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SESSION #4Changing the Digital Trajectory of HealthcareDale SandersPresident, TechnologyHealth Catalyst

For the record I will frequently refer to HealthCatalyst’s strategy and products inthis lecture, but only by necessityto emphasize the concepts I’m not selling products I’m advocating concepts andprinciples that everyone-- allvendors-- should follow Just like these fine youngmen

The story in today’s discussion Why do we need to change the currentdigital trajectory? What’s the business case for a DataOperating System What is a Data Operating System and howdid we get here? What difference will DOS make? What should we do with it and whatshould we expect?

But the military has changed, adapted and transformed itself

Advice to C-levels about a digital health future1. For better or worse, faster or slower, your company runs at thespeed of software now2. Everything you want and need to do is either helped or hinderedby software and data3. All C-levels now need to be a little bit Chief InformationOfficer and Chief Digital OfficerThank you, Russel Reynolds Associates for the graphic

Raise your digital IQ, or else If you choose not to be informed, good luck

“Healthcare CEO, what isyour organization’sDigital Quotient?”Healthcare is one of theleast digital sectors, and itshows in profit margingrowth.DQ Data Assets x Data Usage x Data Skilled LaborSource: McKinsey Corporate Performance Analysis Tool

Digital disruption is already happening The world’s largest taxi company owns no taxis The world’s largest voice/video communications companies own no telco The most popular media company owns no content The largest lodging company owns no property The world’s most valuable retailer owns no inventory The world’s largest software vendors don’t write the appsThanks for the inspiration, Ron Kalifa of Worldpay; and IBM

In the digital future of healthcare The world’s largest and most successfulhealthcare and health management companies,will own no hospitals10

Two fundamental requirements to be “digitized”1.2.Digitize the thing or things youare trying to manage andoptimizeAirplanesDigitize your process ofmanaging the thing you are tryingto manage and optimizeAir traffic control,baggage tsRegistration,scheduling,encounters,diagnosis, orders,billing, claims

Outside the ICU, we haven’t digitized the patient andwe’ve done a crappy job of digitizing our processes

Digitization of the patient and healthcare processWe’re collecting data on the backs of physicians and nurses, and that won’t scaleLots of great ideas for applications and machine learning, but where’s the data?We need to invest significantly in diagnostic and process of care sensorsPwC, 2015

The parallels between health and car maintenanceAn ounce of prevention is worth a pound of cure Every 10 hours, Tesla collects 1 million miles ofdriving data 25Gbytes per car per hour We collect 100Mbytes per patient peryear, on average “We can fix problems in your car and make itsafer, long before you know you need it.” ”10,000 fatalities and 500,000 injuries per yearwill be prevented.” Ram Ramachander, Chief Commercial Officer, Social InnovationBusiness at Hitachi

80% of Factors Affecting Health Outcomes FallOutside Traditional Healthcare Delivery

But we have an EMR Only 8% of data required for a population health and precisionmedicine initiative resides in today’s EMR/EHR Alberta Innovates Health Solutions, Secondary Data Use Project,March 2016

This is my lifeThis is healthcare’sdigital view of my life

Humans gravitate towards freedom of choice6 billion smart phones by 2020 in a world population of 8 billion

Evolution of healthcare IT

In the meantime, this is what’s possible 103 applications on my iPhone 89 different vendors They build on a common platform with opensoftware standards I wouldn’t expect nor hope for a singlevendor to meet all my needs20

Modern software concepts & designs Analytics are embedded it’s ambient to the user interface experienceFrom a blog I wrote in 2010“What if Facebook built an EHR?” Patient’s evolving health story at thecenter of the record Embedded video and images Integrated text and discrete data Secure messaging Social support from family & friends Flexible security, defined by thepatient

EMR screen shot

In traditional healthcare datawarehousing, this curvetakes too long—hours, daysSilicon Valley gives us agood role model forcompressing the curve

If you miss the soft side of humanity on the data anddigital journey, it’s going to backfire on youFindThe Truth Nebulous in healthcare Relative to point of view Tribalism trumps factsTellThe Truth Presentation matters Diplomacy, sensitivity Mastery, Autonomy, PurposeFaceThe Truth Humility Openness Community vs IndividualThe Nebraska Cornhuskers story with Brent Musberger

Poll Question #1At 35B in US government incentives and 105B from the budgets ofhealthcare systems and physician offices, how would you describe thereturn on investment in Electronic Medical Records, in terms of their totalbenefits to US healthcare?a) Terribleb) Poorc) Mediocred) Positivee) Superb

So, what’s a DataOperating System?

Using related concepts DOS is a combination of the following,but enabled by modern technology,designs, and software 1. HIE2. Clinical Data Repository3. Enterprise Data WarehouseDOS is a platform of constantly updated raw and organizeddata, within a domain such as healthcare, that enablesrapid development and changes to the softwareapplications built upon it.

DOS is a Hybrid ArchitectureGartner: Hybrid Transactional/Analytical Processing (HTAP)“Because traditional data warehouse practices will be outdated by the end of 2018,data warehouse solution architects must evolve toward a broader data managementsolution for analytics.”Reservationdogs, aka,“rez dogs”are the best

As computer scientists, we overlooked the last andcritically important layer in the technology stack The Data Layer

Three precipitating events led to the DOS concept30

1. Our Enterprise Data Warehouse at NorthwesternUniversity Medicine, 2005-2009

Fast forward to 2016: New technology and designsKappa architecture from Silicon Valley One data stream for batch and real-time computations in the serving layer One code setKappa architectures can beimplemented with a combinationof open source tools like ApacheKafka, Apache HBase, ApacheHadoop (HDFS, MapReduce),Apache Spark, Apache Drill,Spark Streaming, Apache Storm,and Apache Samza.Note of thanks to Julian Forgeat of Google

2. Realizing the breadth of the human healthdata ecosystem What data do we need for research, personalized care, and community health?And, by the way, we have barelyany data on healthy patients

3. The ”Shark Tank” story20 Healthcare IT startupsPitching great softwareapplications and creativeideasIn my head: “We must give these great ideas and applications thedata they need. They cannot possibly afford to build the data datainfrastructure and skills that we have in Health Catalyst. They andthe industry can’t afford it.”

For dramatic impact, let me quickly share with youthe data content & sources in the Health Catalystlibrary and it’s growing everyday

EMR Data Sources1. Affinity - ADT/Registration2. Allscripts - Ambulatory EMR Clinicals3. Allscripts Enterprise/Touchworks - Ambulatory EMR4. Allscripts Sunrise - Acute EMR Clinicals5. Aprima ERM6. Cerner - Acute EMR Clinicals7. Cerner - PowerWorks Ambulatory EMR8. Cerner HomeWorks - Other9. CPSI - Acute EMR Clinicals10. eClinicalWorks - Ambulatory EMR Clinicals11. Epic - Acute EMR Clinicals12. Epic - Ambulatory EMR Clinicals13. GE (IDX) Centricity - Ambulatory EMR Clinicals14. McKesson Horizon - Acute EMR Clinicals15. McKesson Horizon Enterprise Visibility16. Meditech 5.66 EHR w/DR17. NextGen - Ambulatory Practice Management18. Quality Systems (Next Gen) - Ambulatory EMR Clinicals19. Siemens Sorian Clinicals - Inpatient EMR

Finance/Costing Data Sources1.2.3.4.5.6.7.Affinity - CostingAllscripts (EPSi) - BudgetAllscripts (EPSi) - CostingAllscripts (TSI) - CostingBOXI - GLCost Flex - CostingDigimax Materials Management - InventoryManagement8. IOS ENVI - Costing9. Kaufman Hall Budget Advisor - Other10. Lawson - Accounts Payable11. Lawson - Accounts Receivable12. Lawson - GL13. Lawson - Supply Chain14. McKesson - Accounts Payable15. McKesson Enterprise Materials Management16. McKesson HPM - Costing17. McKesson HPM - GL18. McKesson PFM - Accounts Payable19. McKesson PFM - GL20. McKesson Series - Accounts Receivable21. Meditech - GL22. Microsoft Great Plains - GL23. Oracle (Hyperion) - Costing24. Oracle (PeopleSoft) - GL25. Oracle (PeopleSoft) - Supply Chain26. PARExpress27. PPM - Costing28. Smartstream - GL29. StrataJazz - Costing

Billing Data Sources1. Affinity - Hospital Billing2. CHMB 360 RCM - Hospital Billing3. CPSI - Hospital Billing4. Epic - Hospital Billing5. GE (IDX) Centricity - Hospital Billing6. GE (IDX) Centricity - Professional Billing7. HealthQuest - Patient Accounting8. Keane - Hospital Billing9. McKesson Series - Patient Billing10. McKesson STAR - Hospital Billing11. MD Associates - Professional Billing12. Siemens Sorian Financials - InpatientRegistration and Billing

HR/ERP Data Sources1. API Healthcare - Time and Attendance2. iCIMS3. Kronos - HR4. Kronos - Time and Attendance5. Lawson - HR6. Lawson - Payroll7. Lawson - Time and Attendance8. Maestro9. MD People10. Now Solutions Empath - HR11. Oracle (PeopleSoft) - HR12. PeopleStrategy/Genesys - HR13. PeopleStrategy/Genesys - Payroll14. Ultimate Software Ultipro - HR15. WorkDay

Claims Data Sources1.2.3.4.5.6.7.8.835 – Denials16. Humana (PPO) - ClaimsAdirondack ACO Medicare17. Humana MA - ClaimsAetna - Claims18. Kentucky Hospital Association (KHA) Anthem - ClaimsClaimsAon Hewitt - Claims19. Medicaid - ClaimsBCBS Illinois20. Medicaid - Claims - CCOBCBS Vermont21. Merit Cigna - ClaimsChildren's Community Health Plan (CCHP) - 22. Merit SelectHealth - ClaimsPayer23. MSSP (CMS) - Claims9. Cigna - Claims24. NextGen (CMS) - Claims10. CIT Custom - Claims25. Ohio Hospital Association (OHA) - Claims11. Cone Health Employee Plan (United26. ProHealth - ClaimsMedicare) - Claims27. PWHP Custom - Claims12. Discharge Abstract Data (DAD)28. QXNT - Claims13. Hawaii Medical Service Association (HMSA) - 29. UMR Claims SourceClaims30. Wisconsin Health Information Organization14. HealthNet - Claims(WHIO) - Claims15. Healthscope40

Clinical Specialty Data Sources1. Allscripts - CaseManagement2. Apollo - Lumed X SurgicalSystem3. Aspire - CardiovascularRegistry4. Carestream - Other5. Cerner - Laboratory6. eClinicalWorks - MountainKidney Data Extracts7. GE (IDX) Centricity Muse Cardiology8. HST Pathways - Other9. ImageTrend10. ImmTrac11. Lancet Trauma Registry12. MacLab (CathLab)13. MIDAS - InfectionSurveillance14. MIDAS - Other15. MIDAS - Risk Management16. Navitus - Pharmacy17. NHSN18. NSQIPFlatFile19. OBIX - Perinatal20. OnCore CTMS21. Orchard Software Harvest Pathology22. PACSHealth - Radiology23. Pharmacy Benefits Manager24. PICIS (OPTUM)Perioperative Suite25. Provation26. Quadramed Patient AcuityClassification System - Other27. QXNT/Vital - Member28. RLSolutions29. SafeTrace30. Siemens RIS - Radiology31. SIS Surgical Services32. StatusScope - ClinicalDecisions33. Sunquest - Laboratory34. Sunrise Clinical Manager35. Surgical Information System36. TheraDoc37. TransChart - Other38. Varian Aria - Oncology39. Vigilanz - Infection Control

Health Information Exchange (HIE) Data1. Adirondack ACO Clinical Data from HIXNY (HIE)2. ADT HIE Patient Programs3. Vermont HIE

Patient Satisfaction Data Sources1.2.3.4.5.6.Fazzi - Patient SatisfactionHealthStream - Patient SatisfactionNRC Picker - Patient SatisfactionPRC - Patient SatisfactionPress Ganey - Patient SatisfactionSullivan Luallin - Patient Satisfaction