Architecting High Value Care Solutions with HIPAA-Eligible Services on AWS 

By Laura Breedlove, Chief Technology Officer at hc1.com

High value care means achieving the best possible patient outcomes for the least amount of money. Health systems are looking for ways to deliver high value care as they get increasing pressure from payers to rein in runaway healthcare costs.

And yet, health systems face technological challenges in implementing effective programs to reduce wasted financial, operational, and material resources:

• They have to analyze massive amounts of data about medical activities to identify opportunities to reduce waste.
• They have to be able to continuously monitor and report on changes that occur when high value care programs are implemented.

Using Amazon Aurora and Amazon Simple Queue Service (SQS), hc1.com has built a microservice to deliver two solutions to help our health system customers meet these high value care challenges while staying compliant with HIPAA standards.

A leading precision health platform, hc1.com enables healthcare organizations to personalize treatment for individuals resulting in improved health and reduced medical spending.

hc1.com is an AWS Partner Network (APN) Advanced Technology Partner with the AWS Healthcare Competency.

Defining Customer Goals and Planning the Data Flow

As the single highest-volume medical activity within a health system, lab testing is often the focus of initiatives to eliminate unnecessary and low-value care practices.

Test Utilization Solution

The hc1 Test Utilization Solution helps identify low-value ordering habits that are negatively impacting patients through unnecessary blood draws for diagnostic testing so that care teams can act to change physician behaviors. These low-value ordering practices include testing again after normal results, retesting more frequently than is recommended, testing that is inappropriate for a specific patient, and ordering tests that are obsolete.

The hc1 Test Utilization Solution gathers and houses disparate data that’s often spread across a health system into a single repository, where it’s cleaned and organized. Using cloud-based dashboards, users are able to visualize specific areas of improvement. For example, a health system can see exactly where lost revenue may occur via an unnecessary repeat test.

Benchmarks are easily created so that improvements can be tracked over a given time period and across specific tests and locations. Executives and stakeholders can routinely review real-time progress using data-backed reports.

Blood Utilization Solution

In a similar vein, the hc1 Blood Utilization Solution targets unnecessary blood orders and transfusions in order to eliminate blood product waste and reduce unnecessary patient risk from the transfusion procedure itself.

Health systems can monitor blood unit use in real-time by overall inventory, by specialty, and by specific location, in turn uncovering areas of improvement for certain product types. For example, transfusing blood product is generally not necessary once a patient’s hemoglobin, INR clotting measure, or platelet count is at a certain level.

Customers can customize which test or transfusion exceptions these rules target, and change exceptions as the goals for their utilization programs change.

Both of these high value care solutions require an integration between the health system customer’s electronic medical record or laboratory information system that houses the testing or transfusion data and the hc1 core platform.

Solution Architecture

The diagram in Figure 1 shows the basic data flow between the data source, the hc1 core platform, and the high value care microservice through various AWS services.

1. The hc1 high value care microservices scheduler picks up data from the health system customer regularly and takes it to the Amazon Aurora clinical rules database for analysis.
2. The results of this analysis are then delivered to SQS. This queueing decouples the hc1 platform to improve stability and scalability.
3. The hc1 core platform microservices, running on Amazon Elastic Container Service (Amazon ECS), retrieve these messages and use Amazon Redshift and Amazon Relational Database Service (Amazon RDS) to perform analytics and display the results to users in filterable dashboards and reports.

Figure 1 – hc1 high value care solution architecture overview.

Choosing the Right Services

As a HIPAA-regulated company, hc1.com only uses services that are covered in our BAA (business associate agreement) with Amazon Web Services (AWS) to store, process, and transmit PHI (protected health information).

As an innovative technology company, we are always looking for new and better ways to do what we need to do. When additional services are added to the AWS BAA, we are eager to evaluate them to determine how we can leverage these new capabilities.

The high value care microservice is the first time we have used the Aurora database. We chose it for several reasons:

• High Performance and Resilience: Built expressly for cloud platforms such as hc1, Aurora provides the rapid data retrieval and reliability necessary to provide the critical analysis of healthcare order trends, exception handling, and rules.
• Pay-as-You-Go Pricing Structure: With Amazon Aurora, we can pay just for the data we use, which works well as we implement the first customers on the improved high value care solutions and data demands are still in flux. As demand for these solutions increases, we can scale up.
• Low Maintenance: Amazon RDS handles the basic configuration and management of the Aurora database, freeing up our developers to focus on the codebase.

The high-value care microservice also uses the HIPAA-eligible SQS to coordinate data flow from the microservice to the hc1 core platform. This buffer prevents our system from getting overwhelmed during spikes in the flow of order information, which can occur during loads of historical data.

Within the hc1 core platform, these AWS services provide key functionality for the high value care solutions:

• Amazon Redshift: We use Redshift to meet our data warehousing and analytics needs across all of our solutions. hc1.com encrypts our Redshift clusters and can quickly and cost-effectively store and process all of the order data for the high value care solutions, and offer both standard reporting as well as customized reporting capabilities.
• Amazon ECS: hc1 leverages a microservices-based architecture to allow for better resiliency within our applications. We use Amazon ECS to orchestrate Docker containers on Amazon Elastic Compute Cloud (Amazon EC2) that run these microservices.

AWS services allow for security and compliance while offering cloud agility, performance, and scalability—all essential elements in a value-based care delivery model.

hc1.com Use Case with McLaren Health Care

McLaren Health Care is a Michigan-based, fully integrated health system committed to quality, evidence-based patient care and cost efficiency. With more than 80 primary and specialty centers located throughout the areas served by McLaren’s 12 hospitals, their system includes an entire network of professionals and locations that make the highest level of care a priority.

After successfully launching and managing an effective blood utilization program, McLaren pinpointed lab testing as an area for improvement as part of their mission to deliver high value care. While they understood the inherent value of improving its utilization efforts, disparate data spread across its various locations created complex challenges with respect to gathering the data for analysis.

McLaren also needed to ensure that all stakeholders were fully invested in the reasons for, the process for, and measurement of the program in order for it to succeed. For McLaren to understand their biggest opportunities for improvement, they first needed to break down technology barriers.

Leveraging the hc1 Test Utilization Solution, the organization was able to gather and house all disparate data in a single repository, clean and organize the data, and automatically deliver dashboards that made actionable metrics available to stakeholders for review.

Recognizing that test utilization is an ongoing process, McLaren has quickly achieved measurable success at several of its sites, including in Flint, Mich., a 43 percent decline in lipid panels and 44 percent decline in overall exceptions over a four-month period.

Read more about how McLaren Health Care leveraged hc1 solutions.

Conclusion

As a leader in precision health, hc1.com ensures the right patient gets the right test and the right prescription. Through our advanced bioinformatics platform, we personalize healthcare, resulting in improved patient well-being and reduced medical spending.

Our award-winning solutions enable healthcare organizations to transform business and clinical data into the intelligence necessary to impact critical initiatives including high value care, prescription optimization, and preventative health.

For detailed information on implementing and growing a successful Test or Blood Utilization program, download the hc1 Test & Blood Utilization whitepaper.

The content and opinions in this blog are those of the third party author and AWS is not responsible for the content or accuracy of this post.

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hc1.com – APN Partner Spotlight

hc1.com is an AWS Healthcare Competency Partner. Their precision health platform is dedicated to unlocking answers to solve healthcare’s biggest challenges. hc1’s solutions have been adopted across more than 1,000 labs, hospitals, and public health systems.

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