Data Platform
Medecision Data Platform Overview
The Medecision Data Platform is a cloud-native, enterprise-grade foundation that powers all modular applications across the Medecision ecosystem—including Care Management, Utilization Management, Clinical Intelligence, Appeals & Grievances, and Digital Engagement. It is designed to ingest, transform, store, analyze, and operationalize health data at scale in real time.
Core Architecture Components
Component | Description |
Canonical Data Model | Unified schema across members, programs, tasks, requests, and clinical data |
Event-Driven Ingestion | Real-time and batch ingestion from ADT, claims, SDOH, labs, EHR, and APIs |
Processing Layer | Data validation, normalization, enrichment, and de-duplication workflows |
Secure Storage | HIPAA-compliant, cloud-based warehousing for structured and semi-structured data |
Analytics Layer | Embedded dashboards, BigQuery integration, and real-time metrics APIs |
Interoperability APIs | FHIR R4 and RESTful endpoints for data input/output |
Supported Data Types
Type | Examples |
Member Demographics | Enrollment, eligibility, addresses, coverage data |
Claims & Encounters | Professional, institutional, pharmacy, EDI 837, 835 |
Clinical Documents | CCD, FHIR bundles, LOINC-based lab results |
Assessments & Surveys | HRA, PHQ-9, patient-reported outcomes |
ADTs & Hospital Events | HL7, FHIR Encounter, admission/discharge notifications |
Tasks & Programs | Structured work and programmatic metadata from applications |
Social Determinants of Health (SDOH) | Screening results, risk indicators, geographic data |
Correspondence & Letters | PDF files, outbound letters, audit trails |
Data Ingestion Methods
Batch Uploads: SFTP file drops (e.g., claims files, rosters)
Real-Time Streaming: HL7 and FHIR-based ingestion (e.g., ADT alerts)
Manual Entry: Intake forms and UI-based workflows
API-Based Submissions: EMR and CRM system integrations using REST/FHIR
All data is processed through a validation and enrichment pipeline before surfacing to applications.
Data Processing & Enrichment
Deduplication: Identity resolution across member sources
Code Mapping: Normalization to standard taxonomies (ICD, SNOMED, LOINC, NDC)
Risk Tagging: Predictive tagging (e.g., high-risk diagnosis, cost flags)
Stratification: Population segmentation using Clinical Intelligence Builders
Geocoding: Location-based SDOH overlay and resource recommendations
Analytics and Reporting
Embedded Dashboards: Visuals by module (e.g., task backlog, program reach rate)
BigQuery & BI Tools: Enterprise access for self-service analytics
Real-Time Metrics: API access to counts, performance, engagement, and compliance KPIs
Pre-Built Reports: CMS audit support, productivity dashboards, gap closure tracking
Interoperability
FHIR R4 APIs: Read/write access for member, request, task, assessment, and coverage resources
Custom REST APIs: For legacy system integration, data export, and automation workflows
Webhooks: Event-driven notifications for external systems (e.g., auth decision returned to EMR)
Inbound/Outbound EDI Support: For claims, eligibility, and billing workflows
Security and Compliance
HIPAA, HITRUST, and SOC 2-compliant infrastructure
Role-based access control (RBAC) and data-level permissions
Full data lineage and audit trail logging
Support for encryption in transit and at rest (AES-256)
Key Use Cases
Use Case | Description |
UM Auto-Decisioning | Real-time rules applied to clinical intake and eligibility data |
Care Stratification | Dynamic population scoring with Clinical Intelligence Builder |
Program Enrollment | Member auto-enrollment triggered by event ingestion (e.g., ADT, Dx) |
Regulatory Reporting | Real-time CMS audit tracking for appeals and grievances |
Digital Outreach Targeting | Campaign logic based on risk scores, claims, or clinical gaps |
Governance and Promotion
Configuration changes to data processing logic and mappings follow Medecision’s change control and governance workflows
Builder-driven rules for population, risk scoring, and ingestion logic
Staging and production environment separation with promotion approvals
The Medecision Data Platform underpins every intelligent action and workflow across the ecosystem. It transforms diverse healthcare data into actionable insights, enabling care teams, operations, and clients to operate at scale with confidence and precision.