John W. Robinson, M.D., Ph.D., LLC
Statistics ▪ Analytics ▪ Data Science
Real-Time Clinical Events Monitoring with Health Care Claims
Healthcare organizations often need to monitor a population for the occurrence of specific clinical events, such as the assignment of particular diagnoses or the provision of particular services or procedures... When claims are received via Electronic Data Interchange (EDI) transactions, automated "real-time" mining of claims for important clinical events is an expeditious alternative to waiting for completion of claims processing and data warehousing procedures... Learn more.
Predictive Modeling of Healthcare Cost via Machine Learning
Healthcare organizations often need to predict patients' expected healthcare costs either prospectively, to forecast future expenditures, or retrospectively, for comparison with observed costs. Cost prediction models typically use demographic and diagnostic data, and sometimes procedural data, as inputs... Faced with this complexity, organizations often rely on proprietary prediction or risk-adjustment systems developed by outside vendors... An alternative is for an organization to develop a fully transparent, customized cost prediction model based on data from its own population, via a machine learning algorithm... Learn more.
Harnessing Clinical Expertise for Business Intelligence via a Relational Database System
Healthcare organizations often need to query claims or other administrative data for clinical codes (e.g., ICD-9, CPT, NDC, LOINC) relevant to assessments of quality or appropriateness of care... Thus, an approach is needed that coordinates the capabilities of clinicians and analysts... A simple, but inefficient approach is to have clinicians identify a set of codes for each query, to be incorporated (written) by an analyst into an ad hoc program... A more efficient approach is to incorporate code groups into a relational database. Database tables linking individual codes with group identifiers can be regularly updated by clinicians. Analysts can simply pull codes from these tables into queries by specifying the appropriate group identifier... Learn more.