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extract, transfer, load (ETL) process critically important for healthcare (see sidebar). Perspective: Unlike more established sectors, healthcare lacks a common worldview. Too often, regulatory heavyweights exert undue infl uence on a standard industry vocabulary, with detrimental effects on those organizations who model their BI programs along the same lines. A borrower is a borrower when it comes to loans and mortgages; an “episode of care” may be defi ned differently across organizations such as CMS, a hos- pital, a clinic, a private practice, a health insurer, an HMO or an ACO. How each sees the healthcare landscape will impact vision and use of data.

The ETL of BI: extract, transfer, load

ETL is a widely used process in BI. It involves extracting data from outside sources, transforming it to fi t operational needs and loading it into a database or data warehouse. Without question, ETL can make or break a BI program. References to “garbage in, garbage out,” could refer to ETL. Good ETL is more complex than a simple “dump and load” of data. Good ETL provides the opportunity to apply business rules (the “T” in ETL) and introduce quality checks into the data. In any data warehouse project, the ETL portion requires 80 percent of the effort and usually introduces the most risk. Payers are ahead of the game with ETL, based on their domi- nant use of claims data. Many larger health systems have spent years integrating fi nancial and clinical data. Providers show a more limited focus on ETL; many simply strive to get data out of systems, with little thought to integration or performance effi ciency. These organizations usually end up with a kludge of large data silos.

Consider the recent experience of a stand-alone community hospital system, struggling with cumbersome data structures. Each time users requested a new report, IT created another view of the data – until more than 2,000 views, an incredible amount of replication and very few relationships existed. By applying basic data modeling and ETL principles, the organi- zation eventually streamlined its systems – without sacrifi cing information or insights.

In most hospitals, IT focuses on “mission-critical” systems.

Keeping the EHR up and running takes precedence over extracting data from source systems. Yet meaningful use and future mandates will require sophisticated data repositories to track outcomes. Good ETL is foundational to success in these endeavors. With increasing focus on growing volumes of data, the healthcare industry faces new challenges and opportunities. Financial data remains fundamentally more straightforward than clinical data. Understanding and blending the two in an effi cient and meaningful way requires a dynamic and agile ap- proach. The healthcare C-suite should understand the hallmarks of effective BI, and demonstrate both vision and creativity to ensure the organization captures, stores, models and presents healthcare data for optimal results.


Top 10 ways healthcare organizations can ensure a successful BI program

1. Convene a cross-functional team. Include staff with clinical, technical and business expertise for a 360-degree view of the organization. Take a “T” approach that blends input from those with broad knowledge and those with deep, specialized skill sets. 2. Set a fl exible approach to data. Not all data is

created equal, and just because you can afford to store various data sets in your data warehouse doesn’t mean this will be the most effective process. Evaluate how the data will be used and explore different methods for accessing it quickly and effi ciently. 3. Focus on providing value. Be objective and evaluate all your BI decisions with a critical eye. Everything you do – from creating ETL scripts to visualizing data – should have an end goal of empowering your users to make better decisions.

4. Document the vision. Keep your BI program on track with a 12-month roadmap of projects. Leave room for changes, but always have a planning method at hand. 5. Apply an agile methodology. Healthcare is nothing if not dynamic. Gone are the days when projects could span up to 10 months. Embrace agile methods that reduce costly rework cycles and drive tangible business value in shorter increments. 6. Don’t skimp on ETL. While certainly not the most sexy part of BI, success tends to correlate directly to the amount of effort an organization puts into its ETL development. Hire a professional ETL architect and allow adequate time to complete this critical task. 7. Establish the foundation. The right data model fuels

query performance, data availability and overall BI results; don’t underestimate its importance. Develop a fl exible model that can grow with the organization and adapt to ever-changing market conditions. Avoid “analysis paralysis” by delivering smaller projects that work together toward broader objectives.

8. Apply data governance. Data quality drives user engagement. Treat your data like the corporate asset it is. Set up a governance structure that aligns with your organizational structure. Make sure that team members (both clinical and non-clinical) know their roles and decision rights. Be prepared to enforce best practices to keep critical initiatives on track. 9. Involve users. Business users are the reason BI exists

in the fi rst place. Whether providing analytic sandboxes, reports or mobile dashboards, deliver content that is relevant, in a way that makes users want to consume it. Think beyond static reports, which dominate the regulatory realm, and take advantage of the latest data visualization and mobile capabilities.

10. Implement operational controls. The BI program will not run itself. Develop a plan to manage each aspect, from data models to dashboards. Identify appropriate service levels, and then communicate these expectations to users. A well-run BI program usually translates to a well- funded and strongly supported BI program.


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