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Against All Odds

September 1, 2006
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Political unrest creates unique challenges for healthcare organizations in regions of strife.

Large-scale projects are difficult to implement under the best of circumstances, but leading such projects with virtually no vendor support is quite another. After determining that the King Faisal Specialist Hospital and Research Centre (KFSH) in Riyadh, Kingdom of Saudi Arabia, needed a data warehouse and business intelligence tools to address analytical reporting needs and support performance management initiatives, Hamad Al-Daig, CIO of Information Technology Affairs, confronted a myriad of obstacles on the road to implementation.

When technology vendors exited the Middle East after the first Gulf War due to security concerns, training and support for systems from U.S.-based companies was simply unavailable to hospitals in the region. Among them was KFSH.

One major U.S.-based company refused to honor the original contract's timeline and cost agreements, forcing Al-Daig to accept a plain-vanilla application with no modifications, as the customization team was restricted from traveling to the region. Even finding a consultant with clinical management and data warehouse expertise from the United States or Europe was difficult. Another blow resulted from a miscalculation in the project's scoping exercise, which underestimated costs by between 30 and 40 percent and caused a major revision in system requirement specifications, says Al-Daig.

Between conception and the project's actual start, more than four years elapsed as Al-Daig awaited completion of the installation of two pillar operational systems, namely an integrated clinical system from Cerner Corporation (Kansas City, Mo.) and a financial application from Oracle (Redwood Shores, Calif.). Implementation of the data warehouse project took 16 months, beginning Nov. 24, 2004 and officially ending this past April.

Al-Daig's goal was a data warehouse which could perform extracting, transforming and loading data from cross-functional systems into one single platform for all analytical reporting across the enterprise. But in the Middle East, where data warehousing is still an emerging technology, just conveying the abstract concept of a data warehouse and its value to KFSH's clinical and administrative staff required major effort. Defining end-user requirements and matching them to the data warehouse capabilities was another.

Initial efforts to get buy-in from targeted users were ineffective, says Al-Daig, mainly because end users didn't fully understand the merits. There was great difficulty involving them in the processes of standardizing the definitions, formulas and measurements used in core key performance indicators (KPIs), he adds. "This is due to the fact that the data warehouse is relatively new in a hospital setting. We are the first ones to embark on such a project in the entire Middle East in the medical field." Once executive management bought into the concept, however, they supported the project from beginning to end, backing Al-Daig on all financial, logistical and human resource issues.

KFSH's data warehouse was built from the ground-up using a best-of-breed approach. "The few off-the-shelf solutions available in the market would have required lengthy and expensive modifications," he notes. Ottawa, Ont.-based Cognos' Business Intelligence suites provide the graphical KPI matrices, dashboards and scorecards for end users. Redwood City, Calif.-based Informatica's Power Exchange and Power Centre provides for data extraction, transformation and loading from source systems. Oracle's database engine hosts the warehoused data.

Al-Daig is proud of being first among like-sized hospitals in his region to have a data warehouse. Although the hospital anticipates benefits for both the hospital, particularly in reduced lengths of stay with associated cost reductions, and the ambulatory environment, where a redistribution of physician workloads is anticipated, he says it's still a bit early for ROI and improvement stories.

Author Information:

Charlene Marietti

Kathryn Foxhall is a contributing writer based in Hyattsville, Md.