Two Health System’s Experiences Implementing
an Enterprise Data Warehouse
Ken Gilles, Associate CIO, Essentia Health
Rick Schooler, CIO, Orlando Health
DISCLAIMER: The vi ews and opinions expressed i n this presentation are those of the author a nd do not necessarily represent official policy or position of HIMSS.
Conflict of Interest Disclosure
Ken Gilles
and
Rick Schooler
Have no real or apparent
conflicts of interest to report.
© 2012 HIMSS
Session Learning Objectives
1. Compare two major health systems‟
approaches to developing a core
competency in business intelligence
and enterprise data warehousing
2. Summarize critical success factors in
developing an enterprise data
warehouse based business
intelligence capability
Session Learning Objectives
3. Differentiate requirements for
departmental business intelligence
from enterprise business intelligence
4. Apply lessons learned from two
major health systems‟ experiences
in implementing an enterprise data
warehouse and advanced analytics
to their own organizational setting
Overview
o Common Industry Drivers for an EDW
o Orlando Health’s EDW Approach
o Essentia Health’s EDW Approach
o Common Themes
o Challenges
o Q&A
Industry Drivers for an EDW
Economic Downturn
Healthcare Reform
•
•
•
•
Awareness of changes within organization
Rethink strategies
Rethink operating plans
Greater demands from stakeholders &
government
 Transparency about finances
 Transparency about operations
 Transparency about decisions
 Transparency about core
performance indicators
However, most organizations do not have the information, processes and tools
needed to make informed, responsive enterprise decisions due to
underinvestment in an information infrastructure at the enterprise level.
Gartner
In traditional companies, departments manage analytics —number crunching functions
select their own tools and train their own people. But that way, chaos lies.
Thomas Davenport – “Competing on Analytics”
Industry Drivers for an EDW
Value-Based
Purchasing
MU Measures
CMS Core Measures
Health Grades
Advisory Board, 2008; HHS 2009; Leapfrog, 2009
Industry Drivers for an EDW
2011
Leveraging Information on the
radar screen in 2011
2008
HIMSS Leadership Survey 2008 & 2011
HIMSS, Leadership Survey 2008, 2011
About Orlando Health
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8 hospitals
1,788 beds
14,310 team members
2,206 physicians
88 faculty
194 residents
8 residency programs
12 fellowship programs
Orlando Regional Medical Center
Arnold Palmer Hospital for Children
Winnie Palmer Hospital for Women & Babies
MD Anderson Cancer Center Orlando
Dr. P. Phillips Hospital
South Seminole Hospital
South Lake Hospital (50% partnership)
St. Cloud Regional Medical Center (20% partnership)
Lucerne Hospital
About Orlando Health
o One of Florida's most comprehensive private, not for
profit healthcare networks
o Nine facilities: Five leading community
hospitals, three nationally-recognized specialty
hospitals and one world-class cancer center
o Central Florida's fifth largest employer
o Central Florida's only statutory teaching hospital
offering graduate medical education
o A healthcare leader for nearly two million residents
and thousands of international visitors annually
Orlando Health‟s EDW Approach
Analytics… “It’s now shorthand for what people
really want from business intelligence:
concise, actionable insight that lets them
respond to what’s happening now and
anticipate what will happen in the future rather
than just react to the events of last week or last
month.”
- Doug Henschen, Information Week Magazine, June, 13 2011
Orlando Health‟s EDW Approach
Overarching Objective:
Establish an Enterprise Data Warehouse
strategy that is aligned with key business
strategies and needs. EDW solutions will be key
solutions for ACO organizations in the future.
… a solution that all health care organizations
will need to master as the industry moves to
accountable care delivery models.
- Mike Davis, The Advisory Board Company, January 2011
Competitive Advantage
Orlando Health‟s EDW Approach
Optimization
What‘s the best that can happen?
Predictive modeling
What will happen next?
Forecasting/extrapolation
What if these trends continue?
Statistical analysis
Why is this happening?
Alerts
What actions are needed?
Query/drill down
Where exactly is the problem?
Ad hoc reports
How many, how often, where?
Standard reports
What happened?
Degree of Intelligence
Source: Competing on Analytics, Thomas Davenport & Jeanne G. Harris, Harvard Business School Press, 2007, p. 8
Analytics
&
Predictive
Modeling
Access &
Reporting
Orlando Health‟s EDW Approach
o Historically multiple BI/DSS work is done across Orlando
Health
o The move to an Enterprise Data Warehouse(EDW)
provides the foundation to consolidate (to the extent
desired) this work into a common technology platform and
resource center of expertise - Enterprise Analytics (EA)
o However, doing so will be a challenge for various reasons
 Control and timing (immediate needs vs. transition)
 Existing vendors and agreements (some deep hooks)
 Significance of cultural conversion (a significant 3-5+ year effort)
o Executive commitment and governance must be visible
and understood - otherwise a lot of time, effort and
money will be wasted and our current scenario will be
exacerbated
Orlando Health‟s EDW Approach
EDW Status & Immediate Next Steps
o The EDW platform is now in place with its pilot
deliverable – Quality Dashboard
o An Analytics Executive Governance structure
being formed to:
prioritize future initiatives
monitor progress
establish accountability for value/impact reporting
and data integrity
Orlando Health‟s EDW Approach
EDW Status & Immediate Next Steps (cont.)
o Future priorities may target:
Oncology
Supply Chain
Revenue Cycle
Patient Population/Risk/Reimbursement
Management
There will be many as we progress
Orlando Health‟s EDW Approach
EDW Status & Immediate Next Steps (cont.)
o Continue to inventory:
departmental BI/DSS technologies
reporting sources
supporting staff
o This will enable subsequent enterprise
convergence and resource migration/integration
plan
o Initial data load validation
Orlando Health‟s EDW Approach
Enterprise Analytics (EA) Roles & Responsibilities
o EDW is a necessary but insufficient condition to achieve our
objective
o To move forward, a core EA team needs to be established
with the following summary duties
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Inventory current BI/DSS platforms and resources
Establish analytics methods and standards
Serve as liaisons to others across organization
Define organizational requirements, map and validate source data
With the IS EDW team, manage the technology platform and ETL process
Provide expertise for software tools, data model evolution
Publish data for mining/reporting, train super users and others
Perform complex analytics as required
Provide overall program and project management
Provide process improvement support if/as appropriate
Orlando Health‟s EDW Approach
The EA Team – Initial & Future
o The initial core EA team (4-6 FTEs) will need
the following minimum resources to launch
 Experienced leader
 Data experts (clinical, financial, operations) as well as data
extraction, transformation & load (ETL) experts
 Healthcare analytics methods and standards expert (will
also teach/train), may be a statistician or similarly
educated/experienced
 Software tool and database expert (will also teach/train)
 Process improvement expert
Orlando Health‟s EDW Approach
The EA Team – Initial & Future (cont.)
o Leader and analytics experts may be external
hires
o This group will grow as consolidation of BI/DSS
platforms and resources occurs along with
new organization needs and increased priority
for process improvement
Enterprise Analytics Steering &
Governance Committee
Enterprise champions/sponsors
Program oversight & prioritization
Align projects with enterprise strategic goals
Drive priorities and requirements, monitor progress
Track benefits
Enterprise Data Governance
Sub-Committees
Identify Data and KPIs owners
Standardize reporting
Resolve data quality issues
Resolve data definition conflicts
Contribute to business rules
Contribute to data strategies
Enforce data policies
Crimson
Information
Services
Enterprise
Analytics
Programmer/Analysts
Leader
Database Administrator
Data Experts
System Administrator
Analytics Experts
Clinical Informatics
PI Experts
Functions
Individuals
Quality
Executive
Finance
Administrator
Operations
Director
MedeAnalytics
HBI
EPSi
Programmer/Analysts
Requirements definition
Source system data extraction
System performance
Platform maintenance
Data integrity/availability
Health Care DataWorks
Enterprise
Data Warehouse
Requirements definition
Software tool experts
Liaisons to organization
Standards
Complex analytics
Data publishing
Data Model evolution
Data mapping & load
Data quality, definition
Toolset training
Process improvement
Project management
Technology & Analytics Experts
Marketing
Manager
Research
Physician
Other
Team
Member
Super Users
Casual & Dashboard Users
Sunrise
Analytics
Other
Existing BI/DSS
Platforms
About Essentia Health
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4 States – MN, ND, WI, ID
3 Regions – East, West, Central
17 Hospitals
62 Clinics
6 Long-Term Care Facilities
1 Research Institute
Approximately 700,000 Patients
Approximately 750 Physicians
Approximately 13,000 Employees
About Essentia Health
North Dakota
International Falls
Montana
Ely
Great Falls
Medina
Jamestown
West
Region
Fosston
Mahnomen
Deer River
Ada
Remer
Walker
Lake Park
Valley City
Casselton
Orofino
Chisholm
Hibbing
Fargo
Moorhead
Detroit Lakes
Frazee
Menahga
Lisbon
Hankinson
Eveleth
Babbit
Aurora
East
Region
Duluth
Superior
Ashland
Wahpeton
Cottonwood
Park Rapids
Virginia
Brainerd
Minnesota
Hayward
Sandstone
Graceville
Idaho
Wyoming
Central
Region
South Dakota
Shakopee
Jerome
Le Sueur
Hospitals & Clinics
DC/I Hospital
DC/I Clinic
SMDC Clinic
SMDC Hospital
ECHC Hospital
ECHC Clinic
Spooner
Wisconsin
About Essentia Health
About Essentia Health
Essentia Health Major Application Vendors
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o
Epic – EHR, Revenue Cycle, Patient Portal, etc…
SoftLab - Laboratory Information System
Philips – PAC‟s, Cardiology, Radiology
OnBase – Document Imaging
o Lawson - Enterprise Resource Planning (ERP)
o EPSI – Cost Accounting and Budgeting
o LaborWorx - Time and Attendance management
System
About Essentia Health
Essentia Health Major Reporting Applications
o Departmental Needs - Native System
Tools
Epic Radar, Reporting Workbench and Clarity
Lawson BI, Dashboard Gear
EPSI Reporting
o Enterprise Needs - Across Systems
Tools listed above
Business Objects Toolset
Informatica Toolset for ETL
Health Care DataWorks EDW Solution
Essentia Health‟s EDW Approach
o Forces driving the need for EDW…
Where were we (current state)?
Where do we need to be (future state)?
How do we get there (process)?
Where are we now?
Essentia Health‟s EDW Approach
o Forces Driving the Need for EDW at
Essentia Health
External Forces and Healthcare Reform
Research Institute – link to other research
organizations, participation in clinical trials – all to
provide best practices and most efficient
treatments…
Quality and Care Management initiatives
Organizational integration across regions
Migration to common systems
Limited ability to provide enterprise analytics
Essentia Health‟s EDW Approach
o Forces driving the need for EDW
Where were we (current state)?
Where do we need to be (future state)?
How do we get there (process)?
Where are we now?
Current strategies for
research, reporting, analyzing and trending
are costly and inefficient and „no single
source of truth‟….
Quality
Department
Finance
Department
Operations
Managers
Analysis
Create Report
Analysis
Create Report
Analysis
Create Report
Manual
Data
Capture
Lab
System
OR
System
ED
System
Lawson
System
EPSI
System
Micro Results
Hematology
Chemistry
Results
Peri Op
Documentation
OR Med Admin
Time
ED Admit Time
ED DC Time
People Cost
Cost
Accounting
Data
Essentia Health‟s EDW Approach
Historical strategies for data analysis did not provide the
toolsets to get at the data needed for the future…
o Financial, Operational, Clinical, Research Reporting:
 Some Available today…
 Standalone analysis…
Information
Currently
Accessible
o Integrated Clinical Data Analysis:
Cost of care in new reimbursement
models…
Cost of quality…
Compliance monitoring…
Disease State Analysis & Mgmt…
Safety and Outcomes…
Credentialing, OPPE
Research…
Strategy Map, Balanced Scorecard
Benchmark financial and clinical
productivity measurements…
Hidden
Information
photo credit - Ralph Clevenger
Essentia Health‟s EDW Approach
o Forces driving the need for EDW
Where were we (current state)?
Where do we need to be (future
state)?
How do we get there (process)?
Where are we now?
Essentia Health‟s EDW Approach
Need for Enterprise Analytics:
Sample ‘Use Cases’
Institute of Rural Health Research
By Director of Research Institute
What is the most effective and inexpensive treatment for…?
Central Region
By Chief Financial Officer
How do people costs compare across facilities so that we can learn from each
other…? What is our potential risk for a population of patients related to our
Accountable Care Organization…?
West Region
By President
Based upon our payer mix, should I recruit in Neurology or Cardiology…?
East Region
By Chief Operating Officer
What will it cost us to care for diabetic patients as part of an Accountable Care
Organization with bundled payments…?
Organization
By Chief Medical Officer
33
What is it costing us to provide the current level of quality throughout Essentia Health…?
Essentia Health‟s EDW Approach
Vision of the Future…
Implement a set of business intelligence
tools and an enterprise data warehouse that
will transform integrated clinical, financial
and operational data from the disparate
systems throughout the organization to
information that will support real-time
decision-making and facilitate economic and
financial forecasting…
Business Intelligence Definition
Essentia Health‟s EDW Approach
Entities
Data Sources
Misc
Essentia
Credentialing,
Risk, RAC, etc…
Business Intelligence…
Current State to Future State…
Data
Research,
Decision Support,
Quality Analysis
Innovis Health
Brainerd Lakes
Health
Other ECHC
Entities
Other Affiliated
Care Systems
Public Health
& External Data
Personal Health
Data
Cerner
Meditech
Healthland
CPSI
Healthland
NextGen
Externa l
Da ta
PHR
Health Care
DataWorks
Enterprise
Data
Warehouse
(EDW)
Business Intelligence
Analytic Environment
Lawson
Extract, Transform and Load (ETL)
SMDC Health
System
Mapping – Validation - Normalization
Separate Systems & Siloed Data
Epic
Consolidate Clinical Data Across
Entire Organization Into
‘Central Source of Truth’
Research
Dashboards
Reports
Registries
Data Files
Examples:
Compliance Monitoring with Actionable Analytics Drill-down
(System – Facility – Provider – Patients)
Essentia Health‟s EDW Approach
o Forces driving the need for EDW
Where were we (current state)?
Where do we need to be (future state)?
How do we get there (process)?
Where are we now?
Essentia Health‟s EDW Approach
Governance
Structure
Essentia
Executive I.S.
Committee
Essentia Region
Leadership or
Designees
Essentia Data
Warehouse
Steering Committee
Executive leadership at the
Essentia level
Leadership from each of the
functional areas listed below
Functional members from each of
the areas/teams below
Data Warehouse
Project/Implementation
Infrastructure and
Data Management
Servers, Storage
Network, DBMS
PC’s, etc…
Essentia Data Warehouse Project Team(s)
Data Management and
Content Delivery
Architect Portal and Content Delivery
DataSystem
Architecture,
Administration
Model, Analysis
Architect Dashboard/Reports
ETL, Interfaces, Data Migration
Information
Management
Develop end-user presentation
Develop end-user reports
Provide security/training
Analysis of business and
business requirements
Data Warehouse
Data Governance
Essentia Functional
Area Teams
Research (EIRH)
Strategy, Quality
Clinical, Operational
Data Governance
Essentia Health‟s EDW Approach
System Selection Process…
o Four major options:
Purchase from our incumbent vendor(s)
Purchase from third-party vendor (large and
small)
Partner with vendor w/accelerators (purchase
and adapt)
Build Internally
Essentia Health‟s EDW Approach
Future State
Our Decision…
Partner with vendor w/EDW accelerator technology
(purchase and adapt) – Health Care DataWorks
 Vendor with 13+ years of healthcare experience
 Product developed at Ohio State University
 Very robust data model
 Very robust dashboard, report and research
starter toolset
 Willing partner to develop new functionality (ie –
ACO)
Essentia Health‟s EDW Approach
o Forces driving the need for EDW
Where were we (current state)?
Where do we need to be (future state)?
How do we get there (process)?
Where are we now?
Essentia Health‟s EDW Approach
Essentia Data Warehouse Implementation – Stage 1
Project Team Structure
Associate Chief
Information Officer
Ken Gilles
Director, Business
Systems
Pam Marlatt
Manager,
DW, BI, Interfaces
Keavin Bostrom
Project Manager
Kris Almquist
Information
Management
Trainers
TBD
Departmental
Power Users
TBD
IS Technical
Support Staff
TBD
EIRH Analyst
Jodi Anderson
Information
Management
Information
Services
IM Analysts
Data Architect
Sumeet Sharma
.Matt Rohalder (.5)
.Jim Schuller (.5)
.Dan Broman (.2)
.Jill Coleman (.2)
.Mike Leino (.2)
BI Developers
Jim Schuller
Matt Rohlader
Departmental
Support
Research
Departmental
Support
Quality
Departmental
Support
Payor Contracting
Subject Matter
Expert (SME)
Subject Matter
Expert (SME)
Subject Matter
Expert (SME)
ETL Developers
Source System
Experts
.Matt Rohalder
.Jim Schuller
IS Web/Portal
Delivery Staff
TBD
Ad Hoc Team
Members
Core Project Team
Data Stewards
Our Process - Subject Area Focus…
Payor Contracting –
Quality Measures
Focus Area 1
• Subject Areas:
• Encounter Billing
• Encounter
• Quality
Repeat for next Subject Area
Work with Data Owners &
Stewards on element
definition
Focus Area 2
• Subject Areas:
• Labs
• Orders
• Patient Satisfaction
• Problem Lists*
Implement into PRODuction
working with users on
capabilities
Map data from source
system to e2 DW
Focus Area 3
• Subject Areas:
• Physician Billing
• Assessment,
• Emergency Department
Detail Subject Area with HCD
identifying
dashboards, reports, query
capabilities
Test /Verify/Sign Off on
e2 DW data elements
Our Delivery…
Mechanism …
Essentia Dashboard Launch
My Quick Links
Quality Metric
- Care Discovery Quality Dashboard
- Clarity Reports
- Executive Strategy Manager
- Financial Statements
- Improving Patient Care
% Patients w / After Visit Summary Generated
100
80
60
40
20
0
% Generated
Target
Operational Metric
Am ounts
Operating Margin
8,000,000
7,000,000
6,000,000
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
Actual FY12
Budget FY12
Actual FY11
Essentia Health‟s EDW Approach
Our Priorities and Successes…
Research
Ability to provide de-identified
cohort discovery for clinical trials…
Operational
Top-of-Hospital dashboard with
KPI‟s such as:
 Admissions, Daily
Census, ALOS, Surgeries, ED
Visits, etc...
Essentia Health‟s EDW Approach
Our Priorities and Successes…
Quality
Needs identified, identifying data
sources…
Payer Contracting (ie - ACO)
Defining requirements related to
risk scoring, population
management, etc…
Essentia Health‟s EDW Approach
Common Themes
Critical Success Factors
 Both viewed BI/analytics as a “must have” core
competency in order to thrive in future
 Both organizations have strong data-driven
performance improvement culture (process
excellence)
 Both created an enterprise level forum to oversee
EDW prioritization & data governance
 Both leveraged industry pre-built accelerators (data
model, dashboards, reports ) to more quickly deliver
value & reduce overall costs of building/maintaining
EDW
 Both had to explicitly manage organizational culture
change (departmental/regional inertia vs. enterprise
approach)
Common Themes
Challenges
 Loss of key champion(s) or failing to align EDW
project with business owner champion can delay
EDW projects
 Cultural inertia – departmental ownership issues
can create challenges
 Data quality – source system data is notoriously
dirty; gaining release time/participation in
enterprise data governance from functional
application SMEs can be a challenge
 Competing projects – only so many hours in a
day, need to manage organizational expectations
Questions?
Ken Gilles
CIO West Region & Associate CIO, Essentia Health
ken.gilles@essentiahealth.org
Rick Schooler
CIO, Orlando Health
rick.schooler@orlandohealth.com