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Healthcare organizations possess more electronic data than ever before, a situation that has opened up a data management opportunity for service providers.
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Clinical data, once confined to paper charts, is increasingly housed in electronic health record (EHR) systems. EHR adoption has skyrocketed in recent years. The Office of the National Coordinator for Health IT reports that 59% of hospitals use at least a basic EHR system. That figure compares with a 9.4% adoption rate in 2008. Among physician practices, the EHR adoption rate was 78% in 2013 compared with 18% in 2001, according to the Centers for Disease Control and Prevention. The sharp uptick in EHR use coincides with the federal Meaningful Use initiative, which offers financial incentives to hospitals and physicians who deploy EHR systems and meet government guidelines.
The healthcare sector now aims to build clinical data repositories, or warehouses, to analyze the growing stores of electronic information. Healthcare providers hope to obtain better insight into patients, treatment regimens and their effectiveness. Organizations may also seek to create broader enterprise data warehouses that incorporate both clinical and claims data.
Either way, healthcare systems may need help running a data warehouse. Healthcare IT personnel typically have their hands full with day-to-day technology management and pressing initiatives such as 'meaningful use' and ICD-10 conversion. The latter introduces a new diagnostic coding system that goes into effect in October. Managed services providers and cloud services providers believe they can help healthcare customers tackle data warehousing and leverage their information by offering healthcare data management services.
"There is a market demand for hosting data warehouses, particularly in healthcare where IT departments are being asked to do so much," said Alex Eastman, senior director, enterprise solutions, at Premier Inc., a Charlotte, N.C.-based company that offers a cloud-based data warehouse.
Healthcare data management enabling analytics
Every good-sized healthcare organization wants to establish a data repository/data warehouse and get intelligence out of it, according to Prem Pusuloori, chief technology officer of OmniMD, a certified cloud EHR, practice management and medical billing platform provider.
Pusuloori said the very large healthcare organizations often choose to build their own repositories and analytics systems, since they have enough in-house expertise and resources to build the necessary infrastructure. On the other hand, smaller healthcare entities may struggle to deploy the technology.
"It would be very difficult for small to medium-sized healthcare organizations to build and maintain their own data repositories," Pusuloori noted.
Indeed, data warehouse adopters face a number of obstacles, including Health Insurance Portability and Accountability Act (HIPAA) and HITECH compliance. Pusuloori cited the "big responsibility" of holding huge volumes of healthcare data while ensuring security and privacy.
Alex Eastmansenior director of enterprise solutions, Premier
The expertise required to build a data repository adds another degree of difficulty. Among other things, a healthcare system would need to build a data structure for the repository, transform and import the source data from different vendor systems, and build the analytics layer above the repository.
"This process requires a big team of data engineers," Pusuloori said.
Pusuloori also cited the high cost of building, maintaining and upgrading the hardware and software infrastructure supporting the data warehouse.
Service providers are filling the talent and infrastructure gap. Some providers now offer cloud-based repositories and analytics tools.
Premier, for example, delivers its healthcare data warehouse and business intelligence platform as a managed service in the cloud. The company launched the service last February as part of an enterprise-wide analytics offering. That offering also includes managed data acquisition: Premier acquires data from a customer's primary sources -- commonly, EHR, claims and billing systems -- and loads the data into the warehouse.
Eastman said Premier also takes on the task of data standardization and integration.
Healthcare data may come in different data formats and employ differing clinical terminology standards. Some standards may be specific to a given healthcare system, while others are industry standards such as ICD, SNOMED CT and LOINC. In any event, a healthcare system looking to analyze its data on an apples-to-apples basis will need put its data in a common format and regularize any differing standards.
"We do all of that standardization and harmonization of data," Eastman said.
Another data integration chore is identifying a patient represented in multiple data feeds. Data for a given patient will often reside in both claims and EHR data. Premier uses matching algorithms to reconcile and integrate patient data.
Some healthcare organizations outsource the building, hosting and management of a data warehouse to a single company, but that's not the only delivery model. In one variation, a healthcare system hires a healthcare data analytics vendor to provide the repository and business intelligence layer. That vendor, in turn, taps a services provider to perform the hosting duties.
INetU, a cloud hosting and managed hosting company based in Allentown, Pa., is working with a number of healthcare analytics vendors as a hosting partner. Eric Naiburg, director of product management at INetU, said healthcare analytics companies focus on building the data repository and applying their expertise in analytics, but don't want to be in the hosting business.
"That is where we come in," Naiburg said. "We end up hosting that application and hosting that data and helping them manage it."
Naiburg said INetU provides a HIPAA-compliant environment, which also attracts the healthcare analytics companies. He said those vendors lower their risk profile when they reduce the amount of protected health information under their care.
Analytics vendors also turn to a cloud hosting solution for the ability to burst when additional capacity is required, Naiburg noted. He said INetU offers customers the ability to run their application in a managed private cloud, but then burst into the company's public cloud, called the Gated Community Cloud, when they encounter a spike in demand.
"They can easily handle the spikes with a hybrid approach between public and private clouds," Naiburg said.
Along with hosting providers, Database as a Service (DBaaS) companies also see opportunity in the healthcare data warehouse field.
IBM Cloudant, a DBaaS provider that falls under the umbrella of IBM's Cloud Data Services, is currently working with customers to manage their clinical data, noted Derek Schoettle, general manager, Cloud Data Services, at IBM. He said IBM's resources can ensure HIPAA-compliant services for its healthcare customers.
CumuLogic Inc., a Santa Clara, Calif.-based DBaaS provider, meanwhile, has yet to explore the clinical data repository field, but could do so in the future.
"It definitely looks like an interesting emerging field," said Rajesh Ramchandani, vice president of products at CumuLogic.
The healthcare data management customer profile
Very large healthcare organizations typically build, host, manage and maintain their own repository and analytics systems, Pusuloori said. That tendency leaves the small to mid-sized healthcare systems as the sweet spot for service providers.
Eastman noted that the bigger institutions do tend to be the ones that deploy on-premises data warehouses. He added, however, that demand for hosted offerings cuts across a broad spectrum of healthcare systems. He said Premier's customers range from single hospitals to systems with more than 20 hospitals.
"We have found a number of large health systems that are interested in a hosted solution," Eastman said.
For institutions of all sizes, hosting frees in-house IT personnel from managing technical minutiae and lets them focus on more strategic activities. A hosted solution, Eastman explained, can shift the role of the IT department away from managing bits and bytes, enabling a closer engagement with the business side of the healthcare system.
From a technology perspective, healthcare customers are interested in Linux and Windows environments with MySQL, Oracle or SQL Server as the backend database, Naiburg said. Customers running big data-type applications may use NoSQL databases such as MongoDB, he added.
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