As a care delivery provider, you endeavor to bring greater value to patient care by improving health outcomes and reducing cost. To prove your differentiation, you report your clinical and operational metrics to your customers. You characterize your patient population, identifying trends and patterns of disease prevalence and health behaviors, to implement interventions.

As a standard for electronically exchanging healthcare information, FHIR is designed to be interoperable through its flexibility and extensibility. It is optimized for real-time transactional interaction on a single resource or bundle of resources. However, FHIR is not designed for analytics use cases. FHIR’s heavily nested and embedded structure is challenging for the majority of existing analytics infrastructure that relies on “flat” storage. Zus offers a data mart that extracts and transforms your FHIR data into a relational format familiar to seasoned data analysts and engineers for SQL-based exploration and analysis.

Getting Started

Accessing your data mart

If your organization already has a Snowflake account, you can provide your account identifier to Zus to set up secure data sharing. Otherwise, Zus can provision and manage read-only reader accounts for your users that enable them to access and query the data mart. Your organization will be charged for the consumption associated with the reader account.

If you would like access to your data mart, please submit a support ticket

Logging into your Snowflake Account

If you are logging into a Zus-provided Snowflake account, navigate to the URL provided to you https://zus-{company_name}.snowflakecomputing.com/console/login#/ and enter your provided credentials.

Getting Familiar with Zus Data and the Schema

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Beta

This schema is in a stage of development that is subject to change and may not yet be feature complete or perform consistently. We do not warrant against bugs or defects in data availability.

Now that you are logged into Snowsight, click on Data in the left sidebar. You should see a database called ZUS_{COMPANY_NAME}_EXPORT in the panel directly to the right of the left sidebar. If you click on the right arrow next to the database to expand its schemas, click on the right arrow next to the {COMPANY_NAME}_RELATIONAL schema to expand the schema’s contents, and click on the right arrow next to Views, you should see about 200 views available to you to query.

For more information about the data and schema, please see our:

• Entity relationship diagrams
• Data dictionary

Supported resource types

The following resource types are exported as data mart tables: AllergyIntolerance, Appointment, Consent, CarePlan, CareTeam, Condition, Coverage, Device, DeviceUseStatement, DiagnosticReport, DocumentReference, Encounter, FamilyMemberHistory, Goal, Immunization, Location, Medication, MedicationAdministration, MedicationDispense, MedicationRequest, MedicationStatement, Observation, Organization, Patient, Practitioner, Procedure, and RelatedPerson.

Table Types

The Zus Aggregated Profile (or ZAP) is an up-to-date, comprehensive record of a given patient's health history, assembled and curated by Zus from various external data networks. The ZAP is structured to include first-party data written and managed by your Builder organization, Zus-summarized and de-duplicated (Lens) data, and third-party data from EHR networks, pharmacy-sourced medication data, admission notifications (ADT), and lab notifications via the Zus subscription.

There are three types of tables in the data mart:

Data sources

The DATA_SOURCE column is available as a column for every base FHIR resource table. When the DATA_SOURCE column is NULL, that reflects that the data is first-party written and managed by your organization. This also includes data that comes from Zus’ EHR integrations.

When the DATA_SOURCE column is not NULL, this reflects that the data is third-party and came from the Zus network. DATA_SOURCE values include:

• EHR networks: commonwell, carequality
• Pharmacy-sourced medications: surescripts
• ADT notifications: bamboohealth, collective-medical, manifest-medex, eden, florida-hie
• Lab notifications: quest

Universal Patient Identifier

Zus offers its own identity mapping service, the Universal Patient Index , to link disparate and duplicative patient records. The universal patient identifier is available as a column called UPID for every base FHIR resource and Lens table types, except for Location, Medication, Practitioner, and Organization.

Every row in the PATIENT table is a FHIR Patient resource that has a unique ID. Each Patient resource corresponds to a different copy of one human being's data that Zus has aggregated. For example, for one human, there could be one Patient resource from Surescripts, one for each responding organization that responded via the Carequality network, and one from Quest. If there are 10 Patient resources that all correspond to the same human, each Patient resource will have a unique ID but the same UPID.

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Your data mart will include data for patients for whom your Builder organization has an active treatment relationship.

Exploring the data

To start exploring the data, click on + Create in the left sidebar of Snowsight and select SQL Worksheet.

Let's run a simple query to count the number of distinct patients included in the data mart and click the blue play button on the top right to execute.

select
    count(distinct upid)
from patient

🥳 Congratulations! You completed your first query on the Zus data mart!

Refreshing your data mart

You do not need to actively refresh your data mart. The latest state of FHIR resources should be reflected in your data mart:

• Within 3 hours of the change in the Zus FHIR store: Condition, Device, DocumentReference, Encounter, Location, Organization, Patient, and Practitioner
• Within 24 hours of the change in the Zus FHIR store: AllergyIntolerance, Appointment, CarePlan, CareTeam, Consent, Coverage, DeviceUseStatement, DiagnosticReport, FamilyMemberHistory, Immunization, MedicationAdministration, MedicationDispense, MedicationRequest, MedicationStatement, Observation, Procedure, and Related Person