To learn more about how high-performing and cost-effective big data processing forms a foundational element to improving healthcare quality and efficiency, join Dan Woicke, Director of Enterprise Systems Management at Cerner Corp. based in Kansas City, Missouri.
Gardner: We're going through some major transitions in how healthcare payments are going to be made -- and how good care is defined. We're moving from pay for procedures to more pay for outcomes. So tell me about Cerner, and why big data is such a big deal.
Woicke: The key element here is that the payment structure is changing to more of an outcome model. In order for that to happen, we need to get all the sources of data from many, many disparate systems, bring them in, and let our analysts work on what the right trends are and predict quality outcomes, so that you can repeat those and stay profitable in the new system.
My direct responsibility is to bring in massive amounts of performance data. This is how our Cerner Millennium systems are running.
We have hundreds of clients, both in the data center and those that manage their own systems with their own database administrators (DBAs). The challenge is just to have a huge system like that running with tens of thousands of clinicians on the system.
We need to make sure that we have the right data in place in order to measure how systems are running and then be able to predict how those systems will run in the future. If things are happening that might be going negative, how can we take the massive amounts of data that are coming into our new analytical platform, correlate those parameters, predict what’s going to happen, and then take action before there is a negative?
We want to be able to predict what’s happening, so that we can effect change before there is a negative impact on the system.
Gardner: How does big data and the ability to manage big data get you closer to the real-time and then, ultimately, proactive results your clients need?
Woicke: Since January we've begun to bring in what we call Response Time Measurement System (RTMS) records. For example, when a doctor or a nurse is in our electronic medical record (EMR) system is signing an order, I can tell you how long it took to log into the system. I can tell you how long you were in the charting module.
All those transactions produce 10 billion timers, per month, across all of our clients. We bring those all into our HP Vertica Data Warehouse. Right now, it’s about a two-hour response time, but my goal, within the next 12 months, is to get it down to 10 minutes.
I can see in real time when trends are happening, either positive or negative, and be able to take action before there is an issue.
Gardner: Tell us more about about Cerner -- what you do in IT.
Woicke: We run the largest EMR in the world. We have well over 400 domains to manage -- we call them domains -- which allows us to hook up multiple facilities to those domains. Once we have multiple facilities connecting into those domains, at any given time, there are tens of thousands clinicians on the system at one time.
We have two data centers in Kansas City, Missouri and we host more than half for our clients in those data centers. The trend is moving toward being remote-hosted managed like that. We still have a couple of hundred clients that are managing their own Millennium domains. As I said before, we need to make sure that we provide the same quality of service to both those sets of clients.
Cerner Millennium is a suite of products or solutions. Millennium is a platform where the EMR is placed into a single database. Then, we have about 55 different solutions that go on top of that platform, starting with ambulatory solutions. This year was really neat. We were able to launch our first ambulatory iPad application.
There are about 55 different solutions, and it's growing all the time with surgery and lab that fit into the Cerner Millennium system. So we do have a cohesive set of data all within one database, which makes us unique.
Gardner: Where does the data come from primarily, and how much data we are talking about?
Woicke: We're talking about quite a bit of data, and that’s why we had to transform something away from a traditional OLTP database into an MPP type database, because those systems that are now sending data to Cerner.
We have claims data, and HL7 messages. We're going to get all our continuous care records from Millenium. We have other EMRs. So that’s pretty much the first time that we're bringing in other EMR records.
You’ll have that claim data that comes in from multiple sources, multiple EMRs, but the whole goal of population health is to get a population to manage their own health. That means that we need to give them the tools in their hands. And they need to be accurate, so that they can make the right decisions in the future. What that's going to do is bring the total cost of your healthcare down, which is really the goal.
We have health-plan enrollments, and then of course, within Millennium, we're going to drill down into outcomes, re-admissions, diagnosis, and allergies. That’s the data that we need to be able to predict what kind of care we are going to have in the future.
Gardner: So it seems to me that we talk about "Internet of things." We're also going to the "Internet of people." More information from them about their health comes back and benefits you and benefits the healthcare providers. But ultimately, they can also provide great insights to the patients themselves.
Do you see, in the not too distant future, applications where certain data -- well-protected and governed of course -- is made into services and insights that allow for a better proactive approach to health?
Woicke: Without a doubt. We're actually endorsing this internally within the company by launching our own weight-loss challenges, where we're taking our medical records and putting them on the web, so that we have access to them from home.
I can go on the site right now and manage my own health. I can track the number of steps I'm doing. Those are the types of tools that we need to launch to the population, so that they endorse that good behavior, which will ultimately change their quality of life.
Right now, we're in production with the operation side that we talked about a little bit about earlier. Then, we are in production with what we call Health Facts, a huge set of blinded data. We hire a team of analysts and scientists to go through this data and look for trends.
It’s something we haven’t been able to do until recently, until we got HP Vertica. I am going to give you a good example. We had analysts log a SQL query to do an exploratory type of analysis on the data. They would log that at 5 p.m., then issue it, and hopefully, by the time they came back at 8 a.m. the next day, that query would be done.
In Vertica, we've timed those queries at between two and five seconds. So you can see what that’s going to do for the speed of the amount of analysis we could do on the same amount of data. It’s game changing.
There were a lot of competitors that would have worked out, but we had a set of criteria that we drilled down on. We were trying to make it as scientific as possible and very, very thorough. So we built a score sheet, and each of us from the operation side and Health Facts side graded and weighted each of those categories that we were going to judge during the proof of concept (POC). We ended up doing six POCs.
We got down to two, and it was a hard choice. But with the throughput that we got from Vertica, their performance, and the number of simultaneous users on the system at a given period of time, it was the right choice for us.
Gardner: And because we're talking about healthcare, costs are super important. Was there a return on investment (ROI) or cost benefit involved as well?
Woicke: Absolutely. You could imagine that this would be the one or two top categories weighted on our score sheet, but certainly HP Vertica is extremely competitive, compared to some of the others that we looked at.
Gardner: Dan, looking to the future, what do you expect your requirements to be, say, two years from now? Is there a trajectory that you need to take as an organization, and how does that compare to where you see Vertica going?
Woicke: Having Vertica as a partner, we navigate that together. They invited me here to Boston to sit on the user board. It was really neat to sit right there with [HP Vertica General Manager] Colin Mahony at the same table and be able to say, "This is what we need. These are our needs coming around the corner," and have him listen and be able to take action on that. That was pretty impressive.
To answer your question though, it’s more and more data. I was describing the operations side, where we bring in 10 billion RTMS records. There's going to be another 10 billion type of records coming in from other sources, CPU, Memory, Disk I/O, everything can be measured.
We want to bring it into Vertica, because I'm going to be able to do some correlation against something we were talking about. If I know that the RTMS records show a negative performance that's going to happen within the next 10-15 minutes, I can figure out which one of those operational parameters is most affecting that outcome of that performance, and then can send the analyst directly in to mitigate that problem.
On the EMR side, it’s more data as well. On the operations side, we're going to apply this to other enterprises to bring in more data to connect to the experts. So there is always somebody out there. That’s the expert. What we're going to do is connect the provider with the payers and the patient to complete that triangle in population health. That’s where we're going in the next few months.
Gardner: I certainly think that managing data effectively is a huge component of our healthcare challenge here in the United States, and of course, you're operating in about 19 countries. So this is something that will be a benefit to almost any market where efficiency, productivity, quality of care come to bear.
Woicke: At Cerner Corp., we're really big on transparency. We have a system right now called the Lights On Network, where we are taking these parameters and bringing them into a website. We show everything to the client, how they're performing and how the system is doing. By bringing in more and more data and being able to correlate it, we're going to show all the clients, as well as the providers, how their system is doing.