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Presentation Title: Clinical Data Acquisition
Date: 08/26/2019
Speaker info: Brandon K. Raab
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Clinical Data Acquisition
Vision Statement
An integrated foundation of administrative and clinical data on all Anthem members that supports the delivery of high quality and affordable healthcare
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How are we using the data – Use Cases
• CDA Use Case 1: Quality Measure and Care Gap closure
• CDA Use Case 2: Risk Adjustment
• CDA Use Case 3: CM/UM - Use ADT alerts / reports for Care Coordination
Markets we are in
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Line of Business (Distinct Member Count)
State COMMERCIAL MEDICAID MEDICARE FEP Grand Total
OH 835,533 544 232,730 109,026 1,177,833
IN 603,444 453,692 59,054 50,977 1,167,167
CA 828,986 28,071 55,659 15,612 928,407
NY 501,231 102,161 33,410 24,737 661,539
GA 349,327 50,017 20,482 43,884 463,710
VA 251,676 51,115 19,685 50,481 373,030
4,771,686
Top Six Markets
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Markets we are in
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Line of Business (Distinct Member Count)
State COMMERCIAL MEDICAID MEDICARE FEP Grand Total
OH 835,533 544 232,730 109,026 1,177,833
IN 603,444 453,692 59,054 50,977 1,167,167
CA 828,986 28,071 55,659 15,612 928,407
NY 501,231 102,161 33,410 24,737 661,539
GA 349,327 50,017 20,482 43,884 463,710
VA 251,676 51,115 19,685 50,481 373,030
4,771,686
Top Six Markets
Clinical Data Acquisition Sources
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Connectivity– SFTP
– HTTPS
– Web services
– REST
– TCP/IP
– XDS.b
– XDR
– MLLP
– Clinical Portal
– ONC Direct
– FHIR
Multiple Formats, Multiple ways to connectSolving for Interoperability Challenges
Data Types– CDA (unstructured document)
– CCD (Continuity of Care Document)
– C-CDA
– Any HL7 V2.x Message Type
– FHIR DSTU 2, STU 3
– Flat Files
Real-World Data Cleaning
EHR Testing(Clean Data)
Testing bodies ensure EHRs are capable of data capture and exchange given a small sample of test cases
Real-World(Messy Data)
The wrong terminology is used to structure data
Terminologies are too complex for simple queries
Clinician enters free-text rather than structured data
Value aren’t in right units and interpretation omitted
CQG(Usable Data)
Translations for common vocabularies
Normalization and classification of clinical data
Text mapping for high volume codes
Conversion and normality inference for numerical data
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LPR System Map – EMR/Clinical Data Acquisition
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LPR System Map – EMR/Clinical Data Acquisition
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Numbers of lives impacted (Clinical Data)
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• ADT, CCDA – Well known and understood• DB to DB: Basic SQL (ETL) Scripts• MDM: Transcribed Reports (Unstructured Data)• ORU: HL7 V2.x• Other: FHIR, Point to Point, Proprietary API’s
Clinical Data Acquisition
Thank You
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