Around the world healthcare organizations are facing an operating environment of rising medical costs, increased demand for services and increasing scrutiny from patients, governments, insurers and employers. The soaring prices paid to treat the growing volumes of demanding, aging patients are prompting the search for more efficient ways of treatment and care. Consumers and employers are demanding better service and outcomes while regulatory agencies are pushing for mandated improved efficiency and service levels. This must be balanced with the need to control expenses, increase workforce productivity and effectively manage increasingly scarce resources.

There is an onslaught of demands for current and accurate information on performance, quality, safety, efficiency, effectiveness and of course, costs of healthcare delivery at healthcare organizations - whether a healthcare organization is a payer, a provider, a government public health agency, a pharmacy, a laboratory, an imaging facility, or a pharmaceutical company, or whether a healthcare organization is “for-profit” or “non-profit”. Further, optimization of clinical, operational and financial business processes is a major initiative in a healthcare organization to adopt care-based revenue cycle management. In parallel, there is competition amongst healthcare organizations to “do more with less” - to gain and retain optimal consumers (or patients) those with the highest level of profitability and lifetime value while continuing to provide access to affordable and quality healthcare for indigent population. So no longer can a healthcare organization fly blind – whether they are profitable or not.

Healthcare organizations are increasingly looking for business intelligence and analytics as technology enablers to help gain insight into their current business processes so as to optimize them and stand ready to become more agile to the rapidly changing business landscape in healthcare. The new competition amongst healthcare organizations will be based on extensive use of analytics, data, and fact-based decision making.

A Data warehouse forms the architectural foundation for enabling Business Intelligence and Analytics (data mining) – the Information Analytics infrastructure - for healthcare organizations to manage the business of healthcare in the future. A high performance Information Analytics infrastructure promises to deliver solutions such as

Revenue Cycle Management Utilization Management Population Segmentation and Risk Management Patient Registry & Disease Surveillance Enterprise Master Patient Index Priority Conditions Outcomes Dashboard Pay-for-Performance/Clinical Performance Reporting Quality Improvement/Accreditation Reporting (HEDIS™, PQRI, HQI, etc) Resource Scheduling Analysis (Staff, Beds, etc) Research Hypothesis Discovery Access and Outreach Planning Support Patient “Safety, Education and Satisfaction” Analysis Provider Satisfaction Analysis Enterprise Decision Support (Investment, Organizational Direction, Marketing, Operating Efficiency)

The key to successfully planning and implementing a Quality and Performance Analytics infrastructure should address a combination of a goal-driven and user-driven implementation strategy that covers the entire gamut from business process optimization to information integration to operationalizing intelligence delivery with striking an effective alchemy of people, process and technology.

Business Domain Expertise:

PluralSoft combines years of Information Management experience at Global 1000 organizations across multiple industry verticals along with healthcare domain expertise makes us an ideal solution business partner to deliver solutions to any healthcare organization by leveraging our proprietary solution frameworks and our technology partnerships.

A sample of our domain expertise is:

	re-engineering claims processing platforms for a payer
	building the next generation specialty case management solution for a payer
	delivering an medical chart portal for a transcription services provider
	delivering an EMR with clinical analytics for an IPA
	delivering financial and clinical analytics for an IDN
	delivering HEDIS™ reporting for a payer

Our Solution Framework:

We leverage our Information Analytics Framework in delivering data warehousing, business intelligence and analytics solutions to our healthcare clients. The components are:

	An integration engine framework :
	Conversant in multiple healthcare protocols such as multiple flavors of HL7, HIPAA X12 transactions and NCPDP Based on Channel Architecture, with each channel consisting of originating and terminating endpoints which can be a combination of TCP/MLLP, SOAP, RDBMS, File system, JMS and FTP/SFTP. Each channel in turn can have an arbitrary number of filter and transformers to transform the incoming message. A simple and robust ESB (Enterprise Service Bus) with requisite security and audit trail
	Clinical Data Repository modeled using HL7 RIM, a Payer-side data model and combined with years of creating flexible and normalized data model
	A Controlled Medical Vocabulary system to normalize concepts and to cross-reference medical code-sets across competing standards
	A Meta-thesaurus to link the code-sets in pre-defined ontologies
	Flexible data warehouse models which is populated by the Integration Engine, to link clinical, administrative and financial information to provide hindsight, insight and foresight into operational business intelligence
	An unstructured information retrieval and search engine that leverages our clinical data repository and our controlled medical vocabulary system
	An electronic chart abstraction tool and associated services that combines our document management system and our unstructured information retrieval and search engine

Our Technology Expertise:

PluralSoft staff has expertise in various technologies whether open-source or closed-source and collaborates with our technology partnerships to deliver Quality & Performance Analytics solutions to healthcare organizations faster, better, cheaper.

For more information on how PluralSoft can help you deliver a quality, high performance business intelligence and analytics environment for your quality and performance analyses needs, please contact us.