Health Cloud Data Model - Salesforce (Quick Review)

DATA MODELS IN  SALESFORCE HEALTH CLOUD

Health Cloud’s data models represent the objects and fields that support specific healthcare business processes. These data models underlie Health Cloud’s capabilities and features, and provide insight into the kinds of data you can store in Health Cloud. You need to understand the data models to successfully implement and adopt Health Cloud.  

The traditional account-contact model is great for modeling people and organizations. However, most healthcare organizations don’t consider their patients or members in the context of an organization. Therefore, Health Cloud uses person accounts to represent a healthcare patient or member.

In Health Cloud, always model your patients or members as person accounts. You can’t fully use Health Cloud functionality if you don’t model your patients and members as person accounts. The same person account record represents Charles as a patient and a member. Person accounts store information that applies to human beings rather than organizations, such as a first name and a last name, title, address, and birthdate. 

 

 

 

HOUSEHOLD DATA MODEL

In the context of Health Cloud, the household data model maps the relationships between patients or members and the people and organizations who participate in their care. This map helps caregivers work more efficiently as they engage with the patient and provide them with the appropriate care. 

The Account and Contact objects represent these caregivers and organizations. Business account records represent organizations. Person account or contact records represent people. A relationship type determines whether the relationship is between an organization and a person, two organizations, or two people.  

The Account Contact Relationship, Account-Account Relationship, and Contact-Contact Relationship junction objects represent the relationship types.

 

 

 

• Charles needs rides to his medical appointments. Charles has a health insurance plan with Bloomington Health Plans, which covers shuttle transport for patients as an insurance benefit. Patient Shuttle Transportation is an approved provider of this service. Anna Jones is an employee of Patient Shuttle Transportation. She’s a transportation coordinator who arranges rides to medical appointments for Charles. 

 

 

 

 

CLINICAL DATA MODEL

 

A patient’s healthcare journey takes them to multiple providers and healthcare facilities at different times. To ensure the accuracy of patient medical records, Health Level Seven (HL7) defines industry-recognized standards for how healthcare providers structure, store, and transfer medical records. This ensures the systems that different providers and facilities use are interoperable. HL7 defines two standards for this purpose:

• Fast Health Interoperability Resources (FHIR)
• HL7

The Clinical data model aligns with FHIR and supports many of the HL7 message types. This data model captures information from an Electronic Health Record (EHR) system via integration middleware. It displays information commonly associated with EHRs such as patient or member encounters, chronic conditions, allergies, medications, and immunizations. 

 

Clinical Encounter

 

 

 

Diagnosis and Medications

 

 

 

Health Insurance and Claims Data Model:

 

The Health Insurance and Claims data model provides objects for managing the ways healthcare is paid for. These objects represent information about members and their employers, insurance coverage, and dependents. This data model includes objects for claims submitted to a member’s health insurance company by an entity or person who provides a service, medication, or device to the member.

Purchaser Plans:
 

 

 

Member Plans:

 

 

 

Claims:
 

Claims data resides outside Salesforce in a 3rd-party system. The Health Cloud claims functionality is delivered as an unmanaged package that contains a set of external Claim objects. External objects are objects that map to data that’s stored outside your Salesforce org. External objects enable your users to search and interact with the external data.

Before you install the Claims package, make sure your organization has a Salesforce Connect license. You need Salesforce Connect to set up the connection to your source system so that Health Cloud can pull your organization's claims data into the external objects. You need middleware to get this data from the 3rd-party claims systems. 

In Setup, go to External Objects to view the claims objects and open them in Object Manager. You won’t see the objects if you search for them in Object Manager itself.

 

 

 

 

Care Program Data Model:

 

Care programs cover services such as patient outreach, access to care and medications, financial assistance, and fitness and wellness plans. The Care Program data model helps you capture those activities so you can use Health Cloud to plan and track them better. 

Note that a care program is different from a care plan. A care plan helps the healthcare team coordinate care more efficiently for a patient with the goal of improving the patient’s health. You can link a care program to a care plan.

The program goals are for patients to manage their pain by adhering to the prescribed medication dosages and incorporating alternative, nonpharmacological strategies. The program includes education about alternative pain management strategies. 

 

Care Program Enrollments and Goals

 

 

 

Care Program Products

 

 

 

 

Care Program Campaign and Surveys

 

 

 

The Social Determinants of Heath Data Model:

 

Social determinants of health (SDOH) are the critical social and environmental factors that may become barriers to a patient’s or member’s wellness. The Social Determinants data model helps you gain insight into the physical environment and socioeconomic status of a patient so that you gain a holistic perspective on these factors. This helps you identify intervention tasks to address care barriers and reduce health setbacks for patients and members.

A common SDOH example is food insecurity. When patients and members don’t have an adequate number of meals or snacks daily, or the quality of their meals is poor, this can lead to higher-than-average visits to the emergency room. The intervention is to provide access to affordable nutritious food via food debit cards, food banks, food delivery services, farmers markets, and subsidized meal programs.

 

Care Determinants

 

 

 

Care Barriers:

 

 

 

Care Interventions:

 

 

 

The Provider Data Model

 

The Account object with a Business record type represents providers that are organizations. 

For people, use either person accounts or contacts, but we strongly recommend person accounts. Person accounts are a better fit for healthcare providers who are their own independent entity with practicing rights at a number of locations. These individuals have their own unique identification number, such as a National Provider Identifier (NPI), which follows them regardless of where they work. If you map individual providers as contacts, there are limited capabilities for these records.

 

If you model providers only as person accounts, you may not be able to use Health Cloud capabilities such as provider search. However, when you model providers using both the Healthcare Provider object and person accounts, then this ensures they’re aligned to the FHIR Practitioner resource and they can use provider search.

 

People

 

 

 

Organizations

 

 

 

Healthcare Facilities

 

 

 

HealthCare Practitioners Facilities

 

 

 

HealthCare Payer and Facility Networks

 

 

 

HealthCare Provider Facilities

 

 

 

 

HealthCare Provider Certification, Education and Licenses

 

 

 

The Utilization Management Data Model

 

 

Utilization Management (UM) is the use of managed care techniques such as prior authorization to allow payers to manage the cost of health care benefits by assessing a benefit’s appropriateness before it’s provided, using evidence-based criteria or guidelines. UM ensures that patients receive the right care, at the right time, for the appropriate duration, in the right setting.

In Health Cloud’s Utilization Management, OmniStudio components combine to provide a guided user interaction for users who manage authorization request submissions and reviews. OmniScripts are available to create and submit an authorization request, conduct admin, nurse, and medical director reviews of the authorization request, and conduct peer-to-peer reviews with the requesting provider. 

Business Rules Engine components streamline approval processes, simplify complex lookups, and automate business decisions in the authorization request workflows.

The UM data model aligns with FHIR R4 for interoperability and integration with external systems. UM includes APIs and integration applications deployed on MuleSoft for uninterrupted request processing with external Electronic Health Record (EHR) and payer systems. These APIs align with the FHIR Da Vinci Health Record Exchange (HRex) implementation guide.

 

 

Care Requests

 

 

 

 

 

More Healthcare Data Models

 

Data Model	Description
Benefits Verification	Supports healthcare organizations in determining benefits coverage for services and products provided.
Integrated Care Management	Provides objects to store clinical data related to a patient or member’s care plans. This data model is USCDI and FHIR R4-aligned, which helps with your system’s interoperability.
Intelligent Appointment Management	Provides objects to help you work with multiple scheduling source systems operating on different electronic health record platforms.
Intelligent Document Automation	Provides objects to simplify the document management process, reduce manual data entry, and manage patient and member forms all in one place, from intake through processing.
Remote Monitoring and Device Registration	Provides objects for managing data collected from devices issued to patients or program members, such as smart watches and heart monitors.
Unified Health Scoring	The Score data model stores and processes information used for the Score List for Unified Health Scoring and Score Details for Unified Health Scoring components. The Actions data model supports displaying contextual prompts for users to act on in the Dynamic Actions for Unified Health Scoring component.

 

 

Thanks,
Aakash Gupta

Reference - Trailhead

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