Health Care

Healthcare is an area where there is a huge potential to make people’s lives better by unlocking the power of data. Currently, Healthcare is undergoing a massive technology-driven transformation. This technology generates data and creates an opportunity to use this data to further improve the industry.

Today there are a lot of data sources in the healthcare industry. There are traditional sources such as insurance, billing, claims but also newly generated data sources such as sensor data, doctors notes and third party data from websites like data.gov.


Appeal Process Improvement

Whenever a claim gets rejected by the insurance company, the care provider appeals for reimbursement. For this, the appeal consultant has to research about the conducted service, lab results, doctor’s notes, previous medical history and then prepare the appeal. This takes a lot of time as appeal administrator has to look for the information in various systems, and manually find all the necessary information.

Hadoop data lake contains all the information from doctor’s notes to claims and its rejection notes. Any data can be searched in this data lake to find all the relevant information about a patient, this simplifies the time to file an appeal and ultimately provides a cost benefit.


Fraud Detection

Fraud detection
Healthcare organizations need to be able to detect fraud more proactively and fast on the basis of data. For example, they can analyze patient records from diverse sources to identify matching values (such as names, addresses, and account numbers) where they shouldn’t exist. They can do duplicate testing to identify duplicate transactions such as payments, claims, or expense report items. Entry dates can be validated to identify out of line times for postings.


Use Verbatim and Unstructured Data too

For years, documenting clinical facts and findings on paper has trained an industry to capture data in whatever way is most convenient for the care provider with little regard for how this data could eventually be aggregated and analyzed. EMRs attempt to standardize the data capture process but care providers are reluctant to adopt a one-size-fits-all approach to documentation. As a result lot of important information data regarding patient heath and treatment remains uncultured or unused. This information exists in doctor’s or nurse’s notes, patient’s comments etc. As a result, much of the data captured in this manner is difficult to aggregate and analyze in any consistent manner.


Monitor Patient Heath

Health care can be provided more pro-actively to patients by constantly monitoring their vital signs like blood pressure, heart rate, respiratory rate and temperature. The data from these various monitors can be used in real time to send alerts to nurses or care providers so that they can act on it immediately . OvalEdge can help in collecting this fast-growing data and stream it in real-time for actionable alerts that can help in detecting changes. We have algorithms written to improve the likelihood of knowing when a particular patient might have an emergency and allow for effective interventions.