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March 28, 2003 Computer Science 40th Anniversary Symposium 1
Health Care Data Warehousing:Current and Future Directions
Alan R. [email protected]
Information Systems and Decision Sciences
College of Business Administration
University of South Florida
Tampa, FL
March 28, 2003 Computer Science 40th Anniversary Symposium 2
Outline
Research Portfolio Health Care Data Warehousing Future Directions
Bioterrorism Surveillance Systems Environmental Health Physician/Hospital/Procedure Volume Studies
March 28, 2003 Computer Science 40th Anniversary Symposium 3
Research Portfolio
National Institute for Software Testing and Productivity (NISTP) – DOD Funding
Computational Intelligence (CI) Testing Tools Graduate Courses on Software Testing
Telemedicine Quality Attributes – VA Partner Formal Methods for Network-Centric System Specification E-Commerce Software Development Collaborative Programming and Agile Methods Inspection Techniques for Graphical Models Design Science as a Research Paradigm in IS
March 28, 2003 Computer Science 40th Anniversary Symposium 4
Health Care Data Warehouse Research
Co-Principal Investigators James Studnicki - COPH, USF Don Berndt and Alan Hevner - COBA, USF
Research Staff Center for Health Outcomes Research Staff COBA and COPH Doctoral and Masters Students
Collaboration and Funding U.S. Dept. of Commerce TOP Grant Florida Department of Health Bear Stearns Research Laboratory Florida Communities
March 28, 2003 Computer Science 40th Anniversary Symposium 5
CATCH Data Warehouse
Utilizes over 400 health status indicators.
Fine-Grained and Transaction-OrientedData Warehouse Structures
AggregateData Warehouse
Structures
CATCHReport
Structures
VitalStatistics
HospitalDischarges
CancerRegistry
Demographics
Marketing Data
March 28, 2003 Computer Science 40th Anniversary Symposium 6
Data Dissemination Modes
Effective Presentation of Data Warehouse Information to Decision Makers
Data Dissemination Modes Ad-Hoc Queries and Data Browsing (SQL/QBE) Pre-Defined Report Generation (CATCH Reports) Desktop Data Warehousing (iCAP - MS Excel) Online Analytic Processing (OLAP) Geographic Information Systems (GIS) Web-Enabled Access
March 28, 2003 Computer Science 40th Anniversary Symposium 7
CATCH Workflow
Data Staging Customized for state
data. Indicator Calculation Report Production
State-Specific Data Sources
CATCH DataCATCH DataWarehouseWarehouse
Fine-Grained and Transaction-OrientedData Warehouse Structures
AggregateData Warehouse
Structures
CATCHReport
Structures
National Data National Data SourcesSources
Sto
red
Pro
ce
du
res
OLAP Access
Pre-Defined CATCH Reports
March 28, 2003 Computer Science 40th Anniversary Symposium 8
Research Applications
Bioterrorism Surveillance Systems Environmental Health Impacts – EPA
Project Physician/Hospital/Procedure Volume
Studies
March 28, 2003 Computer Science 40th Anniversary Symposium 9
Bioterrorism Surveillance Systems
Sentinel Networks Throughout Florida Anticipate and prevent (if possible). Sense and provide early warning. React and minimize epidemiological impacts.
Surveillance System Infrastructure Networks connecting sensors and early data indicators. Historical data warehouses for pattern recognition. Intelligent agents to alert populace, disseminate reaction,
and eliminate threat.
March 28, 2003 Computer Science 40th Anniversary Symposium 10
Three Pillars of Threat Surveillance
Real-Time Data Collection Data with minimal lag time.
Data Warehousing & Data Mining Historical context, analysis, and pattern recognition
techniques for threat detection. Communications & Alert Networks
Timely dissemination to response groups.
“A surveillance system includes a functional capacity for data collection, analysis, and dissemination linked to public health programs.” [CDC]
March 28, 2003 Computer Science 40th Anniversary Symposium 11
CATCHHealth Care
Data Warehouse
Pattern RecognitionEngines
FlashData Warehouse
Threat AssessmentDashboards
Shared Metadata
Metadata
StatewideHealth CareDatabases
DW
Sta
gin
g
Fla
sh S
tagin
g
Real-TimeData
Surveillance System
ArchitectureResearch Challenges Flash / Real-Time Data
Warehouses Threat Detection via
Data Mining
March 28, 2003 Computer Science 40th Anniversary Symposium 12
Data Mining & Pattern Recognition
Alarm thresholds are determined on the basis of historical pattern recognition. Does the current real time data constitute an abnormal
pattern? Historical health care data is maintained in a data
warehouse. Sophisticated browsing technologies and/or
intelligent data mining will help recognize when data streams trigger alarm thresholds for a threat.
March 28, 2003 Computer Science 40th Anniversary Symposium 13
Environmental Health Project
Develop a series of indicators that can characterize community exposure to various environmental contaminants or hazards.
Use evolving EPA models of dispersion and exposure. Collect experiential and historical information.
Describe the socioeconomic and demographic characteristics of these communities of interest.
Investigate any association between exposure levels and variation in health status.
Tools include hierarchical linear models and spatial statistics.
All Cancer Mortality
Health Status IndicatorsMerged with EnvironmentalExposure Data
Total TRI Air Emissions
Source: EPA 1999 Toxic Release Inventory
Health Status IndicatorsMerged with EnvironmentalExposure Data
March 28, 2003 Computer Science 40th Anniversary Symposium 16
Clinical Volume Research
Web-based access to volume data on: Procedures Physicians Hospitals
Relationship of volume to positive patient outcomes Applications
Healthcare Organizations Consumers
Compelling research results Paper under review at Peer Refereed Journal
Extract of Research Findings
© 2002 Studnicki et al. Submitted for journal publication. Do not copy without permission of authors.
Table 3. For Selected Surgical Procedures in Florida (1998), Physician Volume Distribution Characteristics
ProceduresTotal
ProceduresTotal
Physicians
Mean Procedures/Physician
Median Procedures/Physician
% Single Procedure Physicians
Maximum Volume
Mean Procedures/Physician
% Total Procedures
Mean Procedures/Physician
% Total Procedures
Operations of Cardiovascular SystemCoronary artery bypass graft 25124 384 65.4 20 37.0% 421 2.2 1.7% 235.0 35.5%Removal coronary artery obstruction 39986 906 44.1 9 29.8% 574 2.0 2.3% 196.1 44.1%Open heart surgery 7052 317 22.2 11 31.2% 210 2.7 6.1% 92.0 40.4%Insertion, removal, replacement, repair of pacemaker leads and devices 14569 1124 13.0 3 36.1% 204 1.4 5.3% 65.7 50.5%Puncture of vessel 21549 4712 4.6 2 46.4% 121 1.1 11.7% 23.1 50.4%Cardiac catherization 48956 1350 36.3 14 31.6% 405 2.4 3.4% 153.6 42.0%
All Physicians with at Least One ProcedureBy Surgical Volume
Lowest 50% PhysiciansBy Surgical Volume
Highest 10% Physicians
March 28, 2003 Computer Science 40th Anniversary Symposium 18
Application Directions
Hospital Use Risk Management
Retrospectively analyze patterns of low hospital/MD combinations Identify variation in volume related processes of care (e.g., based on
payer source) “Real time” risk assessment at scheduling Develop guidelines/algorithms
Referral patterns Privileging considerations
Consumer Use Selection of Doctors and Hospitals Education
March 28, 2003 Computer Science 40th Anniversary Symposium 19
Future Research Directions
Health care data quality at source Motivation for reporting timely and accurate data Data collection audits
Use of health care data in communities National Standards for community health assessments (very limited data
sets required) How are data used to make health care decisions? Different stakeholders use of data
Ability to inform national debate on health care issues Quality of Care to poor, disadvantaged, minorities Comparison of care under different health care programs (Managed Care
Programs)