Building a Healthcare Data Strategy With Big Rocks

Shawn Sutherland
Fri, 04/10/2020

Big Rocks banner

The long-awaited 21st Century Cures Act became a Final Rule just before the COVID-19 pandemic escalated in the U.S. Primarily addressing information interoperability, the rule was expected to be announced at the HIMSS conference in early March, where more than 45,000 attendees from around the world – including me! We were looking forward to gathering and discussing the power of life-changing innovation in healthcare – including the impact of the passage of this very rule.  

This is a topic that is near and dear to our hearts. My colleague Bill Moroz (@BizIntelligent) is working feverishly with our partners at @Ready_Computing on an HL7 task force developing new interoperability standards to better manage healthcare resources in the midst of the coronavirus. Their efforts remind me of a favorite quote from the ancient Roman philosopher Seneca: “Luck is what happens when preparation meets opportunity.” If… Read More »

Five Proven Ways for Health Systems to Foster a Data-Centric Culture

Bill Kotraba
Wed, 01/29/2020

You could just send a memo declaring that your healthcare system will adopt a data-driven culture beginning the first of next month and that all subsequent decisions will align with analytical insights.

Then again, a memo likely isn’t enough to change the behavior of thousands of experienced professionals, many of them likely to be wary of the promise of a plan for a single source of truth. If you suspect that a little more encouragement and a lot more inspiration (or vice versa) might help, here are five proven ways – gleaned from Information Builders’ decades of experience with healthcare clients – to cultivate a data-centric culture in your organization.

Lead by (Senior Management’s) Example

  • Create a data steering committee that is chaired by a clinical or business leader – one who’s not from IT – to reinforce the message that better data is meant to help all users, not just technologists. Meet regularly to set priorities, share successes, and coordinate communications throughout the organization
  • Ensure that all communications from executives reflect the value of data. Refer to data collected by the organization as a valuable asset to be protected, maintained, and expanded

Begin With Quick Projects That Can Model Success

  • Start small and specific – consider improving a key area of the patient experience with clear business objectives. Share the method and results widely. Document how… Read More »

Five Steps to Improve Your Risk Adjustment Process

Santosh Padhiari
Tue, 10/01/2019

Risk adjustment models are no longer confined to predicting costs for Medicare Advantage beneficiaries. Now they are more prevalent and widely adopted in various alternative payment models for value-based outcomes.

To calculate a per member per month (PMPM) capitated payment in managed Medicare plans, CMS uses a model that captures Hierarchical Condition Codes (HCCs) and assigns a Risk Adjustment Factor (RAF) to each patient. Different payment methodologies also use that model, for instance:

Medicare and Risk Adjustment Factors
  • Fee-for-service reimbursement (FFS) to compensate Accountable Care Organizations (ACOs) for sicker patients
  • Individual and small group markets on health insurance exchanges
  • Cost and quality measures for value-based purchasing for hospitals and providers

As you see, the implications of risk adjustment are far reaching. Timely assessment and accurate coding of patient problem lists can make huge differences in revenue for payers and providers alike.

Here are 5 steps that can improve clinical documentation at point of care leading to more accurate risk adjustment coding and more appropriate compensation for quality care. 

1. Integrate Clinical Data

Access to… Read More »

How Does AI Solve Healthcare Data Challenges?

Bill Moroz
Mon, 09/23/2019

When “one giant leap” echoed around the world in the summer of 1969, Neil Armstrong’s words marked not only a profound achievement for mankind but also heralded the first digital age1.  Now 50 years on from that triumph of shared vision, leadership, and technology, what can the moon landing teach us about the future of healthcare innovation?Artificial Intelligence (AI) in Healthcare

If artificial intelligence (AI) is the next technology frontier, then healthcare is surely one of its many orbits. Like the moonshot, the stakes are high. AI promises to transform healthcare by producing better clinical outcomes for lower costs. As proof, Accenture predicts that AI applications will save over $150 billion by 20262; and AI investment throughout the public and private sector is expected… Read More »

Leveraging your data? Don't miss the signs.

Bill Kotraba
Wed, 09/04/2019

Are you a Scandinavian pop fan? Yes, there is such a thing. It ranges from groups like Abba and Ah-Ha (who can forget their “Take on Me” video), to Ace of Base’s “The Sign”, which represented the most recent popular zenith for the sub-genre when the song reigned supreme on Billboard’s chart for 1994.The song, billed as techno-reggae, had a killer chorus about a couple seeing the signs leading to a break up. Who can forget the catchy “I saw the sign and it opened up my eyes” hook?

Healthcare's Digital TransformationNot everyone sees the signs, particularly health executives, who are missing them when it comes to leveraging their data. This recent survey from the Center for Connect Medicine shows that a majority of healthcare executives feel they don't have CEO and senior management support to make needed interoperability investments.… Read More »

Artificial Intelligence in Healthcare: Reliable Data Matters

Dennis McLaughlin
Mon, 08/26/2019

You hear a lot in the news about Artificial Intelligence (AI) and Machine Learning (ML) applied to the healthcare industry. And there is no doubt that this technology trend has significant potential to change healthcare delivery. And it is not just care management and delivery. There is significant potential for AI/ML contribution to billing management, claims, cost management and control, staffing, and inventory management. But the key to unlocking the potential in all of those areas is data.  And that is where the biggest barrier to success lurks ready to sabotage these initiatives. 

A typical workflow for a machine learning project involves (at least) the following functionalAI and ML in Healthcare activities:

  1. Acquire data

  2. Prepare the data

  3. Model Training

  4. Model evaluation

  5. Model deployment

Note that there is a critical dependence on the data in this process. In healthcare, we clearly do not have a… Read More »

An Eye in the Sky for Social Determinants of Health, Part 1 of 3

Shawn Sutherland
Fri, 08/16/2019

One of my daughter’s favorite movies to watch (and re-watch) right now is “Alpha”.  Set in Europe 20,000 years ago, it illustrates the similarities between social determinants of health (SDoH) then and now. The story is about a young man who, separated from his tribe, struggles to return home.

The common themes of community, opportunity, spirituality, environment, shelter, nourishment, and medicine in the movie play an important role in our health now and always have over the years.  While today we may not worry about being snatched in the night by a sabre tooth tiger, the probability of encountering an intoxicated evening driver in a large urban environment can be just as harrowing.  

The Struggle

In modern healthcare, there is little doubt that SDoH are important. However, one of the greatest challenges to understanding the extent and relevance of the impact is in the collection of associated data.  Consistently gathering these data in an efficient and standardized approach is difficult to achieve. As my colleague Santosh Padhiari recently pointed out in his blog, our Omni-HealthData (OHD) platform has helped customers address this. There are several subjects defined in OHD across different domains… Read More »

Healthcare Systems Need to Look Closely at Leveraging Data for ROI

Bill Kotraba
Tue, 07/02/2019

A recent article in Fortune Magazine brings to light the deficiencies of EHR systems andEHR their ability to share important medical information between systems and organizations. The piece highlights EHR usability as a main problem effecting healthcare as a whole. In some cases even patient safety was impacted.   

This has influenced the amount of ROI that healthcare executives have seen from their investment, amongst the other challenges that are inherent. To leverage data across the patient journey healthcare organizations have a number of challenges including master data management, harmonization of data, and metrics management. EHR vendors don’t really have the ability to overcome this hurdle, so it is left to their customers to get the best use from all their data assets.

Information Builders’ developed Omni-HealthData in order to allow stakeholders in healthcare organizations to leverage all of their data including financial, operational, and claims sources, increase ROI, and reduce the complexity found in their EHR system. We partnered with St. Luke’s University… Read More »

Healthcare organizations need cloud-based data management to prepare for the future digitization

Bill Kotraba
Wed, 06/19/2019

With the coming 5G and feeding of AI models, a significant rise in the use of medical and healthcare devices is just around the corner. This will dramatically increase the amount of data captured, and provide opportunities for advanced analysis and deeper insights. On the flip side, with huge data, there could be huge problems. 

Cloud-based data management just may be the key to keeping your data and analytics organized and Healthcare Data Management for the Cloudfruitful. There is analyst buzz out there that seems to indicate that the healthcare industry will be spending a huge amount of money on cloud technologies.   I have to believe that there is a good reason for that. 

Providers, payers, and physicians are constantly looking for a single version of the truth when it comes to their patients, members, and organization. There are advantages to this curated data layer residing in the cloud. Some facts that support this:

  • The cloud is scalable; when the need for resources is higher, the cloud can scale up, and when the need for resources is lower, the cloud can scale down. This works with an increasing amount of data as well.
  • Large cloud providers have AI and ML capabilities that healthcare organizations need for… Read More »

Under the covers of Omni-HealthData

Beth Adams
Mon, 06/17/2019

Omni-HealthData is a healthcare data management and analytics application built on top of Information Builders’ Omni-Gen and WebFOCUS platforms. Our technologies are designed for scale: more users, more data, more speed, more use cases, more applications.

The WebFOCUS platform has broad and deep analytical capabilities that help companies use data more strategically across and beyond the enterprise. The Omni-Gen platform is a complete data management solution with integrated data quality and mastering functions for the accurate and complete data your organization is looking for.

Additionally, Omni-HealthData has the benefit of InfoApps™, which are highly interactive, turnkey analytical and reporting apps for healthcare metrics. In conjunction with St. Luke’s University Health Network (SLUHN), we created a set of InfoApps designed to serve a range of critical informational needs for healthcare organizations. These are available as Omni-HealthData Insights.

Need more proof that we’re an industry leader in these technologies? Look no further than Dresner Advisory Services, which called us “…an overall leader in both Customer Experience and Vendor Credibility models” in their tenth… Read More »

Using Benchmarks to Reduce Cost and Optimize Performance

Shawn Sutherland
Fri, 05/10/2019

It’s reasonable to surmise that analytics tools can help healthcare organizations reduce cost and improve care, due to “big picture” insights that drive strategy. However, these insights need to be accessible by more than just senior management, and should include patients, caregivers, physicians, providers, payers, and more.

We know this is true because according to HIMSS, “Clinical and business intelligence efforts empower members with practical guidance and unbiased information on how to harness data to inform accountable, high-quality patient care and fuel unparalleled business insight – all the while improving an organization’s fiscal performance.” But it’s more than just the data. There is also huge value in integrating, cleansing, enriching, and mastering your data and after that, using it to inform business decisions.

The most important thing that I learned from the above is that if you have strategic alignment of improvement efforts and goals it is critical for everyone in your organization to be able to view your progress.

Read More »

The Digitization of Healthcare will transform the Industry in the Coming Decade

Bill Kotraba
Wed, 04/24/2019

Getting your data house in order with an enterprise strategy and data platform is critical for what is to come in the next transformational decade. If you are ahead of the curve with the upcoming trends you can prepare for the future.

Let’s see what themes that have been driving our conversations over the past ten years:

  • In 2009, there was the passage of the American Recovery and Reinvestment Act which incented the adoption of electronic health record systems 
  • Population health and care management gained momentum; organizations are working out how to reduce costs by segmenting their populations into groups and managing their care more proactively
  • Value based care models are on the increase after a slow start; financial, organizational culture, and data challenges abound as obstacles to a successful shift
  • Increased merger and acquisition activity leading to additional data sharing challenges 

In years to come, we should expect:

  • Providers using claims data and payers using clinical data to give more context to the patient journey
  • Patients taking control of their own data through interoperability, user generated data, and apps
  • Care models drifting to non-traditional players like CVS, Walmart, and even Amazon
  • An explosion of interest in the advanced use of data… Read More »

Tackling Social Determinants of Health (SDoH)

Santosh Padhiari
Wed, 04/17/2019

This time last year we discussed different Payer strategies for addressing non-clinical factors such as transportation, affordable housing, and nutritious food accessibility. Each of these have a direct impact both on patient health and healthcare spending.

Payer investments in community-based initiatives have shown encouraging results in improving the quality and experience of their beneficiaries. However, it still remains an industry challenge to identify and tackle these issues in a standardized and coordinated manner.

There are four key phases in implementing any successful program for tackling Social Determinants of Health (SDoH) – collecting data, analyzing data, taking actions, and assessing impact. Let’s discuss the two which are critical for creating successful community engagement programs:

SDoH Collection

One can collect SDoH data either directly (using risk based tools like the ones that the National Association of Community Health Centers does) or indirectly (analyzing credit reports, criminal history, etc… Read More »

The Future Requires an Organizational Commitment to One Healthcare Data Layer

Bill Kotraba
Thu, 03/28/2019

Tolkien's novels about Middle-earth effortlessly weaved together themes from a number of early mythologies and tales with a cautionary nod to the encroachment of technology. At the heart of The Hobbit and The Lord of the Rings was the One Ring with its ability to bring together the power of the other magical rings of the time.

In The Lord of the Rings the great minds of the age were slow to recognize the impact the One Ring could have until it was almost too late. This correlates well to modern healthcare as siloed data continues living in core and ancillary systems in the way power in Middle-earth was concentrated around the other known rings. In the last ten years the industry has placed their eggs in the EHR basket in hopes that would solve their data issues. If anything, the use of data has grown more important and the data sources are only rising.

Over the last several years I have come across surveys and articles about how data challenges are holding back key industry initiatives. Recently, a Kaufman Hall report summarized by Health IT Analytics found a whopping ninety-five percent of CFO's doubted their data analytics abilities because of data issues not dashboard issues. This report noted that executives are not fully confident that… Read More »

Tapping Into Insights for Healthcare Success

Beth Adams
Mon, 03/18/2019

As healthcare organizations strive to become more patient-centric, many are leveraging their enterprise data to improve outcomes and enhance care quality while controlling operating costs, maximizing reimbursements, and adhering to regulatory guidelines. 

Our new Solutions Brief, How to Improve Quality of Care, Costs, and Compliance With Intelligence, Integrity, and Integration, can show you how delivering trusted and timely information across the continuum of care can help healthcare organizations operate a sustainable, profitable enterprise.

Cambridge Memorial Hospital, Halifax Health, Fred Hutchinson Cancer Research Center, St. Luke’s University Health Network, and many others rely on Information Builders technologies to exploit data from physicians’ offices, hospitals, nursing homes, and telemedicine sources, among many others, across a wide range of systems, including electronic medical record (EMR) applications. Download our Solutions Brief to see how.

Healthcare Opportunities and Risks

Bill Kotraba
Mon, 03/11/2019

At HIMSS, CMS and ONC announced proposed rules on data sharing, data blocking, and APIs. These extensive guidelines intend to encourage use of application programming interfaces via FHIR which will speed up how patients can access information via mobile devices. The hope is that patient-oriented apps will be developed, empowering individuals to control their healthcare data, ultimately making their choice of providers more portable.

Additionally, CMS pointed out other data challenges not reflected in these rules:

  • Improved mastering of patient records to create golden patient records
  • Increased capacity to push cleansed, accurate information back to source systems

Interestingly enough, these challenges link directly to Master Data Management (MDM). Plus, CMS is confirming something that many have known all along: creating a mastered patient record in a leading EHR system is just not enough for today’s enterprise.

This isn’t the only deficiency. Not mentioned are mastering physician data and harmonizing data with millions of codes and value sets used in the industry. Combined, this reinforces the need for healthcare organizations to invest in an enterprise data strategy and platform. However, headlines touting data sharing… Read More »

CMS & the ONC fired a shot across the bow on unleashing data during HIMSS 2019

Bill Kotraba
Wed, 03/06/2019

Looking to innovate?

During HIMSS, we heard several discussions around bringing together information from many sources, then leveraging that data’s potential. When you unleash that data, (for example, claims data) it helps create a deeper understanding of the patient’s record. CMS pointed out other data management issues such as pushing information back to source systems and the need to better master patient records though they didn't explicitly term them “data management issues”.

If you step back a bit, you’ll notice that the CMS and ONC announcement was really describing a complex data management problem. Forcing siloed healthcare data holders to open up data exchanges through API standards is good, but it’s far from an immediate solution. Healthcare organizations must invest in a data management layer that can handle the complexities of healthcare information across the value chain to create a single version of truth. Some of the challenges include:

  • Multi-domain mastering. Not just the patient domain that CMS mentioned, but physician data mastering (a huge issue for organizations with many downstream impacts)
  • On boarding dozens of data sources preferably without a large team of ETL developers
  • Read More »

Yesterday’s AI is Today’s Common Technology

Shawn Sutherland
Wed, 02/27/2019

A few months ago, I had the honor of speaking at Optum’s MinneAnalytics conference and enjoyed the opportunity to engage with a broad spectrum of professionals and innovators. In talking with one young data scientist about the definition and types of AI, he commented that “yesterday’s AI is often today’s common technology”. His point is that the definition of AI is constantly evolving – as demonstrated by the pervasive autocorrect with which we all have a love/hate relationship with.

When word processing was first developed, the idea that a computer could correct spelling and suggest grammar changes in real time would have certainly been classified as AI, if not altogether impossible. Today, this is not only commonplace, but expected.

Regardless of definition, it is clear that AI utilization is expanding in many industries, including substantially to healthcare. From faster and more accurate detection of tumors, through imaging analysis, to fraud mitigation, and advance prediction of Alzheimer’s, our industry completed some impressive work. Unfortunately, after years of time and effort spent, there has also been hundreds of millions invested on failed projects.

Everyone that I’ve… Read More »

Blockchain moving into Healthcare

Santosh Padhiari
Tue, 02/19/2019

Blockchain is a rapidly growing industry buzzword, with applications from financial services to supply chain management. The technology’s inherent transparency, security, and reliability can solve several problems in the healthcare industry and can play a critical role in the digital transformation of healthcare in the United States. But before we go into some of the use cases, let’s first get acquainted with the underpinnings of this technology.

What is Blockchain?

Blockchain technology, best known as the technology that powers the digital cryptocurrency Bitcoin, bases itself on a distributed ledger system that assigns a block to each digital transaction. A ledger is formed by chaining each block to the transaction occurring immediately before and immediately after it. The shared records then form the chain amongst a network of computers, hence the term “distributed ledger”.

All encrypted transactions in the blockchain have a cryptographic hash which locks that event in place, creating an unchangeable or immutable record of transactions. A very important characteristic of this distributed ledger is that all transactions must be verified and recorded through the consensus of all parties belonging to the network. New transactions cannot be approved unless a majority of the members in a blockchain… Read More »

Omni-HealthData Ready to Support New ONC Interoperability Framework

Bill Kotraba
Thu, 02/14/2019

This week at HIMSS 2019 in Orlando, the ONC and CMS proposed new rules looking to force the industry, in particular EHR vendors, to open their data through APIs. This will unleash a wave of innovation with patients having rights to their own data and promises to bring a burst of energy around new applications to leverage that data. This overdue move occurs after EHR vendors have collected $34 billion in taxpayer subsidies while continuing to put moat around patients’ data.

With the ONC’s Notice of Proposed Rule Making on Interoperability of health care systems, the focus is clearer on the technology elements required to accomplish that. These technology elements include specific communication protocols, standard messaging contexts, common data models based on HL7’s Fast Healthcare Interoperability Resources (FHIR) standard and specifically identified code sets representing key concepts. The ONC’s 2019 Interoperability Standards Advisory (ISA) spells out these in extensive detail.

Information Builders anticipated this shift, delivering Omni-HealthData with a pre-built healthcare model that adheres to the… Read More »

Join Healthcare Data Champions @HIMSS19 in Orlando!

Bill Kotraba
Thu, 01/17/2019

I feel like it comes sooner every year. After the holiday season is over, the HIMSS conference is upon us (even earlier this year, kicking off on February 10th). HIMSS19 has an awesome theme this year – Champions of Health Unite, where a series of personas will showcase various roles that impact healthcare IT.

Omni-HealthData is building on that theme with “Data Champions”. Hardly a day goes by without hearing about interoperability and challenges impacting the industry, the latest is an ONC (Office of the National Coordinator for Health Information Technology) report sent to congress about continued data sharing challenges.

Hal Wolff, President and CEO of HIMSS, recently spoke about the growing data to information gap. We are at the beginning of this wave as patient generated, machine generated, and social data will explode over the next decade. In order to feed all the future AI and predictive use cases, that data will need to organized and harmonized.

At the latest JP Morgan Healthcare Conference, hospital leaders shared how they are shifting away from the old… Read More »

Health insurers merging with PBMs – the good, the bad and the ugly

Santosh Padhiari
Thu, 01/10/2019

M&A activity is driving much of the change in healthcare delivery at a record pace. In the first half 2018, organizations made announcements about more than $2.5 trillion worth of deals[1].

While this is hardly unprecedented, a noticeable trend is that health insurers are riding the wave of vertical integration and acquiring or merging with pharmacy benefit managers (PBMs). Take, for example, the recently announced merger between Cigna and Express Scripts with a total deal value of $67 billion. That makes it the 11th largest merger of all time between two North American companies.Read More »

Cutting Through the Hype – Part 5 of 5, Enabling Technology; When to Buy and When to Build

Shawn Sutherland
Fri, 12/28/2018

There are many great things coming in healthcare for 2019, and before diving into the last part of the “Cutting Through the Hype” series, here is what we have covered so far:

The Introduction:  Cut Through the Hype

  1. Analytics beyond the EHR, here
  2. Real life illustrations that define healthcare’s unique data challenges, here
  3. Data Governance – how to start, organize… Read More »

Developing Innovative Testing Strategies for Healthcare Data and Analytics

Dennis McLaughlin
Fri, 12/14/2018

Your team is deep into a project to develop a repository of healthcare data for use by the business to perform analytics, trend analysis, complex metrics, and ad hoc reporting. Given the wide range of potential use cases, you want to make sure that the data is ‘good’ before you make it available.  You checked the source data. You checked your integration work. You checked the master data for patient and provider. Your basic test reports all seem to be fine.  But you still aren’t sleeping. And there is a good reason for that. There is a very high probability that the data is far from perfect.  In fact, it might very well be outright wrong. But that is a healthy thing and here is why. 

We have blogged often on the challenges of healthcare data management. The varied nature and use of source data, data harmonization, applying governance standards, compliance challenges, and the complexity in how data is organized and presented for healthcare consumption all contribute to a challenging data environment. As you integrate you make many decisions that prepare the data in a universally accepted format across the organization. But sometimes those decisions are wrong (for all the right reasons) and that can and will impact the data and its perceived reliability.  The key is how to find these scenarios quickly and take corrective action.

One… Read More »

2019 is the Year Healthcare Executives Need to get Strategic on Leveraging Data

Bill Kotraba
Fri, 12/07/2018

A recent McKinsey article on rebooting the chief analytics officer role mentions that only eight percent of companies are reporting they are leveraging data at scale across the enterprise. Since healthcare lags behind general technology adoption we can assume that this number is high for the industry. Additionally, they found a number of key roles chief analytics officers must play as catalysts for change:

Convening a coalition of equals: McKinsey talks about the role catalysts play in leading the process by bringing stakeholders together through consistent communication. Some of the key elements of success include:

  • People and processes are more critical then technology
  • Putting the business value front and center
  • Communicate. Communicate. And then communicate some more
  • Keep an eye ahead

Making analytics an enterprise thing: Catalysts lead the centralized team… Read More »

The Importance of Data Management in Healthcare

Beth Adams
Wed, 11/28/2018

According to, "…the use of data analytics could help save more than $300 billion in U.S. healthcare, apart from making information flow transparent and creating a value chain in healthcare." [1]

Sounds positive, right?

No matter how useful data analytics are, it’s important to realize that they don’t just pop up from your existing healthcare data. Your analytics are only as good as the data that goes into them. And your data is located everywhere: clinical and claims systems, HR and financial applications, and third-party sources. Healthcare organizations that struggle with disparate information assets and siloed processes must find a way to make data “fit for purpose” through aggregation, standardization, and enrichment.

Once information is collected and aggregated from various sources, healthcare organizations must ensure its accuracy, completeness, and consistency. They need a plan and supporting solutions that promote sound data management. A unified… Read More » Wins Gold for Best Healthcare Content

Beth Adams
Mon, 11/19/2018

I have some great news to announce!

Recently, at the 22nd Annual Healthcare Internet Conference in Scottsdale Arizona, the Omni-HealthData website won the gold for “Best Healthcare Content” of the 2018 eHealthcare Leadership Awards program. Even more impressive, there were over 1000 entries submitted for these awards.

Earlier this year, when we launched this website, we wanted to enable healthcare organizations with powerful software to achieve effective data management. Providing informative content, including use cases and best practices, helps awareness of our product, and shows the value in purchasing a complete solution that will take data from anywhere, and turn it into actionable insights.

If you haven’t already, Read More »

The Importance of Provider Mastering

Omni HealthData
Wed, 11/07/2018

While many healthcare systems have implemented Enterprise Master Patient Indexes (EMPIs) for patients, few have embarked upon the daunting challenge of mastering providers. But there is a growing list of reasons why mastering providers is of equal financial importance. Healthcare organizations implement EMPIs to maintain up-to-date and accurate information about every patient. And for good reason: Inaccurate patient identification or information results in 33% claims denial and costs the US healthcare system over $6 billion annually.


Unfortunately, mastering a provider is so much more difficult then a mastering a patient. There are many reasons why.  A provider is not just a doctor, that term can extend to nurse practitioners, physician assistants, and more.  Layer in the dimension of a provider being employed, affiliated, and/or independent and the challenge is further exacerbated.  A sophisticated system will be able to facilitate a provider that is not currently in your system yet is a valid provider.  EMRs struggle with the existence of someone that does not exist in their system.  With their inability to incorporate HR data, a provider does not exist until they are seen by a patient in a… Read More »

Cutting Through the Hype, Part 4 of 5 – Leveraging Governance to Prioritize Clinical and Business Objectives

Shawn Sutherland
Thu, 11/01/2018

In the Marine Corps, one of the first things I learned about how to prioritize and follow various orders I received was the phrase “Stars over Bars”. “Stars” refers to the rank of generals and “bars” indicates the silver or gold bars that makeup the insignia for captains and lieutenants. In the corporate world, we might refer to this as “C’s over VPs”. Clear chain of command is vitally important in the life and death operations of both the military as well as healthcare organizations, but it may not be the most efficient way to order the priorities of an enterprise analytics program. 

In this blog, I will discuss an immediate, short term approach to managing analytic requests that most organizations can easily implement and harnesses your data governance program (from the last blog post). I will also provide a long term approach that optimizes the efficiency of your executive leadership, analytics staff, and performance improvement groups across the enterprise.

In one organization I belonged to, we called the “C’s over VPs” situation the “wild west” method.  Sometimes requests came through a… Read More »

Reference Data Management in a Sea of Codes

Omni HealthData
Wed, 10/24/2018

Many health practitioners seem to think that interoperability among health systems is the most important issue they face. And that’s almost true. Interoperability is key to keeping real-time operations flowing.


But achieving interoperability doesn’t eliminate a more serious problem: the fact that these systems describe the same situations in completely different ways.


The codes inside our systems are a kind of language that we use to describe, track, and communicate what’s happening in our healthcare organizations. When we try to analyze and understand what’s happening in our organizations, we need to get information from all of our systems and make a coherent picture from it.


Suppose an analyst needs to study a cohort of diabetic men over age 45 who are on blood pressure medications. How would you navigate your systems and the variety of code sets they use to get a list of diabetic patients for her?


Could you further refine your list to include a comorbidity of hypertension?


Consider the following… Read More »

Population Health Management, Defined

Beth Adams
Fri, 10/12/2018

Population Health Management refers primarily to the identification of groups that need healthcare support, and the coordination of care for improving their outcomes.

When healthcare organizations have a data driven technology plan, they are more easily able to exchange information, identify opportunities in care, and provide timely interventions. This makes for healthier patients as well as a better overall patient experience.

To implement a data driven technology plan, you may want to use software that enables cohort analysis, which finds groups in a population that share similar characteristics. You also may need help with population metrics by using performance scorecards to highlight areas to focus on for immediate attention.

Leveraging all your data resources in order to achieve optimal population health management is not as hard as you think. For more information on how to succeed with population health management, read our trending topics page.

Employer innovations transforming health care delivery

Santosh Padhiari
Thu, 10/04/2018

Rising healthcare costs are increasing the financial burden on employer groups, especially small employer groups who provide health benefit coverage to their employees. According to data released by Peterson-Kaiser Health System Tracker, health plan cost sharing and deductible spending have outpaced employee wage growth in the past ten years. Employees’ total financial responsibility increased by 54 percent from 2006 to 2016 while wages only increased by 29 percent during the same amount of time. As more and more health plans shift the cost of healthcare services to their beneficiaries, employers are looking at innovative ways to reduce the financial burden of their employees.

Frustrated with the pace at which the healthcare industry is driving change, some employers are taking a more proactive role and driving changes in the healthcare delivery system. They gear these changes towards innovative ways of healthcare delivery that emphasize on the components of value-based care.

ACOs and HPNs

Employers are contracting directly with Accountable Care Organizations (ACOs) or high-performance networks (HPNs) when these organizations offer the highest quality and/or most cost-effective providers. Under many high performance networks such as ACOs or narrow network plans, employers typically leverage… Read More »

Industry Stalwarts Focus on Interoperability's Need for an Architecture

Bill Kotraba
Mon, 09/24/2018

Interoperability in healthcare was the focus this week both from HIMSS and on Capitol Hill. In both cases, missing was the clarion call for healthcare organizations to take charge of their data with an enterprise approach to data management.

First up, Healthcare IT News sat down with HIMSS Chief Technology and Innovation Officer Steve Wretling to discuss interoperability. Wretling focused on the need for an architecture to drive interoperability beyond the use of APIs, which has increased in the last several years. He emphasized, “We’re in a data revolution time period where digital information and technology is opening many avenues to innovation on data that have not been there before."

So, let's examine the outburst of data over the last several years with more to come:

  • Electronic health records have exploded since Meaningful Use Incentive Program was launched with the passage of ARRA (American Recovery and Reinvestment Act) in 2009
  • Changing payment models… Read More »

Know Your Patient: Bringing consumer product marketing techniques to healthcare

Dennis McLaughlin
Wed, 09/05/2018

Let me start by making sure that you, the reader, know that the purpose of this blog post is NOT to debate the concepts of patient versus customer, and the perils of confusing the two. However one feels about the encroachment of consumerism in healthcare, it doesn’t mean that healthcare is so different that we cannot learn and exploit known marketing outreach techniques often targeted at the ”customer” in other industries.  And just like Know Your Customer (KYC) in finance, Know Your Patient (KYP?) depends heavily on knowing every single fact at your disposal that could be relevant to the end goal you are trying to achieve. The optimal use of these facts is highly dependent on the data you collect and your ability to organize it into a coherent representation of everything you know. 

Take for example, the siting of specialized facilities that your network is looking to invest for the future.  One could take an educated guess and surmise that because there are other health related facilities in an area, yours would do well being nearby. But is that what a consumer focused company would do?  No. They would first examine how many of their profile customers live in or around the area in question using market data. Then they would layer the demographics of people who currently travel past the location to determine the level of traffic they could potentially see and compare this to other… Read More »

Cutting through the Hype, Part 3 of 5 – Data Governance; How to Start, Organize and Build to Sustain

Shawn Sutherland
Thu, 08/23/2018

In Part 2 of the “Cutting through the Hype” series, we discussed the importance, especially in healthcare, of getting the data matched, merged, cleansed, mastered and enriched/tagged with the proper HLI code sets and clinical ontologies.  This is the work represented in the first 4 columns (Connect, Move, Fix, and Relate) of the “Data Value Chain” diagram below:

Data Value Chain

Following “Relate” is “Govern”.  For healthcare organizations, data governance is regularly discussed, rarely understood, and hardly attempted.  In my experience working for and collaborating with some of the top analytics groups in the country, data governance failures (or non-starts) are the result of two primary causes:

  1. The columns to the left of “Govern” are not being done with automated, scalable technology
  2. Lack of clarity – what is data governance, what is its purpose, why is it needed?

We’ve reviewed item one with sufficient detail in… Read More »

Thinking beyond the EHR

Bill Kotraba
Tue, 08/14/2018

Last week, I went to see a presentation on the importance of an enterprise data foundation to drive analytical change in healthcare. It made me think about two articles I read recently:

The first article covered Dr. Frank Opekla's testimony in front of congress on behalf of The American College of Surgeons and American Medical Association.  He discussed the possibility of shifting from merit-based incentive payments for EHR use to encouraging a broader use of sources that extend beyond the EHR. His key point was that the focus on EHRs alone is too narrow when in advancing care information there are many more sources to consider.

In addition, the EHR should be a key data source and a consumer of analytics, but not serve as the enterprise data and analytics foundation. Dr. Opekla concluded with “There is so much more we can do for quality and for lowering costs by leveraging digital information. “We have to stop thinking of EHRs and think beyond them.”

The second article was based on the results of a Quest Diagnostics survey on value-based care. The… Read More »

Payer investments in community leading to healthier outcomes

Santosh Padhiari
Thu, 08/02/2018

According to the World Economic Forum, social and environmental risk factors account for 20% of health outcomes. Social determinants of health include the conditions of the places where people live, learn, work, and play. These conditions can affect a variety of health risks and outcomes. Unstable housing, low income, unsafe neighborhoods, and substandard education are some of the major factors that can influence patient health.

Factors Influencing Health Outcomes

Social risk factors increase the danger of a future disease burden, particularly in the lower income populations. Incorporating these social determinants into patient EHRs, and having them become part of the workflow may improve individual and population health. Once these social determinants are mapped, they provide the key to developing personalized care.

Collection will be exacerbated if there are limitations on data sources and challenges to the workflow. Collecting social determinants of health is a challenge to begin with, considering they are not commonly found in claims or medical records. Mostly, this information is found in coded and unstructured… Read More »

The struggle for healthcare in breaking down silos and moving to enterprise data usage

Bill Kotraba
Thu, 07/26/2018

Rather than think about how we tackle data issues for population health, value based care, AI, and predictive analytics, healthcare organizations need to think about what their data strategy is and what platform should be used across the entire enterprise.

Organizations need to take into account data sources, volume, and usage that will be growing year after year. Due to the increased volume, data analysts, who want to use data for impactful change, are really data jockeys, spending more than 80% of their time preparing data for projects.

For data to be most helpful, it must be integrated quickly and at scale from a diverse set of sources, such as: legacy applications, machine data, spreadsheets, web services, user generated data, and more. This data then must be mastered, cleansed, harmonized, and prepared for analytical use. This process seems straightforward, but it not happening enough.

Some of the reasons why healthcare organizations aren’t tackling data as an enterprise issue are:

  1. They all want to continue to use their existing EHR systems, in which they have invested millions of dollars. They hope the EHR will figure out the data and analytics issues on their own.
  2. The landscape is filled with HIE and… Read More »

Healthcare Analytics and the Challenge of Imagination

Dennis McLaughlin
Fri, 07/20/2018

The strategic importance of becoming a data driven organization in healthcare cannot be overemphasized.  Making the transition from opportunistic and transactional information sharing to a proactive data centric business can present challenges for most health systems. It surely is not from lack of motivation, as there is a level of excitement around data in healthcare that couldn’t be more pronounced and it is felt at every level of the organization.  So why when we have the desire, the motivation, the mandate, and the tools to make this transition are we having trouble taking meaningful steps to change?

One big reason that is somewhat unique to healthcare is that this change has to take place while the responsibilities of every day work remain unchanged, especially when working with data is not your primary day job.  Current reporting and analytic strategies often represent past hard-fought battles for data acquisition, hours with Excel getting the data right, and then fighting for the results to be accepted as fact by the business.  Couple those feelings with the sheer habit of my current report and analytic generation process (and yes I know exactly how much of my time it will take to get it done this month!) and you get a recipe for stasis. 

As the barriers to… Read More »

Cutting Through the Hype, Part 2 of 5 – Real Life Illustrations That Help Define Healthcare’s Unique Data Challenges

Shawn Sutherland
Thu, 07/12/2018

In my previous blog post, it was determined that data silos in healthcare require utilization of technology with capabilities in three core competencies: Integration, Integrity (Data Quality), and Intelligence.  Since these are not core competencies of the EHR, we should define the problem in more detail before considering further options. 

In this post, you will see three simple data illustrations to help increase our understanding of the issues.  

First, let’s look at some quality, cost, and operations information for patients or members using data from different systems. We’ll include EHRs, materials management, HR/Staffing, and shift/timekeeping systems.  Let’s group the information by gender, which is stored in each of these four systems as follows:

Patient Gender (22)

However, we only really want to group by the following six types:

Read More »

The Importance of Mastering Provider Information

Omni HealthData
Fri, 06/22/2018

A lot of effort has been put forth in mastering the patient/member and rightfully so.  When effective, patient duplicates drop, the chances of administering the incorrect drugs decline, claims processing improves, the patient member experience enhances and so on.  Now the challenge becomes provider or physician mastering.  On the surface, that would seem to be a relatively easy task, but the devil is always in the details.

Providers wear many hats.  They can be a solo practitioner, a physician as a part of a practice, a hospitalist, credentialed at many hospitals, and even the possibility of a single physician having two different National Provider Indexes (NPI’s).  Some specialists, even within the same practice, will serve patients at different locations.  To compound it further, information about a physician (e.g. – fax number) is spread across the 20+ systems that may be housed even within a single hospital system.

The impacts affect many different areas.  Incorrect physician information could inhibit or delay notification when a patient has been discharged from either Emergency Department (ED) or inpatient services.  When the patient presents for follow up, physicians are commonly surprised to learn they even went to a hospital.  If the patient presented at both ED and subsequently Inpatient, one or both of the encounters may not be communicated to the PCP due to erroneous contact… Read More »

Predictive Algorithms: The importance of reliable data

Dennis McLaughlin
Mon, 06/18/2018

There is little doubt that one of the hottest trends in healthcare information management is predictive analytics. Some of the most common research topics are predicting the likelihood of sepsis in a hospital patient, understanding who is most likely to readmit and getting insight into co-morbidities and their likely progression for certain chronic conditions. These advanced informational algorithms get our attention because they can have such a direct impact on patient wellness and our ability to deliver cost effective quality care. But if we believe that (and I am sure of us most do), why aren’t we doing it already. 

In order to be able to effectively predict the future we need to have a firm understanding of the present and the past. The nature of healthcare data and its tendency to be voluminous while often living in segregated siloed systems often doesn’t allow us to have a firm understanding on what is actually going on. Sure, I can tell you everything we did while the patient was in the hospital, every test we ordered, the results and other observations, what we instructed the patient when they left and what meds we prescribed. But I don’t necessarily know if they filled their prescription, whether they reliably took their medicine or followed any of the instructions. We do… Read More »

Cutting Through the Hype, part 1 of 5 – Analytics Beyond the EHR

Shawn Sutherland
Tue, 06/12/2018

In my introductory blog, I spoke of the importance of getting the foundational aspects of data correct before moving into more technologically advanced areas.  Getting our “data house in order” is the first step to avoiding a lot of rework, which reminds me of a cautionary cartoon a co-worker had pinned in his cube when I first started as a software developer; “Don’t worry about the mule going blind, just load the cart.” 

It is important to think of data as the valued assets that they are, and when it comes to treating data as an asset, we need a new, modernized way of thinking, especially in healthcare.  If data are inaccurate in retail, finance and manufacturing, it can cause logistical issues or cost money.  If they are wrong in healthcare, people get hurt, clinical outcomes suffer and population health declines.  However, if Integration and Integrity (quality) are done correctly, there is a massive increase in speed to value for achieving Intelligence/Analytics with a significant reduction in long-term FTE overhead.  Thereafter, all staff and leadership involved in the effort to solve Data Rich and Information Poor are… Read More »

Apple has the Healthcare IT community FHIRed up!

Santosh Padhiari
Fri, 06/01/2018

Earlier this year, tech behemoth Apple announced it is launching a personal health record (PHR) feature with iOS 11.3. “App”tly named Health Records, the feature will aggregate existing patient-generated data in the Health app with data from a user's electronic medical record at a participating hospital. At launch, Apple is working with 12 hospitals across the country, including Penn Medicine, Cedars-Sinai in Los Angeles, Johns Hopkins, and Geisinger Health System.

The feature will use HL7's FHIR (Fast Healthcare Interoperability Resources) specification. Users will be able to see things like allergies, medications, conditions, immunizations and lab results, as well as the sort of things that can be usually pulled in a patient chart in an EMR. They can be notified when the hospital updates their data. The data will be encrypted and users will need to enter a password to view it.

What is FHIR?

The Fast Healthcare Interoperability Resource is an interoperability standard that has emerged from the non-profit HL7 organization, and functions as a universal… Read More »

Achieving Data Liquidity in Healthcare

Beth Adams
Fri, 05/18/2018

By harnessing the true power of data, healthcare providers can make both clinical and business improvements that transform the way they operate.

But data liquidity, when the right information is delivered to the right people at the right time, is not easy to achieve. Healthcare processes may be fragmented, and as a result, the data generated during the course of healthcare transactions is fragmented as well.  It resides in siloed EHRs, claims processing applications, pharmacy systems, and more. Compounding the problem are new, but important sources of health information such as genetic data and patient-generated data. 

Clinicians and other stakeholders rarely have access to the comprehensive, timely, accurate information they need. This lack of data liquidity makes it difficult to apply data for specific uses, such as managing quality indicators, and nearly impossible to leverage in support of “on the fly” questions and information needs as they arise. 

Providers need to address the entire data value chain – collecting it from various sources, integrating and standardizing it, preparing it for analysis, and offering different tools for interacting with it in different ways – in order to reach full data liquidity. The right… Read More »

Cut Through the Hype – Healthcare Data Governance and Enabling Technology

Shawn Sutherland
Thu, 05/10/2018

When it comes to Business Intelligence and Analytics, people tend to think about big data, artificial intelligence, and data mining. This “silver bullet thinking” tends to be driven by much of the hype out there. The challenge is that none of it works without two key requirements:

  1. The data are accurate, reliable, complete and consistent with the proper relationships.
  2. The definitions for the data types, groups, cohorts, metrics, and benchmarks are clear and easily available throughout the organization – ideally in context of the associated dashboards, scorecards and reports.

PwC, in their “Top health industry issues of 2018” report, calls out that “An AI tool is only as good as the data it uses for decision-making. Companies should invest in finding, acquiring and creating good data, standardizing it and checking it for errors.”

Many healthcare organizations have a master patient/member index.  However, most do not have a practitioner master file or a single source or list of all of their physicians. Many a brave soul has had the experience of showing attributed data to a physician only to have it quickly picked apart. … Read More »

AI, Data Warehousing, and How to Handle the Hype

Bill Kotraba
Thu, 05/03/2018

Recently, I read some articles showcasing technology hype versus what organizations really need. While all sectors suffer from an overload of hype, healthcare’s complexity means it gets hit particularly hard.

For example, there’s a crescendo of noise surrounding Artificial Intelligence (AI) right now. One thing that often gets left out is an age-old maxim: garbage in, garbage out. If you want good results from AI, you need a solid data strategy and enterprise data layer. The more data – good data – that we can feed into the AI algorithms, the more useful they will become. That means we need accurate, harmonized data from all data sources across the continuum of care, including EHR data, machine data, and user-generated data.

This article synopsizes a recent ONC Report on the impact AI will have on healthcare. While recognizing some early AI successes, it also explores future challenges faced by organizations that want to realize its benefits. One significant danger: Putting AI projects in silos rather than looking at multiple AI projects holistically. (We’ve seen this happen before with population health and care management.) In an environment with multiple vendors,… Read More »

Trusted Data and Actionable Analytics in Healthcare

Beth Adams
Thu, 04/26/2018

Did you know that real-time feedback about clinical, financial, and administrative metrics can provide extra visibility into the information that is most critical for your organization? And once you have that visibility, then your firm can maximize their productivity and effectiveness.

We have recently developed this cool asset that you may find interesting. It’s an eBook, and the topic is Success in Healthcare. The information in this eBook can be applied to almost any type of company that works with payers, providers, or clients.

Read this eBook and see great examples of what advanced technologies can be used to achieve a successful organizational strategy. Some of the real-world case studies should how to reduce costs, visualize performance metrics, and boost performance.

Download it here and let us know what you think.

Preparing for the next wave of Medicare Advantage enrollees

Santosh Padhiari
Thu, 04/19/2018

Created in 1965, Medicare is the federal health insurance program for people ages 65 and over, regardless of income, medical history, or health status. The program was expanded in 1972 to cover people under age 65 with permanent disabilities. The program helps to pay for many medical care services, including hospitalizations, physician visits, and prescription drugs, along with post-acute care, skilled nursing facility care, home health care, hospice care, and preventive services. The Medicare Advantage (Part C) refers to the Medicare program where beneficiaries can enroll in a private health plan, such as a health maintenance organization (HMO) or preferred provider organization (PPO), and receive all Medicare-covered Part A and Part B benefits and typically Part D benefits. Medicare spending accounted for 15% of total federal spending in 2016 and 20% of total national health spending in 2015.

Medicare enrollment is on the rise. According to CMS’s recent media release:

  • Medicare Advantage enrollment is expected to increase to 20.4 million in 2018, a nine percent increase compared to 2017… Read More »

A New Perspective on your Healthcare Data

Dennis McLaughlin
Thu, 04/12/2018

Not a day goes by when I don’t receive an email or see an article about the importance of good data at the point of care. As a proponent of maximizing the value of data this is a hard point to argue against. While this represents a trend in terms of thinking about healthcare data, it isn’t clear if there is a payoff for most practitioners, even if it were more than just an idea or goal.  Why?

Since we recently opened the 2018 MLB regular season, now seems to be the perfect time to include a baseball analogy. It would be hard to argue against the concept that the seasoned baseball announcer represents the pinnacle of “knowledge at your fingertips” and its impact on the craft of calling a game in real time. The traditions of the game dictate that especially on the radio, there are a myriad of statistics on the players, the teams, the opponents, and the ballpark itself that shape the perspective of every moment of every game. The announcer is perched in the announcers booth next to the press box with his/her cheat sheet, books, notes, a computer, and a co-announcer (with the same tools available), ready to react with the ‘perfect’ commentary based on what unfolds on the field.

But is this really the scenario we want played out in the precious moments… Read More »

Information Builders Drives Healthcare Transformation at #HIMSS18

Beth Adams
Thu, 03/01/2018

Every year at HIMSS, attendees are given a tremendous opportunity to learn from healthcare’s top experts. This year will prove no different as clinicians, executives, vendors, and IT professionals come together this March to explore the potential of the healthcare industry in 2018. Once again, you’ll find Information Builders talking about Omni-HealthData on the exhibition hall floor at booth #4069, eager to meet and discuss how the ways data can transform healthcare!

Information Builders Drives Healthcare Transformation at #HIMSS18

With the move to value-based and patient-centered care, now more than ever before, healthcare payers and providers need effective BI, analytics, and data management technologies. Only when information from across the healthcare ecosystem is integrated and validated to create a single view of the patient, can payers and providers make clear and data-driven decisions about operations and patient care. With this in mind, Information Builders launched Omni-HealthData in partnership with St. Luke's University Health Network at HIMSS last year.

We’re excited to continue down this path with St. Luke’s and even more thrilled to announce a new solution for healthcare payers… Read More »