Ruminating on EMPI

EMPI (Enterprise Master Patient Index) is a consolidated hub of all patient related information that would act as a single source of truth.

Hospitals have various departmental systems such as lab systems, radiology systems, EMR systems and other Health Information systems that operate in isolation. Typically patient data is spread out across these disparate systems and it is challenging to have a 360-degree view of the patient.

Hence, hospitals create an EMPI hub that assigns a unique ID to each patient. EMPI systems use algorithms to match and link records across disparate systems. The algorithms also identify duplicate records and reduce the number of false negatives. The typical attributes used by the matching algorithms are first name, last name, DOB, sex, social security number, address and more. The matching algorithms (deterministic, probabilistic/fuzzy) must consider typos, misspellings, transpositions, aliases, etc.

Besides the internal attributes, many organizations also source data from external third parties (e.g. Equifax) that can be used for increasing the accuracy of the matching engine. This is helpful as people change addresses, phone numbers, etc. with time.

Many traditional MDM product vendors such as IBM, InfoR provide platforms to implement EMPI.
Few organizations have also started using NoSQL and other Big Data platforms for creating a customer hub as explained here.

Analysis of Healthcare spend in the US

The US department of Health has released interesting stats on the healthcare spend across various dimensions. The report is a bit old and available at http://archive.ahrq.gov/research/findings/factsheets/costs/expriach/

Some eye-opening snippets from the report are copied here -

1. Five percent of the population accounts for almost half (49 percent) of total health care expenses.
2. The top 5 chronic diseases are - Diabetes, Hypertension, Heart Disease, Asthma and Mood Disorders. Treatment for these diseases account for almost 50% of the total healthcare spend.
3. 5% of Medicare fee-for-service beneficiaries accounted for 43 percent of total spending, with 25 percent accounting for 85 percent of all spending.
4. The elderly and disabled, who constituted around 25 percent of the Medicaid population, accounted for about 70 percent of Medicaid spending.
5. The five most expensive health conditions were heart disease, cancer, trauma, mental disorders, and pulmonary conditions

Classification of medical devices by FDA

In the US, the Food and Drug Administration (FDA) regulates any apparatus involved in diagnosing or treating disease.

While we were working on an IoT enabled Diabetes Management Solution, we learned that the FDA classifies all medical devices into 3 categories  - Class 1 / Class 2 & Class 3.

• Class 1 devices are low risk devices and have minimum regulatory control. For e.g. dental floss, lancets, etc.  These devices must be listed in the FDA's medical device registry, but do not have a stringent approval process. 
• Class 2 devices have higher risk and need stronger regulatory controls. For e.g. blood glucose meters, test strips, insulin pumps, etc. 
• Class 3 devices have the highest risk and therefore have the highest level of regulatory control. For e.g. heart valves, continuous glucose monitors, artificial pancreas, etc. 

Patient Engagement Framework for Healthcare providers

HIMSS (Healthcare Information and Management Systems Society) has published a good framework for engaging patients so as to improve health outcomes.

Patients want to be engaged in their healthcare decision-making process, and those who are engaged as decision-makers in their care tend to be healthier and have better outcomes. The whole idea to is to treat patients not just as customers, but partners in their journey towards wellness.

The following link provides a good reference for designing technology building blocks for improving patient experience.

Inform Me --- Engage Me --- Empower Me --- Partner with me

http://himss.files.cms-plus.com/HIMSSorg/NEHCLibrary/HIMSS_Foundation_Patient_Engagement_Framework.pdf

Ruminating on HIE (Health Information Exchange)

The healthit.gov site gives a very understanding on HIE. This is not to be confused with HIX (Health Insurance Exchange). Snippet from the site:

The term "health information exchange" (HIE) actually encompasses two related concepts: 
Verb: The electronic sharing of health-related information among organizations 
Noun: An organization that provides services to enable the electronic sharing of health-related information

Today, most organizations are leveraging HL7 as the standard for HIE. HL7 v3 is XML based, where as the prominent HL7 v2.0 is ASCII text based.  Another standard that is used in HIE is CCR (Continuity of Care Record).

Blue Button is another attempt in simplifying HIE. Providers and Health Plans participating in the Blue Button initiative would allow you to download all your health records as a plain text file from their site.  The image below from www.healthit.gov gives you a good idea on the advantages of having access to your health record.

 

A new initiative called 'Blue Button+' would allow information to be downloaded as a XML (HL7 based) and enable machine to machine exchange of health information. 

HL7 FHIR– Fast Health Interoperable Resources is an interesting initiative that uses REST principles for HIE. 

Ruminating on ACO (Accountable Care Organizations)

The below article on national journal gives an excellent overview of ACO and what were the reasons it was formed.

http://www.nationaljournal.com/innovations-in-health/accountable-care-organizations-a-health-experiment-in-progress-20131010

Some snippets from the article, that would give you a good understanding of ACO. 

"ACOs are groups of providers that have been assigned a projected budget per patient. If the cost of caring for the patient comes in below that level, the group/payer shares the savings. The idea is that doctors will better coordinate care to prevent wasteful or ineffective treatment. 

With accountable care organizations, the theory is that if the provider does a good job taking care of the patient, something the insurer can track with quality metrics, the patient's health will be better, they will use fewer and less expensive services, and, therefore, they will cost less to insure. 

Medicare is running two pilot versions of the program. In one, providers may sustain losses if they're over budget but can be handsomely rewarded if they're under. The other rewards providers for coming in under budget but has no downside risk. The government is monitoring quality to make sure providers aren't skipping necessary treatment to come in under budget. 

Making ACOs work will require many organizational changes on the part of providers. They'll have to orient their systems more around quality than quantity. They'll have to track patients closely, using new analytics, to make sure their status is improving. And they may focus on high-risk, high-cost patients, using analytics and tailored interventions to help them. The payoff for improving the health of that population could be substantial."

What is HIMSS?

The Healthcare Information and Management Systems Society (HIMSS) is a not-for-profit organization dedicated to improving healthcare through innovative use of modern information technology.

Found a wealth of information on the HIMSS site that is definitely worth a perusal:
http://www.himss.org/library/topics?navItemNumber=17591 

Good links to understand Health Insurance Domain

Was quite impressed with the simple and lucid language used on about.com to explain the basic of Health Insurance in US. The following articles are worth a perusal for anyone wanting to jump-start on the fundamental concepts in Healthcare.

HMOs vs. PPOs – What Are the Differences Between HMOs and PPOs?
What Is a Health Insurance Provider Network? and also this link.
What's the Difference Between Copay and Coinsurance? and also here.
Why Is Health Care So Expensive?
What Is Hospice Care?
What’s the Difference Between Medicare and Medicaid?
Why do we need healthcare reforms? and What are the dangers of having uninsured people?
What is ACA (Affordable Care Act) or ObamaCare? Another good link here.
What Is a Health Insurance Exchange?
Bronze, Silver, Gold & Platinum–Understanding the Metal-Tier System
What are Health Saving Account and Flexible Saving Accounts?
Understanding Claims Adjudication
What are ICD-9 or ICD-10 Codes?
What is HIPAA regulation around privacy of patient information?
Myths About HIPAA, Patients and Medical Records Privacy
Explanation of Benefits - Understanding Your EOB  : EOB goes to the member
What is ERA? : ERA goes to the provider during electronic payments. EDI 835
What is Individual Mandate?
What is MLR? (Medical Loss Ratio). Another link here.
What are Consumer Directed Health Plans (CDHP)?
What is the National Practitioner Data Bank (NPDB)?
What is SBC? (Summary of Benefits and Coverage)
What is provider credentialing?
What are tiered network health plans?
Who runs Medicare and Medicaid? Centers for Medicare & Medicaid Services (CMS)
What is OIC (Office of the Insurance Commissioner)?
What is medical necessity?
What does NCQA (National Committee for Quality Assurance ) do?
What Is the Coordination of Benefits?

What is longitudnal data?

A dataset is considered to be longitudnal if it tracks the same kind of information at multiple points of time. For e.g. the marks of students over multiple years, patient health records over a period of time, etc.

The most important advantage of longitudnal data is that we can measure change and the effect of various factors over the data-point time values. For e.g. what is the effect a particular drug had on a cancer patient? The effect of different teachers on a student?

So essentially, longitudnal data helps in establishing cause-n-effect relationships. Longitudnal data stores are also being used for predictive modeling and other areas. Longitudnal data stores are very popular in the Life Sciences and Healthcare industry.
I am interesting in learning the best practices for creating and optimizing a data-model for longitudnal data stores.

Difference between biostatistics and bioinformatics

Working in the healthcare domain, I often come across the terms - biostatistics and bioinformatics and wondered as to what were the differences between the two branches of studies. A quick googling revealed the following:
The term Biostatistics is a combination of the words biology and statistics. So it essentially it is the application of statistics to biology. The science of biostatistics encompasses the design of biological experiments, especially in medicine and agriculture; the collection, summarization, and analysis of data from those experiments; and the interpretation of, and inference from, the results.
Bioinformatics is the application of information technology and computer science to the field of molecular biology. Its primary use has been in genomics and genetics, particularly in those areas of genomics involving large-scale DNA sequencing. Bioinformatics now entails the creation and advancement of databases, algorithms, computational and statistical techniques, and theory to solve formal and practical problems arising from the management and analysis of biological data.
Bioinformatics focuses on applying computationally intensive techniques (e.g., pattern recognition, data mining, machine learning algorithms, and visualization) to understand biological processes.
More information can be found on Wikipedia at:
http://en.wikipedia.org/wiki/Bioinformatics
http://en.wikipedia.org/wiki/Biostatistics