making obamacare work with big data

Making ObamaCare Work With Big Data

Healthcare Use Cases

About Bob

About Vishnu

Overview

• What is wrong with healthcare?• What is ObamaCare?• What does patient data look like?• Risk Adjustment use case• Care Network use case• Apixio’s Big Data solutions

Poll

Are you a:A. ProgrammerB. Data scientistC. ManagerD. Health IT technologistE. Other?

What Is Wrong With Healthcare?

Fee-For-Service

Skyrocketing Cost

84 Million People Under- or Un-Insured

Healthcare Reform

• Liberate Clinical Data• Care Coordination• Efficiency• Risk Adjustment

What Does a Patient Look Like To A Data Scientist?

Structured Data

Text

Scanned Documents

% with Pneumococcal

Vaccine

54%

17%

No CodedHistory in EHR

Coded History

Decision Support Fails Without Access to Required Clinical Data

3 x lower

Coded29%

Non-coded71%

How is Splenectomy documented?

04/11/2023

Poll:

What percent of the key clinical data to you think is missing from the coded layer?

A. 10-25 %B. 25-50 %C. 50-75%D. 75+ %

>63%Missing

Jonathan Everett & Bob Rogers

Real Patient Example

Coded Data

Free Text

Scanned Documents

Other Data Silos

17

Question your assumptions about data.

18

“Heart Failure”in EHR problem list

Is it Heart Failure?

Heart Failure No Heart Failure

… or Chart Failure?

Where is the valuable data?

How Much Data Is There?

Sources: EHR Structured, EHR Text, EHR Scanned, Claims, RAPS

200,000 Pts over 5 years 10 TBStructured: 13 M unique codes

4.8 M CPT, 4.8 M ICD9

Narrati ve: 338 M unique codes98 M CPT, 120 M ICD9

Use Case: Risk Adjustment

How risk scores are used1.01 1.20

Risk Assessment & Risk Scores

CADICD-9 746.85

HCC 138Score: 0.312

Total Score: 0.6

+0.312-------------0.912

Risk Assessment & Risk Scores

Decubitus UlcerICD-9 707.14

HCC 217Score: 0.954

Type II DiabetesICD-9 250.00

HCC 19Score: 0.215

Total Score: 0.6

+0.215+0.954-------------1.769

Where’s the beef?

AssessMonitor Evaluate Treat

MEAT

Manual Chart Audit

1 hour per chart100,000 patients=11.4 PERSON-YEARS!

Use Case: Care Network

Referring MD represented in GreenConsulting MD represented in Blue

29

Referring MD represented in GreenConsulting MD represented in Blue

30

Care Network- Referrals of Interest

How Do We Solve These Problems?

Apixio Architecture High Level

EHR coded data

EHR text documents

EHR scan documents

Claims

ParseOCR

Norm.Load

Client Ingest Pipeline

Patient ObjectModel

GeneralEvent Stream

HCCEvent Stream

QualityEvent Stream

ReferralEvent Stream

3rd PartyEvent Stream

API

Clinical Knowledge Exchange

CareOptimizer

Quality Optimizer

HCCOptimizer

3rd PartyEvent Stream

Application

Eligibility

Provider files

Apixio Platform Physical Architecture

Audit(Trace CF)

Logging(Hive/Trace CF)

Metrics (Graphite)

Apixio Pipeline Receiver (HTTP)

Cassandra Hive/HDFS S3

Apixio REST API

Web TierJava/Python

External Clients End Users

Persistence

ComputeJob Control Pipeline

ApplicationsExperimental Infrastructure

Logging

Apixio Platform Logical Architecture

• Append Only Model in Cassandra• Document Based

L0

L0 – Document Level• Stored in cassandra• 2 Column Family / Customer• Append only

ApixioID DOCID1 DOCID2 DOCID3

Partial Patient Object

Partial Patient Object

Partial Patient Object

Documents Column Family

DocID:<DOCID> ApixioID

APIXIOID

Indices Column Family (2 types of data)

DocHash:<HASH> ApixioID

APIXIOID

L1 – Event Streams

An event is an assertion (fact) about a specific subject (patient) at a specific time

Cassandra

Event Extraction&

Inference

HIVE/HDFS

Event Extraction & Inference

Cassandra

Event Extractors

Event Transformer

HIVE/HDFS

Mapper Reducer

Event Extractors

Event Transformer

Converts Documents/Patients to Events

Combines multiple events to create new events

Event Extraction & Inference

Stacking Composition

Event Extractors

Event Extractors

Event Extractors

Event Extractors

Event Extractors

Event Extractors

Sequencing Composition

Functional Composition of extractors/transformers gives us a scalable flexible inference engine.

Auditing• Access information stored in a tracing CF in cassandra• Append only• Keyed by document

DocID Timestamp1 Timestamp2 Timestamp2

Activity Info Activity Info Activity Info

Audit Column Family

Parsing User Access Timeline

We can reconstruct the timeline of activity on any document once it hits our system.

What happens when something goes wrong?

• Comprehensive Logging through custom appenders (log4j)• All pipeline level events are logged to a trace column family• Real-time metrics logged through graphite.

Thanks!

bob@apixio.com@scientistBob

vvyas@apixio.com@vishnuvyas