Transcript of a Briefings Direct podcast on how a large provider of healthcare services is providing insight into patient outcomes as well as EMR system performance.

1. Efficient Big Data Capabilities Help Cerner Drive
Needed Improvements into US Healthcare System
Transcript of a Briefings Direct podcast on how a large provider of healthcare services is
providing insight into patient outcomes as well as EMR system performance.
Listen to the podcast. Find it on iTunes. Sponsor: HP
Dana Gardner: Hello, and welcome to the next edition of the HP Discover Performance
Podcast Series. I'm Dana Gardner, Principal Analyst at Interarbor Solutions,
your moderator for this ongoing discussion of IT innovation and how it’s
making an impact on people’s lives.
Once again, we’re focusing on how IT leaders are improving their business
performance for better access, use and analysis of their data and information.
This time we’re coming to you directly from the HP Vertica Big Data
Conference in Boston. [Disclosure: HP is a sponsor of BriefingsDirect
podcasts.]
Our next innovation case study highlights how a healthcare solutions provider leverages big-data
capabilities. We’ll see how they deployed the HP Vertica Analytics platform to help their
customers better understand population healthcare trends, as well as to help them run their own
systems internally.
To learn more about how high performing and cost effective big data processing forms a
foundational element to improving healthcare quality and efficiency, please join me
now in welcoming our guest. We're here with Dan Woicke. He is the Director of
Enterprise Systems Management at Cerner Corporation based in Kansas City,
Missouri. Welcome, Dan.
Dan Woicke: First of all, thank you very much for having me. It’s my first time
in Boston. So I'm having a blast here.
Gardner: Terrific. Let’s start at a high level and talk a little bit about why, in the healthcare
industry in particular, big data is super important. We're going through some major transitions in
how payments are going to be made and how even the definition of 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: Obviously, you hit the nail on the head. 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.

2. Gardner: It’s interesting that, on one side of the coin, you're looking to bring large data sets
together to analyze what’s going on in the field, but in order to allow you to better serve those
needs, you also have big IT systems. They're putting out a lot of data, and you need to analyze
them. Tell us a little bit about two ways in which big data is being employed there at Cerner.
Woicke: We’ll touch on more of the clinical side of how we are processing this data in the new
model. 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: Everybody, almost across any business you talk to, wants to be more proactive and get
out in front of these issues. Tell me how big data and the ability to manage big data gets you
closer to the real time and then, ultimately, proactive.
Woicke: Since January of this year, we've started 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.

3. Gardner: That’s impressive. Tell us a little bit about Cerner and describe the company -- what
they do, and this idea that you have not just your own systems, but you're managing systems that
other people use as well.
Woicke: 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.
Gardner: So you're used primarily by healthcare organizations. Tell us how you actually
function within healthcare and the services that you provide to these organizations.
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.
Gardner: I'm still trying to tease out a little bit of more understanding of the function that you
provide to these health providers. Are you doing their medical records inventory for them or do
you have a set of applications in addition to that? Help us understand better what services you
provide.
Single database
Woicke: Cerner Millenium is a suite of products or solutions. Millenium 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 Millenium system. So we do have a cohesive set of data all within one database,
which makes us unique.
Gardner: Before we go to some more insights about the healthcare industry, population health,
and some of the great analytics that can be brought there, let’s drill down a little bit into what
you're doing on site. Where does the data come from primarily? Is this log information. Do you
have a set of management systems of your own, 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.

4. 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.
We have health-plan enrollments, and then of course, within Millennium, we're going to drill
down into outcomes, readmissions, 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: Now, you're also looking to how you can better understand the marketplace and
provide insights, so that people can literally change on a dime, change the wings on the airplane
while it’s still in the air, if you will, in healthcare and population health. What are the insights
that you can get there and what are the data sets that you need in order to do that?
Woicke: The data sets are similar to what we just discussed. 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.
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.
Gardner: Then, there is also this notion of anonymized patient information, where you can take
an aggregate and find out what works and what doesn’t work when it comes to behavior, patterns
of fruition when it comes to things like weight loss. Tell me how that grander view, the holistic
view of the data, comes to bear as well.

5. Woicke: 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.
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.
Gardner: Let me ask you, Dan, about that process through which you acquired Vertica. How did
you adopt it? What were some of the requirements, and why didn’t some of the other alternatives
work out?
Woicke: 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 Colin 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.

6. 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
omething 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.
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 Corporation, 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.
Gardner: Well, great. I'm afraid we’ll have to leave it there. We've been learning about how a
healthcare solutions provider has been leveraging big-data capabilities, and we've seen how at
Cerner Corporation they've deployed HP Vertica Analytics Platform to help their customers
better understand population health trends, as well as to gain terrific insights into their own
systems and the systems that they host for others.
So, a big thank you to our guest. We've been here with Dan Woicke. He's the Director of
Enterprise Systems Management there at Cerner Corporation. Thanks so much, Dan.
Woicke: Thank you for having me.
Gardner: And thank you also to our audience for joining this special HP Discover Performance
podcast coming to you directly from the HP Vertica Big Data Conference in Boston.
I'm Dana Gardner; Principal Analyst at Interarbor Solutions, your host for this ongoing series of
HP sponsored discussions. Thanks again for joining, and don’t forget to come back next time.
Listen to the podcast. Find it on iTunes. Sponsor: HP

7. Transcript of a Briefings Direct podcast on how a large provider of healthcare services is
providing insight into patient outcomes as well as EMR system performance. Copyright
Interarbor Solutions, LLC, 2005-2013. All rights reserved.
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