Healthcare

White Paper

Extracting Value from Healthcare Data:

An Analysis of Industry Leading Data Models

About the Authors

Pankaj Sinha
Pratice Head - Information Management, Big Data & Analytics, Tata Consultancy Services
Pankaj has 20+ years of experience in Information Technology with expertise in Strategy,
Planning, Architecture and implementation of business systems across various industry verticals
and technology platforms. Over the years he has led several strategic and large scale
engagements in Information Management, CRM, Enterprise Application Development &
Transformation areas. Currently, Pankaj heads up the Information Management, Big Data &
Analytics Practice for TCS Insurance & Healthcare unit.
Anupam Kumar
Technology Excellence Group, Healthcare
Anupam Kumar is part of the Technology Excellence Group of the Healthcare and Insurance
Industry Solutions Unit at Tata Consultancy Services (TCS) where he focuses on analytics and data
management. Anupam has a Ph.D in Statistics and over 18 years of industry experience, which
spans technology, solution design, and consulting across the healthcare, insurance, and banking
domains. He has worked with leading client organizations in the U.S. and Europe. Anupam also
conceptualizes strategic solutions and platforms for healthcare and insurance customers
including payers, integrated payer-providers, specialty providers, and pharmacy benefit
management companies.
Anantha Ramakrishnan
Solution Architect, Healthcare
As part of the Technology Excellence Group, Anantha Ramakrishnan is responsible for information
management solutions and data architecture design for healthcare clients in North America. He
has 20 years of experience in defining and implementing comprehensive, large-scale data
architecture and management solutions.
Rajaram Narasimhan
Business Intelligence Solution Architect, Healthcare
Rajaram Narasimhan works with the Healthcare Technology Practice, and is responsible for
providing information management solutions to healthcare clients. He specializes in data
architecture, business intelligence, and analytics. Narasimhan has 10 years of experience in the
healthcare domain at TCS.

Abstract

The lack of data is not a problem today. The advent of Electronic Health Records (EHR) and
regulations such as the Affordable Care Act (ACA) has resulted in billions of terabytes of data
for payers and providers. Making effective use of this data however can be a huge challenge.
The data deluge has opened up many challenges related to organizing, managing, and
sharing healthcare data across the care continuum. Much of the critical information is
fragmented and spread across different departments and systems in multiple formats.
This makes it difficult to integrate clinical data with financial and operational data to gain a
holistic picture.
Transitioning to data-centric healthcare requires a strong focus on building the foundation
for a robust information management infrastructure. Data models serve as blueprints to
identify the structures necessary to design an operational data store, data ware house, or
data marts. They also facilitate data services, integration, and exchange as well as
development of analytics platforms that cater to the unique needs of the healthcare
environment. They enable the extraction of actionable intelligence from data to improve
stakeholder outcomes through a more cost efficient and higher quality healthcare delivery
system.
This white paper reviews three industry leading data models from IBM, Oracle, and Teradata,
that can be used by payers, providers, and Pharmacy Benefit Management (PBM) companies
in their data modeling initiatives. These models have been reviewed in the context of the
Federal Health Architecture (FHA), the Federal Health Information Management (FHIM)
model, and the Domain-Driven Design (DDD) concept. Choosing the right data model can
help healthcare organizations obtain deeper strategic and operational insights to realize data
driven healthcare improvements and further their cost optimization efforts.

Contents

Designing data models: A blueprint for healthcare intelligence

Aligning data models with industry standards and best practices

IBM Healthcare Provider Data Model

Teradata Healthcare Logical Data Model

Oracle Healthcare Data Model

10

How the Healthcare Data Models Help Industry Players

11

Data model decisions

12

Turning the data onslaught into competitive advantage

13

Designing data models: A blueprint for healthcare

intelligence
Today, there is a compelling need to use the available healthcare data in better ways to drive superior patient and
business outcomes. However, the information flow in the healthcare ecosystem is turning increasingly complex, as
shown in Figure 1. The growing flood of unstructured information further complicates the matter, making
extraction and management of information a top priority.
Is there a simple and cost effective way to enable seamless information flow between stakeholders to help
healthcare organizations move to a patient centric and collaborative business model?
Medical Research

Consumer
(Patient / Member)

Explanation of Benefits

Prescription

Registration
(Demographics)

Research

EMRs

Government
Regulatory Body

Payer
Benefits & Eligibility

Network Mgmt.

Pricing

Acc. Payable
Receivable

Morbidity,
Mortality
Statistics

Point of Care

Pre-Authorization
Claims

Treatment

Prevention

Claims

Recovery

Quality of
Care Data

Diagnosis

Health
Promotions

Disease Prevention

Education

Pharmacy

Provider

Standard Reporting
Standard Reporting

Eligibility

&

TRR

Membership

Monitoring & Analysis

Surveillance

Payments

Sales

Genomics

TPA / Clearing
House

Like HEDIS

Wholesaler
Formulary Data

PBM

Rebate Info

Pharmaceutical

Figure 1: Information flow in the healthcare landscape

Sophisticated data models offer industry players precisely this option. They simplify the information landscape by
capturing the crucial data elements and structure needed for effective decision making. They can represent a single
functional area or provide a big picture of the healthcare organization in the form of an Enterprise Data Model
(EDM). An EDM aims to establish trust and confidence in the organizational
data assets. It plays a crucial role in defining the data architecture as well as
maintaining data quality, consistency, security, and accessibility. It also
Pre-built industry data
models provide faster time
supports data governance, metadata management and master data
to
value, and enable
management.
superior decision making
Significant skills and resources are required to build an EDM from scratch.
and compliance.
Pre-built industry data models enable understanding of the varied uses of
data, their relationships and attributes, and provide faster time to value. In
addition, they reduce operational expenditures by eliminating the need for
skilled data modelers and integrators.
Serving as the foundation of actionable intelligence, they help healthcare leaders manage budgets, prioritize
technology investments, and ensure regulatory compliance.

Aligning data models with industry standards and

best practices
Electronic
Health Record

Personal
Health Record
Quality
Measures

Clinical
Research

Public Health

Patient

Population

Practice
Public
Health Policy

Clinical Decision
Support

National & International

Health Analytics

Health Information
Exchange

Public
Clinical
Guidelines

Source: HealthIT.gov

Integrated Care

Personalization of Care

Care Coordination

Outcomes

Patient Engagement

Patient
Satisfaction

Cost Containment

Patient Safety

Personal Health
Record

Wellness
Initiatives

Genomics

Simplification of Business & IT Operations is essential to achieve the Industry Vision

Figure 2: Driving efficient data exchange across healthcare stakeholders

With increasing emphasis on providing integrated and personalized care, healthcare data models have become key
to driving efficient data exchange and interoperability across the healthcare community and government
healthcare programs (see figure 2).
Several industry standards support the overarching vision of creating an interoperable ecosystem to improve the
exchange of health data among stakeholders. The Federal Health Architecture (FHA) started in 2004 is one such
initiative. It encompasses stakeholders such as the federal government, private sector healthcare providers, and
others. The FHA is currently managed by the Office of the National Coordinator for Health IT (ONC) within the
Department of Health and Human Services (HHS).
FHA aims to improve access to and quality of care while reducing overall healthcare costs by focusing on the
following1:
n

Supporting federal efforts to deploy standardized health IT systems and measure health IT standard adoption.

Ensuring that federal agencies can seamlessly exchange health data among themselves as well as with the state,
local, and tribal governments, and private-sector partners.

Providing guidance to federal agencies on how best to manage and

maintain health IT investments.

The Federal Health Information Model: A standard for supporting

healthcare interoperability
The Federal Health Information Model (FHIM) is an information model of
healthcare data developed for the FHA partner agencies. The FHIM seeks to
support health interoperability by harmonizing information from federal
partners and standards development organizations (SDOs) into a unified,
logical, health information model.
This logical model uses the HL7 Reference Information Model (RIM) as its
reference point. It is designed to support multiple Office of Interoperability
and Standards initiatives, including CONNECT and the Standards and
Interoperability (S&I) Framework2.

The FHIM is an Information

model and not a data
model. Usually, data models
are meant to be
implemented, whereas
information models are
higher level specifications.
An information model is like
a building blueprint. It
defines metadata types that
are stored in a repository
database and used by tools
and applications.

The FHIM is designed to enable meaningful information exchange among the partner agencies as well as
externally, with the broader health community. Its key features include:
n

Integration with Model Driven Health Tools (MDHT) to support a Model Driven Architecture (MDA) approach for
the development of health information exchange interoperability specifications.

Use of the Unified Modeling Language (UML) - that describes the health-related information needed by the FHA
federal partner organizations - for model development

A semantic information base for information exchange, traceability, and alignment with industry information
models and standards.

Suitability as a Logical Information Model to guide the enterprise architecture of the federal partner
organizations.

[1] Healthit.gov, Federal Health Architecture, accessed, June 2015, https://www.healthit.gov/sites/default/files/pdf/fact-sheets/federal-health-architecture.pdf

[2] Healthit.gov, Federal Health Architecture, accessed, June 2015, https://www.healthit.gov/sites/default/files/pdf/fact-sheets/federal-health-architecture.pdf

Domain Driven Design: A best practice for emphasizing core domain concepts
A domain is a sphere of knowledge, influence or activity. With respect to FHIM, it is a subject area in healthcare
such as allergies, vitals, or orders. Domain-Driven Design (DDD) is a conceptual model of a domain of interest that
describes the various entities, their attributes, roles and relationships. Data models encompass entities and their
relationships, while domain models identify how these entities interact with each other to make these actions an
integral part of entities behavioral specifications. It also describes the constraints that govern the integrity of the
model elements comprising that problem domain.
As an approach to developing software for complex needs, DDD places the project's primary focus on the core
domain and domain logic. It supports collaboration between technical and domain experts to get closer to the
conceptual heart of the business challenge in this case - providing health information insights.
In the following section, we look at three industry-leading data models
that enable the seamless flow of information between stakeholders in the
healthcare ecosystem to deliver patient-centric and accountable care.

What is unique about the

IBM model?
n

Integration across products

to support all four major
data warehouse use cases

Continuous investment in
product innovation to meet
emerging customer and
market demands, including
a data warehouse PaaS
offering- dashDB that
offers in-memory columnar
capabilities

Integration with the

Cloudant NoSQL databases
as well as PureData for indatabase analytics

Deployable with
technologies such as
BigInsights BigSQl, DB2
with BLU Acceleration and
IBM PureData powered by
Netezza (which supports
high performance for
complex analytic
workloads)

IBM Healthcare Provider Data Model

The IBM Healthcare Provider Data model is part of the IBM InfoSphere
software portfolio. It integrates clinical, administrative, and financial data to
support real time analytical needs. By leveraging this data model, healthcare
delivery organizations can remain responsive to client and marketplace
requirements, and the evolving healthcare regulatory environment. The data
model builds a strong foundation for information management
infrastructure, and helps drive evidence based, patient centric, accountable
care. It supports Clinical Care and Research, Supply Chain, Service Line
Analytics, Model Extensions and Business Glossary Enhancements. The key
components and features of the IBMs Healthcare Provider Data Model are
given below:

[3] IBM Europe Sales Manual, November 2013, IBM Healthcare Provider Data Model V8.8, Accessed June 2015,
http://www-01.ibm.com/common/ssi/printableversion.wss?docURL=/common/ssi/rep_sm/8/877/ENUS5725-I48/index.html
[4] IBM Software, Accessed June 2015, http://www-03.ibm.com/software/products/en/healthcare-provider-data-model

Components
n

Business terms: Enterprise-wide vocabulary of business

concepts that provide a view of itself and the industry.
Business data model: Conceptual data model that specifies
the third normal form (3NF) data structures required to
represent concepts defined in business terms.

Features
n

Atomic warehouse model: Design-level data model that

represents an enterprise-wide repository of atomic data used
for information processing.

Dimensional warehouse model: Enterprise-wide repository

for analytical data. It contains star schema-style dimensional
data structures organized around fact entities.

Business solution templates: Set of industry-relevant

analytical reporting requirements organized around business
focus areas.

Extensibility and scalability: Offers a robust set of business

and technical data models that are extensible and scalable to
address current as well as future needs.
Cross functional enterprise views: Integrates business
model, atomic warehouse model, and dimensional
warehouse model to support cross-functional enterprise
views, analytics, and applications.
Comprehensive analytics: Addresses the analytical business
requirements covering clinical research, financial, and
operational data integrated across the enterprise.
Content delivery: Supports quality analysis, shared savings
programs, patient safety initiatives, and other industry-wide
standards.

Benefits
IBMs Healthcare Provider Data Model helps correlate clinical, financial, operational, and payer data in a cohesive
and flexible manner. This helps accelerate the understanding of population-level health, manage and quantify risk,
and identify opportunities for transformation and innovation. It also offers the following benefits :
n

Operational insight: Provides a comprehensive, analytical reporting framework

Risk and compliance reporting: Supports the reporting for a series of regulatory requirements

Enterprise architecture: Offers structure and content to support the business and application layers of an
enterprise architecture

Teradata Healthcare Logical Data Model

The Teradata Healthcare Logical Data Model (HC-LDM) offers cross-functional coverage and a single view of data
across the enterprise. It provides a holistic view of healthcare insurers, providers, managed care organizations,
healthcare data administrators, vendors, and consultants. In addition, the HC-LDM can be easily extended as the
business grows by leveraging the Teradata iLDM unification. Key components and features of the Teradata
Healthcare Logical Data Model are given below:
Components
n
n

Features

Conceptual, business high-level, subject area data model.

Business LDM Third Normal Form (3NF), fully attributed data

model.

Preliminary Physical Database Design, populated with

technical names and/or abbreviations.

A database, data warehouse construction, or implementation

data model configured to maximize throughput.
n

Includes structures which capture data elements and business

rules that govern day-to-day operations.
Built using the process of normalization and completely
independent of both application and technology.
Offers extensibility which allows healthcare organizations to
add new structures and eliminate unnecessary existing
structures.
Consists of data elements in third normal form 3NF that
support a number of industry standards.

[6] The Teradata Healthcare Industry Logical Data Model, Accessed June 2015,
http://in.teradata.com/Resources/White-Papers/The-Teradata-Healthcare-Industry-Logical-Data-Model/?LangType=16393&LangSelect=true

Benefits
The Oracle Healthcare Data Model integrates data from electronic medical
records, clinical departmental systems, patient accounting, back office,
research, and various other source systems. It supports diverse analytical
requirements to unlock value from clinical and operational data quickly and
cost-effectively and provides:
n

Query and reporting for information: Supports the extraction of

detailed and summary data

OLAP for data analysis: Provides summaries, trends, and forecasts

Data mining for insight and prediction: Uncovers hidden patterns and
insights

How the Healthcare Data Models

Help Industry Players
The models discussed here are designed by industry experts and supported
by best-in-class technologies. They help healthcare organizations avoid the
pitfalls of complex integration requirements and reduce the total cost of
ownership. These models also offer fast and predictable implementation,
accelerating the return on investment while reducing deployment risks.

Healthcare data models:

Key business outcomes
n

Improved access to
information across the
healthcare ecosystem

Better insights from clinical

and operational data
through data mining

Fast and precise, clinical

and non-clinical decision
making through better
analytics

Improved data governance

and standardization

Predictable healthcare
outcomes through accurate
forecasting

Improved risk and

compliance reporting

Identification and
prioritization of key areas of
improvements across
service lines

The IBM Healthcare Data Model allows healthcare organizations looking for
enhanced data governance and standardization to define a corporate set of
n Better scalability to meet
standard best practices related to their data. This enables IT to enforce
future growth
standards as well as use data profiling techniques for compliance
requirements
monitoring and exception alerting. In addition, the solution provides service
line analytics through an enterprise framework to create visibility across the
organization and gain insight into re-admission rates, quality indicators, operating margins and clinical outcomes.
The Oracle Healthcare Data Model is a good fit for healthcare organizations interested in working with a single
vendor solution to minimize compatibility issues, and accelerate deployment and training. The solution also
enables data mining to identify inefficiencies and best practices, and supports forecasting to predict and manage
healthcare outcomes.
The Teradata Healthcare Model is a party (organization, individual) centric model which is derived from Teradatas
extensive experience in the payer industry. This model integrates the financial entities such as claims, payments etc.
Moreover, since the party is defined as a common subject, the data model supports seamless integration and offers
increased flexibility for analysis.

11

Benefits
The Teradata HC-LDM provides an integrated base of strategic business and
clinical information. It supports the creation of an ideal framework for a wide
range of knowledge applications as well as new payment models. It helps
healthcare organizations launch new lines of business and meet evolving
government mandates. In addition, the Teradata HC-LDM offers the
following benefits:
Integrated base of information: Offers a single source of clinical and
business information, more seamless care management, tighter customer
and supplier relationships, and more accurate pricing

Operational insights: Provides additional insight to negotiate more

favorable contracts, segment customers better, or identify greater cost
saving opportunities

Scalable model: Establishes a base for adding more applications and

capabilities to exploit data

Modular architecture: Allows users to design and implement a data

warehouse strategy one functional area at a time

What is unique about the

Teradata model?
n

Demonstrates continuous
technology enhancements
to meet production
demands

Has a broad user type

support

Can be combined with the

Teradata Healthcare Data
Integration Roadmap (DIR)
which is a visual reference
model that helps align
strategic organizational
objectives with the
supporting data in the
integrated data warehouse.

Oracle Healthcare Data Model

The Oracle Healthcare Data Model provides an integrated view of enterprise-wide clinical and operational data for
better decision making. It includes both logical and physical data models that are designed to support Oracle data
warehouses, including the Oracle Exadata Database Machine. It supports common entities such as party and care
site, core clinical activities such as observation, intervention and order, and financial and billing activities for
accounting, equipment, HR, and payroll. The key components and features of the Oracle Healthcare Data Model are
given below:
Components
n

Physical model: Physical manifestation of the logical data

model into database tables and relationships. Partitions,
indexes, parallel definitions, and Cube Views aid performance.
Intra-ETL database packages: Pre-built ETL component
which loads the information present in the foundation layer
(3NF tables) into the Oracle Healthcare Data Model Analytical
Layer.
Oracle Interactive Dashboard: Sample reports and
dashboards using Oracle Business Intelligence Suite
Enterprise Edition.

Features
n

Embedded analytics: Offers embedded advanced analytics,

using pre-built data mining, Oracle Online Analytical
Processing (Oracle OLAP), and dimensional models.
Query and reporting: Enables extraction of detailed and
summary data.
3NF data warehouse model: Provides a solid base for a
healthcare data warehouse, while the derived layer provides
the infrastructure for creating KPI's, cube views, and reports.
Robust infrastructure: Supports the creation of a range of
reports.

[7] Teradata Healthcare Data Model, Accessed June 2015, http://in.teradata.com/logical-data-models/healthcare/?LangType=16393&LangSelect=true

[8] Oracle Healthcare Data Model Reference, Accessed June 2015, https://www.db.bme.hu/files/Manuals/Oracle/Oracle11gR2/doc.112/e18026/intro_hdm.htm

10

A detailed analysis is provided in figure 3.

Features

IBM Healthcare Data Model

Oracle Healthcare Data Model

Teradata Healthcare Data Model

Caters complex and fluid

analytical needs

Scalability
Cross functional enterprise views

[
[

[
[

[
[

Handles Data governance and

Standardization

Logical Data Model Support

[
[

[
[
[
[
[
[
[
[

Physical Data Model Support

Single vendor solution package
Provides metrics & insights
Embedded Advanced Analytics
OLAP

[
[

Data Mining & Forecasts

BI
Integrated Data Warehouse
Integrated Strategy

[
[
[

[
[

[
[
[

[
[

Supports

Clinical care and research

Service-line analytics

Supply chain

Platform

[
[
[
[

Figure 3: A comparative analysis of the healthcare data models

Data model decisions

The move towards patient-centric and collaborative care delivery requires the seamless flow of information across
the healthcare ecosystem. Several programs such as the Federal Health Architecture and Federal Health
Information Model (FHIM) establish standards for creating an interoperable ecosystem to improve the exchange of
health data among stakeholders. Integrating clinical, administrative, and financial data can help healthcare
organizations answer complex strategic and tactical business questions faster and more accurately. This is made
possible by data models that serve as blueprints for healthcare intelligence. They play a crucial role in defining the
data architecture, and capturing data elements and structures.
12

As opposed to proprietary enterprise data models, pre-built industry models can help reduce the time and resources
required to build a proprietary enterprise data model. The IBM Healthcare Data Model facilitates enhanced data
governance and standardization to define a corporate set of standard best practices related to healthcare data. It also
offers service line analytics. Healthcare organizations looking for a single vendor solution can leverage Oracles
Healthcare Data Model. It enables data mining and supports forecasting to predict and manage healthcare outcomes.
The Teradata Healthcare Model is a party centric model, which integrates the financial entities such as claims and
payments. It supports seamless integration and provides increased flexibility for analysis.

All of these models offer predictable implementation, reduced deployment risks and faster time to value,
while enabling a cost efficient and higher quality healthcare delivery system.

Turning the data onslaught into competitive advantage

Delivering high quality healthcare is an information intensive effort, and organizations must evolve their data
management approach to match the changing and complex needs of the industry. Moreover, with healthcare data
growing in volume, velocity, and variety, the ability to leverage Big Data to derive insights has become an
important competitive differentiator. The chosen data model must therefore be robust enough to support the
current needs while being scalable to address future requirements. Healthcare organizations that identify the right
data model for their unique needs will gain a truly comprehensive approach to healthcare intelligence, resulting in
competitive advantage.

13

About TCS' Healthcare Business Unit

TCS partners with leading health payers, providers and PBMs globally to enable business model
transformations to address healthcare reforms, improve quality of care, increase customer
engagement and reduce overheads.
By streamlining and modernizing business processes and systems, TCS helps healthcare
organizations realize operational efficiencies and reduce operating costs. We work closely with
healthcare players to empower them to meet their consumers' demands for higher levels of service,
quality of care, and new ways of interacting and engaging. Our advanced data solutions, analytics,
and cutting edge digital technologies deliver a higher degree of customer centricity.
TCS' portfolio of services covers the entire payer value chain from Plan Definition, Eligibility and
Enrollment, Policy Servicing, Billing, Claims Processing, Claims Adjudication, Benefit Management,
Provider Management and Member Services. For providers, we deliver bespoke services for Provider
Management, Claims Management, Patient Information and Financial Management, Clinical Data
Management, Pharmacy Benefit Management and Revenue Cycle Management.
Contact
For more information about TCS Healthcare Business Unit, visit:
http://www.tcs.com/healthcare
Email: healthcare.solutions@tcs.com
Subscribe to TCS White Papers
TCS.com RSS: http://www.tcs.com/rss_feeds/Pages/feed.aspx?f=w
Feedburner: http://feeds2.feedburner.com/tcswhitepapers
About Tata Consultancy Services (TCS)
Tata Consultancy Services is an IT services, consulting and business solutions organization that
delivers real results to global business, ensuring a level of certainty no other firm can match.
TCS offers a consulting-led, integrated portfolio of IT and IT-enabled infrastructure, engineering and
assurance services. This is delivered through its unique Global Network Delivery ModelTM,
recognized as the benchmark of excellence in software development. A part of the Tata Group,
Indias largest industrial conglomerate, TCS has a global footprint and is listed on the National Stock
Exchange and Bombay Stock Exchange in India.

IT Services
Business Solutions
Consulting
All content / information present here is the exclusive property of Tata Consultancy Services Limited (TCS). The content / information contained here is correct at
the time of publishing. No material from here may be copied, modified, reproduced, republished, uploaded, transmitted, posted or distributed in any form
without prior written permission from TCS. Unauthorized use of the content / information appearing here may violate copyright, trademark and other applicable
laws, and could result in criminal or civil penalties. Copyright 2015 Tata Consultancy Services Limited

TCS Design Services I M I 12 I 15

For more information, visit us at www.tcs.com