Category Archives: Healthcare
In a previous life, I was a pastry chef in a now-defunct restaurant. One of the things I noticed while working there (and frankly while cooking at home) is that the better the ingredients, the better the final result. If we used poor quality apples in the apple tart, we ended up with a soupy, flavorless mess with a chewy crust.
The same analogy can be applied to Data Analytics. With poor quality data, you get poor results from your analytics projects. We all know that companies that can implement fantastic analytic solutions that can provide near real-time access to consumer trends are the same companies that can do successful targeted marketing campaigns that are of the minute. The Data Warehousing Institute estimates that data quality problems cost U.S. businesses more than $600 billion a year.
The business impact of poor data quality cannot be underestimated. If not identified and corrected early on, defective data can contaminate all downstream systems and information assets, jacking up costs, jeopardizing customer relationships, and causing imprecise forecasts and poor decisions.
- To help you quantify: Let’s say your company receives 2 million claims per month with 377 data elements per claim. Even at an error rate of .001, the claims data contains more than 754,000 errors per month and more than 9.04 million errors per year! If you determine that 10 percent of the data elements are critical to your business decisions and processes, you still must fix almost 1 million errors each year!
- What is your exposure to these errors? Let’s estimate the risk at $10 per error (including staff time required to fix the error downstream after a customer discovers it, the loss of customer trust and loyalty and erroneous payouts. Your company’s risk exposure to poor quality claims data is $10 million a year.
Once your company values quality data as a critical resource – it is much easier to perform high-value analytics that have an impact on your bottom line. Start with creation of a Data Quality program. Data is a critical asset in the information economy, and the quality of a company’s data is a good predictor of its future success.
Every year, I get a replacement desk calendar to help keep all of our activities straight – and for a family of four, that is no easy task. I start with taking all of the little appointment cards the dentist, orthodontist, pediatrician and GP give to us for appointments that occur beyond the current calendar dates. I transcribe them all. Then I go through last year’s calendar to transfer any information that is relevant to this year’s calendar. And finally, I put the calendar down in the basement next to previous year calendars so I can refer back to them if I need. Last year’s calendar contains a lot of useful information, but no longer has the ability to solve my need to organize schedules for this year.
In a very loose way – this is very similar to application retirement. Many larger health plans have existing systems that were created several years (sometimes even several decades) ago. These legacy systems have been customized to reflect the health plan’s very specific business processes. They may be hosted on costly hardware, developed in antiquated software languages and rely on a few developers that are very close to retirement. The cost of supporting these (most likely) antiquated systems can be diverting valuable dollars away from innovation.
The process that I use to move appointment and contact data from one calendar to the next works for me – but is relatively small in scale. Imagine if I was trying to do this for an entire organization without losing context, detail or accuracy!
There are several methodologies for determining the best strategy for your organization to approach software modernization, including:
- Architecture Driven Modernization (ADM) is the initiative to standardize views of the existing systems in order to enable common modernization activities like code analysis and comprehension, and software transformation.
- SABA (Bennett et al., 1999) is a high-level framework for planning the evolution and migration of legacy systems, taking into account both organizational and technical issues.
- SRRT (Economic Model to Software Rewriting and Replacement Times), Chan et al. (1996), Formal model for determining optimal software rewrite and replacement timings based on versatile metrics data.
- And if all else fails: Model Driven Engineering (MDE) is being investigated as an approach for reverse engineering and then forward engineering software code
My calendar migration process evolved over time, your method for software modernization should be well planned prior to the go-live date for the new software system.
I live in a very small town in Maine. I don’t spend a lot of time thinking about my privacy. Some would say that by living in a small town, you give up your right to privacy because everyone knows what everyone else is doing. Living here is a choice – for me to improve my family’s quality of life. Sharing all of the details of my life – not so much.
When I go to my doctor (who also happens to be a parent from my daughter’s school), I fully expect that any sort of information that I share with him, or that he obtains as a result of lab tests or interviews, or care that he provides is not available for anyone to view. On the flip side, I want researchers to be able to take my lab information combined with my health history in order to do research on the effectiveness of certain medications or treatment plans.
As a result of this dichotomy, Congress (in 1996) started to address governance regarding the transmission of this type of data. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a Federal law that sets national standards for how health care plans, health care clearinghouses, and most health care providers protect the privacy of a patient’s health information. With certain exceptions, the Privacy Rule protects a subset of individually identifiable health information, known as protected health information or PHI, that is held or maintained by covered entities or their business associates acting for the covered entity. PHI is any information held by a covered entity which concerns health status, provision of health care, or payment for health care that can be linked to an individual.
Many payers have this type of data in their systems (perhaps in a Claims Administration system), and have the need to share data between organizational entities. Do you know if PHI data is being shared outside of the originating system? Do you know if PHI is available to resources that have no necessity to access this information? Do you know if PHI data is being shared outside your organization?
If you can answer yes to each of these questions – fantastic. You are well ahead of the curve. If not – you need to start considering solutions that can
- Identify PHI in all of your data streams
- Monitor and track the flow of this data throughout your organization and
- Mask this data if it is being shared with resources that don’t need to be able to identify the individual.
I want to researchers to have access to medically relevant data so they can find the cures to some horrific diseases. I want to feel comfortable sharing health information with my doctor. I want to feel comfortable that my health insurance company is respecting my privacy. Now to get my kids to stop oversharing.
I understand that fighting for budget and time to implement analytics is a challenge with all the changes happening in healthcare (ICD-10, M&A, etc.). But hospitals using analytics to drive Value-based care are leading healthcare reform and setting a higher bar for quality of service. Value-based care promises quicker recoveries, fewer readmissions, lower infection rates, and fewer medical errors – something we all want as consumers.
In order to truly achieve value-based care, analytics is a must have. If you are looking for the business case or inspiration for the business driver, here are a few ideas:
- In surgery, do you have the data to show how many patients had lower complication rates and higher long-term survival rates? Do you have that data across the different surgical procedures you offer?
- Do you have data to benchmark your practice quality? How do you compare to other practices in terms of infection rates? Can you use that data to promote your services from a marketing perspective?
- Do you know how much a readmission is costing your hospital?
- From a finance perspective, have you adopted best practices from other industries with respect to supply-chain management or cost optimization strategies?
If you don’t have the expertise, there are plenty of consulting organizations who specialize in implementing analytics to provide insight to make the transition to value-based care and pricing.
We are always going to be facing limited budgets, the day will always have 24 hours in it, and organizations are constantly changing as new leaders take over with a different agenda. But one thing is certain; a decision without data is just someone’s opinion. In healthcare with only half of the executives making decisions based on analytics, maybe we should all be asking for a second opinion – and one based on data.
However, there is another wearable that has my attention – a wearable designed to save children’s lives: Embrace. Embrace is the first medical-quality wearable to help measure stress, epileptic seizures, activity and sleep. The idea is it an be used to detect early signs of an event and alert you when an unusual event is about to happen. If you have a toddler or infant, the wearable could alert parents in the middle of the night. As a mother of four children, peace of mind in the night is king.
Imagine the possibilities.
Biometric data collected from devices like these when used in the classroom could be used as a predictor children with Autism, Asperger Syndrome, or Mood Disorders to help clinicians, educators and parents better understand when a child is starting to become dis regulated. Integrating that data with therapeutic and educational strategies could potentially provide insight into a practice that is largely trial and error.
I pledged my support for Embrace in hopes that innovation in this field will continue to prosper, saving lives, and ultimately making a difference in the world.
At the DIA conference in Berlin this month, Frits Stulp of Mesa Arch Consulting suggested that IDMP could get the business asking for MDM. After looking at the requirements for IDMP compliance for approximately a year, his conclusion from a business point of view is that MDM has a key role to play in IDMP compliance. A recent press release by Andrew Marr, an IDMP and XEVMPD expert and specialist consultant, also shows support for MDM being ‘an advantageous thing to do’ for IDMP compliance. A previous blog outlined my thoughts on why MDM can turn regulatory compliance into an opportunity, instead of a cost. It seems that others are now seeing this opportunity too.
So why will IDMP enable the business (primarily regulatory affairs) to come to the conclusion that they need MDM? At its heart, IDMP is a pharmacovigilance initiative which has a goal to uniquely identify all medicines globally, and have rapid access to the details of the medicine’s attributes. If implemented in its ideal state, IDMP will deliver a single, accurate and trusted version of a medicinal product which can be used for multiple analytical and procedural purposes. This is exactly what MDM is designed to do.
Here is a summary of the key reasons why an MDM-based approach to IDMP is such a good fit.
1. IDMP is a data Consolidation effort; MDM enables data discovery & consolidation
- IDMP will probably need to populate between 150 to 300 attributes per medicine
- These attributes will be held in 10 to 13 systems, per product.
- MDM (especially with close coupling to Data Integration) can easily discover and collect this data.
2. IDMP requires cross-referencing; MDM has cross-referencing and cleansing as key process steps.
- Consolidating data from multiple systems normally means dealing with multiple identifiers per product.
- Different entities must be linked to each other to build relationships within the IDMP model.
- MDM allows for complex models catering for multiple identifiers and relationships between entities.
3. IDMP submissions must ensure the correct value of an attribute is submitted; MDM has strong capabilities to resolve different attribute values.
- Many attributes will exist in more than one of the 10 to 13 source systems
- Without strong data governance, these values can (and probably will be) different.
- MDM can set rules for determining the ‘golden source’ for each attribute, and then track the history of these values used for submission.
4. IDMP is a translation effort; MDM is designed to translate
- Submission will need to be within a defined vocabulary or set of reference data
- Different regulators may opt for different vocabularies, in addition to the internal set of reference data.
- MDM can hold multiple values/vocabularies for entities, depending on context.
5. IDMP is a large co-ordination effort; MDM enables governance and is generally associated with higher data consistency and quality throughout an organisation.
- The IDMP scope is broad, so attributes required by IDMP may also be required for compliance to other regulations.
- Accurate compliance needs tracking and distribution of attribute values. Attribute values submitted for IDMP, other regulations, and supporting internal business should be the same.
- Not only is MDM designed to collect and cleanse data, it is equally comfortable for data dispersion and co-ordination of values across systems.
Once business users assess the data management requirements, and consider the breadth of the IDMP scope, it is no surprise that some of them could be asking for a MDM solution. Even if they do not use the acronym ‘MDM’ they could actually be asking for MDM by capabilities rather than name.
Given the good technical fit of a MDM approach to IDMP compliance, I would like to put forward three arguments as to why the approach makes sense. There may be others, but these are the ones I feel are most compelling:
1. Better chance to meet tight submission time
There is slightly over 18 months left before the EMA requires IDMP compliance. Waiting for final guidance will not provide enough time for compliance. Using MDM you have a tool to begin with the most time consuming tasks: data discovery, collection and consolidation. Required XEVMPD data, and the draft guidance can serve as a guide as to where to focus your efforts.
2. Reduce Risk of non-compliance
With fines in Europe of ‘fines up to 5% of revenue’ at stake, risking non-compliance could be expensive. Not only will MDM increase your chance of compliance on July 1, 2016, but will give you a tool to manage your data to ensure ongoing compliance in terms of meeting deadlines for delivering new data, and data changes.
3. Your company will have a ready source of clean, multi-purpose product data
Unlike some Regulatory Information Management tools, MDM is not a single-purpose tool. It is specifically designed to provide consolidated, high-quality master data to multiple systems and business processes. This data source could be used to deliver high-quality data to multiple other initiatives, in particular compliance to other regulations, and projects addressing topics such as Traceability, Health Economics & Outcomes, Continuous Process Verification, Inventory Reduction.
So back to the original question – will the introduction of IDMP regulation in Europe result in the business asking IT to implement MDM? Perhaps they will, but not by name. It is still possible that they won’t. However, for those of you who have been struggling to get buy-in to MDM within your organisation, and you need to comply to IDMP, then you may be able to find some more allies (potentially with an approved budget) to support you in your MDM efforts.
CMS points out the overall improvement in quality which they position as the result of focusing, and incenting quality. I agree that putting funding behind a quality program was a valuable strategy to motivate the industry. This has not always been the case, in fact a former colleague who related a common dialog previous to this program:
- He would present a quality initiative to executive management
- They would nod politely and say, “Yes, of course we are interested in quality!”
- The conversation would continue until the cost of the program was disclosed.
The faces would change, and the response was, “Well, yes, quality is important, but funding is tight right now. We need to focus on programs with a clear ROI”.
Thankfully the Star program has given quality initiatives a clear ROI – for which we are all grateful!
The other dynamic which is positive is that Medicare Advantage has provided a testing ground for new programs, largely the result of ACA. Programs very similar to the Star program are part of the ACO program and the marketplace membership. Risk Adjustment is being fitted to meet these programs also. Private insurance will likely borrow similar structures to insure quality and fair compensation in their various risk sharing arrangements. MA is a significant subset of the population and is providing an excellent sandbox for these initiatives while improving the quality of care that our senior population receives.
My concerns are around the cultures and mission of those plans who are struggling to get to the magic four star level where they will receive the bonus dollars.
Having worked in a health plan for almost nine years, and continuing to interact with my current customers, has shown me the dedication of the staffs that work in these plans. One of my most rewarding experiences was leading the call center for the Medicare population. I was humbled each day by the caring and patience the reps on the phones showed to the senior population. I have also seen the dedication of clinical staffs to insuring the care for members is carefully coordinated and that their dignity and wishes were always respected. I sincerely hope that plans with a clear mission find the right tools and supports to improve their ratings to the point where they receive the additional funding to maintain their viability and continue to serve their members and the medical community. I am sure that there are poor quality plans out there, and I agree that they should be eliminated. But I am also rooting for the plans with a mission who are striving to be a bit better.
What is our personal information worth?
With this 2014 holiday season rolling into full swing, Americans will spend more than $600 Billion, a 4.1% increase from last year. According to the Credit Union National Association, a poll showed that 45% of credit and debit card users will think twice about how they shop and pay given the tens of millions of shoppers impacted by breaches. Stealing identities is a lucrative pastime for those with ulterior motives. The Black Market pays between $10-$12 per stolen record. Yet when enriched with health data, the value is as high as $50 per record because it can be used for insurance fraud.
Are the thieves getting smarter or are we getting sloppy?
With ubiquitous access to technology globally, general acceptance to online shopping, and the digitization of health records, there is more data online with more opportunities to steal our data than ever before. Unfortunately for shoppers, 2013 was known as ‘the year of the retailer breach’ according to the Verizon’s 2014 data breach report. Unfortunately for patients, Healthcare providers were most noted for the highest percentage of losing protected healthcare data.
So what can we do to be a smarter and safer consumer?
No one wants to bank roll the thieves’ illegal habits. One way would be to regress 20 years, drive to the mall and make our purchases cash in hand or go back to completely paper-based healthcare. Alternatively, here are a few suggestions to avoid being on the next list of victims:
1. Avoid irresponsible vendors and providers by being an educated consumer
Sites like The Identify Theft Resource Center and the US Department of Health and Human Services expose the latest breaches in retail and healthcare respectively. Look up who you are buying from and receiving care from and make sure they are doing everything they can to protect your data. If they didn’t respond in a timely fashion, tried to hide the breach, or didn’t implement new controls to protect your data, avoid them. Or take your chances.
2. Expect to be hacked, plan for it
Most organizations you trust with your personal information have already experienced a breach. In fact, according to a recent survey conducted by the Ponemon Group sponsored by Informatica, 72% of organizations polled experienced a breach within the past 12 months; more than 20% had 2 or more breaches in the same timeframe. When setting passwords, avoid using words or phrases that you publicly share on Facebook. When answering security questions, most security professionals suggest that you lie!
3. If it really bothers you, be vocal and engage
Many states are invoking legislation to make organizations accountable for notifying individuals when a breach occurs. For example, Florida enacted FIPA – the Florida Information Protection Act – on July 1, 2014 that stipulates that all breaches, large or small, are subject to notification. For every day that a breach goes undocumented, FIPA stipulates $1,000 per day penalty up to an annual limit of $500,000.
In conclusion, as the holiday shopping season approaches, now is the perfect time for you to ensure that you’re making the best – and most informed – purchasing decisions. You have the ability to take matters into your own hands; keep your data secure this year and every year.
To learn more about Informatica Data Security products, visit our Data Privacy solutions website.
The Rising CFO is Increasingly Business Oriented
At the CFO Rising West Conference on October 30th and 31st, there were sessions on managing capital expenditures, completing an IPO, and even managing margin and cash flow. However, the keynote presenters did not spend much of time on these topics. Instead, they focused on how CFOs need to help their firms execute better. Here is a quick summary of the suggestions made from CFOs in broadcasting, consumer goods, retail, healthcare, and medical devices.
The Modern CFO is Strategic
The Broadcasting CFO started his talk by saying he was not at the conference to share why CFOs need to move from being “bean counters to strategic advisors”. He said “let’s face it the modern CFO is a strategic CFO”. Agreeing with this viewpoint, the Consumer Goods CFO said that finance organizations have a major role to play in business transformation. He said that finance after all is the place to drive corporate improvement as well as business productivity and business efficiency.
CFOs Talked About Their Business’ Issues
The Retailer CFO talked like he was a marketing person. He said retail today is all about driving a multichannel customer experience. To do this, finance increasingly needs to provide real business value. He said, therefore, that data is critical to the retailer’s ability to serve customers better. He claimed that customers are changing how they buy, what they want to buy, and when they want to buy. We are being disrupted and it is better to understand and respond to these trends. We are trying, therefore, to build a better model of ecommerce.
Meanwhile, the Medical Devices CFO said that as a supplier to medical device vendors “what we do is compete with our customers engineering staffs”. And the Consumer Goods CFO added the importance of finance driving sustained business transformation.
CFOs Want To Improve Their Business’ Ability To Execute
The Medical Devices CFO said CFOs need to look for “earlier execution points”. They need to look for the drivers of behavior change. As a key element of this, he suggested that CFOs need to develop “early warning indicators”. He said CFOs need to actively look at the ability to achieve objectives. With sales, we need to ask what deals do we have in the pipe? At what size are these deals? And at what success rate will these deals be closed? Only with this information, can the CFO derive an expected company growth rate. He then asked CFOs in the room to identify themselves. With their hands in the air, he asked them are they helping to create a company that executes or not. He laid down the gauntlet for the CFOs in the room by then asserting that if you are not creating a company that executes then are going to be looking at cutting costs sooner rather than later.
The retailer CFO agreed with this CFO. He said today we need to focus on how to win a market. We need to be asking business questions including:
- How should we deploy resources to deliver against our firm’s value proposition?
- How do we know when we win?
CFOs Claim Ownership For Enterprise Performance Measurement
The Retail CFO said that finance needs to own “the facts for the organization”—the metrics and KPIs. This is how he claims CFOs will earn their seat at the CEOs table. He said in the past the CFO have tended to be stoic, but this now needs to change.
The Medical Devices CFO agreed and said enterprises shouldn’t be tracking 150 things—they need to pare it down to 12-15 things. They need to answer with what you measure—who, what, and when. He said in an execution culture people need to know the targets. They need measurable goals. And he asserted that business metrics are needed over financial metrics. The Consumer Goods CFO agreed by saying financial measures alone would find that “a house is on fire after half the house had already burned down”. The Healthcare CFO picked up on this idea and talked about the importance of finance driving value scorecards and monthly benchmarks of performance improvement. The broadcaster CFO went further and suggested the CFO’s role is one of a value optimizer.
CFOs Own The Data and Drive a Fact-based, Strategic Company Culture
The Retail CFOs discussed the need to drive a culture of insight. This means that data absolutely matters to the CFO. Now, he honestly admits that finance organizations have not used data well enough but he claims finance needs to make the time to truly become data centric. He said I do not consider myself a data expert, but finance needs to own “enterprise data and the integrity of this data”. He said as well that finance needs to ensure there are no data silos. He summarized by saying finance needs to use data to make sure that resources are focused on the right things; decisions are based on facts; and metrics are simple and understandable. “In finance, we need use data to increasingly drive business outcomes”.
CFOs Need to Drive a Culture That Executes for Today and the Future
Honestly, I never thought that I would hear this from a group of CFOs. The Retail CFO said we need to ensure that the big ideas do not get lost. We need to speed-up the prosecuting of business activities. We need to drive more exponential things (this means we need to position our assets and resources) and we need, at the same time, to drive the linear things which can drive a 1% improvement in execution or a 1% reduction in cost. Meanwhile, our Medical Device CFO discussed the present value, for example, of a liability for rework, lawsuits, and warranty costs. He said that finance leaders need to ensure things are done right today so the business doesn’t have problems a year from today. “If you give doing it right the first time a priority, you can reduce warranty reserve and this can directly impact corporate operating income”.
CFOs need to lead on ethics and compliance
The Medical Devices CFO said that CFOs, also, need to have high ethics and drive compliance. The Retail CFO discussed how finance needs to make the business transparent. Finance needs to be transparent about what is working and what is not working. The role of the CFO, at the same time, needs to ensure the integrity of the organization. The Broadcaster CFO asserted the same thing by saying that CFOs need to take a stakeholder approach to how they do business.
In whole, CFOs at CFO Rising are showing the way forward for the modern CFOs. This CFO is all about the data to drive present and future performance, ethics and compliance, and business transparency. This is a big change from the historical controller approach and mentality. I once asked a boss about what I needed to be promoted to a Vice President; my boss said that I needed to move from a technical specialist to a business person. Today’s CFOs clearly show that they are a business person first.
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