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May 24 2011   8:19AM GMT

Implementing cloud based provider performance management

Posted by: Jenny Laurello
Cloud, Cloud computing, Data management, virtualization

Guest post by Matias Klein, Senior Vice President, Technology, Portico Systems


As the health care industry moves further toward accountable, collaborative care delivery, the need for solutions to understand and manage provider performance is becoming more and more critical. In this blog post, I will lay out a high-level approach to rapidly implement the key building blocks necessary to support value-based insurance programs by leveraging “the cloud.” Why the cloud you may ask?   Simply because the cloud increases the speed to the market, lowers upfront costs and adds massive scalability. All of these capabilities are key to creating a competitive advantage and achieving success in today’s rapidly changing health care environment.


Let’s start with a visual example of what a provider performance management solution could look like (see Figure 1).


Figure 1 – Example Provider Performance Management Solution


The first consideration with regard to the design outlined in Figure 1 is to determine where each of the relevant systems will be located.  This is precisely where the cloud comes into play.  Utilizing a cloud enables rapid provisioning of servers via virtualization technology.   By leveraging the cloud, you can avoid costs associated with procuring hardware, software, bandwidth, space and various other IT infrastructure related expenses.  Additionally, it is essential to identify a cloud provider that has a secure, HIPAA-compliant, SAS 70 certified data center.   If you choose a public cloud provider like Amazon Web Services (AWS), be prepared to further harden your deployment in support of HIPAA requirements.  Alternatively, several leading health care IT companies have already established HIPAA-compliant software-as-a-services (SaaS) offerings.


The next key consideration is how clinical data will be collected and integrated with your performance management solution.  There are many standards that support interoperability of clinical performance data (HL7, CCR, web services, etc.).   Unfortunately, uniform adoption of these standards by electronic medical records (EMR), practice management systems (PMS) and hospital information systems (HIS) vendors is spotty at best.  Your best option is to identify a clinical data integration solution that can non-disruptively collect, standardize and securely transport data from multiple vendors.  Don’t be fooled by EMR/PMS/HIS vendors that claim they can do all this for you by deploying their one vendor “integrated” solution.  The fact remains that there are hundreds of clinical information systems vendors, which creates a heterogeneous market place. The one size fits approach is not practical unless you are a health system that owns all of its providers.    


As you will be integrating data from numerous information systems and independent organizations, you’ll also need a Master Data Management (MDM) solution to enable the creation and maintenance of unique provider and patient identity records. Preferably, your MDM solution can link patients and providers for attribution in the context of accountable care.   Once you’ve aggregated and mastered your data, you’ll also need a Clinical Data Warehouse (CDW) with a Clinical Rules Engine to store and crunch the data.  Finally, you’ll need a powerful analytics tools to create drill-down dashboards and provide accessible reports in support of transparency of performance calculations.  Look for analytics platforms that can slice and dice your performance data by multiple dimensions, including by provider network, patient population, demographic characteristics and quality measures.  Ideally, you should find a vendor that can also offer you scenario-based reimbursement models. This will enable you to model “what if” scenarios against pay-for-performance contracts to identify strategic improvement opportunities that will drive better outcomes and high-levels of reimbursement.


Hopefully you now have a clear idea of what it will take to deploy your own game-changing provider performance management solution in the cloud.  Given the changes occurring in the health care industry, due to health care reform and the drive toward accountable care, the time is now for making the foundational investments in a provider performance management solution.  If you are interested in the solution described in this blog post and you’re looking for a health care cloud provider that can get you up and running quickly, feel free to drop my company a line. 


Please visit Portico Systems for more information.

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