Showcasing a Case

Study on
Healthcare Analytics
Team Members:
Lu Ren
Aditi Agrawal
Sahil Kadam
Vaibhav Chauhan

Agenda
Introduction
Background
Effect on consumers
Problem Statement
Pain Points of the Clients
How our System contributes
Expected Capabilities
Dimensions of Healthcare Analytics
Attribute Definitions
How the system works
ERD
Feasibility Analysis
Conclusion

Introduction

IMS Health is the world's leading information, services and technology

company dedicated to making healthcare perform better.

The company connects more than 10 petabytes of complex healthcare

data on diseases, treatments, costs and outcomes to enable their
clients to run their operations more efficiently.
IMS experts draw on data from 100,000 suppliers and on insights from
more than 45+ billion healthcare transactions processed annually,
drives results for over 5,000 healthcare clients globally.
Customers include pharmaceutical, medical device and consumer
health manufacturers and distributors, providers, payers, government
agencies, policymakers, researchers and the financial community.

Background
Our Information system uses outlet purchasing and outlet dispensing
information along with geographical comparative data to provide visibility
to prescription activity for certain controlled substances at the national
level.

So what exactly is Controlled

Substance?
A controlled substance is generally a drug or
chemical whose manufacture, possession, or use is
regulated by a government. Controlled substances
are substances that are the subject of legislative
control. This may include illegal drugs and
prescription medications (designated Controlled Drug
in the United Kingdom).
Some precursor chemicals used for the production of
illegal drugs are also controlled substances in many
countries

Examples: Oxycodone 30mg, Hydrocodone etc.

Annual Comparison of CS
Products Dispensed

The illicit
use of
controlled
substances
is on the
RISE

How does this affect the

consumers?
The illicit use of controlled substances is a societal issue that affects us
all.

Improper consumption of CS has various side effects

Abuse

Addiction

Ex: narcotics, stimulants, depressants, hallucinogens andcannabis

Who is responsible for

In
the U.S., the DEA is responsible
for suppressing illegal drug use and
regulating
CS?
distribution by enforcing the Controlled Substances Act.
The DEA is cracking down on Wholesalers, Pharmacies, and Physicians to
help stop illicit use of controlled substances

Problem Statement
Multiple stakeholders may be involved in illicit CS activities but no
provider has the full picture of product prescribing, dispensing, or
purchasing needed to detect illicit activities
Retail Pharmacies: Can only see Rx activity in their store
No visibility into physician prescribing outside their store
No visibility into patient purchases outside their store
Prescribers: Can only see patient visits / history in their office
No visibility into patient visits to other physicians
No visibility into patient Rx history
Wholesalers: Can only see their own customer purchasing behavior
No visibility into customer purchasing from other sources
Can not effectively identify if activity is normal or considered outlier
activity in local market

Pain Points of the clients!!!

The illicit use of controlled substances is on the rise...

Wholesalers, Pharmacies, and Prescribers are being

closed, fined, and losing their licenses...

Do you have all of the information you need to recognize

potentially illicit activities?

Coffee Co. pharmacists arrested

Mediplan Pharmacy June 2012: 20 years in prison and up to $95 million

in restitution

And the solution is.

CONTROLLED SUBSTANCE
INFORMATION SYSTEM

How our system contributes?

Our Information system uses outlet purchasing and outlet dispensing
information along with geographical comparative data to provide
visibility to prescription activity for certain controlled substances at the
national level.

Provides wholesalers and retailers with a means of monitoring

potentially inappropriate use of scheduled drugs so they can limit
distribution and avoid government sanctions

Identifies pharmacies and prescribers that have higher than normal

controlled substance usage which may warrant additional investigation

Expected Capabilities
Clients gets overall view of the CS Products dispensed information

They can regulate themselves the distribution of CS

Gets hold of illicit activities

Licensing

Fines saved in Million Dollars($)

Introduction to IMS clients

Retailers:
Rite Aid
Walgreens
CVS Caremark Corporation
Walmart
Wholesaler
Wholesaler ABC
Cardinal Health

Dimensions of Healthcare
Analytics

The American Government has record of all patient level data.

This data is encrypted and sold to companies after coding and
encryption.
ICD9, CPT , NDC codes are provided to various diseases, diagnosis,
drugs respectively.
The data is classified on the basis of its source
Hx Hospital Data
This Is the data coming from hospitals and other facility
Mx- Claims data
Data coming from the insurance companies
Rx data Prescription Data
Data coming from pharmacies.

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Input/Output
Pharmacie
s
Claim
s

3rd-Party Data
Encryption Engine

APLD Data Warehouse

Prescription
Claims Data
(RX)

Payer
s
Claim
s

3rd-Party Data
Encryption Engine
Medical Claims
Data
(MX)

Healthcare Provider
System
Claim
s

3rd-Party Data
Encryption Engine
Hospital Claims
Data
(HX)

Claim
s

3rd-Party Data
Encryption Engine

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Rx Data

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Mx Data

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Hx Data

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Attribute Definitions
we tried to devise a ratings system encompassing pharmacy,
prescriber and patient metrics.. It provides views to particular
geographies, products (certain controlled substances), outlets
and/or prescribers and howthey rate relative to comparable
benchmarks. Ratings will be based on a scale of 0 100.
Patient Rating: It is calculated by
Total number of prescriptions filled for the selected product
Total cumulative dosage obtained is a sum across
prescriptions using the amount of the controlled substance
within the product
Outlet Rating: It is calculated by
The pharmacys sale of total pills in prescriptions filled (for CS
products)
The number of prescriptions that were paid in cash by the
customer
Prescriber Rating: It is calculated by

the number of pills in prescriptions for the product that were

written by the prescriber
Total number of prescriptions filled (for CS products)

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Attribute Definitions

Per Capita $ spent: Per capita $ spent for a particular product

Prod Unit Volume: Sum of total pills of all Outlets for a particular
State and Product

Product Rx: Total number of prescriptions for a particular CS

product

Outlet Count: Number of Outlets with a primary address in the

state

Prescriber Count: Number of Prescribers with a primary address in

the state

High Rated Outlets: Outlets with a rating greater than or equal to

90

High Rated Prescribers: Prescribers with a rating greater than or

equal to 90

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System Mockup

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System Mockup

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How the system works?

User will log in to the IMS health customer portal home page by
entering his/her user id and password
After logging in, the user will be landed to the Home page where
he/she can put filters and select a particular CS Product and Time
Period. Then one can select a particular state in the US and view
the attribute values aggregated at a National level
The user can also drill down on any state and view the same data
at the zip3 level so as to track down a particular prescriber or
outlet with high rating.
The user can only see the Rating and Count Attributes for Outlets
and Prescribers. In order to view other information like Product Rx
and Volume, the user must click on the tab More Info in order to
generate the request for the same.
A Technician sitting at the backend is automatically assigned to
this request. The technician checks whether the data is available
or not and if it is available then he/she shoots an email to the
client with the requested data. The status of the request is also
updated.
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How the system works?

The user might also want to do a market analysis for his/her
outlets and see how they are performing in the market in terms of
CS Products. They might also want to know how much they have
been penalized for the last 5 years. All this data is confidential so
it cannot be directly shown on the home page when the user logs
in. It requires an extra verification check. So they user needs to
click on the tab Performance Report to generate a request for its
own performance report.
This request is assigned to a Technician who in turn forwards it to
the concerned Data Analyst. The Data Analyst works on the client
data and generates a report with the necessary attributes as
requested by the client. This report is sent back to the Technician
who it turn sends it to the client over email. The Data Analyst does
not directly communicate with the client. So a Technician functions
as the liaison sometimes. The Technician also updates the status
of the request in the system.

How the system works?

The client might also face some technical issues while working
with the system or he/she might require some training or
guidelines with how to operate the system. So a user can generate
a service request with the technical issues that they are facing
with the system by simply clicking on the tab Live Chat.
This will alert a Technician sitting at the backend who would
directly communicate with the client and resolve the issue then
and there. He/she can then mark the request as resolved.
The Technician, Data Analyst and the Management can view client
history by logging in to the information system. They can validate
and update the data as and when requested by the client.
Only the Management can view the clients confidential data
(contract terms, revenue information) and update it as and when
requested by the client.
It is the book keepers responsibility to enter client data into the
database whenever a contract is signed with any new client.

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ERD

Decision Analysis

For any project it is very essential to analyze the pros and cons of
the project with respect to certain prospects.

Based upon information collected from the phase of our study, and
subsequent analyses, following is a summary of our findings and
conclusions relating to the proposed HealthCare Analytics project.

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Strengths
Proper monitoring of the controlled substance on the basis of the unique
NDCs
Can keep a check on patients persistence period thus concluding if the
patient has enough dose per day on hand.
Can monitor regions with a higher per capita controlled substance
Based on the ratings it can revoke licences of outlets who have more
dealing of these prescription based controlled substances.
Management can view its clients history through some confidentiality
restrictions which ensures safety.

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Weaknesses
The system allows monitoring up to a certain rating which doesnt
completely eliminate the possibility of it not getting exploited for
example lets say that a persons rating is supposed to be 60 but it
turns out to be 70 on its monthly/yearly check. The tolerance level
would not initiate an action for this.
It is the bookkeepers responsibility to update its clients and failure
to do so might not resurrect efficient data.
The technician at the backend needs to respond to clients with
respect to the technical issue the client is facing and it is not
automated.

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Opportunities
The implementation of this system serves as an opportunity to
eradicate the illicit use of controlled substances especially drugs like
hash, cocaine etcetera.

It also opens the door for creation of standards to regulate the

manufacturing of such drugs or precursor chemicals on the basis of
demand in the respective state.

The narcotics and the other such organizations can look into drug
pedlars through this system given from where the evident leak is
found to have taken place based on the rating.

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Threats
A fragmented sector of healthcare might lead to non-cooperation
which may tend to hamper the effective monitoring.

Outlets in remote regions with restricted access to the internet

may be off the monitoring radar.

Inadequacy of agreed governance of the system may be an issue

at a later stage.

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Technical Feasibility
Practical Solution to track the controlled substances given that
there is no such system in place which allows such tracking with
every entitys details involved in the handling of the drug/chemical
or end product.
The requirement of this system is huge and it requires a database
of all the states in the US drilling down to cities and further into
individual retail outlets along with each of the physicians details
and patients details.
Modifications can be easily brought to it with respect to the further
framework alterations

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Operational feasibility

Performance -The proposed model will help the end user to track
down a particular prescriber or an outlet which has a higher rating
for a particular controlled substance during a particular period and
also in the selected state at zip3 level.
Information -The data that is used is extracted from several different
sources.
Economy -This Information system provides a fair amount of cost
benefits to the users.
Control -In this system Retailer Company users have access only to
their individual company outlet.
Efficiency The current mode of operation makes maximum use of
the available resources, including people, time and flow of forms.
Services -This system provides reliable services and is also flexible
and reliable.

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Cultural feasibility
There is no harm in acceptance of this system in the environment.
The system works towards the goal of eliminating the use of drugs
which in any culture would be appreciated than opposed.

If any culture do use the substances regulated by the government

they could seek special permission but unless that it would
anyway be against the federal law.

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Economic feasibility
Project investments involve the expenditure of capital funds and other
resources to generate future benefits, whether in the form of profits,
cost savings, or social benefits.
The Cost of the Information System designed is based on a number of
factors.
Overall Implementation Cost of the system will be around $ 540,000
and the Operating Cost is $ 100,000.

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Implementing
Cost
1

Data

$200,000

Database ($10,000/database)

$50,000

Software Design

$125,000

Personnel:
4

Data Analyst

$50,000

Technician

$25,000

Book Keeper

$15,000

Programmer

$75,000

Total Implementation Cost:

$540,000

Operating Cost:
1

Backup and Recovery Process costs.

$50,,000

Expanding the Database if required.

$25,,000

Maintaining and Updating System

$25,000

-Total Operating Cost:

100,000/annually

Schedule feasibility

With the illicit use of controlled substances on the rise the

proposed technology is just a step at the right time to keep a
check on these chemicals and avoid illicit use.
Since there is availability of data through various claims Rx, Hx
and Mx, it can be improvised and put to use to monitor the flow
of these controlled substances.
Adequate agreed governance on the matters of handling the
system if managed, its a system to be in place as soon as
possible.

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Risk feasibility
Capital involved in the project: The cost involved would be claiming of
that huge amount of data and cost of setting up the architecture. The
buyers of this company would certainly invest these amounts and capital
should not be a problem.
Completion of the project: With huge amount of data in hand the project
would take a years time to be designed within the proper framework
with the right set of business rules governing the system.
There would be no rents involved but some maintenance costs would be
involved which would be barely minimal with respect to the huge
amounts involved in laying down of the project.

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Conclusion
Despite the rise in activities of illicit use of controlled substances, there
have not been appropriate measures taken to put an end to these
activities.
The proposed project serves just in a way to monitor and track these
controlled substances in an end to end manner.
The system takes all of these into consideration and prepares a
framework which has information on every entity handling the substance.
With feasibility discussions on various parameters, we conclude that the
project is viable given that the benefits outweigh the costs involved in the
project implementation.

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Any Questions?

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THANK YOU!!

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