Gravic's HPE Shadowbase Data Integration Solution
Company: Gravic, Inc.
Company Description: Gravic, Inc. is a world leader in providing innovative data collection, replication, integration, and distribution solutions. For almost 35 years, our Shadowbase and Remark software product groups have produced technologically advanced solutions that improve enterprise businesses and the personal lives of our over 50,000 customers and tens of thousands of OEM end-user licensees.
Nomination Category: New Product & Service Categories - Software
Nomination Sub Category: New Product or Service of the Year - Software - Healthcare Technology Solution
Nomination Title: Gravic's HPE Shadowbase Data Integration Solution
Tell the story about this nominated product or service (up to 650 words). Describe its function, features, benefits, and performance to date:
Prescription fraud is a growing worldwide problem. According to the World Health Organization, $415 billion (USD) is lost to healthcare fraud worldwide every year.1 A centralized prescription fraud decision support solution was implemented to help a government healthcare agency prevent fraud losses and stem the increase in opioid abuse and consequently, unexpected deaths.
In particular, the government healthcare agency wanted to detect and ultimately prevent:
1. Multiple claims for the same or similar drug(s) and patient over a short period of time (either from the same or different doctors/pharmacies)
2. Multiple claims for the same or similar drug for the same patient address over a short period of time (either from the same or different doctors/pharmacies)
3. A doctor or pharmacy receiving healthcare or manufacturer reimbursements for prescriptions that do not match those that were prescribed
4. A doctor or pharmacy submitting for reimbursements for the same prescriptions through multiple (regional) jurisdictions
5. A doctor or pharmacy prescribing/dispensing an atypical amount of controlled substances or receiving an atypical amount of reimbursements when compared to the size or geographic area served
To address these issues, the government agency chose HPE Shadowbase data replication software to provide real-time replication from an HPE NonStop-based prescription claims processing system to feed a new environment for fraud decision support. Each was managed by a different entity – an outsource organization managed the claims processing environment, and the government agency managed the new prescription fraud decision support environment. Working extensively with both the government agency and outsource organization complicated the project as both maintained different schedules, management, skillsets, and roles for the project.
This new solution introduces both agencies to real-time data integration and replication, utilizes various analytical techniques to automatically identify, prevent, and recover payments for fraudulent prescription claims, and provides evidence to support criminal proceedings against fraudulent claimants. The solution architecture requires both data protection (via multiple levels of data encryption at every point in processing the data), and high availability (so that any one component’s failure would not prevent claims processing or fraud review from occurring).
During the project-planning phase, the HPE Shadowbase team designed an architecture using the government agency’s project specifications, resulting in the placement of several contingency plans. Consequently, multiple HPE Shadowbase replication paths connect the various redundant systems. If an active system or path fails, then processing and replication can continue using alternate/standby systems and paths, keeping the claims data current on the fraud decision support system at all times.
Figure 1 (please see attachment) illustrates the application configuration where claims are sent to the active NonStop server running in datacenter 1, DC1 (\ACTIV system), with HPE RDF replicating over Expand to a backup NonStop server running in DC2 (\BKUP system). The government agency installed intermediate staging systems (comprised of Oracle Solaris servers with an Oracle RAC database), which feed the new decision support system and run the claims adjudication application. The staging database is continuously synchronized with the HPE NonStop database of record for these failure scenarios. All databases are rigorously tested and must pass the agency’s acceptance criteria: failure of the main NonStop system, the network, or any Solaris system, or outage of an entire datacenter. To load the new environment, the HPE Shadowbase Online Loading (SOLV) utility enables the new solution to load into production with no user application downtime.
As a result of the project, HPE Shadowbase software enables each agency to perform independent maintenance, analytics, and other necessary healthcare solution functions on individual schedules. This architecture improves the solution’s availability to eliminate failover fault risk and dramatically improve recovery time if a failure occurs at any point. The updated solution now assures the agency’s important healthcare data is fault tolerant, encrypted, reduces overall reimbursement cost, and enables law enforcement to monitor and investigate fraudulent claims activity.
In bullet-list form, briefly summarize up to ten (10) of the chief features and benefits of the nominated product or service (up to 150 words).
1. Constant analysis of real-time prescription drug claims for fraudulent activity, which flags and forwards questionable cases for further investigation and possible criminal proceedings
2. Data flow automation through four different claim datacenters via homogeneous and heterogeneous data integration, which helps ensure data protection and maximizes solution utilization
3. High availability solution
4. Fault tolerance through numerous replication paths, which eliminate a disaster's effects on processing and fraud detection of drug claims
5. Seamless solution implementation with a zero-risk approach to existing operations
6. Encryption for confidential data in flight and data at rest protection
7. Real-time claim status and operational analytics
8. Project coordination with numerous groups
9. Segregation of duties, which eliminates fraud, solution downtime, or error risks that unilateral actions could cause
10. Unmatched product capabilities and project coordination within the timeframe and cost requirements