In the Field with our Experts

A Data Governance Primer (Part 2 of 3)

By Carol Newcomb, Senior Consultant

Minding Your Metadata

The second part of my summertime primer addresses ‘Minding your Metadata’.  I can just hear the collective groans and yawns now.  Sorry, but metadata collection is one of those necessary evils that may not be fun in the doing, but having it available as a resource to understand your data and use it appropriately is invaluable.  And you just might find some interesting surprises along the way!

Metadata: What Is It & Why Do I Need It?

As you start your Root Cause Analysis (see last week’s primer), you first need to examine existing data definitions (or lack thereof).  Metadata is the foundation of good data management and forms the basis for Data Governance.   Pardon me for stating the obvious, but metadata is fundamental to investigating and resolving data issues and it is the first place to start when investigating data quality issues.

Metadata is “data about data”.  Plain and simple.  It includes descriptive information about electronic data used in common daily business practice.  Metadata includes items usually found in a data dictionary: field name, field length, retention rules, and security access, as well as additional descriptive information that may include data origin (source or system), creation/entry date, method of creation (key-entry or the result of a calculation), purpose of the data (its intended use), how frequently it gets updated or refreshed, and current location in a database (table, view, schema).  If a data element is the result of calculation logic or groupings (such as age categories), those business rules used to generate the resulting data values should be collected as part of the metadata.

A good example of metadata that you may use every day would be ‘document properties’ in a Word document.  This feature captures data on the original document creation date, most recent access and update times, document creator, count of characters, words and pages.  If the document should be private, this will be indicated in its properties.  You may also tag the document by indicating key words in order to make it easier to find by you or others.

A few of the benefits of Metadata Management include:

• Clarify rules for data entry
• Reduce ambiguity around appropriate use of data elements
• Eliminate problems associated with not having data definitions, business rules or transformation logic available
• Validate legitimate values at the data element level
• Provide evidence to regulators that security and confidentiality are protected
• Centralize the storage and accessibility of metadata for end-users
• Reduce the amount of effort required to research data results.

A Metadata Management Repository is a central location or system to collect and store metadata that may exist in disparate parts of the organization (data dictionaries, systems, spreadsheets, or people’s brains). The metadata repository will store detailed definitions centrally on a network where other users can find it.

There are three general sources of metadata that should be included in this repository:

Business Metadata – Business metadata attributes facilitate identification, understanding, and appropriate use of existing data elements.  These include clear business names and descriptions, relevant business rules, descriptions of the data sources, security and privacy rules, etc. 

Technical Metadata – Describes the technical attributes of data such as physical location (host server, database server, schema, etc.), data types, any transformations applied and domain of valid values, relationships to other data elements, precision, and lineage.  Technical metadata is used by business users and by IT staff to design efficient databases, queries, and applications, and to reduce duplication of data. 

Operational Metadata – Describes the attributes of routine operations on data and related statistics.  These include job schedules and descriptions, data movement and transformation processes, data read, update and performance statistics, volume statistics, backup and archival information.  Operational metadata is used by operations staff, and DBA’s to tune the system and ensure its continued efficient operations.  It is also used by business users to track such events as “last use” of a field, and “last load” of a data element.

Exciting stuff, huh?  Well, the whole point of metadata is to have the information about data available to a multitude of users when they need it, to keep it current, and to avoid confusion around usage.  So if you appreciate having a clean bathroom, and knowing where you keep your antiperspirant, you will also appreciate having good metadata!  The time for spring cleaning is well overdue.

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Carol Newcomb is a Senior Consultant with Baseline Consulting. She specializes in developing BI and data governance programs to drive competitive advantage and fact-based decision making. Carol has consulted for a variety of health care organizations, including Rush Health Associates, Kaiser Permanente, OSF Healthcare, the Blue Cross Blue Shield Association and more. While working at the Joint Commission and Northwestern Memorial Hospital, she designed and conducted scientific research projects and contributed to statistical analyses.

A Data Governance Primer (Part 1 of 3)

By Carol Newcomb, Senior Consultant

They say that Data Governance is about People, Process and Organization.  Much of the design work in planning for data governance is around people’s roles and responsibilities, then designing the organizational structure that will provide authority for decisions to be made and enforced.  The processes, however, are not new.  They are probably already being practiced within your organization, just in a decentralized, informal way.  In this blog series, I discuss the processes for 1) investigating and isolating the data quality issues—Root Cause Analysis—, 2) starting to collect complete Metadata Definitions, and 3) performing Data Quality Analysis.  Only when your governance group has worked through each step, in order, will you be more likely to design the appropriate solution.

Root Cause Analysis

The process of data governance is fundamentally very simple.

1. Identify the data quality issues to address
2. Prioritize the portfolio of issues to isolate/tackle the most important
3. Perform Root Cause Analysis to determine the true source of the data issue
4. Design the corrective action
5. Formalize the correction through consideration & approval by the Data Governance organization
6. Implement the fix
7. Monitor the results

It seems like when we start to map out the discrete steps involved in the data governance process, much of the work is already being done in informal ways throughout the organization.  What some folks don’t realize is that data governance is often nothing more than formalizing a whole bunch of informal processes that either don’t get communicated, or aren’t accepted as a data standard.

Root Cause Analysis is the process of identifying probable causes of a data issue, and isolating the contributing factors.  In order to resolve any particular issue, root cause analysis involves fact-finding, drilling into details of the problem, talking to the right people, and separating out other associated (but not contributing) factors.

A standard tool for supporting the detailed findings is the Ishikawa Diagram, below.  

To conduct a thorough Root Cause Analysis, use the following checklist:

• Diagnose the problem as if you are a physician or a detective. Consider all possible sources of the symptom. Don’t rule anything out yet!
• Boil the ocean—be exhaustive and creative.
• Don't practice problem solving before collecting all possible causes.
• Practice the “5 Why’s”—don’t stop asking “Why” until you have exhausted every conceivable potential reason.
• Rank the factors if possible.  Identify the Primary causes versus the Secondary or associated factors.
• Rule out each possible factor one at a time.  Justify why (you may need to come back to this later).
• Find all potential business process and data owners to involve them in your understanding of the possible sources of the problem.
• Share the findings with everyone involved in troubleshooting. They could rule out certain factors with their knowledge.
• Test your hypotheses with actual data.   
• Fix the problem and test again.
• Publish/share your findings and fixes.  Communicating your findings may reveal additional factors you hadn’t considered.

After a thorough Root Cause Analysis has been completed, Data Stewards should proceed to Metadata Analysis and Data Quality Analysis.  These two techniques will be discussed in my next blogs.

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Carol Newcomb is a Senior Consultant with Baseline Consulting. She specializes in developing BI and data governance programs to drive competitive advantage and fact-based decision making. Carol has consulted for a variety of health care organizations, including Rush Health Associates, Kaiser Permanente, OSF Healthcare, the Blue Cross Blue Shield Association and more. While working at the Joint Commission and Northwestern Memorial Hospital, she designed and conducted scientific research projects and contributed to statistical analyses.

IT-Business Alignment: Let The Business Drive

By Caryn Maresic, Senior Consultant

Julia’s parents were planning a vacation.  Her mother thought Pensacola would be a great destination—she’s heard so much about the wildlife, especially the dolphins!  Her father wants to see the National Naval Aviation Museum and the Blue Angels.  Since Julia’s traveled extensively, her parents asked her to make all the arrangements.  While having dinner with them to discuss plans, she jotted down the following notes:

• Location:  Moderately-priced hotel close to water/sights.
• Budget: $3,000 for transportation and accommodations.
• Activities:  Beach and nature activities (Mom), science/historic sights (Dad)
• Duration: 10 days.

Julia felt honored that her parents trusted her to get the job done.  After doing some online research, she made all the reservations and met with her parents to review the reservations.  She eagerly awaited the look on her parents’ faces as they scanned the vacation itinerary and read through the glossy brochures.

“Hawaii?”, they said in unison.  “We didn’t want to go to Hawaii!"

"Honey, we chose Florida because we can drive there.  I don’t want to fly anymore.  Flying is such a pain,” Dad grumbled.

“I appreciate what you’ve done, Julia, but an old friend of mine lives near Pensacola and I was hoping to visit while we were there.” said Mom.

“But, Mom!”, exclaimed Julia, “You said you wanted beaches, dolphins, sunny weather.  Dad, you like science and history—what about Pearl Harbor?  You two can’t go to the gulf coast—what about the oil spill?”

What happened here is typical of what happens to IT projects all the time.  It’s easy to say that we wouldn’t do what Julia did.  Would we?  Don’t we oftentimes:

• Interview the business and record the requirements in an abstract way.
• Believe that the we can deliver something better than what the business asked for.
• Assume that the business lacks the capability to understand the technology.
• Fail to get all of the requirements.  Not exactly our fault, but still a problem.
• Neglect to keep the business involved in the process.

There has been a lot of buzz on IT-Business alignment of late, including this article on some specific companies that are going the extra mile: Beyond Alignment—as well as this one on lack of user involvement: Why IT Projects Fail: Lack of User Involvement.  Most companies aren’t as progressive.  The willingness to work together has to occur at all levels. Only when we let them drive can we deliver, if not what they asked for, then at least something useful.

photo by stevendepolo via Flickr (Creative Commons license)

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Caryn has over 20 years experience in providing high-quality data solutions to clients in the areas of Business Intelligence, Data Warehousing and System Integration.  Caryn has expertise in across industries with an emphasis in Pharmaceutical, Manufacturing, and Insurance.  Prior to joining to Baseline, she ran her own consulting company.

Agile Analytics: Put Your SaaS in the Sand

By Rob Paller, Consultant

Recently at a client, the data warehouse administrator was asked to define a sandbox environment in the production data warehouse for  analysts and developers working on a small project. The idea behind this sandbox was to allow the team a working area for collaboration and intermediate storage of results while working with the data in a purely ad hoc capacity. Instantly it was recognized this could be the start of something bigger within the organization—something that could not currently be provided by the incumbent business intelligence tools. The response had to be formulated quickly in order to avoid stifling the creativity of the analysts—or worse, the progress of the project—but care had to be taken as well; if managed incorrectly it could get out of hand and become a waste of system resources and a drain on human resources that had already been spread thin.  The business unit in question is looking to move from the confines the current business intelligence environment and push the edges.

This was a group of analysts that wanted to get their hands dirty and weren’t afraid to fail. They wanted to mash data together that previously could not be done by the business intelligence tools in their controlled ad hoc environments. This was data mining for the next set of KPIs that would shape the way business moves forward.

The concept of agile analytics is not new, eBay presented on and blogged about this concept in 2008. The idea at this client was simple. By leveraging the existing enterprise data warehouse system to house their sandbox environment the duplication of data is all but eliminated. Groups interested in sharing data between their sandbox environments are strongly discouraged until the data has been properly integrated into the production environment. The sandbox environments would also be given a short life expectancy at their inception to prevent the prototypes from becoming production and data ending up in a wasteland. This all sounded great on paper.

In the midst of a development architecture overview, a brief conversation among a few enterprise architects uncovered the potential Screw-Me Scenario that could bring the concept of agile analytics to an untimely demise. “The users of the data warehouse are not permitted to write ad hoc queries outside of a controlled business intelligence tool. They might write a bad query.” Thanks for the warning, we’ll be sure to refine our pitch to the enterprise architects to diffuse this scenario before it turns ugly.

In Oliver Ratzesberger’s presentation for eBay’s Analytics as a Service, he acknowledges that the metrics we already know are cheap and the unknown metrics are expensive. But the known metrics are not pushing the edges. Known metrics are found in the middle of the box. Agile analytics is about pushing the edges about how your enterprise data warehouse is used to improve response to the needs of the business. It is about the evolution of the user community from one who plays in controlled ad hoc environments to encouraging them to experiment with new ideas and not to fear failing along the way. Agile analytics is about encouraging your users reach out for the edges and P U S H. Only once the edges are stretched can the middle of the box redefined.

photo by edenpictures via Flickr (Creative Commons License)

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Rob Paller is an expert at business analytics and database administration. Since joining Baseline, Rob has been responsible for developing a case analysis system to streamline the oversight of food assistance benefits, implementing a common citizen data model, and assisting in the rollout of a new public assistance data model integrating data from over 10 years of legacy with a new benefit eligibility determination system.

The Role of Logical Data Models

By Caryn Maresic, Senior Consultant

Logical Data Models (LDMs) were the standard means of recording business rules and data definitions back in the ‘80s and ‘90s.  Business and IT partnered to learn the art of data modeling and 3rd normal form in hopes of finding a common ground to record requirements.  Over time, it became evident that in today’s fast-paced development environment the business doesn’t have the time to digest all the nuances in a data model.  It is IT’s job to gather information via interviews.  Many times, we skip the LDM task because we don’t have time and LDMs are too academic and we find ourselves asking…

Are Logical Data Models really necessary?  Yes!

LDMs drive BI design by defining business rules independent of physical implementation.  There are many tools (CA ERwin Data Modeling, Embarcadero Technologies), and techniques (UML, IDEF, Bachman) in use today. To illustrate the difference between the benefits of a PDM and an LDM, let’s look at an example:  Customer/Address relationships.

The PDM above (created using) supports many Customer/Address business rules, but it does not tell me the Customer/Address relationships as defined by the business.

In contrast, the following LDM is more rigorous and definitive:

What does the LDM above tell me that the PDM did not? 

• There are two types of Addresses – Physical and Mailing.
• The Customer Bill To Address can be either a Physical or Mailing Address
• Customer Ship To Addresses must be Physical Addresses.
• Every customer must have a Bill To Address.
• A Customer has zero, one or many Ship To Addresses.

All of these relationships can be implemented using the PDM, but they aren’t dictated by the PDM.  The LDM explicitly defines each relationship and prompts us to ask better questions of the business, such as:

• Are there any Customers who do not have a Bill To Address?
• Are there any Customers who do not have a Ship To Address?
• When there are multiple Ship To Addresses, how do you know which one to use?
• Are there any Customers who have more than one Bill To Address?
• Do you know of any upcoming business initiatives that might change these rules?
• Was there ever a time when the business rules were different?

The answers to these questions may require changes to the model, but without the LDM, we may not have asked the right questions!  The best part about the LDM is how valuable it is to the rest of the development process.  It will be used in production of training materials, test plans and test cases, data profiling and migration efforts and, finally, physical database design.

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Caryn has over 20 years experience in providing high-quality data solutions to clients in the areas of Business Intelligence, Data Warehousing and System Integration.  Caryn has expertise in across industries with an emphasis in Pharmaceutical, Manufacturing, and Insurance.  Prior to joining to Baseline, she ran her own consulting company.

To Infinity and Beyond! — Healthcare in the Cloud (Part 3)

By Carol Newcomb, Senior Consultant

This is the final installment in a 3-part blog series, discussing the opportunities that cloud computing offers in healthcare. I present futuristic scenarios from each healthcare contingent’s vantage point:  patients, providers and payers.   A myriad of technologies exist today.  It will be up to healthcare organizations of all types to get their data ready to meet the demands for data integration, security, portability, transparency and accountability in this brave new world.  Mature data governance systems and enterprise-wide data integration will be critical in this endeavor.

III: Payers

I’ve worked in the insurance industry for 30 years now, and I’ve never seen anything like this!  For years, we had consultants running around here, designing portals, databases, dashboards and training us on new software to use in running analyses.  But half the time, we just went back to using the antiquated systems that most of our data servers were designed to use.  In the last couple of years, we have completely stopped talking about those different hardware platforms.  Now, the Risk Management division, Actuarial, Medical, Quality, Marketing and Claims Processing all use one software package; all the data management (since we get millions of transactions and claims each day) is handled offsite.  It’s never been this simple!  We still have our Data Governance Committee that works with each department to flush out any issues, but things have really improved.Since all the data is now integrated on what they call “The Cloud”, we get daily dashboard updates on our desktops, showing use trends, costs, disease prevalence around our region, geographic mappings of where the large employers have families, results of marketing activities, and new health and wellness information that is also shared with our subscribers.  We had a period of some pretty large layoffs, since our entire IT department is now outsourced, and all those consultants have disappeared.

Our Fraud and Risk Management analysts used to have hundreds of spreadsheets on their desktop computers, which they would constantly be updating and piecing together to look for patterns or gaps.  Now they can use more sophisticated statistical detection algorithms because the data is updated and fed to them each night.  The simplest algorithms are actually run offsite, and those results are delivered to them daily.  From those, they can then drill into services or providers that look suspect.  They can now turn around reports in about 2 days, where it used to take them 2 months!

Our business model has shifted from using claims history to cut anticipated high-cost cases, to using the data from those same claims to design health and wellness programs stressing prevention and care management.  If we see pockets of infectious diseases in one region, for example, we do further analysis on the saturation and specialty mix of our network providers, the employer group mix, and the educational factors that may be contributing to higher medical costs.  We then work with the schools, employers and practitioners to combat the spread of that particular disease.  We have been able to avert hundreds of hospital admissions through lower cost prevention measures, which we track through our “Population Health” Program.  Across our company, there is a competition to target and drive down claims rates, and each group gets an annual part of their bonus based on their results.  It’s pretty interesting.

Even though we don’t get as much data through claims-processing as the local hospitals get in their clinical systems, we participate in national research studies of medical effectiveness.  Some procedures that we used to consider experimental, we now collect data on and enlist our Actuarial Department to help with statistical analysis and cost-accounting.   Our Medical Quality Department works with other government-sponsored research groups to compare the results of our findings, and often they lead to some pretty surprising conclusions.  Where we thought we were saving money in the past, we were actually driving up utilization in higher cost medical facilities, but now we’re helping encourage subscribers to get medical attention sooner, which prevents some pretty catastrophic claims.  We couldn’t do this before because our Utilization Review desk would deny those services that we now know help reduce lifetime costs.

Probably the best benefit we’ve gained from using Cloud computing services is that our claims processing is now practically effortless.  Twenty-five percent of our cost of business was dedicated to claims handling, denials, reviews, exceptions, and remediation.  Not only have we saved money, we have reduced premiums to our subscribers, and the healthcare providers have reduced the cost of their back-office operations, which used to handle all the churn of rejected and resubmitted claims.  They now get paid faster and we save money.  How’s that for amazing! We’ve also noticed another side benefit: our subscriber turnover rate has dropped by 10%!  Customer satisfaction rates have never been higher!

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Integration of claims data with population-based data and actuarial model results has significant business impact.  Clearly, departmental governance representation was required to mesh all the different data types.  Several large data warehousing systems can be housed and integrated using Cloud technology, but the rules in how to match and align different data collected for entirely different purposes is the key to analytic power in this example.  As companies offload daily transaction processing, which can be automated and scaled, business dollars can be better deployed to more strategic purposes, and those resources then achieve more with the data at hand.

photo by Simone Ravella via Flickr (Creative Commons license)

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Carol Newcomb is a Senior Consultant with Baseline Consulting. She specializes in developing BI and data governance programs to drive competitive advantage and fact-based decision making. Carol has consulted for a variety of health care organizations, including Rush Health Associates, Kaiser Permanente, OSF Healthcare, the Blue Cross Blue Shield Association and more. While working at the Joint Commission and Northwestern Memorial Hospital, she designed and conducted scientific research projects and contributed to statistical analyses.

To Infinity and Beyond! — Healthcare in the Cloud (Part 2)

By Carol Newcomb, Senior Consultant

This is the second installment in a 3-part blog series, discussing the opportunities that cloud computing offers in healthcare. I present futuristic scenarios from each healthcare contingent’s vantage point:  patients, providers and payers.   A myriad of technologies exist today.  It will be up to healthcare organizations of all types to get their data ready to meet the demands for data integration, security, portability, transparency and accountability in this brave new world.  Mature data governance systems and enterprise-wide data integration will be critical in this endeavor.

II:  Providers

It’s 11:30pm on a Sunday night, and I’m working a double shift in the Emergency Room.  It’s been a little slow tonight, so I’ve been online researching some reasons why we’ve been seeing more Somali children here recently.  The hospital keeps the latest demographic figures on the intranet.  Turns out that at first just a few families settled here, but more relatives are joining them and many of the children are orphaned.  When they came through immigration, though, they were given medical checkups and those records are available for each of the kids I have treated recently, since they were each given a universal medical record number.  I can see the results of any tests they had, and whether they were given any medications or treatment.  There’s also a public health database through CDCP that tracks the incidence of infectious diseases, and some primary prevention steps we should prescribe at the time we treat these kids.  It’s very helpful stuff.  I’m going to share what I learn through the local Health Information Exchange (HIE) with the social workers in the neighborhood clinics.

Whoa!  Suddenly things are picking up!  There’s a little old lady with severe dementia who fell and knocked out her tooth, and a teenager who got into a brawl with a black eye.  Where are his parents!?  First I try talking to the lady, but she’s confused.  At least she is wearing an ID tag, so I look up her name (Dorothy Xu) in the HIE portal.  She’s never been to this hospital, but I see that she has spent some time in a local nursing home, and was recently discharged to the care of Dr. Jones.  We start a new hospital record for her, instantly downloading the data from the nursing home and Dr. Jones’ office.  I also see that her daughter lives nearby and that her husband died less than a year ago, so I get her daughter’s telephone number and give her a call.  I’m surprised that the ambulance techs didn’t do this already, but they were making sure she didn’t have any other injuries.  When her daughter arrives, she has brought a list of all of Dorothy’s medications, and one of her favorite nightgowns.  I send an email requesting an urgent appointment with one of the dentists in her insurance network first thing in the morning, and then make sure she has a prescription for some pain medications to get her through the night.  Poor thing.  Also, I talk to her daughter about whether Dorothy has seemed depressed since her husband’s death.  I give her daughter a printout of some good psychiatrists in in the local area, and then she takes her Mom home.

So what about this black eye?  Jason is 15 and it looks like he already has a police record.  He refuses to talk to me, so we get his fingerprint and match it to his medical record.  He doesn’t want the police to know he was in another fight, but I’m going to have to call his parents to pick him up.  He seems concerned, but refuses to say anything more.  I scan through his chart and his Mom’s, and I see that she has also been treated for a fractured wrist and a black eye about 4 weeks ago.  Either this family is really clumsy, or something is going on here!  Apparently, a social worker at school also noted a few things in his record, and the pieces are beginning to suggest some family abuse problems.

When his Mom arrives, we talk privately for a few minutes.  I tell her I am concerned, but don’t really have very much information.   As we talk, she becomes visibly upset.  Eventually, she admits that her husband, who was recently laid off, has been taking his anger out first at her son, and also at her.  I ask if she needs any other assistance or resources, but she refuses.  So I treat her son’s eye and send them on their way.  I also make note in the husband’s record that he may have some history of abusive behavior, and I notice that he was recently in the hospital as a result of a car wreck.  At least this information will be available to the nurses in case they are treated here again.

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Offloading disparate datasets to integrated Cloud servicers that will also perform basic analytics can greatly empower healthcare providers with ready access to data.  Remotely hosted Health Information Exchanges will empower social workers, schools and hospitals, even law enforcement authorities, to work together in assisting their local communities.   This is the profile of the new healthcare provider as a result of Cloud technology.

photo by dawvon via Flickr (Creative Commons license)

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Carol Newcomb is a Senior Consultant with Baseline Consulting. She specializes in developing BI and data governance programs to drive competitive advantage and fact-based decision making. Carol has consulted for a variety of health care organizations, including Rush Health Associates, Kaiser Permanente, OSF Healthcare, the Blue Cross Blue Shield Association and more. While working at the Joint Commission and Northwestern Memorial Hospital, she designed and conducted scientific research projects and contributed to statistical analyses.

To Infinity and Beyond! — Healthcare in the Cloud

By Carol Newcomb, Senior Consultant

This is the first in a 3-part blog series, discussing the opportunities that cloud computing offers in healthcare. I present futuristic scenarios from each healthcare contingent’s vantage point:  patients, providers and payers.   A myriad of technologies exist today.  It will be up to healthcare organizations of all types to get their data ready to meet the demands for data integration, security, portability, transparency and accountability in this brave new world.  Mature data governance systems and enterprise-wide data integration will be critical in this endeavor.

Introduction: Welcome to the Brave New World

Now that the Healthcare Reform bill has passed (phew!), it is time to get back to the basics of Healthcare Data Infrastructure.   It is such an interesting time to be involved in Healthcare IT!  The technology is exciting.  The resources are available.  Healthcare providers are gaining some traction in the use of electronic health records.  Consumers are developing interest in eHealth, mHealth and other web-enabled resources.  RHIOs faltered but HIEs are picking up steam, and will also use new web technologies.  Could it be that healthcare data systems will deliver on the promise of accessible, portable, transparent data?  

But hold on a second!  If all that technology exists today, why aren’t we already using it?  It’s complicated, but the main reason is: DATA INFRASTRUCTURE.  There is a mad dash among providers (hospitals, physician’s offices) to transfer from paper-based systems to integrated EHRs.  But, systems that traditionally haven’t been integrated (Finance, HR, Education, Credentialing, Inventory, Purchasing) still won’t be integrated.  Insurance companies receive claims from a host of different feeds, and different departments use data in completely different ways.  Coordination of Benefits isn’t (technically) well coordinated.  My personal ability to assemble a complete PHR might require information from many different doctors’ offices.  Mergers and acquisitions challenge even the most sophisticated health systems.  The list goes on.  Data integration and the need for better data governance everywhere is critical.

There are many kinds of cloud computing, ranging from platform, software and application services to storage and raw computing power.  They will offer opportunities for efficiencies of scale and analytic capabilities, housing massive amounts of raw data.  The technologies and capabilities at hand are truly exciting, but they won’t succeed without sustained infrastructure design and mature governance standards to ensure common usage, security and data integrity. 

I: Patients

It’s so different now when I go to the doctor’s office.  When I show up at the front desk, the receptionist, instead of shoving a clipboard and a pen at me, greets me by name.  “How are you today, Carol?  Please take a seat and use this e-tablet to write down any changes in your insurance, and what you want to see the doctor about today.  Your wait will be about 10 minutes, but in the meantime, have a cup of coffee, and use the e-tablet to write down anything else that you would like to discuss.  You can also look up some health education materials you may want to find.  Our online library is more trustworthy than some popular websites.  If you like, we can include this information with your medical record, which you will get an electronic copy of when you check out.”

Even though I’m feeling crummy, when I get escorted to the exam room, I’m surprised to see that the setup is completely different.  Instead of the tiny stool the doctor used to sit on, hunched over a computer terminal tucked into the farthest corner of the room (so they can type without prying eyes?), there is a full-sized desk with TWO chairs.  The doctor comes in, shakes my hand, and says “I see your blood pressure has been under control.  But your blood glucose is a little high.  Let’s look at your readings.”  She sits next to me as she pulls up my chart on the computer, and shows me a graph of the data I’ve been sending through my monitor at home.  Twice a day, the monitor reminds me to check my vitals and transmit them to the office, where they are downloaded to my chart.  “This could be why you’re feeling light-headed.”

As we look at the graph, we discuss my recent surgery and other medications I am taking, and we come up with a plan to make some modifications.  “I talked to your surgeon and he says things went well.  But I see from your e-tablet that you’ve also been researching Alzheimer’s.  Is there someone in your family who is having symptoms?”  We discuss my Dad for a while; then she adds the note to my family history, and makes some changes to my prescription.  She then offers to review everything we’ve discussed today on the computer, to make sure she has noted everything correctly.   “When can I see you again?”  I’m startled because usually the front-desk clerk makes all the appointments, but she finds an opening in her calendar, and automatically sends me an email reminder.

When I’m ready to leave, the front desk clerk hands me a printed copy of the summary from today’s visit, and she swipes my health card to update my medical record and file the bill at the same time.  I now carry this card in my wallet, along with my insurance cards and credit cards because I want to have it with me.  I can also access this information through the web at home, or even at work, through my personal login.  When I go next week to see the dentist, he will be able to access all of my latest drug and medical history information, in case he also has concerns about my blood glucose or blood pressure. 
That coffee was really good.  Maybe I’ll have another cup on the way out!

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This benefit of having integrated data available through remote exchanges to this patient will enable her to have a data-informed discussion with her practitioner and to be a better informed patient.  Her office visit is more personalized and streamlined as a result of integrated scheduling and billing.  The time spent is more educational because she can get information for her condition as well as her relatives, from a trusted source.  And through sharing this information, important updates to her family history become part of her own health record.  This is the profile of the new healthcare consumer as a result of Cloud technology.

photo by kevinpoh via Flickr (Creative Commons license)

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Carol Newcomb is a Senior Consultant with Baseline Consulting. She specializes in developing BI and data governance programs to drive competitive advantage and fact-based decision making. Carol has consulted for a variety of health care organizations, including Rush Health Associates, Kaiser Permanente, OSF Healthcare, the Blue Cross Blue Shield Association and more. While working at the Joint Commission and Northwestern Memorial Hospital, she designed and conducted scientific research projects and contributed to statistical analyses.

Data Profiling with SQL is Hazardous to Your Company’s Health

By Stephen Putman, Senior Consultant

Data Profiling is the act of extracting descriptive  and statistical data about what resides in a database in order to facilitate data quality and design efforts, among other things. Tools for performing profiling range from open-source software (DataCleaner, Talend) to database system tools (Microsoft SQL Server, Oracle) to specific and purpose-built products (vendors Trillium and DataFlux both offer data profiling solutions). All of these tools automate and standardize the data profiling task, and integrate with other areas of the design effort to varying degrees. However, most organizations do not use them, relying instead on SQL queries, run manually. Why does this happen?

The main reason is that data profiling is not seen as a high-priority activity. Therefore, the investment in licenses, hardware resources, and training for a profiling system is seen to be an unnecessary expense. Consequently, data and business analysts are forced to use existing tools such as SQL query clients to perform basic profiling tasks.

Many times, this is due to a basic misunderstanding of the power of a data profiling tool, and the data it analyzes. Profiling data is useful in logical and physical data modeling, functional system requirement production, and test script generation. Profiling gives the overall system scope and context, and ensures that the system produced satisfies the requirements of the business by characterizing the values present in source systems.

Manual SQL data profiling is fraught with risk. It relies on the skill and knowledge of the analysts producing the queries for accuracy and effectiveness, and there is no guarantee of consistency of results or standardization.. Modern profiling tools have optimized data gathering technology that is faster than manual SQL and scenario repositories that can be shared between analysts and projects to promote reuse.

Implementing a robust data profiling system is an essential part of an effective data management environment. The cost of putting such a system into place is more than offset by the benefits of deep analysis of data sources in both the transactional and analytic spaces. The essential activity is to discover just how powerful such a system can be in your organization.

Photo by mandolux via Flickr (Creative Commons license)

Consulting Terms of Engagement: a Readiness Checklist

By Carol Newcomb, Senior Consultant

Having worked at least half of my professional life either with consultants or as a consultant myself, I need to offer some practical advice on increasing the probability of success on a consulting engagement.

Remember, a consultant is just another tool in your management toolbox that provides either the leverage (expertise/experience) or the hard skills that you and your staff are missing today.

There are three main reasons to hire consultants:  1) you want coaching from expert advisors to mentor your existing team and provide tactical advice; 2) you don’t have the skill-sets that you need (ETL programmers, software/hardware experts, etc.); or 3) to provide frameworks and processes to build and sustain ongoing programs (like business intelligence or data governance).

Regardless of the type of consulting engagement, your staff need to be on board with the presence of consultants in their midst.  Ask yourself, as the sponsor, some basic questions:

• Have you explained to your team what the purpose of the consulting engagement is intended to achieve and their role in making it successful?
• Are you as a sponsor willing and able to provide authority for the consultants on the ground?
• Are you willing to spend time with your team and the consultants in the same room, to work out issues, questions, strategy and tactics as they evolve over time?  Don’t think you can just punt and run.
• Do you have committed resources on your team to help with knowledge transfer?  This is not an “all other duties as assigned” task for your staff.
• If consultants will replace or supplement existing staff, is your staff aware and comfortable with this?  This will inevitably become a problem if the expectations are not managed upfront.
• Are IT and Business ready to start working together?
• Do you have true business users and are they ‘on board’ with your project?
• Is there a way to prioritize issues as they come up?  One thing all consulting engagements do is bring to light an unsightly set of issues that become obstacles to progress.
• Can you be honest about your culture? Are their repeated patterns or behaviors that could sabotage a key project?
• Can you comfortably “park” issues that are not showstoppers in order to move ahead despite them?

There are probably many more items I could include on this “preparedness checklist.”  The point is that consultants can often be perceived as disrupting the natural order of things.  Either you, as their sponsor, will need to introduce them and guide them through the organization to ensure they are effective, or you need to clearly delegate to your staff what the expectations are for them to do the same.  If technical knowledge transfer needs to occur, don’t just assume it will happen.  I have seen too many consultants spend the first few weeks twiddling their thumbs either because they don’t have access to key systems, or they don’t understand the environment and haven’t been provided any documentation to work with in the meantime.  How much time will you allow for consultants to become proficient?

If the consulting engagement is to collect facts, conduct interviews, summarize findings, provide best practices, roadmaps or assessments then make sure they have a political lay-of-the-land upfront.  Otherwise, they will attend meetings they have no context for, they will assume things that may be incorrect, and they will be off-target in their recommendations. Also, many consulting firms sell their methodologies as separate and packaged products. If you expect your consulting firm to transfer its intellectual property as part of the engagement then your consulting contract should stipulate that. If you have secured the funding to bring consultants into your organization, you need to ensure that the project is a win-win.  The risks to you are probably larger than to the consultant group, because at the end of their engagement, they go away.  A good consulting firm will have ensured knowledge transfer along the way, but your staff carries some of the responsibility for that, too. 

If you’re considering or starting a consultant engagement, here are a few things to consider:

• Is your department/division receptive to advice or change?
• Are department heads, directors and managers on board with the engagement?
• If ‘best practices’ are recommended, does the department have the appropriate technical tools and agility to put them into practice?
• Have you done everything within your control to ensure the success of this engagement?

If the answer to any of the above is NO, then reconsider your readiness, regroup with your staff, and discuss alternative strategies with the consulting group you are working with.

If you have an opportunity to change and improve your department, leverage the effort to instill that change.   You may not get more than one chance.

photo by mykpwedding via Flickr (Creative Commons License)

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Carol Newcomb is a Senior Consultant with Baseline Consulting. She specializes in developing BI and data governance programs to drive competitive advantage and fact-based decision making. Carol has consulted for a variety of health care organizations, including Rush Health Associates, Kaiser Permanente, OSF Healthcare, the Blue Cross Blue Shield Association and more. While working at the Joint Commission and Northwestern Memorial Hospital, she designed and conducted scientific research projects and contributed to statistical analyses.