Chapter 7:

7 Healthcare Data
Analytics
Bill Hersh MD
Learning Objectives
After reviewing these slides, the viewer should be able to:
▸ Discuss the difference between descriptive, predictive and prescriptive
analytics
▸ Describe the characteristics of “Big Data”
▸ Enumerate the necessary skills for a worker in the data analytics field
▸ List the limitations of healthcare data analytics
▸ Discuss the critical role electronic health records play in healthcare data
analytics

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 Important
Introduction
▸ One of the promises of the growing clinical data in electronic health record
(EHR) systems is secondary use (or re-use) of the data for other purposes,
such as quality improvement and clinical research
▸ Interest in healthcare data has grown exponentially due to EHR incentives
after the HITECH Act and the addition of genomic information that will
eventually be integrated with EHRs

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 Important
Terminology of Analytics
▸ The term analytics is achieving wide use both in and out of healthcare. A
leader in the field defines analytics as “the extensive use of data,
statistical and quantitative analysis, explanatory and predictive models,
and fact-based management to drive decisions and actions”
▸ IBM defines analytics as “the systematic use of data and related business
insights developed through applied analytical disciplines to drive fact-
based decision making for planning, management, measurement and
learning

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 Different Types of Analytics
Increasing functionality and value very important
• standard types of reporting that describe current
Descriptive situations and problems (how many uninsured patients
should do we have with type 2 diabetes?)

know • simulation and modeling techniques that identify

trends and portend outcomes of actions taken (can we
the Predictive
predict who will be readmitted for heart failure in the
different next 30 days?)

• optimizing clinical, financial, and other outcomes (of

those patients identified as high risk for readmission for
Prescriptive
heart failure is it more cost effective to case manage in
the hospital or at home?)
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 Important
Analytics Concepts (1-2)
▸
* Machine learning is the area of computer science that aims to build

systems and algorithms that learn from data

* Data mining is defined as the processing and modeling of large amounts
▸
of data to discover previously unknown patterns or relationships
*
▸ Text mining, a sub-area, applies data mining techniques to mostly
unstructured textual data
*
▸ Provenance, which is where the data originated and how trustworthy it is
for large-scale processing and analysis

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 Read
Analytics Concepts (2-2)
▸ Business intelligence, which in healthcare refers to the “processes and
technologies used to obtain timely, valuable insights into business and
clinical data”
▸ Learning health system, where data can be used for continuous learning
to allow the healthcare system to better carry out disease surveillance and
response, targeting of healthcare services, improving decision-making,
managing misinformation, reducing harm, avoiding costly errors, and
advancing clinical research

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Big Data The definition is important
▸ Another related term is big data, which describes large and ever-
increasing volumes of data that adhere to the following attributes:
▹ Volume – ever-increasing amounts
▹ Velocity – quickly generated
▹ Variety – many different types
▹ Veracity – from trustable sources
▸ While big data is considered a buzz word by some, we are having to deal
with terabytes and petabytes of information today. With the addition of
genomics big data will escalate
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 Important
&*
Big Data
▸ Healthcare organizations are generating an ever-increasing amount of
data. In all healthcare organizations, clinical data takes a variety of forms,
from structured (e.g., images, lab results, etc.) to unstructured (e.g.,
textual notes including clinical narratives, reports, and other types of
documents)
▸ For example, it was estimated by Kaiser-Permanente in 2013 that its
current data store for its 9+ million members exceeds 30 petabytes
(petabyte = 1024 terabytes) of data

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&
Big Data Important
▸ Another example is CancerLinQ that will provide a comprehensive system
for clinicians and researchers consisting of EHR data collection,
application of clinical decision support, data mining and visualization, and
quality feedback
▸ Lastly, IBM’s Watson is now focusing on healthcare, specifically Oncology
so that massive amounts of cancer information/research can be analyzed
and applied to individual patient decision making

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 The Analytics Big
Data Pipeline
According to Kumar et al
▸ One begins with multiple data
sources, that are extracted and
cleansed and normalized
▸ Statistical processing prepares the
data for output
▸ Finally, the data helps generate
descriptive, predictive and
prescriptive analytics
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Big Data - Big Data will Drive ACOs
▸ Accountable care organizations (ACOs) provide incentives to deliver high-
quality care in cost-efficient ways that will require a robust IT architecture,
health information exchange (HIE) plus analytics. This approach would be
used to predict and quickly act on excess costs
▸ As a well-known informatics blogger put it: ACOs = HIE + Analytics

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 Important
Challenges to Data Analytics (1-2)
▸ Data generated in the routine care of patients may be limited in its use for
analytical purposes. For example, data may be inaccurate or incomplete. It
may be transformed in ways that undermine its meaning (e.g., coding for
billing priorities)
▸ It may exhibit the well-known statistical phenomenon of censoring, i.e.,
the first instance of disease in record may not be when it was first
manifested (left censoring), or the data source may not cover a sufficiently
longtime interval (right censoring)
▸ Data may also incompletely adhere to well-known standards, which makes
combining it from different sources more difficult
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 Important
Challenges to Data Analytics (2-2)
▸ Clinical data mostly allows observational and not experimental studies,
thus raising issues of cause-and-effect of findings discovered
▸ Research questions asked of the data tend to be driven by what can be
answered, as opposed to prospective hypotheses
▸ Data are not always as objective as one might like, and “bigger” is not
necessarily better
▸ There are ethical concerns over how the data of individuals is used, how it
is collected, and the possible divide between those who have access to
data and those who do not
▸ Who owns the data and who can use it? 14
Research and Application of Analytics
▸ There is an emerging base of research that demonstrates how data from
operational clinical systems can be used to identify critical situations or
patients whose costs are outliers
▸ There is less research, however, demonstrating how this data can be used
to improve clinical outcomes or reduce costs. Studies using EHR data for
clinical prediction have been proliferating

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The Most Important Use Cases for
Application of Data Analytics
▸ High-cost patients – looking for ways to intervene early
▸ Readmissions – preventing
▸ Triage – appropriate level of care
▸ Decompensation – when patient’s condition worsens
▸ Adverse events – awareness
▸ Treatment optimization – especially for diseases affecting multiple organ
systems

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Important
Research and Application of Analytics
▸ One common area of focus has been the use of data analytics to identify
patients at risk for hospital readmission within 30 days of discharge. The
importance of this factor comes from the US Centers for Medicare and
Medicaid Services (CMS) Readmissions Reduction Program that penalizes
hospitals for excessive numbers of readmissions
▸ This has led to research using EHR data to predict hospital readmissions.
Thus far, the results are mixed, and several examples of trials are included
in the textbook chapter

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Research and Application of Analytics
Identifying Patients for Research Using EHR Data

▸ Identifying patients who might be eligible for participation in clinical

studies
▸ Identification of children with asthma
▸ Improving on ICD-9 to identify patients with hepatocellular carcinoma
▸ Automated phenotyping using EHR data and machine learning

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 Research and Application of Analytics
Scenarios for EHR Data Analysis to predict healthcare utilization outcomes

▸ Predicting healthcare utilization ▸ Predicting risk of suicide and

7-68 or primary care panel size ability to do so better than
▸ Risk-adjusting hospital mortality clinicians
rates ▸ For cancer patients, detecting
▸ Detecting postoperative potential delays in cancer
complications diagnosis or predicting trajectory
▸ Measuring processes of care of disease using NLP
▸ Determining five-year life ▸ Severity of illness in ICU based on
expectancy usual physiological models
▸ Cardiovascular event risk
prediction
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Research and Application of Analytics
Use EHR Data to Replicate Randomized Controlled Trials
▸ Virtual Data Warehouse (VDW) Project was able to demonstrate a link
between childhood obesity and hyperglycemia in pregnancy
▸ United Kingdom General Practice Research Database (UKGPRD), a repository
of longitudinal records of general practitioners, was able to demonstrate the
ability to replicate the findings of the Women’s Health Initiative and RCTs of
other cardiovascular diseases
▸ Other data repositories have helped to predict a variety of cancers, risk for
venous thromboembolism (blood clots) and even rare medical disorders

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Research and Application of Analytics
Using Genomic Information and EHRs

▸ Researchers have carried out genome-wide association studies (GWAS) that

associate specific findings from the EHR (the “phenotype”) with the growing
amount of genomic and related data (the “genotype”) in the Electronic
Medical Records and Genomics (eMERGE) Network
▸ eMERGE has demonstrated the ability to identify genomic variants
associated with atrioventricular conduction abnormalities, red blood cell
traits, white blood cell count abnormalities, and thyroid disorders

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Research and Application of Analytics
Using Genomic Information and EHRs

▸ More recent work has “inverted” the paradigm to carry out phenome-wide
association studies (PheWAS) that associated multiple phenotypes with
varying genotypes
▸ Genome-wide and phenome-wide association studies are also discussed in
the chapter on bioinformatics

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 Important
Role of Informaticians in Analytics
▸ There has been little focus on the human experts who will carry out
analytics, to say nothing of those who will support their efforts in building
systems to capture data, put it into usable form, and apply the results of
analysis
▸ Where will these workers come from and what will be the education of
those who work in this emerging area, that some call data science?
▸ We do know that data analytics experts are in high demand

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 Important
Role of Informaticians in Analytics
*
▸ From basic biomedical scientists to clinicians and public health workers,
those who are researchers and practitioners are drowning in data, needing
tools and techniques to allow its use in meaningful and actionable ways
▸ Dr. Hersh believes that a strong background in Health Informatics or
Biomedical Informatics is the best preparation for the healthcare data
analytics field

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Role of Informaticians in Analytics
very important
▸ Data science is more than statistics or computer science applied in a
-

specific subject domain. It requires an understanding of data, its varying

types, and how to manipulate and leverage it
▸ The field requires skills in machine learning, a strong foundation in
statistics (especially Bayesian), computer science (representation and
manipulation of data), and knowledge of correlation and causation
(modeling)

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 X
The Need for Data Analytics Experts
▸ A report by McKinsey consulting states that there will soon be a need in
the US for 140,000-190,000 individuals who have “deep analytical talent”
and an additional 1.5 million “data-savvy managers needed to take full
advantage of big data”
▸ An analysis by SAS estimated that by 2018, there will be over 6400
organizations that will hire 100 or more analytics staff
▸ Another report found that data scientists currently comprise less than 1%
of all big data positions, with more common job roles consisting of
developers (42% of advertised positions), architects (10%), analysts (8%)
and administrators (6%)

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 Important
The Need for Data Analytics Experts
▸ The technical skills most required for big data positions were NoSQL,
Oracle, Java and SQL
▸ PriceWaterhouseCoopers noted that healthcare organizations need to
acquire talent in systems and data integration, data statistics and analytics,
technology and architecture support, and clinical informatics
▸ Business knowledge is also useful

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 Important !
The Need for Data Analytics Experts
What Skill Sets Should Universities Train For?

▸ Programming - especially with data-oriented tools, such as SQL and

statistical programming languages
▸ Statistics - working knowledge to apply tools and techniques
▸ Domain knowledge - depending on one's area of work, bioscience or
health care
▸ Communication - being able to understand needs of people and
organizations and articulate results back to them

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Conclusions
▸ Healthcare data has proliferated greatly, in large part due to the

“ accelerated adoption of EHRs

▸ Analytic platforms will examine data from multiple sources, such as
clinical records, genomic data, financial systems, and administrative
systems
▸ Analytics is necessary to transform data to information and
knowledge
▸ Accountable care organizations and other new models of healthcare
delivery will rely heavily on analytics to analyze financial and clinical
data
▸ There is a great demand for skilled data analysts in healthcare;
expertise in informatics will be important for such individuals
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THANKS!
Any questions?

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Reference
▸ Hersh WR, Hoyt RE. Health Informatics: Practical Guide Seventh Edition.
Informatics Education; 2018.
https://books.google.com.kw/books?id=UnxeDwAAQBAJ
Chapter 7: Healthcare Data Analytics (pp 149-160)

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