the transformative power of data in...

How Microsoft Amalga Unified Intelligence System 2009 leverages data to empower people to improve healthcare

The Transformative Power of Data in Healthcare

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THE TRANSFORMATIVE POWER OF DATA IN HEALTHCARE / APRIL 2009 2

Table of Contents

Executive Summary

The Unified and Intelligent Healthcare Enterprise

Roadblocks to Realizing the Vision

Healthcare’s data challenges

Using Microsoft Amalga UIS to Transform Healthcare

Liberating data

Empowering people

Connecting care

Microsoft in Health

References

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Executive Summary

Data, data everywhere…but intelligence to drive a high-performance healthcare organization is difficult to achieve in healthcare. While healthcare is the most information intensive and dependent industry in the world, to date, very few organizations have effectively leveraged the data assets captured in their information technology (IT) systems to convert data bytes into agile intelligence able to drive improved outcomes, safer care, and bottom-line results.1

Healthcare enterprises are challenged to meet rising expectations of the public, regulators, and other stakeholders in an increasingly complex environment. Escalating healthcare costs, increasing public scrutiny, reduced reimbursements, and increasing competition are pushing healthcare enterprises to compete on value.2 New care paradigms are forming around sweeping challenges of care coordination and process transformation.3 These major trends have been developing for many years.

Moving forward, healthcare enterprises will need to adapt to survive. Health leaders will need to regularly take a fresh look at their organizations to ask what can be done to provide additional value, serve their communities better, and become higher performing organizations.

It’s a tall order. Effective leadership and strategy will be pivotal to success. Systems are needed to leverage the amazing amounts of data that already exist and to facilitate collaboration across multiple groups and care boundaries. Accelerating the need for data across the ecosystem is the need for “meaningful use” of electronic health records (EHRs) to qualify for stimulus money under the American Rehabilitation and Recovery act. A key criteria for meaningful use is the ability to exchange critical health data for improved care coordination.

Healthcare organizations that can create an effective strategy that leverages their data assets to deliver unified intelligence have great potential to transform their organizations to achieve excellence in quality and financial performance.

This white paper introduces the Microsoft® Amalga™ Unified Intelligence System (UIS) 2009, a different approach and technology that leading healthcare providers indicate is a “major advancement in defining, storing, and accessing healthcare data,” as reported in a KLAS Research report, “Beyond the CIS: Why are hospitals buying aggregation solutions?”4 This paper provides an explanation of how Microsoft Amalga UIS simultaneously optimizes the value of existing health information systems while transcending the current capabilities of data warehouses, business intelligence, and portals to arm healthcare enterprises with the information they need to become high-performing organizations.

“. . . until every knowledge worker who has a question can say, ‘I could find the information I needed and answer that question myself,’ we’ll still have work to do.”

Steve BallmerChief Executive OfficerMicrosoft


The Unified and Intelligent Healthcare Enterprise

A review of high-performing organizations unveils that what sets their operations apart is the way they tightly couple the process of doing work with the process of learning to do it better as it’s being done.5 According to a Harvard Business Review article, “Fixing Healthcare from the Inside, Today,” organizations must develop four organizational capabilities to create excellence6:

1) Work is designed as a series of ongoing experiments that immediately reveal problems.

2) Problems are addressed immediately through rapid experimentation.

3) Solutions are disseminated adaptively through collaborative experimentation.

4) People at all levels of the organization are taught to become experimentalists.

At the heart of these capabilities is the free flow of information to all employees at the point of impact.7 The person who is most adept at making a decision or understanding how a process works has real-time or near real-time access to all relevant enterprise information. They also have the ability to manipulate the information to question and explore, without the restraints of structured queries or the difficulty of learning multiple systems and tools.

While there is an abundance of data in most healthcare systems, employees and clinicians often lack the relevant, on-the-spot information they need to participate in driving a high-performance organization both in real-time and over time. Data is housed in multiple systems and often in a form that cannot serve the information needs of the multiple stakeholders who use it.

Most hospital leaders understand that they need to become more efficient in accessing, organizing, and sharing data and want to focus on what matters so that they can use their constrained resources to the best effect.8 Despite substantial efforts in IT and in quality-improvement programs, progress continues to be slow, lessons learned are fragmented, and little effort is being devoted to evaluating the impact of these initiatives so that future efforts can be guided by evidence rather than anecdote.9

The Unified, Intelligent Healthcare Enterprise

Desired Outcomes:•Improved patient outcomes•Improved patient/ consumer experience

•Improved clinician experience•Lower costs

Strategies:•Extend care •Develop new points of care•Change economics of care

Requirements:•Real-time, agile use of health data

•Data liquidity•Process mastery to reduce improvement cycle times

•Empower end users to answer their own questions

Enabler•Unified data platform


Roadblocks to Realizing the Vision

While hospitals spend millions of dollars on clinical, administrative, and financial information systems, the data by-product of these investments is rarely harnessed to unlock insights that can improve care and financial well being.

The issues surrounding healthcare data are complex and numerous. So great is the effort expended by healthcare enterprises to chase after the data, that there are few resources left to explore, analyze, trend, and correlate the data to drive performance improvement.10

There are two sides of the healthcare data challenge: the inability to get a unified view of data across the ecosystem on one hand, and the inability to explore it agilely on the other. These two challenges have historically been addressed by two fundamentally different solution sets: integration and interoperability for the former, and business intelligence and data warehouses for the latter. The lack of a unified solution, which enables visibility across the ecosystem and exploration of that data, has blocked the ability to create a solution that truly addresses the data needs of today’s healthcare enterprise. A unified solution can uniquely meet the data challenges of the healthcare industry.

Healthcare’s data challenges The information needs of healthcare workers are fundamentally different than those of other industries11 for a number of reasons.

Volume and nature of health data The ever-growing volumes of data and the complexity of the interrelationships between data elements in healthcare is a significant challenge not seen in other industries. There are numerous details captured about every patient—demographics, family history, insurance coverage, various tests, lab results, medications, and more. New advances in medicine and technologies, such as genomics and RFID, promise to generate increasing amounts of data. Today’s very important and necessary transaction systems are not equipped to process this data deluge, nor can they accommodate all data sources in a single, usable view.

The millions of megabytes of medical data are comprised of multiple data types. A crucial challenge is bringing together structured data (data that resides in transaction systems such as clinical information systems and financial systems) and unstructured data (data that is held in scanned medical records, images, and transcriptions) into a single data platform to query. Various sources estimate that 80 percent to 90 percent of all healthcare data is unstructured.12

At the same time, there are numerous data standards and terminologies within healthcare. While there are global efforts underway to unify standards, there is no single standard to date, and possibly never will be, to help bring together a complete and holistic view from across all data sources.13

So great is the effort expended by healthcare enterprises to chase after the data, that there are few resources left to explore, analyze, trend, and correlate the data to drive performance improvement.


Current transaction systems are built to enforce standardized processes The nature of the varying types of services provided in healthcare requires a myriad of diverse processes. Transactional healthcare IT solutions, such as clinical information systems, have been designed to handle a complex set of data to catalog human health issues across a wide variety of areas. They cannot provide agile use of information because they were developed and optimized to address discrete needs, and enforce standardized processes.

Designed to create a record to manage a single patient, generating hierarchal or object-oriented data sets for each patient transactional, healthcare IT systems provide a structured end-user view of one patient at a time. The nature of the data structure makes it difficult to query or combine with other existing data elements. These systems usually report only on the data they generate, rather than all of the pertinent data available.

Many solutions designed to organize data into more meaningful and usable forms have emerged, such as portals, dashboards, scorecards, and tracking boards. This point solution approach can create high operational costs, multiple solutions with redundant functionality, and low reusability of the data..

The reality at most hospitals is a confusing maze of manual data aggregation. Individual teams often build their own data repositories and ad-hoc data sets using spread sheets and databases to meet their own needs. Organizations also typically employ head-spinning numbers of FTEs devoted to querying systems or manually pooling information.

Each point solution—dashboard, tracking board, portal—requires its own interface to the source data, or a complete restructuring of the database if new data elements are required. This can make creating new solutions to gain insight and improve performance cost- and resource-prohibitive. Some of these point solutions can require months or years to implement, and are often not portable to other settings of care in the enterprise.

Data warehouse tools not sufficient for health data needs The interest in business intelligence and enterprise data warehouses is peaking as well. While data warehouse and business intelligence tools have successfully created smaller, departmental, or singularly focused inquiries into data, few healthcare organizations have developed an enterprisewide approach.14 , 15

These tools, built for queries based on static hierarchies, require organizations to know the structure of the data, the meaning of the data, the relationships in the data, and the usage of the data, before they begin storing it. Unfortunately, the period of data structure design is also the point in time when organizations are least likely to have answers to inform these decisions. The fundamental nature of healthcare data, the manner in which it is stored, and poor design are all cited as reasons why it is so difficult to succeed with enterprise data warehouse projects.16

Transactional health IT solutions, such as clinical information systems, cannot provide agile use of information because they were developed and optimized to address discrete needs and enforce standardized processes.


Using Microsoft Amalga Unified Intelligence System 2009 to Transform Healthcare

To effectively leverage data assets to improve both quality of care and financial performance, the healthcare industry needs a fundamentally different approach to the technology of information handling.

Amalga UIS is designed to address the information management requirements of healthcare, a complex environment where leaders are still gaining an under-standing of the relationships between information elements. Amalga UIS is built for change, reducing the complexity, effort, and resources required to deliver an agile enterprise-wide data platform that allows use and re-use of healthcare data, leveraging and extending the value of existing technology solutions

Liberating data Amalga UIS gets, amalgamates and shares data, addressing problems and creating solutions in unprecedented ways because it stores data differently. The unique techniques and architecture of Amalga UIS allow organizations to scale their data store while maintaining speed and performance for the end-user’s experience.

Ready today If the healthcare industry waits until interoperability standards are set, data is cleansed, and consensus is achieved across the industry, providers may be challenged to survive the current healthcare environment. The risks are now too great to continue to lead hospitals in anything other than data-driven management. Amalga UIS enables organizations to get started without delay because it offers an alternative to traditional interfacing and integrating disparate data sources.

Amalga UIS has a unique, highly flexible data model, and unlike today’s transaction systems, it does not require incoming data to adhere to predetermined data structures. Amalga UIS allows multiple models of data to be built for different audiences or uses, from a single source—in other words, data is captured once and used in infinite ways. As a result, solutions to complex financial, operational, and clinical problems can be more easily and cost-effectively developed. Once the data is consolidated within Amalga, the time and cost to create new uses for that data is minimal, the cost of change is significantly reduced and, most importantly, the data is now liquid and reusable.

Protecting past investment and future choice Amalga UIS enables organizations to optimize the impact of existing systems by allowing more flexible use of the data captured in those systems. With data liberated from core clinical systems, organizations may have greater choice when assessing future IT investment decisions, which can potentially reduce IT spending over time and better serve the needs of clinical end users.

Let your data do the talkingKim Jackson, Director of Clinical Informatics at St. Joseph Health System, speaks out about the transformative power of Amalga.

St. Joseph Health System in Orange, California, a $3.7 billion not-for-profit Catholic healthcare system, with 14 hospitals in three states, is using Amalga to achieve a balance of hospital and community care.

“With Amalga, our first conversation can be about the outcomes of the data, instead of how to get the data.

What used to take two months and 50 phone calls now takes one analyst with five clicks. It is a huge change in the way things work. Not only can someone have a graph that really quickly compares ministries, we can ponder, ‘who is the best person across ministries,’ and do a root cause analysis about why they are the best right then and there.

With Amalga, we can easily view data from different perspectives—from the patient level to the location level, from the population level to the patient level, from the micro level to the macro level—in a single view.

Amalga allows us to take a completely different approach to using our data—we’re using our data right away, and rapidly exploring answers to critical questions that we might have never thought to ask if the data wasn’t so readily available.”


Amalga UIS delivers powerful data presentation capabilities

The Amalga UIS user interface is deceptively simple. Created with an intuitive appeal that is comfortable and familiar for most people to use and view, Amalga UIS requires fewer questions and less time spent around how to use the data, and more time effectively using the data.

The end user is quickly presented with a default view that may look like a more familiar, patient-centric list. The power comes in the abil-ity to rapidly create new views and explore data from multiple levels—going as deep as a single test result for a single patient, or as wide as a view showing how that test result may impact the organization’s bottom line or the health of an entire patient population. The result is a relevant, unique experi-ence for any end user, with minimal training required.

Empowering people In healthcare, answering a single question can require compilation and analysis of data from many different, systems. The original request can take weeks, and if a requestor has follow-up questions when finally viewing the report, it must be generated again with each new data element. Months later, questions may remain unanswered. And when the frustration of finding answers grows, people may stop asking questions altogether—which can lead to lost opportunities.

Driving Improvements Healthcare workers need to move quickly to find answers that impact today and tomorrow. But with data held captive in data silos across a health organization, compiling the data to form those answers can take months—so workers are often studying past results rather than focusing on immediate change.

With Microsoft Amalga Intelligence System (UIS), workers can:

• Get data in real time from across the enterprise, rather than relying on batch pulls of historical data.

• See any view of data, sort or filter by any criteria or data element—rather than just seeing the patient-centric views of data provided by most healthcare IT systems.

• Create new customized views of data without the intervention of IT or the need for an analyst. It is a simple process of selecting and adding field names from a list.

• Work with data easily, using a simple, user-friendly interface. The familiar look and feel of Amalga UIS enables anyone who is familiar with Microsoft Office applications to begin exploring data with minimal training.


Amalga UIS creates a single point for unified access to the wealth of information present in healthcare organizations. What’s more, Amalga UIS enables end users to manage their own information needs, which frees the IT team from acting as ad-hoc report generators.

Single Solution, Unbounded Uses Once organizations do the heavy lifting work to pool enterprise data into Amalga UIS, the use and re-use of the information is unbounded. A short list of how Amalga UIS customers are leveraging unified, real-time views of their data includes:

• Chronic disease management. Connect records that patients send from their HealthVault accounts with payer information to identify high-risk patients, proactively intervene and optimize care across the healthcare ecosystem.

• Service line analysis. Conduct “what if?” explorations, view trends, and gain insights into where costs are, how to gain efficiencies, and how to improve service to the patient.

• Retire old systems. Amalga UIS allows the retirement of inactive systems being maintained solely as a data store, resulting in substantial maintenance and support fee savings.

• Extending life of existing systems. Amalga UIS allows organizations to aggregate data from disparate systems into a single view, potentially providing more flexibility in when to invest in next generation revenue cycle and clinical information systems.

• Connecting with the physician community. By aggregating ambulatory and inpatient data in a common data store, Amalga UIS delivers a cross-care continuum view of the patient without requiring clinicians to learn multiple systems or requiring IT to maintain multiple systems.

• Personalized medicine. By empowering researchers to access combined views of data from different systems in a single, easy-to-use tool and allow iterative questioning and exploration of hypothesis, Amalga UIS can help accelerate the development of personalized medicine.

Connecting care The ultimate goal in healthcare is a dynamic health system that transforms how physicians provide care, individuals manage their own health, and healthcare organizations improve their quality and financial performance. Healthcare organizations require the ability to:

• Drive the right health outcomes and payments. The health industry must be focused on lifelong wellness, and the information technology must support preventative care and innovation for delivering care in new, connected electronic ways.


• Achieve data liquidity. Health organizations should be able to easily access and explore their existing data to improve efficiency, decision making, quality, and value; analyze their operations holistically; and focus on continuous improvement.

• Connect and share data securely within and between health organizations. The secure electronic access to a lifetime of treatments, prescriptions, and tests will allow individuals and providers to make better medical decisions, reduce wasteful spending, and increase quality. The ability to share data across providers and outside the bounds of the enterprise will likely become a criteria in defining “meaningful use” of electronic health records to qualify for stimulus dollars under the American Rehabilitation and Recovery Act.

• Empower consumers to be stewards of their own health data. Consumers should have the ability to gather their health information from many sources, including applications, portals and devices; to store and manage that health information in a central location; and to share it with those they trust.

Microsoft’s Health Solutions Group delivers a comprehensive set of solutions that help realize the vision to connect key stakeholders to the secure data they need. Both Amalga UIS and HealthVault can help organizations bridge multiple and disparate systems to help qualify for funding for “meaningful use” of electronic health records by freeing the data from within the systems for use and re-use of authorized stakeholders and consumers, regardless of organizational boundaries.

• Connecting separate organizations through HIEs and RHIOs. With Microsoft Amalga Unified Intelligence System (UIS), HIEs and RHIOs are able to mobilize healthcare information electronically across organizations in a region or community, seamlessly and rapidly bringing real-time data from a wide variety of clinics and hospital departments into a concise collection of information that can be shared.

• Connecting the enterprise with physician communities. By aggregating ambulatory and inpatient data in a common data store, Amalga UIS delivers a cross-care continuum view of the patient without requiring clinicians to learn multiple systems or requiring IT to maintain multiple systems.

• Connecting the enterprise with patient-controlled data. Patients can choose to send information stored in their Microsoft HealthVault personal health record to their providers. Using Amalga UIS, organizations can leverage this data to provide a more complete view of a patient’s history, or combine data with payer information to identify high-risk patients, proactively intervening and optimizing care across the healthcare ecosystem.


Microsoft in HealthOur vision: To improve health around the world through softwareMicrosoft is committed to improving health around the world through software innovation. Over the past 12 years, Microsoft has steadily increased its investments in health, with a focus on addressing the challenges of health providers, health and social services organizations, payers, consumers, and life sciences companies, worldwide.

Microsoft closely collaborates with a broad ecosystem of partners and develops its own powerful health solutions, such as Amalga and HealthVault. Together, Microsoft and its industry partners are working to advance a vision of unifying health information and making it more readily available, ensuring the best quality of life and affordable care for everyone.

For more information: www.microsoft.com/amalga www.healthvault.com


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6 Spear, Steven J. “Fixing Health Care from the Inside, Today.” Harvard Business Review. September 1, 2005.

7 IBID


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10 “Building the Foundation for Analytics: Accelerating Data Warehousing Efforts through Enhanced Data Quality.” The Advisory Board, 2008. http://www.advisory.com/members/default.asp?contentID=76390&collectionID=925&program=16&filename=76390_56_16_09-30-2008_1.pdf (accessed March 15, 2009).

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12 Varney, Sarah. “Information lifecycle needs data realignment fast.” July 23, 2008. http://searchcio.techtarget.com/tip/0,289483,sid182_gci1322359_mem1,00.html (accessed March 15, 2009).

13 “Health Care at the Crossroads: Guiding Principles for the Development for the Hospital of the Future.” The Joint Commission, 2008. http://www.jointcommission.org/NR/rdonlyres/1C9A7079-7A29-4658-B80D-A7DF8771309B/0/Hosptal_Future.pdf (accessed March 15, 2009).

14 “Building the Foundation for Analytics: Accelerating Data Warehousing Efforts through Enhanced Data Quality.” The Advisory Board, 2008. http://www.advisory.com/members/default.asp?contentID=76390&collectionID=925&program=16&filename=76390_56_16_09-30-2008_1.pdf (accessed March 15, 2009).

15 “Enterprise Business Intelligence Opening the Flood Gate.” KLAS Research. June 2008.

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The information contained in this document represents the current view of Microsoft Corporation on the issues discussed as of the date of publication. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information presented after the date of publication.

This white paper is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS DOCUMENT.

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Microsoft, Amalga, and HealthVault are trademarks of the Microsoft group of companies.

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