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Bullet-Proof Warehouses

September 1, 1998
by Charlene Marietti
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Organizational transformation, complex reporting requirements and growing respect for evidence-based medicine are driving data warehousing implementations. But the current dearth of healthcare-specific applications and turnkey systems still makes the data warehouse a custom project.

Blistering budget cuts in the military four years ago hit the medical services units particularly hard. Slated to lose about a quarter of their resources, managers searched for ways to live with less, while still caring for 8.5 million beneficiaries. Medical services managers realized they had to improve business processes and embrace managed care. The question was how.

The ultimate answer consisted of a titanic, multi-phase effort to integrate the collection of IT systems across the Military Health System headquartered at the Pentagon in Arlington, Va. The key integration tools: data warehouses. Four years and nearly millions of dollars later, a collection of local and regional data warehouses pump financial stats and patient profiles into administrative and clinical systems.

An enterprise data warehouse, now in final development, should become operational in the first quarter of 1999. Although project directors hope for total buy-in by clinicians and administrators, they realize they still have a long way to go. Caregivers usually are skeptical when they first encounter a computer system that changes how they do their daily jobs. "They go through a grieving process that includes denial and shock," says Michael Mauro, system architect for the integration project and its enterprise data warehouse (for more details about this project, see Case in Point "Warehouses for the New World Order" on page 50). But shock often turns to delight, Mauro adds. "Once they see the light, they become ravenous for data."

Data power
The axiom that information is power describes the driving force behind data warehouses--central repositories of enterprisewide information that with the right analysis tools can help organizations spot operational ills and uncover market trends. The military isn’t the only sector hungry for accurate internal data.

Civilian healthcare is looking to data warehouses to help attack inefficiencies. Insurers led the charge in the private sector, wading in as early as 1991, when few turnkey data warehousing systems or knowledgeable consultants existed. But the custom data warehouse insurance companies did build helped them identify fraudulent claims and increase operational efficiency and risk prediction.

Today, as warehouse systems and data-analysis tools mature, healthcare organizations are finding that financial operations aren’t the only beneficiaries of a central data storehouse. Clinicians now use warehouses for evidence-based medicine--a new discipline that taps historical data to validate diagnoses and treatment regimes. "If data is properly captured in one big database, the data is worth its weight in the most precious metal for commercial medicine and for research," Mauro says.

Pharmaceutical companies, progressive integrated delivery systems and health plans build warehouses for extracting valuable clinical and cost management statistics. Other companies dedicate warehouses to chronic diseases, such as multiple sclerosis, diabetes, chronic wounds and asthma. In the future, data warehouses in healthcare may underpin the entire delivery system, from the patient’s bedside care to organizational management, says Marshall Ruffin, MD, president of The Informatics Institute, Bethesda, Md.

Table 1 Data warehouses and data mart uses in healthcare


Claims analysis

Cost benefit determinations

Customer relationship management

Fraud detection

Intellectual asset aggregation

Key business performance analysis

Operational management

Provider performance benchmarking and management

Risk management


Clinical research

Computer-based patient record

Continuing education

Disease management

Evidence-based medicine

Image management (radiology)

Matching specialty clinicians with patients-in-need

Preventive health

Public health

Building blocks
Whether used for clinical or financial analysis, the basic components of a data warehouse are the same. At a warehouse’s heart is a database that’s relational or multidimensional (i.e., image, video and audio as well as alphanumeric information). The database usually runs on a dedicated server and mirrors data residing on other enterprise databases used for day-to-day operations.

Augmenting the data warehouse are software tools that extract, cleanse, transform and move selected data elements from the operational systems. Query and reporting applications, known as decision support systems (DSS), let users search the database for specific nuggets of information or compare data to uncover hidden trends, such as finding departments that habitually go over budget or recognizing that a significant percentage of the patient population is older than 50. With its data stored in standardized formats that make comparisons easy, the warehouse provides a "single version of the truth" or a single representation of the business entity.