Implemention Technology
Warehouse Engine
  Informix Dynamic Server
Hardware
  Sun Enterprise Servers

Started in 1985, HCIA Inc. has grown from a small Medicare cost reporting business into one of the leading healthcare information service companies in the nation with revenues of $63 million in 1998. HCIA works with both healthcare providers and payers to improve healthcare decision making by providing information that can be used by clients to effect and manage change. HCIA's products and services enable healthcare organizations not only to better understand their healthcare environment but also to take action to improve quality and become more efficient in the way healthcare services are delivered.

HCIA currently maintains the industry's largest healthcare database, containing more than 325 million patient records. Each year, HCIA collects data from more than 40,000 healthcare organizations. Serving a client base of more than 7,000 customers, HCIA provides decision support systems to more than 1,500 hospitals as well as 18 of the largest U.S. health insurance companies, 16 of the largest U.S. managed care organizations and 21 of the largest pharmaceutical manufacturers.

A Shift to Open Systems Computing

In 1991, HCIA decided to migrate from a mainframe environment to an open systems environment in order to take advantage of high-performance systems with more flexibility, scalability and cost-effectiveness. After looking at the available vendors, we chose to base our data management systems on Informix Dynamic Server 7.x software and a computing platform of Sun Enterprise servers, Ultra servers and the Solaris Operating Environment.

With the new technology from Sun and Informix, we started out with a 10 gigabyte online data warehouse for a state hospital association. By the end of 1995, we had over one terabyte of warehoused data supporting more than 300 corporate and client users. Today, we support over seven terabytes of online data and more than 1,000 corporate and client users.

HCIA's databases are considered to be the largest among healthcare-related databases and are among the largest relational databases of any kind in existence. The open, flexible solution from Sun and Informix allowed a wide breadth of choices for integrating other hardware and software components into our systems. Performance and functionality met the unique requirements of a data warehouse and enabled a clear strategy for providing incremental improvements. The scalability of Sun systems makes it easy to accommodate additional users for more complex operations over time.

Data Sharing and Collaboration

HCIA's business model is predicated on collaborating with organizations from all segments of the healthcare industry in the design and implementation of data warehousing projects for outcomes analysis. HCIA has developed these warehouses and decision support applications for managed care health plans, pharmacy benefits managers, pharmaceutical organizations, self-insured employer groups and for more than twenty state hospital associations.

One of the unique aspects of HCIA is its dedication to working with healthcare associations in the development of data-sharing programs through the creation of customized data warehouses and decision support systems. To support these relationships, HCIA employs a two-tiered structure for access to the data warehouse which is divided between corporate and client systems. The warehouse and related data marts are operated on Sun's Enterprise 4000 and Enterprise 6000 servers with Informix Dynamic Server 7.x software. The corporate access is achieved through a partially meshed frame-relay intranet distributed among multiple geographically dispersed locations.

Improved System Responsiveness and Productivity

HCIA has achieved significantly improved responsiveness in delivering timely information to the healthcare industry, due in great part to the Solaris Operating Environment's symmetric multiprocessing (SMP) capabilities. SMP enables HCIA to run multiple applications on the Informix database server simultaneously. The system also supports multiple complex SQL queries running concurrently, versus running one or two programs overnight as was the case with the older mainframe systems. This highly optimized solution is a direct result of the Sun/Informix alliance, which devotes joint engineering resources to provide finely tuned products and services. It is this tight integration between Sun and Informix systems, their adherence to industry standards and their support for heterogeneous network environments that allows us to gain optimal performance from our systems and our staff.

The new system has also increased the productivity of our staff. We have tripled our throughput with the same staff by increasing the efficiency of our analysts and expanding our reporting capabilities. In addition, the ability to accommodate our rapidly growing data management business has opened up new opportunities for enabling access to our information.

In the future, the trend to move more and more medical treatment to nonacute care settings is likely to continue, creating the need to capture additional sources and types of medical data as well as new opportunities to deliver the information. The need for accurate, easily accessible medical information is likely to explode. For HCIA, this presents tremendous opportunities and challenges. With the right technology in place, we are confident we can meet our customers' needs in an efficient and cost-effective manner.

Recommendations

The following recommendations are based on our experience in implementing a comprehensive data warehousing solution:

Go with open systems computing. Choosing an open, standards-based data warehousing platform ensures that you can integrate technologies from multiple vendors into your system and take advantage of the best available products. Open computing protects your technology investment.

Choose proven technology. Make sure your system provider can prove to you that their products can perform as advertised. Look for technology with well-established track records of high performance in real-world environments.

Start small, think big. Data management systems can grow much larger than you might initially envision. Start small to get yourself going but invest in a computing infrastructure that can readily scale up.

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