Data Security and Analytics

Shaping the future of healthcare

Baskaran Gopalan, Senior Vice President, IT & Projects, Omega Healthcare Management Services Pvt. Ltd.

The article talks about digitisation of medical records highlighting role of Predictive Healthcare Analytics & Big Data in optimising Indian and global healthcare industry. It also brings out the need of IT security in the healthcare domain for data protection and compliance in the same segment.

The healthcare industry has been undergoing tremendous change thanks to the ever advancing innovation in computing technologies. According to a recent report released by Springboard Research, the growth in healthcare IT market in India has been the highest in Asia. A few studies also forecast Indian medical technology market to grow from US$2.7 billion in 2008 to US$14 billion in 2020.

The recent advent of analytics has impacted the scenario of patient services in healthcare including the management and delivery of healthcare, governance and more. As the demand for improved healthcare services rise, the need for securing patient healthcare data and easing access to it also grows manifold.

The need and demand for big data analytics has grown tremendously owing to the deep insights that can be obtained to help resolve challenges and improve services. Data analysis and insights have been made a lot easier with the use of big data platform that is capable of processing terabytes and pet bytes of data.

Big data analytics has now become a necessity for all healthcare service providers. Insightful information regarding their management, planning, and the relevant measurements can help healthcare organisations to develop their future vision, optimise time and resources, and scale their financial outcomes.

Data Analytics in Healthcare

Data Analytics can be utilised in the healthcare industry for many purposes:

Public Health:  Public health issues can be addressed with a detailed analysis of healthcare data covering disease patterns and records of disease outbreaks. Healthcare crises can be predicted and prevented, thereby improving the quality of care provided.

Electronic Medical Record (EMR): An EMR is a consolidation of structured and unstructured medical data for a given individual. A digitised version of the healthcare reports and prescriptions will help in continual treatment giving quick access to a patient’s healthcare history.

Patient Profile Analytics: This advanced analytics when applied to patients’ profile can help identify any impending health risks and facilitate preventive care.

Fraud Analysis: Effective data analytics can reduce fraud, waste and abuse by thorough analysis of claim requests and identifying claims with incorrect and incomplete information well before submission.

Safety Monitoring: Data analytics can help in safety monitoring and negative event prediction by real time analysis of large volumes of data in hospitals.

Baby Steps of IT in Healthcare

While the World Wide Web came about in the late 1900s, Gustav Wagner had already foreseen the need for technology in healthcare and came up with a professional organisation for health informatics in Germany. The platform Health Information Technology (HIT) created by him is dedicated to process information using hardware and software. HIT is beneficial in storing and using information on healthcare, data and knowledge to communicate and help make decisions. The platform utilises communication and computers to build systems and share health information.

In early 1990, the United States healthcare industry started to be driven by competition. Many households and industries resorted to using ICT as momentum in Internet usage grew. This gave rise to the need of adopting IT in healthcare. Even though it started only with helping the service provider with process-oriented systems, the focus eventually shifted to being a patient-centered and outcome-oriented platform. In the late 1990s, the need for more integrated healthcare facilities, providers, and better managed care offerings was felt in the healthcare BPO industry.

Year 2000 saw the use of technology to increase productivity. Electronic Medical Records (EMR) started being adopted. The HIPPA Act which was passed in late 1990s, brought in a greater emphasis on EMRs and EHRs. With continuous flow of information, it created a platform for global digital healthcare infrastructure. Cloud computers along with cloud-based big data analytics came together and became the driving force for customer requirements for value added services.

At the same time, Health Information Exchanges (HIEs) earlier referred to as RHIOs (Regional Health Information Organisation) came about.

Need for IT in Healthcare

The Indian Brand Equity Foundation (IBEF) states that India is considered to be the largest Information Technology (IT) sourcing destination in the world. It accounts for approximately 67 per cent of the US$124-130 billion market, with about 10 million workers. India’s USP, according to the report, is its cost competitiveness in providing IT services. This accounts for services being approximately four times cheaper when compared to the United States. The recent change observed is in the growth of intellectual capital in the country with a number of global IT firms setting up their innovation centers in India. The emergence of IT solutions in healthcare is a consequence of the need to improve outcomes and slash costs. But, this process is heavily data-intensive. The need to protect data came along with the changing process. IT started playing an important role in the healthcare sector in late 1960s when the techniques to utilise its advantages recognised. This was when hospitals and healthcare providers understood the need to save data digitally.

The benefits of this are many: it eases access to patients’ medical histories during follow-up; with data being saved in the cloud, it can be accessed from anywhere. Likewise, IT has also made medical billing easy and accurate. With the help of medical coders, the hospitals are able to utilise their resources optimally and not engage them with the process of manual billing.

Use of Electronic Health Records (EHRs)

How many times have physicians opened a file containing lab reports and prescriptions without dropping any of them? While handwritten prescriptions have been a norm since ages, their drawbacks are aplenty. Apart from the trouble in analysing the content on the prescription, papers are difficult to store as they age with time. Sometimes, they also get misplaced which leads to loss of valuable data. They also cannot be accessed with ease at any given point in time. However, data that is stored digitally can be accessed anywhere through cloud. The format in which it is stored is also understood by everyone. This data will remain there till such time it is manually deleted. And in case data is lost, there are many ways to retrieve the same.

The format maintained in an EHR is better organised than paper charts or prescriptions. EHR also gives a consolidated list of complications such as major illness, surgeries, allergies and medications that should not be missed during follow-up care or consultation for any other ailment.

One study notes that 25 per cent of paper charts are usually found missing. Even in the presence of papers, specifics were missing in 13.6 per cent of times. President’s Information Technology Advisory Committee reported that they found 20 per cent of laboratory tests being re-ordered as previous medical records were not available.

This makes it important for hospitals to maintain records digitally. To find out how digitising patient’s medical history has improved the efficiency of hospitals, Harris Poll, on behalf of  Ricoh Americas Corporation, conducted a survey. His subjects included 2,053 adults in the United States in 2015. He found that 74 per cent hospitals that used digital platforms such as tablets or some mobile devices to store patient’s information were more efficient. He also found 54 per cent patients to be less anxious when they found healthcare providers to be using digital platforms for data collection.

Improving Revenue Cycle Management

While there is a need for affordable healthcare, the changing regulations and the delayed cash flow directly impact the revenue generated by healthcare facilities. Data is much more than the final outcome of analytics for a healthcare provider. It involves a lot of cost to a company where they would have to employ resources to take care of all the aspects from on-boarding a patient to ensuring that all the data about them is well-maintained.

Innovative use of analytics can help these hospitals gain deeper understanding of the techniques to create quick, accurate, efficient and, most important of all, predictive revenues.

During the consultation process, a lot of iterations take place in claims. They are denied for a number of reasons. Things that usually go wrong include incorrect claims submitted to payer; sometimes the information given doesn’t turn out to be authentic, and there would be additional negotiations in the process. The increasing number of iterations impacts the account receivable cycle. This further impacts profits.

With a sound RCM process in place, top reasons for claim denials such as incorrect patient demographics, eligibility issues and prior-authorisation numbers, can be mapped and a pre-check can be conducted to eliminate any possibility of denial scenarios. Any information found to be incomplete can be updated immediately and resent so that there is no time lag because of lack of information.

The analysis of historic data to understand the time and effort put in to recover underpaid claims can help understand the need for better strategies. For example, if the spent time does not justify the recovered amount, a strategy to automate the process can be devised thereby helping in optimal use of available human resources.

These insights will also help a service provider set a threshold limit on the revenue collection and determine transactions for follow-ups beyond the thresholds.

The combination of data and its analytics play a key role in revenue cycle management process. They help unearth hidden and previously unseen insights to manage the revenue flow more accurately and provide results leading to profit generation for healthcare providers.

Predictive Analytics (PA)

Here a combination of statistical methods and technology are used to analyse large amounts of information and predict outcomes for individual patients. With the help of predictive analytics, there is a systematic process to monitor supply chain efficiencies and improve patient care, chronic disease management and hospital administration. The use of this analytical tool is fast gaining popularity as healthcare systems explore how to best use it to make improvements.

Predictive analytics is most useful when both the predictor and the care intervention are integrated with the same systems. It is easier to identify trends and obtain best results. Data can be compared to analyse the outcomes for all the diseases that a healthcare provider could encounter. Physicians and insurance companies rely on predictive analytics for extensive research and statistical analysis that can range from improvement of patient’s health, post medication, to their readmission rates.

Health Information Privacy and Security

Privacy is a fundamental governing principle of the patient–physician relationship for efficient delivery of healthcare. Patients need to share information with their doctors to facilitate the right diagnosis and effective treatment, especially to avoid selective drug allergy. However, patients might not be comfortable in sharing important information in cases of health problems such as mental illness and HIV as their disclosure may lead to social discrimination. After a period of time, a patient‘s medical record has a collection of personal information that includes identification, past medical history, digital record of medical scans etc. Safeguarding such data is a necessity and companies do all that it takes to protect the data.

Understanding the operational effectiveness of data disclosure technology from the field may help hospital administrations refine disclosure policies, as well as choose appropriate data disclosure technology solutions.

With the storage and access to patient information becoming more digital, and utilisation of Big Data and Predictive Analytics, the security and safety of such information in compliance with various government regulations becomes more critical.

Protecting the privacy of clients’ patient data is a core operating principle at Omega Healthcare. The number one objective of the company is to help hospital and health systems improve outcomes, and as a precursor to that objective, priority is given to the security of their data. Omega achieves this by creating a culture with a deep focus on HIPAA compliance through a security awareness program. This programme includes mandatory, rigorous HIPAA training for  new employees, regular refresher trainings, monthly newsletters with a focus on security, and on-going dialogue about best practices.

We also instill an understanding of exactly why we are working so hard to protect data. HIPAA’s Privacy and Security Rules are designed to protect patients’ civil right to privacy. Healthcare providers often feel a sense of ownership over PHI because they work so closely with it and are responsible for its protection. This can happen with vendors also. Our commitment to protect and secure PHI stems not only from our responsibility to our clients. We also emphasise to employees that PHI really belongs to patients, and it’s our responsibility to protect patients’ privacy.

In addition to creating a culture that focuses on the security and privacy of PHI, our technology plays a significant role in preventing data breaches. Technology features such as tracking and audit trails and features to protect physical security of the data ensure that patient information remains secure and HIPAA-compliant.

The use of various business intelligence tools makes data open to threats. At Omega Healthcare, data is protected from Internet threats using a firewall that is configured in High Availability mode and filters the data packets coming in and going out of the company network according to predefined access rules. The firewall has three layers - the first layer is Gateway Antivirus which checks for virus and spam. After this the data is filtered through Real Time Blacklist which is the second layer and then filtered through IDS/IPS which is the third layer for any unknown signatures. Further, content filter is used for securing HTTP and HTTPS traffic. All the firewall logs are reviewed and guarded.

--Issue 37--

Author Bio

Baskaran Gopalan

Baskaran Gopalan comes with over seventeen years of experience in the healthcare billing industry. He has managed operations for hospitals and large physician groups in the past and possesses in-depth domain knowledge of the US healthcare industry, with a special focus on Receivables Management.

Baskaran also has expertise in Quality Assurance processes and client management having more than 8 years of experience at other India-based Healthcare BPO/KPO organisations. Baskaran joined Omega in its early months and has since then nurtured India operations with some of the best industry practices as well as fostered a culture of team loyalty.

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