(Dr. Bala Hota of Cook County Heath and Hospitals System, and Lydia Murray CIO of Cook County)

Patient records is one of the largest pillars of Big Data to be tackled.

While the politics of the Patient Protection and Affordable Care Act, often dubbed ObamaCare, are far from over, there were several key provisions that mandated a switch to electronic records.

The integration of patient records into broader federal government reforms has been a big task, which has strained rural hospitals, but jump started larger ones to cut costs.

In Illinois, the task of getting Cook County’s records on the grid falls on Dr. Bala Hota.

Hota heads up the effort to digitize medical records and streamline workflows at Cook County Health and Hospitals System.

He has a masters in public health and specializes in infectious diseases having done a residency at Rush University Medical Center.

He and Lydia Murray, Cook County’s chief information officer, made a presentation and took online questions for Big Data Week.

Murray was recently appointed to that position by county President Toni Preckwinkle last July. She was a former deputy chief of staff under Mayor Richard M. Daley.

In an odd role reversal, Murray actually interviewed Hota, with host Steve Boyce occasionally popping in with questions.

Though the interview was heavily controlled and on message, there were some takeaways that Hota made regarding the use of county data.

"The Affordable Care Act has been something really driving change at the health system, pretty incredibly," he said.

"Cook County Health and Hospitals system is one of the first sites in the country to be able to get access to the expanded Medicaid population that is going to be present in 2014 for most of the country," he said referring to a waiver granted last year.

It’s that waiver that he says the county is using as a launchpad to streamline electronic records, essentially forcing the Cook County Hospital to assume the financial risk of not adapting fast enough.

For Cook County residents, those at the poverty line, U.S. citizens,  ”Cook County Health and Hospitals System will assume the risk for care for those patients,” Hota said.

"In other words, we will receive a per-member-per-month payment from the federal government, and in exchange, we need to improve the outcomes for those patients and decrease costs."

Like businesses, Cook County is seeking a quick return on investment by consolidating data warehouses and applying analytics to measure performance in hopes of streamlining care.

Hota also cited the need for the system to adapt to adhere to the HITECH Act, which passed in 2009, mandates the use of “meaningful use of health information technology.”

What does this all come down to?

This essentially requires Cook County to adopt a massive IT overhaul, while retraining staff to adhere to new practices.

This can take the form of doctors being required to fill out fields and notes while observing patients.


(This slide is an example of the information doctors will have available when observing a patient.)

The end result takes the form of interfaces that feed into a database, which allow administrators to measure the performance of doctors —and and they hope— the quality of care.

And doctors, staff and others using the system will have a report card of sorts documenting how well they’re inputting data as show in the image below.


Hota said that utilizing metrics could better assist in preventative care, being able to use a database history of medications, previous visits and measurement of symptoms to help staff diagnose and better treat patients.

From an adminstrative point of view, it’s about managing resources, reducing paperwork and expediting scheduling.

The end result would look like this, reducing the amount of patients that don’t show up to appointments — or preempt an appointment with analytics to better inform doctors of a health history.


Like all Big Data systems, privacy is a central concern for health records. 

The same day that Hota gave his presentation for Big Data Week, the Chicago Tribune published an article about breeches in security with patient records in Illinois, including three at the Cook County Health and Hospitals System.

Hota said their new systems will include security permissions that insure only the care providers (doctors) that need access to patient records will have them.

The Health Insurance Portability and Accountability Act (HIPAA) is the law that requires health care providers to ensure patient records are kept private.

However, for the purposes of addressing public health problems on a larger scale, Hota said the data collected can be used in collaboration with outside research institutions.

Hota said there opportunities for the information to be released, but would have to done very carefully with guidelines.  

When asked what type of information would need to be stripped out for the data to remain private, but useful, Hota gave a few examples.

"Personally identifiable information, personal health information, the security level around that data, it’s essential that that be preserved."

Accordng to Hota, HIPPA has language that describes what information should be private such as name, date of birth, date of care, address and social security number.

In order to release information to outside groups or insitutions that may use the data to study infectious dieseases for instance, may require the use of a “limited data set.”

Hota said a limited data set might be “the removal of a name, use of the age, and not the date of birth; removal of all dates to the resolution of the month and year – and use of zip, not the single point address.”