New Healthcare Data Warehousing Model Gain...

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New Healthcare Data Warehousing

Model Gains Favor - InformationWeek
Ken TerryNews

"Late binding," a just-in-time method, gives healthcare

organizations more flexibility, say proponents.

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A method of assembling data from disparate sources just in time
for particular analytic "use cases," known as the "late-binding"
model of data warehousing, is starting to gain traction in
healthcare as many provider organizations gear up for population
health management. The advantage of this approach is that it
allows users to combine disparate data very quickly for targeted
analyses without locking data warehouses into a predetermined
data model.
A sign of late binding's potent appeal is that Health Catalyst, a data
warehousing firm that uses this approach, has just raised $8 million
in venture capital funding from Kaiser Permanente Ventures and
CHV Capital, which is associated with Indiana University Health. A

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Salt Lake City firm founded by former Intermountain executives,

Health Catalyst also received $33 million in December from
Norwest Venture Partners, Sequoia Capital and Sorenson Capital.
In the wider world of information technology, late binding goes back
to the 1980s. But in health care, most data warehousing still uses
the early binding approach, in which data is mapped to standard
vocabularies and is bound to business rules at the outset. One
problem with this model, say proponents of late binding, is that
business rules change and vary from one organization to another.
Also, it takes time and effort to bind data that might never be
needed for any analytic use case.
[ Hospitals are warming up to data analysis. Read Pittsburgh
Healthcare System Invests $100M In Big Data. ]
Providence Health & Services, a 32-hospital, five-state organization
based in Seattle, has tried warehousing data both ways. Dick
Gibson, chief healthcare intelligence officer for the system, told
InformationWeek Healthcare that, when his team began building a
data warehouse in 2011, it was intended only for Providence's
Oregon operations. Then, early in 2012, it became a system-wide
project.
That posed severe challenges to the early binding model that
Providence started with. Although the majority of the system's
hospitals and clinics were using Epic, there were other clinical
systems involved, as well as 10 different costing systems, noted
Gibson. "When you jump that quickly from a state-based to a

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system-based initiative, you have to adapt to those 10 different

costing systems. And if you have an early-binding model, your
model has been disrupted. So the advantage of a late-binding
model is it's more flexible."
Taking the level of complexity up another notch, Swedish Health
Services, another Seattle-area healthcare system, formed an
affiliation with Providence in 2012. "Swedish has a whole other
electronic health record and a different materials management
system and a separate costing system," Gibson pointed out. "Now
people say, 'I want you to produce reports for both Providence and
Swedish.' If you did early binding, you'd have to go back and
rebuild your model, and to some degree, redo the work. With the
late binding model, you only have to start reconnecting data points
that go across both facilities at the same time. Late binding allows
you to connect only those separate sources that need to be there to
answer the question. So it allows you to be faster and more
flexible."
Providence had already brought in Health Catalyst in February
2012 to build certain elements of its data warehouse. By October,
Gibson said, it was clear that the early binding approach wasn't
going to work, so Providence decided to switch over to late binding
for its entire data warehouse.
In November, the IS department delivered its first product to clinical
end users: a data mart designed specifically to help clinicians figure
out how to lower the organization's C-section rate. That data mart
came with a dedicated dashboard that made it easy for users to get

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answers to their questions. The next product showed all surgical

encounters in Providence facilities, allowing users to look up cases
based on procedures, DRGs, surgeons or location. This year,
Gibson and his team will tackle other major areas such as financial
systems and materials management.
Gibson emphasized that the late binding approach requires a
decentralized approach to report generation. For this to succeed,
clinicians must work directly with analytics experts who are skilled
in a number of different areas. Training these folks can be a
challenge, he admitted, but clinicians love the end result, "because
they don't face handoffs to the IT team, as is typical in an early
binding model."
Health Catalyst says that about 80 hospitals, including Epic and
Cerner customers, are already using its product. Besides
Providence, they include Allina Health, Indiana University Health,
MultiCare Health System, North Memorial Health Care, Stanford
Hospital and Clinics, and Texas Children's Hospital. Intermountain
is not a client, but uses the same principles in its data warehouse,
said Health Catalyst CEO Dan Burton in an interview.
Burton said that Health Catalyst is in discussions with Kaiser
Permanente about using its services. Although the investment by
Kaiser's venture capital arm doesn't guarantee anything, he added,
"We're optimistic that we'll be establishing a commercial
relationship with them."
New delivery models such as accountable care organizations have

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created incentives for healthcare providers to invest in analytics

and data warehouses, a recent IDC Health Insights survey found.
Because only about 30% of providers currently have data
warehouses, Health Analytics expects the market to expand
rapidly, Burton said. "Every health system in the U.S. must put in a
data warehouse if they're serious about population health
management," he said.
As large healthcare providers test the limits, many smaller groups
question the value. Also in the new, all-digital Big Data Analytics
issue of InformationWeek Healthcare: Ask these six questions
about natural language processing before you buy. (Free with
registration.)
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