Data Cubes

A VA programming team'from left, Steve Schreiner, Jean Laubscher, Stephen Anderson, Don Nagorski and Rita Gregory'keep the medical data warehouse stocked.

(GCN Photo by Peter Yates/Corbis Saba)

VA's Steve Schreiner creates medical data marts

Steve Schreiner compares his data marts to Rubik's cubes. The Veteran Affairs Department computer specialist says their intersecting cells can mix and match data about almost everything in the VA Northwest Health Network, from lab reports to medications to finances.

With a software tool called ProClarity Analytics Platform, Schreiner and 100 other users in Veterans Integrated Service Network 20 can manipulate data in a 40G storehouse of information about eight VA hospitals in four states: Alaska, Oregon, Washington and part of Idaho.

The users'physicians, quality assurance managers, pharmacists and radiologists''slice data by the quarter' and compare results for different hospitals and physicians against each other.

Each day the IT staff at the VISN 20 data center in Tacoma, Wash., extracts records from the hospitals' host systems into a Microsoft SQL Server repository running under Windows NT 4.0. An upgrade to the Windows 2000 operating system is on the way, said Jean Laubscher, project manager for the 4-year-old data warehouse. KB-SQL from Knowledge Based Systems Inc. of Ashburn, Va., maps the data from the host systems' native M programming language into the repository, she said.

Schreiner said he first used ProClarity software, from ProClarity Corp. of Boise, Idaho, to target particular data sets for building the marts.

So far there are separate marts for physician profiles, outpatient pharmacy use, outpatient visits and disease outcomes. The data links physicians to their prescriptions, he said, and users can compare patient outcomes for Dr. A versus Dr. B.

'There's no positive correlation between outcome and cost of patient care,' said Clay Young, ProClarity's cofounder. 'That's what started the whole managed care phenomenon. VA is one of the leading users of analytic technology. It led the commercial space by a couple of years.'

Young said physicians might not otherwise know, for example, that a 400-milligram dose of a drug they commonly prescribe costs VA more than two 200-mg doses.

Briefing books

ProClarity, an online analytical processing server, queries data cached in Schreiner's data marts. The ProClarity users at the VISN 20 center have desktop clients running Microsoft Windows, but the tool also can work via browser on thin clients through a firewall.

Individual users of the data marts have created what Schreiner called briefing books, or templates for views of topics they track'say, the top 20 drugs used at the hospitals in the last three years.

'We're trying to help people go get their own data,' Schreiner said.

The three-tier data warehouse also is accessible to VA managers via open database connectivity-compliant applications such as Microsoft Excel and Access or statistical tools from SAS Institute Inc. of Cary, N.C., Laubscher said.

Ensuring that the disparate groups see only what they are authorized to see is an ongoing job, Schreiner said. All the warehouse and data mart users must have assigned roles, which Windows NT authenticates.

The ease of generating comparative statistics from the data cubes means that medical egos and professional reputations are on the line.

'Folks do question the data,' Schreiner said, 'but we can go back to the actual host record and match it up. Data validation is extremely important'you always have to know where the data came from' via metadata and internal record numbers. The data lets users zero in on specific prescriptions and lab tests.

As for patient privacy, mandated by the Health Insurance Portability and Accountability Act, 'we parallel our security with the national VA system,' Schreiner said. 'Every privacy requirement for a transactional system, we also require.'

The warehouse effort has helped VA pharmacists keep up with alerts about drug interactions and recalls. Physicians also receive alerts when their patients' treatments fall outside the VISN 20 benchmarks.

To see some of center's graphical analysis of treatment and drug costs, visit www.visn20.med.va.gov/qagrant/grant00/7.2%20Financial%20(75).pdf.

For example, the $5,000 average cost per patient treated in 1997 had dropped 3 percent by 2000. The number of treated veterans rose by 24 percent over the same period, to more than 145,000.

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