Case Study: A Data Warehouse for an Academic Medical Center
Jonathan S. Einbinder, MD, MPH; Kenneth W. Scully, MS; Robert D. Pates, PhD; Jane R. Schubart, MBA, MS; Robert E. Reynolds, MD, DrPH ABSTRACT The clinical data repository (CDR) is a frequently updated relational data warehouse that provides users with direct access to detailed, ﬂexible, and rapid retrospective views of clinical, administrative, and ﬁnancial patient data for the University of Virginia Health System. This article presents a case study of the CDR, detailing its ﬁve-year history and focusing on the unique role of data warehousing in an academic medical center. Speciﬁcally, the CDR must support multiple missions, including research and education, in addition to administration and management. Users include not only analysts and administrators but clinicians, researchers, and students. KEYWORDS • Data warehousing • Database • Academic medical center • Clinical research • Case study • Evaluation Large organizations build data warehouses to “analyze what has occurred within the business across time” in order to obtain “a competitive edge in the marketplace.”1 Many healthcare organizations see data warehousing as a way to facilitate operational efﬁciency and informed administrative decision making. In the 2000 HIMSS Leadership Survey of more than eleven hundred healthcare professionals, 58 percent of respondents indicated that their organizations were currently creating data warehouses or planned to do so within the next two years.2 However, the missions of academic medical centers extend beyond administrative analysis and decision making. The mission statement for the University of Virginia Health System, for example, refers to JOURNAL OF HEALTHCARE INFORMATION MANAGEMENT®, vol. 15, no. 2, Summer 2001 © Healthcare Information Management Systems Society and Jossey-Bass, A Publishing Unit of John Wiley & Sons, Inc.
Einbinder, Scully, Pates, Schubart, Reynolds
“advancement of medical and scientiﬁc knowledge” and “professional preparation of individuals dedicated to health care service”—missions that can be expressed more succinctly as research and education. At the University of Virginia, we have created the clinical data repository (CDR)—a data warehouse that is intended to support the research and education functions of our academic medical center in addition to providing data for managers and administrators. In this article, we present a case study of the CDR, describing the system and discussing the premise that a data warehouse for an academic medical center should support the organization’s academic missions.
History of the CDR
When the project began in 1995–96, the CDR, initially referred to as the “clinical research database,” was intended to support and enhance clinical research at the University of Virginia by providing clinicians, students, and researchers with direct, rapid access to retrospective clinical and administrative patient data.3 Reﬂecting this intent, the system was funded by the School of Medicine and housed in the Academic Computing Health Sciences group, which is distinct from the medical center’s IT group. With considerable assistance and cooperation from data owners and stewards, legacy data from several different sources were loaded into a single relational database and periodically updated. Authorized 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 model was not performed. The CDR project team consists of 2.5–3.0 FTEs (full-time equivalents)— one 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...
References: 1. Kachur, R. J. The Data Warehouse Management Handbook. Upper Saddle River, N.J.: Prentice Hall, 2000. 2. “The Eleventh Annual HIMSS Leadership Survey,” sponsored by IBM. [http://www.himss.org/ survey/2000/survey2000.html]. 2000. 3. Scully, K. W., and others. “Development of an Enterprisewide Clinical Data Repository: Merging Multiple Legacy Databases.” Paper presented at the annual symposium of the American Medical Informatics Association, 1997. 4. Reynolds, R. E., and Knaus, W. A. “Clinical Data Repository Enhancements.” Internal memorandum, University of Virginia, Jan. 30, 1998. 5. Slack, W. V. “Assessing the Clinician’s Use of Computers.” MD Computing, 1993, 10(8), 357–360. 6. Schubart, J. R., and Einbinder, J. S. “Evaluation of a Data Warehouse in an Academic Health Sciences Center.” International Journal of Medical Informatics (forthcoming). 7. Rogers, E. Diffusion of Innovations. (3rd ed.) New York: Free Press, 1983. 8. Schubart, J. R., and Einbinder, J. S. “Evaluation of a Data Warehouse: Understanding User Needs.” Paper presented at the annual symposium of the American Medical Informatics Association, 2000. 9. Halamka, J. D., and others. “Managing Care in an Integrated Delivery System via an Intranet.” Paper presented at the annual symposium of the American Medical Informatics Association, 1998.
About the Authors
Jonathan S. Einbinder, MD, MPH, is assistant professor of clinical informatics in the Department of Health Evaluation Sciences at the University of Virginia, director of data administration at the University of Virginia Health System, and project director for the CDR. Kenneth W. Scully, MS, is technical director and database administrator for the CDR. Robert D. Pates, PhD, is a developer for the CDR. Jane R. Schubart, MBA, MS, is a lecturer in clinical informatics in the Department of Health Evaluation Sciences at the University of Virginia. Robert E. Reynolds, MD, DrPH, is vice president and interim chief information ofﬁcer for the University of Virginia and professor of informatics in the Department of Health Evaluation Sciences.
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