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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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Presentation Transcript
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
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

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

proposed value realization dashboard
Proposed Value Realization Dashboard

Clinical

Operational

Financial

Satisfaction

Overall

$61M

$25M

$25M

$61M

$330M

Example metrics only

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