Services

For high-quality healthcare data to flow and translate into actionable decisions for clinicians, researchers and CIOs, it is critical that healthcare organizations build a solid strategy to serve as their foundation for success.

Recombinant has the background and experience as well as an exclusive methodology to accelerate the process of creating a strategic roadmap to achieve your organization’s data goals, now and into the future.

Recombinant’s PAR Methodology 

At the heart of Recombinant’s strategy consulting service is its Provider Analytic Roadmap (PAR) methodology. PAR recognizes both the wide variety and breadth of healthcare data and the significant number of common analytical needs within the healthcare industry.

Most data warehouse failures do not result from a problem with the tools. They result from a problem with the design. Too often organizations fail to ask the simple question: Do we have the right solution for the needs of our business?  As a result, solutions end up solving one specific need at the expense of addressing the broader needs of the organization.  This widespread, but avoidable, shortcoming is exactly why a strategic roadmap effort is required.

Healthcare has unique attributes including complex internal, payer, and public reporting needs, clinical research, disease management, large volumes of unstructured data, and many more factors that may be critical to an organization’s data architecture. The specific components of your organization must be recognized, analyzed, and ultimately addressed to achieve an effective data solution.

Recombinant’s PAR methodology systematically uncovers the needs of your organization, from its goals to its potential limitations in technology and staffing, then lays out a distinctive roadmap to address them.

How PAR Works

The PAR methodology comprises three steps: Understand, investigate and recommend.

Step 1: Understand

To develop an inclusive strategic roadmap, Recombinant starts by gaining an overall understanding of your organization. We work with you to capture, validate and prioritize information related to your vision, mission, strategy and objectives within the context of building a data warehouse. In this way, we can make sure we are aligning your desired core competencies to a solution that will help you measure and manage all aspects of your business.

We also look at how your business is organized and structured to map out the required enterprise-wide data governance and enterprise standards.

Step 2: Investigate
 
Next, we analyze your business needs and data with a focus on reviewing the essential functions of the data warehouse, identifying the constituencies and recognizing any organizational hurdles and technical challenges. We also analyze terminology mapping and modeling, mapping between vendor source terminologies or mapping non-standards-based terminology to well-recognized national standards. Finally, we focus on data governance and compliance issues, including HIPAA privacy and security assessments as well as IRB (Institutional Review Board) considerations.

Step 3: Recommend

Finally, based on our investigation and analysis, we deliver a comprehensive assessment document and management presentation that explains our findings, delineates critical success factors, and provides a roadmap/plan outlining the steps to deliver value incrementally toward a long-term vision.

Incremental Approach

Recombinant ensures that data and software development anticipates both medium- and long-term goals.  To that end, our strategic planning focuses up-front on three interconnected work streams – technology, workflow and management – to provide a framework for successful and steady deployment and implementation.

Our incremental approach strives to reduce risk by promoting quick wins with the big picture in view:

Deployment and Implementation Services

Once the roadmap is developed and approved (or where a roadmap is not needed), Recombinant provides full deployment and project management to design and deliver a data warehouse as well as implementation of the clinical intelligence applications (quality reporting and/or i2b2 research workbench). Depending on the needs of the organization, Recombinant offers over-the-shoulder implementation for those who want to use their own project resources. We also deliver training, support, and/or staff augmentation to help maintain the solution.

A key component of deployment is the ETL (extract, transform and load) process, which automates data extract from its various source systems.  

These services include:

• ETL database design, including creating and using metadata in ETL and creating a simple ETL process
• Creating, testing, and optimizing both batch and stream processes
• Monitoring, trouble-shooting, and benchmarking the ETL process

Recombinant’s specialized experience in the healthcare industry provides a unique skill set to streamline the ETL process to gain efficiencies both in start-up as well as in use, since data redundancies are eliminated.

Deployment also includes:

• Collecting, developing, and fitting requirements into an architecture model for data warehouse development, organizational support (buy-in and sign-off) and managing expectations and change
• Planning production data operations (systems infrastructure planning, process and schedule), cutover contingency planning, delineating roles and responsibilities, determining training
• Documentation and testing
• Determining backup and recovering procedures

Once the data warehouse is deployed, implementation of the clinical intelligence applications can begin.

Installation of the Report Central Solution

Implementation of the Report Central application encompasses:

• Developing reporting requirements and prioritizations, managing expectations, and assessing benefit and cost
• Reviewing reporting considerations, including content; format; parameters; drill down; aggregation; auditing, security and authentication; and delivery
• Creating a database architecture for reporting that reflects preprocessing for aggregation and external data management
• Providing quality assurance for reporting that includes assessing errors as well as external data management
• Auditing requirements

Installation of the Translational Research Solution

Recombinant helps organizations get started using the NIH's i2b2 open source technology, including addressing issues related to informatics, technology and management.

Specifically, Recombinant can help your organization:

• Analyze your available clinical data, including:
• Identifying the data sources
• Selecting appropriate vocabularies
• Working with the data sources to establish policies and procedures for data sharing
• Structure data in the warehouse:
• Apply i2b2 natural language processing capabilities to dictations to extract structured data
• Verify data and ontology integrity
• Ensure the data are de-identified to appropriate standards
• Demonstrate utility (i.e., help researchers access the warehouse, user support)
• Develop mechanisms, processes and procedures for authenticating and authorizing users (identity management) based on existing identity management federation
• Integrate i2b2
• User support for access
• Extend the open source code to provide custom functionality that can then be contributed back to the open source community for others to use
• Set up and configure the hardware and software to maintain the i2b2 infrastructure, possibly shared among institutions
• Determine resources required to accomplish and maintain the solution including staff training and augmentation

Training

Our training is designed so your organization can independently support and maintain the data warehouse and clinical intelligence system following deployment.  We offer training that provides true knowledge transfer to your project staff as well as managers. Specifically, our training: 

• Provides the necessary technical skills to manipulate data and prepare reports
• Emphasizes the importance of asking the right questions – the key to ensuring that technical skills are spent on the right tasks
• Establishes a common foundation and language to help build a highly functional team that improves productivity and enhances job satisfaction

i2b2 Training for Translational Research

Recombinant offers a suite of programs to help academic medical centers get started on the National Institutes of Health’s i2b2 (Informatics for Integrating Biology and the Bedside) translational research software platform. Whether you need a planning workshop or full implementation of a data warehouse and a platform, we can help accelerate your planning process and lower your risk in i2b2 implementation. To learn more, review the i2b2 Quick Start Program.
 
Support and Maintenance

In addition to helping our clients maintain their healthcare data warehouse and clinical intelligence systems by training client staff who can provide day-to-day support (see Training above), Recombinant provides second-level support.   We treat every project from a software lifecycle perspective. This means tracking bugs, anticipating platform changes, and providing upgrade paths over time.

Data Quality Assurance

Recombinant’s Data Quality Service (DQS) ensures data is loaded into an organization’s data warehouse in a timely and efficient manner, audited for quality assurance and follows exception management procedures.
Below are the specific DQS offerings:

Data Loads:  On a regular basis (usually monthly) Recombinant loads new data making it available in accordance with agreed-upon service level commitments. Recombinant follows defined processes for extraction, transformation and load, while following the organization’s data governance guidelines.

Data Audits: Following each regular data load, Recombinant audits the data to ensure all processes ran properly and the new data is consistent with the previously loaded data. Specifically, Recombinant performs four types of reviews:

• Automated Data Tests – A series of automated reports to check month-over-month data counts to validate each data load process; this high-level screening ensures major data errors are found immediately
• Semi-Automated Data Tests – A series of semi-automated tests that focus on month-over-month comparisons of certain key metrics (e.g., mean scores, etc.) to further identify data integrity issues at an early stage in the process
• Manual Data Tests – A manual test on a series of pre-determined reports to spot-check for obvious errors in the data loading process
• Regression Tests – Regression testing to ensure all previously identified data loading issues are working properly

Exception Management: Any exceptions generated during the load or audit processes are analyzed to determine the cause of the data error; numerous factors can produce such exceptions, including new data types, new codes, as well as failures in the software that generated the data extracts. Errors are fixed, data is reloaded, a follow-on data audit is performed, and the data is released to the organization on the production server.All corrections to the data integration process are added to the auditing processes so they are processed properly in subsequent periods.
Data Integrity: As part of its monthly data audit process, Recombinant validates all four audit types (automated, semi-automated, manual, and regression) with the organization to ensure adequate data validation procedures are in place. We document that these procedures have been followed each month along with any additional testing procedures required by known exceptions.

Technical Support

Quality Reports

We maintain the Report Central software and provide regular upgrades based on our software lifecycle schedule (typically a new full release every 12-18 months). In addition, we maintain our Report library and provide regular updates reflecting regulatory changes (e.g. pediatric immunization guidelines) and offer a service to develop custom reports or modify existing reports as needed by our clients.

i2b2 Technical Support for Translational Research

We offer a full range of commercial open source support including telephone and email support and a service level agreement to resolve installation problems, software bugs, and questions about the source code.