Understanding Health Cloud Data Models
Salesforce Health Cloud, offered as part of Salesforce Industries, is a patient-first healthcare CRM.
In this blog post, we want to focus on how Health Cloud structures data and how various entities involved in the Health Ecosystem (patients, caregivers, care providers, insurance providers, etc) are represented in Health Cloud.
The Health Cloud Data Model
Health Cloud is a managed package installed on top of Salesforce. Its data model is based on the standard Salesforce object model. The managed package comes pre-bundled with a rich set of standard and custom objects to store and access specialized health information.
The Health Cloud data model is the foundation of the entire system. Therefore, understanding the model is essential for the successful implementation and adoption of Health Cloud. Since its Salesforce, the data model can be customized and enhanced by adding custom objects, fields, and automation tailored to an organization’s specific use cases.
In order to better grasp the various Health Cloud data models and how they interact with each other, let us go through a health care journey of Mr. John Smith, employed by CloudVille Limited. John plays football on the weekends and has recently suffered an ACL tear.
Household Data Model
Health Cloud uses a household model to represent the patient (John), and relationships with the people who participate in their care.
A household is a plain old Salesforce account with the Household record type. The household is related to the contact part of the individual using the Account Contact Relationship junction object. Contact can be related to a different contact (for example, John’s wife Mary) using the Contact Contact Relationship junction object.Clinical Data Model
Clinical Data Model
An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. Clinical data can be integrated with Salesforce using standard APIs. The API’s map messages from EHR systems into Health Cloud objects and fields.
The global standard for passing healthcare data between systems is FHIR (Fast Healthcare Interoperability Resources). It is free, open, and designed to be quick to learn and implement. Health Cloud also offers an FHIR-aligned clinical data model.
The diagram below shows the Clinical Data model as modeled in Health Cloud.
- In the clinical data model:
- Case object represents a Care plan. In our case, the care plan is focused on healing John’s ACL injury.
- Case Team object represents John’s doctor, spouse, and other caregivers.
- Care Plan Problem object represents any issue that the care team would like to solve for John. For example, John might have indicated that walking has become a chore and is impacting his lifestyle.
- Care Plan Goal object represents a care plan goal for example to try remedies to allow John to walk pain-free.
- Task represents any recommendation to achieve a Care Plan Goal. For example, the doctor might assign a Task to join to do some leg exercises every morning for 5 minutes.
Insurance and Claims Data Model
Where there is care, Insurance and claims are not far behind. The Insurance and Claims data model provides an insight into a patient’s insurance information. This makes it easy to verify membership, benefits, and claims.
The Health Cloud claims functionality is delivered as an unmanaged package containing a set of external objects that can be customised to fit your specific requirements.
The diagram below shows the Insurance and claims data model in brief.
- In the Insurace and claims data model:
- Purchase Plan object represents a health insurance plan, usually offered by an Insurance company.
- Purchaser Group object represents a group of employees who are part of the purchaser Plan. In our example, all employees of CloudVille Limited, including John, are part of the Purchaser Group.
- Coverage Benefit object represents benefits under the plan. For example, Rehabilitative Services and/or Psychotherapy.
- Coverage Benefit Item object represents a benefit item under the plan. For example, under his plan, John is entitled to 20 physical therapy visits per year.
- Claim and Claim line represents any previous and current claims.
Program Management Data Model
In a typical use case of a long-running injury like John’s, a care program is usually created. The program targets immediate care but also post-treatment care. Care programs are created to support patients on their health and wellness journeys and in some cases can also provide financial assistance.
A typical program will include services such as remote monitoring, online or offline counseling sessions, medication access, etc. The program management data model captures the entire picture of a program and can help track adherence and encourage wellness practices.
The diagram below shows the Program Management data model in brief.
- In the Program Management data model:
- Care Program object represents a care program tailored to a patient. In our case, John might be enrolled in an ACL post-recovery Management program.
- Care Program Goal object represents the objective of the program. This could range from medication assistance and/or including physical exercise to better cope with pain in John’s case.
- Care Program Campaign object represents an educational campaign educating patients about the benefits of the program or help they can get through the program.
- Care Program Provider object represents a care provider organization that is involved in the care program.
- Care Program Product object represents a product by the Care Program Provider which is part of the Program. For example, John’s care provider, as part of the program he is part of, may enroll him with a Pain Management Medication.
Social Determinants Data Model
Have you ever tried losing weight? I bet you did. Everyone has. In any health care journey, there are factors that work in our favor and there are factors (social, environmental, etc.) that act as determinants to our wellness journey.
The Social Determinants Data Model helps model these determinants thus allowing the provider to gain insight into the physical environment, social factors that are hindering the wellness outcomes the patient is trying to achieve. For someone trying to lose weight, no access to an affordable gym nearby points to a physical and socioeconomic determinant for a patient.
The diagram below shows the Social Determinants data model in brief.
- In the Social Determinants data model:
- Care Barrier object represents the circumstances or obstacles affecting a patient or members.
- Care Determinant object represents the determinants of health for a patient such as lack of Car or adequate employment.
- Care Barrier Determinant object is a junction object connecting a barrier to a determinant for a patient.
- Care Barrier Type object represents a standard list of barriers maintained by an organization.
- Care Intervention object represents Intervention or step to overcome the Care barrier. Providing Uber vouchers is an intervention to solve the transportation issue faced by a patient or member.
Utilization Management Data Model
Utilization Management is a process that evaluates the efficiency and medical necessity of the treatments, services, and facilities provided to patients on a case-by-case basis. This process is run by or on behalf of insurance providers.
Health Cloud provides objects you can use to review and evaluate medical care services such as:
· Preauthorization requests
· Admission cases
· Prescription or medical service requests
· Appeals, complaints, and grievances
The diagram below shows the Utilization Management data model in brief.
- In the Utilization Management data model:
- Care Diagnosis object represents details of a diagnosis. It comes bundled with code type, name, and description.
- Care Request object represents details about a Care Request. A single Care Request can have multiple diagnoses, services, or drugs.
- Care Request Configuration object represents configuration of service request, drug request, and/or admission request via record types.
- Care Request Item object represents details of a care service request.
- Care Request Reviewer object represents a reviewer assigned to review the Care Request. This includes reviewer notes, date of reviewer and reviewer decision.
This blog presented a very brief introduction to the various Health Cloud Data Models and the purpose and scenarios where these models are applicable. These Data Models are however just the start. With this knowledge, you can now adopt and customize Health Cloud for your specific business use case.