Wednesday, November 6, 2013

Efficient big data capabilities help Cerner drive needed improvements into healthcare outcomes

Listen to the podcast. Find it on iTunes. Read a full transcript or download a copy. Sponsor: HP.

The next edition of the HP Discover Podcast Series delves into how a healthcare solutions provider leverages big-data capabilities. We’ll see how Cerner has deployed the HP Vertica Analytics platform to help their customers better understand healthcare trends, as well as to help them better run their own systems.

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.

The discussion, which took place at the recent HP Vertica Big Data Conference in Boston, is moderated by me, Dana Gardner, Principal Analyst at Interarbor Solutions. [Disclosure: HP is a sponsor of BriefingsDirect podcasts.]

Here are some excerpts:
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?

Effect change

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.

Single database

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.
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?

Proactive approach

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.
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.

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?

Extremely competitive

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.
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.

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.
Listen to the podcast. Find it on iTunes. Read a full transcript or download a copy. Sponsor: HP.

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Monday, November 4, 2013

Different paths to cloud and SaaS enablement yield similar major benefits for Press Ganey and Planview

Listen to the podcast. Find it on iTunes. Read a full transcript or download a copy. Sponsor: VMware.

The next VMworld innovator panel discussion focuses on how two companies are using aggressive cloud-computing strategies to deliver applications better to their end users.

We'll hear how healthcare patient-experience improvement provider Press Ganey and project and portfolio management provider Planview are both exploiting cloud efficiencies and agility. Their paths to the efficiency of cloud have been different, but the outcomes speak volumes for how cloud transforms businesses.

To understand how, we sat down with Greg Ericson, Senior Vice President and Chief Innovation Officer at Press Ganey Associates in South Bend, Indiana, and Patrick Tickle, Executive Vice President of Products at Planview Inc. in Austin, Texas.

The discussion, which took place at the recent 2013 VMworld Conference in San Francisco, is moderated by Dana Gardner, Principal Analyst at Interarbor Solutions. [Disclosure: VMware is a sponsor of BriefingsDirect podcasts.]

Here are some excerpts:
Gardner: We heard a lot about cloud computing at VMworld, and you're both going at it a little differently. Greg, tell us a bit about the type of cloud approach you’re taking at Press Ganey.

Ericson: Press Ganey is the leader in a patient-experience analytics. We focus on providing deep insight into the patient experience in healthcare settings. We have more than 10,000 customers within the healthcare environment that look to us and partner with us around patient-experience improvement within the healthcare setting.

We started this cloud  journey in July of 2012 and we set out to achieve multiple goals. Number one, we wanted to position Press Ganey's software as solution products of the next generation and have a platform that was able to support them. 

We went through a journey of consolidating multiple data centers. We consolidated 14 different storage arrays in our process and, most importantly, we were able to position our analytic solutions to be able to take on exponentially more data and provide that to our clients.

Gardner: Patrick, how has cloud helped you at Planview? You were, at one time, a fully a non-cloud organization. Tell us about your journey.

Tickle: Planview has been an enterprise software vendor, a classic best-of-breed focused enterprise software vendor, in this project and portfolio and resource management space for over 20 years.

We have a big global customer base of on-premise customers that built up over the last 23 years. Obviously, in the world of software these days, there's a fairly seismic big shift about being in software as a service (SaaS) and how you get to the cloud, the business models, and all those kinds of things.

Conventional wisdom is for a lot it was that you can't get there unless you start from scratch. Obviously, because this is the only thing we do, it was pretty imperative that we figure out a way to get there.

So two or three years ago, we started trying to make the transition. There were a lot of things we had to go through, not just from an infrastructure standpoint, but from a business model and delivery standpoint, etc.

The essence was here. We didn’t have time to rewrite a code base in which we've invested 10-plus years and hundreds of thousands of hours of customer experience to be a market-leading product in our space. It could take five years to rewrite it. Compared to where we were 10 years ago, when you and I first met, there are a lot more tools in the bag for people to get to the cloud that there were then.

So we really went after VMware and did the research sweep much more aggressively. We started out with our own kind of infrastructure that we bolted together and moved to a FlexPod in our second generation.

We have vCloud Hybrid Services now, and leveraging our existing code base, and then the whole suite of VMware products and services, we have transformed the company into a cloud provider. Today, 90 percent of all our new Planview customers are SaaS customers. It's been a big transition for us, but the technology from VMware has been right in the center of making it happen.

Business challenges

Gardner: Greg, tell us a little bit about some of the business challenges that are driving your IT requirements that, in turn, make the cloud model attractive. Is this a growth issue? Is this a complexity issue? What are your business imperatives that make your IT requirements?

Ericson: That’s a great question. Press Ganey is a 25-year-old organization. We pioneered the concept of patient experience and the analytics, and insight into the patient experience, within the healthcare setting. We have an organization that's steeped in history, and so there are multiple things that we're looking at.

Number one, we have one of the largest protected health information (PHI) databases in the United States. So we felt that we had to have a very secure and robust solution to provide to our clients, because they trust us with their data.

Number two, with the healthcare reform, the focus on patient experience is somewhat mandatory, whereas before, it was somewhat voluntary. Now, it's regulated or it's part of the healthcare reform. When you look at organizations, some were actually coming to us and saying, "We want to get however many patient surveys out that we need to satisfy our threshold."
Our scientists are also finding a correlation between the patient experience results and clinical and quality outcomes.

Our philosophy is why would you want to do that? We believe that if you can understand and leverage the different media to be able to fill that out, you can survey your entire population of patients that are coming into not only your institution but, in the accountable care organization, the entire ecosystem that you’re serving. That gives you tremendous insight into what's going on with those patients.

Our scientists are also finding a correlation between the patient experience results and clinical and quality outcomes. So, as we can tie those data sets together in those episodic events, we're finding very interesting kinds of new thought, leading thought, out there for our clients to look at.

So for us, going from minimally surveying your population to doing census survey, which is your entire population, represents an exponential growth. The last thing is that, for our future, in terms of going after some of those new analytics, some of the new insight that we want to provide our clients, we want to position the technology to be able to take us there.

We believe that the VMware vCloud Suite represents a completeness of vision. It represents a complete a single pane of glass into managing the enterprise and, longer-term, as we become more sophisticated in identifying our data and as the industry matures, we think that a public cloud, a hybrid cloud, is in the future for us, and we're preparing for that.

Gardner: And this must be a challenge for you, not only in terms of supporting the applications, but also those data sets. You're getting some larger data sets and they could be distributed. So the cloud model suits your data needs over time as well?

Deeper insights

Ericson: Absolutely. It gives us the opportunity to be able to apply technology in the most cost-value proposition for the solutions that we’re serving up for our customers.

Our current environment is around 600 server instances. We have about 300 terabytes (TB) running in 20 SaaS applications, and we're growing exponentially each month, as we continue to provide that deeper insight for our customers.

Gardner: Patrick, for your organization what are some of the business drivers that then translate into IT requirements?

Tickle: From an IT perspective, it changed the culture of the company, moving from being a on-premise perpetual kind of "ship the software and have a customer care organization that focuses on bug and break-fix" to a service-delivery model. There were a lot of things that rippled through that whole thing.
We had to move from an IT culture to an OPs culture and all the things that go along with that, performance and up time.

At the end of the day, we had to move from an IT culture to an operations culture and all the things that go along with that, performance and up-time. Our customer base is global. So it was being able to provide that around the globe is. All those things were pretty significant shifts from an IT perspective.

We went from a company that had a corporate IT group to a company that has a hosting and DevOps and Ops team that has a little bit of spend in corporate IT.

Out of the gate, the first step at Planview was moving to colo. SunGard has been a great partner for us over the last couple of years as our ping, power, and pipe. Then, in our first generation, we bolted together some of our storage and computer infrastructure because it wasn’t quite all the way there. Then, in our most recent incarnation of the infrastructure we’re using FlexPods at SunGard in Austin, Texas and London.
OPEX spend

We're always having to evaluate future footprints. But ultimately, like many companies, we would like to convert that infrastructure investment from a capital spend into an OPEX spend. And that’s what’s compelling with vCloud Hybrid Service.

What we've been excited about hearing from VMware is not just providing the performance and the scalability, but the compatibility and the economic model that says we’re building this for people who want to just move virtual machines (VMs). We understand how big the opportunity is, and that’s going to open up more of a public cloud opportunity for us to evaluate for a wide variety of use cases going forward.

Gardner: How big a deal is it when we can, with just a click of a mouse, move workloads to any support environment we want?

Tickle: It's a huge deal. Whether it’s a production environment or disaster recovery (DR) environment, at the end of the day it's a big deal for both of us. For a SaaS company the only matter is renewals. It’s happy customers that renew. That transition from perpetual-plus maintenance to a renewal model, where you're on the customer service watch at another level, and it's every minute of every day.

Everything that we can do to make the customer experience, not just from our UI and our software, but obviously the delivery of the service, as compelling as possible, allows us to run our business. That can be a disaster scenario or just great performance across our geography where we have customers and then to do that in a cost effective way that operates inside our business model, our profit and loss.

So our shareholders are equally pleased with their turn off. We can't afford to have half of the company’s OPEX go into IT, while we’re trying to make customers as successful as they possibly can. We continue to be encouraged that we’re on a great path with the stack that we're seeing to get there.

Gardner: I think it's fair to say that cloud is not just repaving old cow paths, that cloud is really transforming your entire business. Do you agree, Greg?

Rejuvenate legacy

Ericson: I agree. It allows us, especially an organization that’s 25 years steeped in history, to be able to rejuvenate our legacy applications and be able to deliver those with maximum speed, maximizing our resources, and delivering them in a secure environment. But it also allows us to be able to grow, to flex, and to be able to rejuvenate and organically transform the organization. It's pretty exciting for us and it adds a lot of value to our clients indirectly.

Gardner: Greg,what are some of the more measurable pay-offs when you go to cloud? Are these soft payoffs of productivity and automation or are there hard numbers about return on investment (ROI) or moving more to a operation cost versus capital cost? What do you get when you do cloud right?

Ericson: We justify the investment based on consolidation of our data centers, consolidation and retirement of our storage arrays, and so on. That’s from a hard-savings perspective. From a soft-savings perspective, clearly in an environment that was not virtualized, virtualizing the environment represented a significant cost avoidance.
Our focus is on a complete solution that allows us to really focus in on what's important for us, what's important for our clients.

Longer-term, we're looking at how to position the organization with a robust, virtual secured infrastructure that runs with a minimum amount of technical resources, so that we can focus most of our efforts on delivering innovative applications to our clients.

The biggest opportunity for us is to focus there. As you look at the size of the data set and the growth of those data sets, positioning infrastructure to be able to stay with you is exciting for us and it’s a value proposition for our clients.

Entire environment

With a minimum amount of staff, we were able to move in nine months and virtualize our entire environment. When you talk about 600 servers and 300 TB of data, that's a pretty sizable enterprise and we're fully leveraging the vCloud Suite.

Our network is virtualized, our storage is virtualized, and our servers are virtualized. The release of vCloud Suite 5.5 and some of the additional network functionality and storage functionality that’s coming out with that is rather exciting. I think it's going to continue to add more value to our proposition.

Gardner: Some people say that a single point of management, when you have that comprehensive suite approach, comes in pretty handy, too.

Ericson: It does, because it gives you the capability of managing through a single pane of glass across your environments. I was going to accentuate that we’re about 50 percent complete in building on our catalog.

For our next steps, number one is that we’re looking at building upon the excellence of Press Ganey and building our next-generation enterprise data warehouse. We’re looking at leveraging from a DevOps perspective the VMware vCloud Suite, and we already have some pilots that are up and running. We'll continue to build that out.
Not only are we maximizing our assets in delivering a secure environment for our clients, but we're also really working toward what I call engineering to zero.

As we deploy, not only are we maximizing our assets in delivering a secure environment for our clients, but we're also really working toward what I call engineering to zero. We’re completely automating and virtualizing those deployments and we're able to move those deployments, as we go from dev to test, and test to user acceptance testing, and then into a production environment.

Tickle: As we all know, there are lot of hypervisors out there. We can all get that technology from a wide variety of sources. But to your question about the value with the stack, that’s what's we look at and again. What's important now is not just the product stack, but the services stack.

We look at a company like VMware and say, "Site Recovery Manager in conjunction with vCloud Hybrid Services brings a DR solution to me as SaaS vendor and that fits with my architecture and brings that service stack plus."

There's no comparing another hypervisor vendor to build out that stack of service. Again, we could probably talk about probably numerous, but that’s when I listen to the things that go on at the event and get to spend time with the people at VMware. That whole value stack that VMware is investing in is what looks so much more compelling than just picking pieces of technology.

Gardner: Looking to the future, Greg, based on what you've heard at VMworld about the general availability of vCloud Hybrid Services and the upgrade to the suite of private cloud support, what has you most excited? Was there something that surprised you? What is in the future road map for you?

A step further

Ericson: A couple of different things. The next release of NSX is exciting for us. It allows us to be able to take the virtualization of our network a step further. Also to be able to connect hypervisors into a hybrid-cloud situation is something that, as we evolve our maturity in terms of managing our data, is going to be exciting for us.
One of the areas that we're still teasing out and want to explore is how to tie in that accelerator for a big-data application into that. Probably, in 2014, what we're looking at is how to take this environment and really move from a DR kind of environment to a high-availability environment. I believe that we’re architected for that and because of the virtualization we can do that with a minimum amount of investment.
Listen to the podcast. Find it on iTunes. Read a full transcript or download a copy. Sponsor: VMware.

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