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Data + API = a perfect marriage
Aashima Gupta
Executive Director, Incubation & Innovation
Kaiser Permanente
The Healthcare Landscape
An Evolution:
•
•
•

Paper
Electronic
Digital (One paradigm shift)
Sick Care
Health Care (Second Paradigm Shift)
Patient as a passive recipient of care
Patient as a participant in the
conversation about care (Third paradigm shift)
First Paradigm Shift: Paper

Digital
Second Paradigm Shift: Sick

Healthcare
Third Paradigm Shift: Passive Patient

Engaged
API - Access to information, Access to Applications,
Access to knowledge

QCare
Provider
Accumulators
External Claims
(Paper)

General Ledger
(G/L)

Common Membership
Membership

Referrals

Individual
Demographics

Risk Adjustment
Tracking System
(RATS)

Claims

Detailed
Benefits

Benefit Interface

Group / Contract

KPIC

Detailed
Benefits
Extract

Disease
Prevention

PCP Selection

KP Clearing
House
(External
Claims)

Preventive
Alerts

PCHS

EOC Print
Vendor
(Moore)

Personal
Advantage

Member

External Claims
(Electronic)
HealthTRAC

Perot

Broker
Commissions

Member

Employer
Group
Extract

ID Card
Vendor
(Personix)

Internal
Encounters
(Electronic)

Immunization
Tracking

IVR

AMR

Apria

Disease State
Management

CNA

Health
International

Panel
Management

KP HealthConnect
EpicCare
Dictation /
Transcription

Provider
(SER)

Referrals

EKG

Prelude

Bridges

Claims and Encounters

Cadence
Patient
(EPT)

Tapestry

ExaBytes

DSS
(Business Intelligance)

Formulary
(XXX)

Pharmacy
Pharmacy
RX

Resolute

150

Charges

Payor
(XXX)

Lab

Benefit
Accumulator
s (Data)

Employer
Group (PPG)

Special
Features
Flag
(Category
List)

Coverage
(CVG)

PIMS

ARC
Reporting

Benefits Engine
Benefit
Accumulator
s
(Definitions)

Benefit
Package
Display
(CMD)

Medical Record

Radiology

Optical (SDS)
Patient
Recall

MOOPS /
Deductible
(CMM)

Network
Component
(CMP)

OctoPOS
Modalities

Picture Archive
Capture System
(PACS)

Cache

Clarity

Finanical
Data
Marts

Benefit
Package
(CMK)

IDX / RIS

OctoPLUS

Clinical
Data
Marts

Benefit Plan
(EPP)

Component
Group
(CMG)

Adjudication
Table
(CML)

Authorization
Received

Benefit Tier
(CMT)

Referral
Class

Adjudication
Formula
(CMA)

Benefit
Variable
(CMW)

Limit
Variable
(CMW)

Benefit
Bucket
(CMB)

Data Warehouse

Operation
al
Data

2011 Global size
of healthcare
data

5 Exabytes = All words ever spoken by humans
Mashup: KP Location

Farmers Markets

Transit Options
Mashup: Wellness

Analytics

Goals
Convergence

Behavior

Social

Mobile

Access

Digital
Health
Context

Delivery
Analytics

Cloud
Health Happens Outside Our Hospital Walls

Health is everywhere !
How do we make it accessible ?
How do we make it affordable ?
Ask yourselves,
what will you do with data?
Thank you

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Data + APIs: A Perfect Marriage

  • 1. Data + API = a perfect marriage Aashima Gupta Executive Director, Incubation & Innovation Kaiser Permanente
  • 2.
  • 3. The Healthcare Landscape An Evolution: • • • Paper Electronic Digital (One paradigm shift) Sick Care Health Care (Second Paradigm Shift) Patient as a passive recipient of care Patient as a participant in the conversation about care (Third paradigm shift)
  • 4. First Paradigm Shift: Paper Digital
  • 5. Second Paradigm Shift: Sick Healthcare
  • 6. Third Paradigm Shift: Passive Patient Engaged
  • 7. API - Access to information, Access to Applications, Access to knowledge QCare Provider Accumulators External Claims (Paper) General Ledger (G/L) Common Membership Membership Referrals Individual Demographics Risk Adjustment Tracking System (RATS) Claims Detailed Benefits Benefit Interface Group / Contract KPIC Detailed Benefits Extract Disease Prevention PCP Selection KP Clearing House (External Claims) Preventive Alerts PCHS EOC Print Vendor (Moore) Personal Advantage Member External Claims (Electronic) HealthTRAC Perot Broker Commissions Member Employer Group Extract ID Card Vendor (Personix) Internal Encounters (Electronic) Immunization Tracking IVR AMR Apria Disease State Management CNA Health International Panel Management KP HealthConnect EpicCare Dictation / Transcription Provider (SER) Referrals EKG Prelude Bridges Claims and Encounters Cadence Patient (EPT) Tapestry ExaBytes DSS (Business Intelligance) Formulary (XXX) Pharmacy Pharmacy RX Resolute 150 Charges Payor (XXX) Lab Benefit Accumulator s (Data) Employer Group (PPG) Special Features Flag (Category List) Coverage (CVG) PIMS ARC Reporting Benefits Engine Benefit Accumulator s (Definitions) Benefit Package Display (CMD) Medical Record Radiology Optical (SDS) Patient Recall MOOPS / Deductible (CMM) Network Component (CMP) OctoPOS Modalities Picture Archive Capture System (PACS) Cache Clarity Finanical Data Marts Benefit Package (CMK) IDX / RIS OctoPLUS Clinical Data Marts Benefit Plan (EPP) Component Group (CMG) Adjudication Table (CML) Authorization Received Benefit Tier (CMT) Referral Class Adjudication Formula (CMA) Benefit Variable (CMW) Limit Variable (CMW) Benefit Bucket (CMB) Data Warehouse Operation al Data 2011 Global size of healthcare data 5 Exabytes = All words ever spoken by humans
  • 8. Mashup: KP Location Farmers Markets Transit Options
  • 11. Health Happens Outside Our Hospital Walls Health is everywhere ! How do we make it accessible ? How do we make it affordable ?
  • 12.
  • 13. Ask yourselves, what will you do with data?

Notas del editor

  1. * SMAC - is a key tactic as a foundation for the above three paradigm shifts * Online/Mobile : we need to think "Beyond the browser" - API * API - Access to information, Access to Applications, Access to knowledge * Mashup : KP Location -> Farmers Markets ->Transit Options * Mashup : Wellness -> Analytics -> Goals * Think Different - Crowdsource : Location of ERs across the country ? Location of AED across the country ? * Health is everywhere - How do we make it accessible, How do we make it affordable ?
  2. Health Care –Massive Data – locked inside corporate –Interconnected quagmire
  3. As the Internet becomes “pure plumbing”, Kaiser Permanente is developing and delivering capabilities beyond the browser. These capabilities will be driven by the ability to expose digital assets through an open interface, where appropriate, to trigger application innovation through KP and our partners (developer community, other vendors, and start ups).
  4. I’ve gone from the “Road Less Travelled” to the new (much worn) road to Digital HealthThank you