.

Such laser sharp focus on quantitative data is the hallmark for Population Census, Surveys and even Market Research – where absolute number, a figure in percentage is the gospel truth.

What about Health / Medical Data of the population? What about the Medical History? What about the Medical Condition – improvement / degradation?

The last point gets easily converted into an explainable number or a percentage as an indicator, but what about the relapse or repeat condition of the same person – it’s again… just a number!  

Limitations of data especially in developing countries are a real concern, as available data is not reliable and post-2015 presents an opportunity to think beyond what data is available so that countries can invest in capacity building to get it.3

Alongside the number comes a lot of health and health-related data, but with the focus being statistics, basic essential health data is obviously missed out.

Non-communicable disease continues to be an important public health problem in India, being responsible for a major proportion of mortality and morbidity. Surveillance of NCDs and their risk factors should also become an integral function of health systems. Evidence based clinical practice and appropriate use of technologies should be promoted at all levels of health care, including tertiary services.4

With the focus on Non-Communicable diseases (NCDs) – it is imperative we focus on the Healthcare & Medical Data for Clinical outcomes and not mere Health Information for Management Systems.

Ageing Population is one of the major concern globally, more so in India. It is now recognized that while both developed and developing countries are experiencing growing proportions of elderly, developing countries currently are ageing faster than developed countries. In India, the proportion of the population aged 60 years and above was 7 per cent in 2009 (88 million) and is expected to increase to 20 per cent (315 million) by the year 2050. 7

As per a study conducted 5, among the most significant findings that emerged was the incompleteness of data on the burdens of access and affordability among elderly populations in India. A major reason for this is that routine health data collection in India is not designed to reflect or characterize pathological progression. Many routine data collection procedures (National Sample Surveys, Census data, or death certificates) in India do not capture pathological progression nor do they disaggregate morbidity and disability outcomes among the elderly. 5

Further research, especially qualitative research, is needed to explore the depth of the problems of the elderly. 6

With a rise in the Ageing Population, it is all the more important to look at the efficacy of the health data collected than mere health statistic data and a Longitudinal Study along with Cross-Sectional Study is needed for an efficient health data repository.

With the advent of new age technology: connected technology, Connected Health has become pervasive and with embedded systems and IoT taking center-stage, it is all the more essential to focus on the Data and not mere Number! And when I say ‘Data’ it is ‘Health Data’.

And last, but not the lease – the necessity for increased clinical / medical research in today’s evidence based approach makes it is all the more important to focus on the fundamental health data collection, collation, transformation and consolidation to begin with leading to Analysis, Research and building the knowledge base for Healthcare / Medical Data Management.

Looking at the underlining need for Health / Healthcare Data, we need to move from just Statistical Data to Meaningful Data – not to mistake ‘Meaningful use of Data’!

References
  1. CIGI, TISS, KDI, Post-2015 Development Goals, Targets and Indicators: Indian Perspectives, Mumbai, India / Meeting Report, August, 2012
  2. An Overview of the Burden of Non- Communicable Diseases in India – R Prakash Upadhyay. Iranian J Publ Health, Vol. 41, No.3, 2012, pp.1-8 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481705/pdf/ijph-41-1.pdf
  3. Health of the Elderly in India: Challenges of Access and Affordability. Subhojit Dey, Devaki Nambiar, J. K. Lakshmi, Kabir Sheikh, and K. Srinath Reddy. National Research Council (US) Panel on Policy Research and Data Needs to Meet the Challenge of Aging in Asia; Smith JP, Majmundar M, editors. Washington (DC): National Academies Press (US); 2012. http://www.ncbi.nlm.nih.gov/books/NBK109208/
  4. Health and Social Problems of the Elderly: A Cross-Sectional Study in Udupi Taluk, Karnataka A Lena, K Ashok, M Padma,1 V Kamath, and A Kamath. Indian J Community Med. 2009 Apr; 34(2): 131–134. doi:  10.4103/0970-0218.51236 PMCID: PMC2781120
  5. Demographics of Population Aging in India. Subaiya, Lekha and Dhananjay W Bansod. 2011. Demographics of Population Ageing in India: Trends and Citation Advice: Differentials, BKPAI Working Paper No. 1, United Nations Population Fund (UNFPA), New Delhi.

Author

Atul Bengeri

Digital Health Influencer & Evangelizing Digital Transformation across verticals, Strategic Planning, Leadership, Program Management, Partnerships / Alliance Management

Incorporation of Health Informatics in the curriculum for Healthcare Professionals by @Supten

The  article was first published in Dr. Supten’s Blog. The article is published here with the authors permission.

The art and science of processing “information” is informatics, where “information” is the processed “data” (anything that is observed and recorded). Just as we get information by “data processing”, using informatics tools, we condense information into “knowledge” that can be applied to real life situations 


When the informatics tools are applied to the “biomedical” field, it is called “biomedical informatics” which is a very broad term encompassing the study and application of computer science, information science, informatics, cognitive science and human-computer interaction in the practice of biological research, biomedical science, medicine and healthcare. Other fields, including bioinformatics (proteomics, genomics, and drug design), clinical informatics (including clinical research informatics), public health informatics and medical informatics (including imaging informatics, nursing informatics, dental informatics, pharmacy informatics, consumer health informatics, healthcare management informatics and veterinary informatics) are commonly counted as sub-domains within biomedical informatics

Health or Healthcare informatics is an alternative term that has been defined: “If physiology literally means ‘the logic of life’, and pathology is ‘the logic of disease’, then health informatics is the logic of healthcare. It is the rational study of the way we think about patients, and the way that treatments are defined, selected and evolved. It is the study of how clinical knowledge is created, shaped, shared and applied. Ultimately, it is the study of how we organize ourselves to create and run healthcare organizations.”It deals with the resources, devices, and methods necessary for optimizing the acquisition, storage, retrieval, and optimal use of information in health and biomedicine. The health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication technology (ICT)

Biomedical / Health Informatics can be applied to diagnostic procedures, imaging, decision-support systems, patient records, financial and administrative systems, educational systems (for healthcare delivery students, practicing professionals and patients), patient monitoring (e.g., anaesthesia control), and accessing health knowledge

The National eHealth Authority (NeHA) is in the process of being set up through an Act of Parliament. Under such circumstances, for the smooth adoption of eHealth throughout Digital India, there would be a tremendous requirement for formally trained health informatics professionals in India very soon. It will be prudent to incorporate health informatics as a part and also as a speciality for healthcare professionals in India. Ministry of Health and Family Welfare has notified Standards for Electronic Health Records since August 2013 and India has been a country member of IHTSDO that develops and maintains a terminology standards SNOMED-CT. It is essential to make healthcare professionals at all levels aware of such initiatives and adopt standards for health information exchange

Source: Connectathon India – http://ow.ly/ve8t300Qa3M


In the USA, all ABMS (American Board of Medical Specialties) member boards have agreed to allow their diplomates to take the clinical informatics subspecialty examination if they are otherwise eligible. The ABPM (American Board of Preventive Medicine) website provides information about eligibility for the exam and online application.Certification in Clinical Informatics is a joint and equal function of the ABP (American Board of Pathology) and the American Board of Preventive Medicine (ABPM)

CDC, Atlanta, Georgia, USA, offers PHIFP (Public Health Informatics Fellowship Program) as a 2-year, competency-based training program in public health informatics. The fellowship provides a problem-based learning environment in which fellows apply information and computer sciences and information technology to solve public health problems

They have the opportunity to: learn about informatics and public health in an applied setting work with teams involved in research and development of public health information systems lead an informatics project design, develop, implement, evaluate, and manage public health information system

The  article was first published in Dr. Suptens’ Blog


References

1 Sarbadhikari SN, Medical Informatics: A Key Tool to Support Clinical Research and Evidence-based Medical Practice (Ch 15), In, Babu AN, Ed, Clinical Research Methodology and Evidence-based Medicine, 2nd Ed, 2015: 179-191. 
2 Abdel-Hamid T, Ankel F,…Sarbadhikari SN, et al, Public and health professionals’ misconceptions about the dynamics of body weight gain/loss, Syst. Dyn. Rev. 30, 2014: 58–74 
3 Ahmed Z, Sarbadhikari SN, et al., Using online social networks for increasing health literacy on oral health, Intl. J User Driven Health, 2013, 3: 51-58. 
4 Karishma SH,…, and Sarbadhikari SN, Creating Awareness for Using a Wiki to Promote Collaborative Health Professional Education, Intl. J User Driven Health, 2012, 2:18-28. 
5 Sarbadhikari SN, Unlearning and relearning in online health education, (Ch 21) In, Biswas R, and Martin C M, Ed, User Driven Healthcare and Narrative Medicine, IGI Global, Hershey, USA, 2011: 294 – 309. 
6 Sarbadhikari SN, How to Make Healthcare Delivery in India More “Informed”, Education for Health, Volume 23(2), August 2010: 456. 
7 Sarbadhikari SN and Gogia SB, An Overview of Education and Training of Medical Informatics in India, IMIA Yearbook of Medical Informatics, 2010: 106-108. 
8 Sarbadhikari SN, Applying health care informatics to improve student learning, Really Good Stuff, Medical Education, 2008; 42: 1117–1118. 
9 Sarbadhikari SN, How to design an effective e-learning course for medical education, Indian Journal of Medical Informatics. 2008; 3(1): 3: http://ijmi.org/index.php/ijmi/article/view/y08i1a3/15 
10 Sarbadhikari SN, The State of Medical Informatics in India: A Roadmap for optimal organization, J. Medical Systems, 2005, 29: 125-141. 
11 Sarbadhikari SN, Basic Medical Education must include Medical Informatics, Indian J Physiol. Pharamcol., 2004, 48(4): 395-408. 
12 Sarbadhikari SN, Guest Editorial on “Medical Informatics — Are the Doctors Ready?”,J.Indian Med. Assoc. , 1995, 93: 165 – 166. 
13 Mantas J,et al, Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics – 1stRevision, IMIA, 2009 
14 Burnette MH, De Groote SL, Dorsch JL. Medical informatics in the curriculum: development and delivery of an online elective. Journal of the Medical Library Association : JMLA. 2012;100(1):61-63. doi:10.3163/1536-5050.100.1.011. 
16 NHP, EHR Standards helpdesk: http://www.nhp.gov.in/ehr-standards-helpdesk_ms 
17 IHTSDO, SNOMED-CT: http://www.ihtsdo.org/member/india 
18 American Academy of Family Physicians, Recommended Curriculum Guidelines for Family Medicine Residents on Medical Informatics: http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint288_Informatics.pdf 
19 AMIA, ABPM, ABP, Clinical Informatics Subspecialty Board Examination: https://www.amia.org/clinical-informatics-board-review-course/board-exam 
20 CDC, Public Health Informatics Fellowship Program:http://www.cdc.gov/PHIFP

Author

Dr. Supten Sarbadhikari

Digital Health Influencer & Project Director at Centre for Health Informatics of the National Health Portal; President IAMI (2016)