Data Warehouse Case Study Essay

History of the CDR When the retch began in 199596, the CDR, initi each(prenominal)y referred to as the clinical research selective information nucleotide, was int nullifyed to musical accompaniment and enhance clinical research at the University of Virginia by providing clinicians, students, and researchers with level, rapid adit to retrospective clinical and administrative patient selective information. Re? ecting this intent, the system was funded by the School of Medicine and ho engrossd in the Academic Computing Health Sciences group, which is unambiguous from the medical centers IT group. With shrink fromsiderable assistance and cooperation from info owners and stewards, legacy data from several different sources were loaded into a single relational database and periodically updated. Authorized substance ab users accessed the CDR through a standard Web browser and viewed or downloaded data to their personal computers for further analysis.Initially, emphasis was placed on getting the CDR running as quickly as possible and with a minimum of resources consequently, extensive transformation of data to an enterprise data place was not performed. The CDR protrude police squad consists of 2. 53. 0 FTEs (full-time equivalents) sensation developer, one developer-database administrator, and portions of analyst, clinician, and administrative FTEs. To date, the costs of developing and operating the CDR have been approximately $200,000 per year, underwritten by the School of Medicine.Over the course of the project, there have been signi? cant enhancements to the user port wine, incorporation of additional data sources, and the development of an integrated data model. at that place has also been increasing interest in using the CDR to serve a broader audience than researchers and to delay management and administrative functionsto meet the challenge of providing a way for anyone with a need to knowat every level of the organizationaccess to accurate and timely data necessary to support effective decision making, clinical research, and process improvement.In the area of education, the CDR has come a core teaching resource for the De go badment of Health military rank Sciences masters program and for the School of Nursing. Students use the CDR to understand and master informatics issues such as data capture, vocabularies, and coding, as well as to perform grammatical case Study A entropy Warehouse for an Academic Medical midpoint 167 exploratory analyses of healthcare questions. outset in Spring 2001, the CDR will also be introduced into the universitys undergraduate medical curriculum. System Description Following is a brief overview of the CDR drill as it exists at the University of Virginia.System Architecture. The CDR is a relational data store that resides on a Dell PowerEdge 1300 (Dual Intel 400MHz processors, 512MB RAM) running the Linux operating system and Sybase 11. 9. 1 relational database management system. For sto rage, the system uses a Dell Powervault 201S 236GB RAID disc Array. As of October 2000, the database contained 23GB of information about 5. 4 million patient gibbers (16GB visit data, 7GB laboratory results). selective information loading into Sybase is achieved using custom Practical extraction and Report Language (Perl) programs. CDR Contents. The CDR currently draws data from four independent systems (see parry 1).In addition, a flesh of derived look ons (for example, number of days to close inpatient visit, number of times a diagnostic code is utilise in discordant settings) are computed to bid summary information for selected data elements. Data from each of these source systems are integrated into the CDRs data model. In addition to the current contents listed in Table 1, users and the CDR project team have identi? ed additional data elements that might be incorporated Table 1. Contents of the CDR Type of Data Inpatient, outpatient visits Source of Data Shared Medica l Systems DescriptionPatient registration and demographic data, diagnoses, procedures, building block and census information, billing proceedings, including medications, costs, charges, reimbursement, insurance information Physician billing transactions from inpatient and outpatient visits, diagnoses, and procedures research laboratory test results Available Dates Jul 1993Jun 2000 Professional billing Laboratory results cardiac surgery IDX billing system HL-7 messages from SunQuest Lab System Cardiac surgery outcomes data (de? ned by Society of Thoracic Surgeons Oct 1992Jun 2000 Jan 1996Jun 2000 Clinical detail for thoracic surgery casesJul 1993Jun 2000 168 Einbinder, Scully, Pates, Schubart, Reynolds into the CDR, including microbiology results, discharge summaries (and other narrative data), outpatient prescribing information, order gateway details, and tumor registry information. As of October 2000, we have just ? nished incorporating death registry data from the Virginia Dep artment of Health into the CDR. These data will provide our users with direct access to more(prenominal) comprehensive mortality outcomes data than are contained in local information systems, which generally are restricted to an in-hospital death indicator. drug user Interface. The user interface runs in a standard Web browser and consists of a data dictionary, a collection of common gateway interface (CGI) programs implemented using the C programming language, and JavaScript changed hypertext markup language pages. Structured interrogative language (SQL) statements are generated automatically in response to point-and-click actions by the user, enable submission of ad hoc queries without prior knowledge of SQL. The SQL queries are sent to the CGI programs that call into question the database and return results in dynamically created HTML pages.The entire process is controlled by the contents of the data dictionary, which is used to format SQL results, set up HTML links for data d rill-down, and provide on-line help. Data may be downloaded immediately into Microsoft Excel or another analysis tool on the users workstation. doubt Formulation. Most CDR users use the Guided Query function to retrieve data. This process involves three steps 1. De? ne a population of interest by setting conditions, for example, date ranges, diagnostic codes, medical student identi? ers, service locations, and lab test codes or encourages. 2.Submit the query, specifying how much data the CDR should return (all matching data or a speci? ed number of rows). 3. After the CDR returns the population of interest, use the Report Menu to explore various attri yetes of the population on a case-by-case or group level. practise reports can also be de? ned, and the results of any report can be downloaded into Microsoft Excel, Access, or other analysis tool. Generally, the query process requires several iterations to metamorphose the population conditions or report options. In addition, br owsing the data may help the user generate ideas for additional queries.We believe that it is helpful for end users to go through this query process themselvesto directly engage the data. However, galore(postnominal) users, especially those with a pressing need for data for a meeting, report, or grant, prefer to use CDR team members as intermediaries or analysts. To date, we have try to meet this preference, but as query volume increases, our ability to provide data in a timely manner may strike off. Security. A steering committee of clinicians guided the initial development of the CDR and launch policies for its utilization and access. Only authorized users may log onto the CDR.To protect con? dentiality, all patient and physician identifying information has been partitioned into a secure Case Study A Data Warehouse for an Academic Medical Center 169 database. Translation from or to disguised identi? ers to or from actual identi? ers is possible but requires a written request an d appropriate approval (for example, from a executive program or the human investigations committee). All data transmitted from the database server to the users browser are encrypted using the secure Netscape Web server, and all accesses to the database are logged.In addition, CDR access is restricted to personal computers that are part of the Virginia. edu domain or that are authenticated by the universitys substitute server. Evaluation Understanding user needs is the basis for improving the CDR to enable users to retrieve the data independently and to increase utilisation of the CDR at our institution. Thus, assessing the value of the CDRhow well we meet our users needs and how we might increase our user basehas been an important activity that has helped guide planning for changes and enhancements and for allocation of our limited resources.Efforts to assess the CDR have included several approaches Monitoring user population and usage patterns Administering a CDR user survey Tracking queries submitted to the CDR and performing follow-up anticipate interviews Usage Statistics. Voluntary usage of an IS resource is an important measure of its value and of user satisfaction. 5 However, usage of a data warehouse is credibly to be quite different than for other types of information resources, such as clinical information systems. A clinical system is likely to be used many times per day a data warehouse may be used sporadically.Thus, although we monitor system usage as a measure of the CDRs value, we believe that frequency of usage cannot be viewed in isolation in assessing the success of a data warehouse. Since the CDR went live, more than 300 individuals have requested and obtained logon IDs. As of September 30, 2000, 213 individuals had logged on and submitted at least one query. This number does not include usage by CDR project team members and does not re? ect analyses performed by team members for end users. Figure 1 shows the cumulative number of a ctive users (those who submitted a query) and demonstrates a linear growth pattern.