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Clinical Data Warehouse Modeling: A Practical Approach to Modeling a Successful Healthcare EDW. Agenda. But as long as we plan…. Moving fast can be scary…. Landscape Challenges Clinical Data Warehouse Success Story a Case Study Lessons learned Q & A. Landscape: Healthcare BI Drivers.

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Clinical Data Warehouse Modeling: A Practical Approach to Modeling a Successful Healthcare EDW

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Clinical data warehouse modeling a practical approach to modeling a successful healthcare edw

Clinical Data Warehouse Modeling: A Practical Approach to Modeling a Successful Healthcare EDW


Agenda

Agenda

But as long as we plan…

Moving fast can be scary…

  • Landscape Challenges

  • Clinical Data Warehouse Success Story

    • a Case Study

  • Lessons learned

  • Q & A


Landscape healthcare bi drivers

Landscape: Healthcare BI Drivers

1

2

3

Avoid cost overruns (shared risk)

Obtain bonuses and/or incentives (shared savings)

Meet metric-based reimbursement requirements

4

5

Fill the revenue loss gap

Improve care quality


Challenges

Challenges

  • Healthcare data complexity

  • Structural diversity of operational systems

  • Workflow variations alter the fact storage

  • Domain-specific knowledge (operational and IT) for data source analysis

  • Large scale differences in granularity, terminology and perspective in source data

  • Overlapping/competing solutions and tools


Case study

Case Study

Building for Meaningful Use and the Future

  • EHR

  • Deployment

    • Capture the data

Criteria:

Regulation Requirements Analysis and Implications

  • Capability, process and data element analysis and design – Right data, right format enabled by right workflows

Measure, monitor and optimize

Aggregation and Analytics

Reuse the data

  • Infrastructure plan and design

  • BI Tool selection and ONC certification

  • Proof of concept

  • Create MU compliance and quality reports

CMS other entities

  • Hospital-based MU compliance assessment tools

  • Test and submit

  • Optimize systems and processes


Context

Context

6


Key invested sponsorship

Key: Invested Sponsorship

  • Value Realization Program

  • The Program purpose is to promote clinical performance improvement and business value, ensuring Tenet qualifies and receives full incentive dollars as a result of the EHR program

  • The Program serves to identify, act on, report and monitor the CMS Meaningful Use requirements and value based metrics


Integrated clinical bi strategy overview

Integrated Clinical BI Strategy Overview

Initial Focus

  • Point of Care

  • Cerner

  • Clinical Quality

  • eMeasures

  • Clinical

  • Operational

  • Financial

  • Satisfaction


Key business objectives to solve

Key: Business Objectives to Solve

Determine

MU Requirements

Attest to

CMS

Identify

Content

Sources

  • Capture the right data in the right format enabled by workflow to support Meaningful Use Stages 1-3 and other related initiatives

  • Support Tenet’s overall BI Objective, joining of Clinical and Operational data in a common repository

Develop

Processes

Workflows Impacted

Data Warehouse

Capture Data

Reg*

Cerner*

EDW*

  • MU Dashboard

Make Design Decisions

* CERTIFICATION REQUIRED


Tools and methods

Tools and Methods

Building for Meaningful Use and the Future

Build and Deploy

  • Data

  • Maps

  • Design

  • Decisions

  • Workflows,

  • Content, Order Sets

  • ETL Design

  • Data quality analysis

  • Value set modification

  • Operational decisions

  • Application build

  • Metric impacts

  • Reference

  • Library

  • Descriptions

  • Issues tracking

  • Responsibilities and tasks

  • Metric impacts

  • Evidence based

 Metric definitions

 Code sets

 Data definitions

 Derived data

EDW

Analytics

Dashboard

ONC certification


Developing the clinical quality dashboard

Developing the Clinical Quality Dashboard

“Metadata” for each meaningful use objective and stage 1 clinical quality measure including source data (knowledge base)

Meaningful Use Dashboard

Clinical Quality Measures Analysis Reports

  • Use Cases:

  • Meaningful Use Compliance

  • Clinical Quality Measures Analysis

Map to business glossary and data model for accelerated data acquisition from source systems


Bi architecture

BI Architecture

Data Warehouse Platform

Meta Data Repository

Analytics

Dashboard

Analytics Mart

Enterprise DataWarehouse

EDW

Query

ETL

Scorecard

SourceSystems

ODS Layer

Reporting

ELT

Query

ETL

Meaningful Use

Derivations & Measure Calcs

SubmissionReporting

DAAC

Cerner

ODS

ETL

ETL

Outbound

HIE

Quality

HIM

MUADM

  • Cerner

  • H1 – H5

  • CPOE, LAB, RX

Other…

ADT, Billing, Claims Mgt, Admin (PBAR +)

MedHost

12


Key data model

Key: Data Model


Data model approach

Data Model Approach

  • Aligneddisparate source data: syntactically and semantically

  • Enriched information via reintegrated derivations and calculations

  • Retained relationship of summarized, aggregated information with detail facts

  • Managed and Documented analytics with embedded metadata

Measure Model

Derivation Model

Metadata Model

Core Model


Edw core model

EDW Core Model

  • Normalized, but not Strict 3NF

  • Captured critical analysis facts

  • Ignored extraneous data

  • Conformed source data; structure and semantics


Edw derivation model

EDW Derivation Model

  • Normalized

  • Organized by granularity

  • Relationships to base fact maintained

  • Derivations treated as columns

  • Snapshot per calculation


Edw measure model

EDW Measure Model

  • Normalized

  • Organized by granularity

  • Relationships to base fact & derivation snapshot maintained

  • Measures treated as dimension

  • Snapshot per calculation


Mu mart visit analytics model

MU Mart Visit Analytics Model

  • Dimensional Star

  • Central facts organized by granularity

  • Summary generated and persisted

  • Conformed dimensions

  • Detail evidence retained in dimensions

  • Dimensional hierarchies ignored


Solution stats

Solution Stats

Element

Delivered

Result

EDW Dashboard

2 Dashboards

Hospital ownership for monitoring

EDW – 19 CQM

59 Unique Data Elements

486 Mappings

EDW -24 Utilization

75 Unique Data Elements

379 Mappings

Physician Order Entry

CPOE EHR Volume Oct-Nov

1537 Physicians

Clinical Decision Support

Non Pharmacy Rules

50

PowerPlans & Order Sets

Developed and Rolled Out

488

Start to finish: Jan 2010 to Sept 2011

  • 7 Hospitals attested for 2011

  • On track to take 13 hospitals live in 2012 including one Epic site

  • Total number of facilities' live by 2014, 49

  • Building out Stroke and VTE quality measures (preparation for expanding CMS Inpt Quality Reporting requirements)

Building for Meaningful Use and the Future


Clinical business intelligence meaningful use dashboard

Clinical Business IntelligenceMeaningful Use Dashboard


Clinical business intelligence meaningful use dashboard1

Clinical Business IntelligenceMeaningful Use Dashboard


Clinical business intelligence meaningful use dashboard2

Clinical Business IntelligenceMeaningful Use Dashboard


Clinical business intelligence meaningful use dashboard3

Clinical Business IntelligenceMeaningful Use Dashboard


Proposed value realization dashboard

Proposed Value Realization Dashboard

Clinical

Operational

Financial

Satisfaction

Overall

$61M

$25M

$25M

$61M

$330M

Example metrics only


Adverse drug events warfarin examples

Adverse Drug Events Warfarin Examples


Lessons learned

Lessons Learned …


Lessons learned1

… Lessons Learned


Thank you

Thank You


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