Architecting HBase Applications

Chapter 8. Use Case: Near Real-Time Event Processing

This next use case focuses on handling claims records for the healthcare industry. The claims processor utilizes a software-as-a-service (SaaS) model to act as a bridge for patients, hospitals, and doctor’s offices. Because medical claims are quite difficult to manage for many hospitals and healthcare providers, the claims processor (also known as a clearinghouse) accepts claims from customers (i.e., hospitals and doctor’s offices) and then formats those claims to send to the payer. This is a difficult and tedious process, as most hospitals and doctor’s offices did not traditionally use a standardized format for claims. This is where the clearinghouse comes in to submit all claims in a unified format designed specifically for the payer.

Compared to the previous use cases, the clearinghouse has a few extra layers of complexity. For example, this data is not just machine-generated data to be loaded in batch; the incoming data has to be processed inflight. In addition, because the data is classified as personally identifiable information (PII) or protected health information (PHI), and thus protected under the Health Insurance Portability and Accountability Act (HIPAA), it requires numerous layers of security. This use case focuses on electronic medical claims records and creating a system to process these records. The end objective for this system is to lower the typical claims processing time from 30 days to eventually processing ...