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Business Critical Architecture for Healthcare

Richard Proctor | GM Global Healthcare & Life Sciences | Hortonworks Inc.

Page 1 Hortonworks Inc. 2011 2014. All Rights Reserved


Data Driven Organizations-Shifting the Data Paradigm
Current data process with latent architecture
Primary audience regulatory agencies
o Regulatory-centric
o Manual data review/collection
o Repressive data silos
o What data to store?
Data as an independent business Reactive reporting o Expensive storage w/limited
process(Silos of data) Secondary audience
options
Modern Data Architecture with Hadoop
All data types
Primary audience Healthcare organization
Near real-time & predictive
Organization & Patient centric
Store everything!
Inexpensive storage with lots of
Data as a byproduct of patient care Prospective analysis
Secondary audience
options

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The problem: Current data architecture under pressure
Value in New data sources
APPLICATIONS

Business Custom Packaged OLTP, ERP, CRM Systems


Analytics Applications Applications

Unstructured documents, emails

Server logs
Limited Application interaction
DATA SYSTEM

RDBMS EDW MPP


Costly to Scale storage Sentiment, Web Data
REPOSITORIES
Silos of Data
Inability to manage new data sources Sensor. Machine Data
Schema on Write vs. Read
Existing Sources
Geolocation
SOURCES

ADT, Patient Accounting, GL, Payroll,


Physician entry, Core measures, Patient
Sat, AHRQ, External benchmarks,, Clinical
Systems (ED, Radiology, PACS), Other Clickstream
Sources (Clinics, home health, Ambulatory,
LTACs)
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New Data Paradigm Opens Up New Opportunity

Clickstream Opportunity LEADERS


44 zettabytes
Transform every industry via in 2020
Web & social
full fidelity of data and analytics Enterprise
Blind Spot
Geolocation

Ability to
Internet of Things Consume Data
NEW

Server logs LAGGARDS

2.8 zettabytes
Files, emails in 2012

TRADITIONAL
PROD, LOE, SHE

1 zettabyte (ZB) = 1 million petabytes (PB); Sources: IDC, IDG Enterprise, and AMR Research

90% of all information created by humans originated in the last 2 years


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True Population Health
Management

80% of healthcare
determinants lie outside
the US healthcare delivery
system

Can healthcare systems


expand into these other
areas, and become true
public health systems?
Thank you for the diagram, Robert Wood
Johnson Foundation, 2014

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Learning from other industries!
Retail Approach- Step 1:
Central Data Repository to store and process all longitudinal patient history Data
Lake
Analyze information across multiple touch points and episodes of care within the
Healthcare system or across Providers, Clinics, pharmacies, Home Health, and
specialty providers

Predictive Modeling/Analytics- Step 2:


360 degree Patient view used to build Predictive Models around high cost/high
quality patients e.g. long-term chronic disease management
Data gathered on patients after they leave the care setting enables more timely
visibility into patient behavioral/clinical changes.

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Use Cases- Providers
Hortonworks. We do Hadoop.

Page 7 Hortonworks Inc. 2011 2014. All Rights Reserved


Mercy

A Healthcare Data Platform


For a Single View of the Patient

35 hospitals and 500 clinics, 1 million patients


annually
Mercy analyzes data to improve processes around:
Operations, Revenue Cycle, and Clinical outcomes
Existing platform was hard to scale and impeded
Mercys goal to enrich Epic data for its one patient,
one record program

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2014. All Rights Reserved
Near Real Time Analytics with Epic
Batch

Oracle W P

APPLICATIONS
Clarity Business Custom Packaged
Analytics Applications Applications

EPIC W P

Sqoop

The Process:
Initial bulk load via sqoop from
Oracle/Clarity EDW to HDP. They then
& Integration
Governance

Operations
Data Access
capture deltas every 3-5 minutes from

Security
Near Real-time
Data Management cache into HDP.

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Healthcare Historical and Legacy system data offload
Hadoop Enables Scalable Compute & Problem
Storage at a Compelling Cost Structure:
Legacy system licensing when moved to new EMR
22 years of data for 1.2 million patients ~ 9 million records
Data on legacy system was not searchable nor retrievable
Cloud Storage Cost to move data to new system not feasible
HADOOP Difficulty in combining data from 2 systems
Solution
NAS
Unified repository provides data to both researchers & clinicians
Engineered System View only legacy system retired, saving $500K
MP 9 million historical records now searchable & retrievable
P Records stored with patient identification for clinical use, same data
SA presented anonymously to researchers for cohort selection
N

$0 $20,000 $40,000 $60,000 $80,000 $180,000

Fully-loaded Cost Per Raw TB of Data (MinMax Cost)

Storage Costs and licensing


reduction of latent systems
5 x the amount of usable storage, plus $500,000
5 x processing power, for about 30% of
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the cost of traditional technologies,
Healthcare Monitor Patient Vitals in Real-Time with Sensor data

Problem
Benefits
Managing The Volumes of System Sensor Data
Proactively Predict Events In a typical hospital setting, nurses do rounds and manually monitor patient vital signs.
rather than reactively They may visit each bed every few hours to measure and record vital signs but the
Real-time Alerts patients condition may decline between the time of scheduled visits.
This means that caregivers often respond to problems reactively, in situations where
Capture & Transmit Patient
arriving earlier may have made a huge difference in the patients wellbeing.
Vitals at Much Higher
Frequencies
Solution
Improve Patient Satisfaction
Hadoop Empowers Healthcare by Converting High Volumes of Sensor Data into a
Improve operational efficiency Manageable Set of Data
Improved response times New wireless sensors can capture and transmit patient vitals at much higher
frequencies, and these measurements can stream into a Hadoop cluster.
Reduce adverse drug
response times Caregivers can use these signals for real-time alerts to respond more promptly to
unexpected changes.
Over time, this data can go into algorithms that proactively predict the likelihood of an
emergency even before that could be detected with a bedside visit.

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Use Cases- Payers

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Improve Reimbursement by Correcting Claims
Problem: Difficulty identifying coding errors among 300K daily
Healthcare claims
Large US Payer Health insurer had goals of marrying electronic health records with claims data

Data analysis is disjointed, making it difficult to identify coding errors

Undiscovered errors may harm patient health and reduce reimbursement from
government programs, costing many millions in missed payments

Impact Solution: Natural language processing over PDFs in Hadoop to


improve reimbursement revenue and health outcomes
$125+ M top line
benefit annually All of the unstructured, text-based data stored on HDP

Optical character recognition & natural language processing discovers errors

Coding accuracy improves reimbursement of claims and increases revenue

Analysis of aggregate data uncovers trends used to improve treatment & lower cost

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Industry Overview Cheat Sheet
Target Business Personas: Industry Priorities:
CIO Managing the paradigm shift of
Chief Medical Information Officer (CMIO) reimbursement models (MU, P4P, Bundled
Chief Data Officer payments)
VP of Business Intelligence The changing rules and compliance
mandates associated with ARRA (MU)
Director of Data Management
Improving and managing the supply chain
VP Clinical Informatics and labor costs
Business & Technology Indicators to Look For: Expanding effective capacity and care
Magnet Hospital and Medical Research teaching collaboration
facilities Improving care while reducing costs
Multi-facility hospital operators with multiple facilities > Proactive analytics around Care delivery and
500 beds Quality
Forward thinking younger CIO, CMIO, VP of Analytics
Employs: data scientists, statisticians, data Architects
Gaining better visibility to patients within
Population Health mandates

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Page 14
Lessons Learned
1. Like it or not: your business and success runs at the
speed of software
2. No Question: The Hadoop ecosystem is revolutionizing
data management and analytics and evolving faster than
any one company possibly can.
3. Adoption Curve: Start learning and adopting now; be
ready for full adoption soon to stay competitive
4. There is only one Hadoop licensed by the Apache
software foundationchoose your distribution carefully
to avoid vendor lock from proprietary solutions as you
scale out!
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