De Mystifying Healthcare Data Governance

Demystifying Healthcare Data
Governance
Dales Sanders May 7, 2014
Creative Commons Copyright

2014 Health Catalyst

www.healthcatalyst.com
Todays Agenda
General concepts in data governance
Unique aspects of data governance in
healthcare
The layers and roles in data governance
Constant theme: Data governance as it relates
to analytics and data warehousing

A Sampling of My Up & Down Journey

TOO MUCH DATA
GOVERNANCE
(2005)
Northwestern
EDW
(1995)
IMDB
& PIRS
(1996)
Intel
Logistics
EDW
(1987)
MMICS
2014
1983
(1986)
WWMCCS
(1992)
NSA Threat
Reporting
(1998)
Intermountain
Healthcare
(2009)
Cayman
Islands HSA
WWMCCS: Worldwide Military Command & Control System
MMICS: Maintenance Management Information Collection System
NSA: National Security Agency
IMDB: Integrated Minuteman Data Base
PIRS: Peacekeeper Information Retrieval System
EDW: Enterprise Data Warehouse
TOO LITTLE DATA

GOVERNANCE

The Sanders Philosophy of

Data Governance
The best data governance governs to
the least extent necessary to achieve
the greatest common good.
Govern no data until its time.

Data Governance Cultures

HIGHLY
CENTRALIZED
GOVERNMENT
BALANCED
GOVERNMENT
HIGHLY
DECENTRALIZED
GOVERNMENT
AUTHORITARIAN
DEMOCRATIC
TRIBAL
Centralized EDW;
monolithic early
binding data model
Centralized EDW;
distributed late
binding data model
No EDW; multiple,
distributed analytic
systems

Characteristics of Democracy
Elements of centralized decision making
Elected or appointed, centralized representatives
Majority rules
Elements of decentralized action
Direct voting and participation, locally
Everyone is expected to participate in developing

shared values, rules, and laws; then abide by them
and act accordingly

Whats It Look Like?

Not enough data governance
Completely decentralized, uncoordinated data analysis
resources-- human and technology
Inconsistent analytic results from different sources,
attempting to answer the same question
Poor data quality, e.g., duplicate patient records rate is >
10% in the master patient index
When data quality problems are surfaced, there is no formal
body nor process for fixing those problems
Inability to respond to new analytic use cases and
requirements like accountable care

Whats It Look Like?

Too much data governance
Unhappy data analysts and their customers
Everything takes too long
Loading new data
Making changes to data models to support new analytic use

cases
Getting access to data
Resolving data quality problems
Developing new reports and analyses

Poll Question
What best describes the current state of affairs for
data governance in your organization?
193 Respondents
Authoritarian 19.7%
Democratic 24.3%
Tribal 56%

Poll Question
How would you rate data governance effectiveness
in your organization?
179 Respondents
5 Very effective 1.6%
4 7.2%
3 22.3%
2 44.1%
1 Ineffective 24.8%
10

The Triple Aim of Data Governance

1. Ensuring Data Quality
Data Quality = Completeness x Validity
2. Building Data Literacy in the organization
Hiring and training to become a data driven company
3. Maximizing Data Exploitation for the
organizations benefit
Pushing the data-driven agenda for cost reduction,

quality improvement, and risk reduction
11

Keys to Analytic Success

The Data Governance Committee should be a driving
force in all three
Mindset
Setting the tone of data driven for the culture
Skillset
Actively building and recruiting for data literacy

among employees
Toolset
Choosing the right kind of tools to support

analytics and data governance
12

The Data Governance Layers
Happy Data
Analyst
13

The Different Roles in Each Layer

Executive & Board Leadership
We need a longitudinal analytic view across the
ACO of a patients treatment and costs, as well
as all similar patients in the population we serve.
14


Data Governance Committee
We need an enterprise data warehouse
that contains all of the clinical data and
financial data in the ACO, as well as a
master patient identifier.
We need a data analysis team, as well as
the IT skills to manage a data warehouse.
The following roles in the organization
should have the following types of access
to the EDW.
15


Data Stewards
Im responsible for patient

registration. I can help.
Im responsible for clinical
documentation in Epic. I can help.
Im responsible for revenue cycle
and cost accounting. I can help.
16


Data Architects & Programmers
We will extract and organize the data from the
registration, EMR, rev cycle, and cost
accounting and load it into the EDW.
Data stewards, can we sit down with you and
talk about the data content in your areas?
DBAs and Sys Admins, here are the roles
and access control procedures for this data.
17


DBAs & System Administrators
Here is the access control list and
procedures for approving access to this
data. Lets build the data base roles and
audit trails to support these.
18


Data access & control system
When this person logs in, they have the
following rights to create, read, update,
and delete this data in the EDW.
19


Data Analysts
Ill log into the EDW and build a query
against the data in the EDW that should be
able to answer these types of questions.
Data Stewards, can I cross check my
results with you to make sure Im pulling
the data properly?
Data architects, Ill let you know if I have
any trouble with the way the data is
organized or modeled.
20

Who Is On The Data Governance

Committee?
Chief Analytics Officer
CIO
Representing the
analytics customers
The data technologist
CMO & CNO
The clinical data owners
CFO
The financial and supply

chain data owner
CRO
Representing the
researchers data needs
21

Data Governance Committee Failure Modes

Wandering: Lacking direction and experience
We know we need data governance, but we dont know how to go about it.
Technical Overkill: An overly passionate and inexperienced IT person leads the

data governance committee
Cant see the forest for the trees
For example, Executives on the Data Governance Committee (DGC) are asked
to define naming conventions and data types for a database column
Politics: Members of the DGC are passive aggressive, narrowly motivated, data
poseurs
They pretend to be data driven and selfless, but they arent
Territorial and defensive about their data
That person isnt smart enough to use my data properly.
Red Tape: Committee members are not governors of the data, they are bureaucrats
Red tape processes for accessing data
Confuse data governance with data security

22

Poll Question
Your organizations biggest risks to the success of
the Data Governance Committee
182 Respondents Multiple Choice
Wandering 52%
Politics 61%
Technical Overkill 20%
Red Tape 36%
Other 16%
23

Data Governance & Data Security

Data Governance Committee: Constantly pulling for broader
data access and more data transparency
Information Security Committee: Constantly pulling for
narrower data access and more data protection
Ideally, there is overlapping membership that helps with the
balance
24

Tools for Data Governance

Data quality reports
Data Quality = Validity x Completeness
CRM tools for the data warehouse
Whos using what data? When? Why?
White Space data management tools
For capturing and filling-in computable data thats missing in the source
systems
Metadata repository
Whats in the data warehouse?

Are there any data quality problems?
Whos the data steward?
How much data is available and over what period of time?
Whats the source of the data?
25

The Four Levels of Closed Loop Analytics in

Healthcare
2014 Denis Protti, Dale Sanders & Corinne Eggert
Supporting
information
CDS: Clinical
Decision
EDW: Support
EHR: Enterprise Data
MTTI:Warehouse
Electronic Health
Record
Start
Mean Time To
here
Improvement
Internal
Evidence
Clinicians
suggestions
Clinical
Variations &
Needs
Quality
Governance
Monitor baselines
& clinical
processes
Select a problem
Set outcomes &
metrics
External
Literature,
reports, etc.
Evidence
Clinical, EHR,
EDW &
Analytics
Align metrics &
Teams
data
Update EHR &
EDW with new
data items if
needed &
possible
use of evidence &

standards
Enterprise Clinical
Act onTeams
performance
information
Clinical, EHR,
EDW & Analytics
UpdateTeams
EHR
Performanc
e
Practice
MTTI
Protocols
Lo Hi
Standar
ds
Clinical Information
Systems
Decisions & Actions
Executive &
Clinical
Set Leadership
expectations for
protocols & EDW

metrics
Optimal State
Clinicians use
standard protocols
& orders
in
daily care
EHR & CDS
Electronic clinical
data
Sub-Optimal State
Clinicians use
diverse protocols
& orders in daily
care
Processing
EDW
Analyzable data
Clinical Analytics
Analyze data
quality &
process/outcom
e variations
Generate the
internal
evidence
Other Data
Clinical,
Financial, etc.
Sources
Best Evidence
Information
that
clinicians
trust
Quality
Governanc
Useecomparative
data to identify best

outcomes
Determine
standard order
sets, protocols &
decision
support
External
Literature,
reports, etc.
rulesEvidence
26www.healthcatalyst.com
Healthcare Analytics Adoption Model
Sanders, Protti, Burton, 2013
Level 8
Personalized Medicine
& Prescriptive Analytics
Tailoring patient care based on population outcomes and

generic data. Fee-for-quality rewards health maintenance.
Level 7
Clinical Risk Intervention

& Predictive Analytics
Organizational processes for intervention are supported

with predictive risk models. Fee-for-quality includes fixed
per capita payment.
Level 6
Population Health Management

& Suggestive Analytics
Tailoring patient care based on population metrics. Feefor-quality includes bundled per case payment.
Level 5
Waste & Care Variability Reduction internal optimization and waste reduction.
Level 4
Automated External Reporting
Efficient, consistent production of reports & adaptability to

changing requirements.
Level 3
Automated Internal Reporting
Efficient, consistent production of reports & widespread

availability in the organization.
Level 2
Standardized Vocabulary
& Patient Registries
Relating and organizing the core data content.
Level 1
Enterprise Data Warehouse
Collecting and integrating the core data content.
Level 0
Fragmented Point Solutions
Inefficient, inconsistent versions of the truth. Cumbersome

internal and external reporting.
Reducing variability in care processes. Focusing on
27

Progression in the Model
The progressive patterns at each level

Data content expands
Adding new sources of data to expand our understanding of care

delivery and the patient
Data timeliness increases
To support faster decision cycles and lower Mean Time To

Improvement
The complexity of data binding and algorithms increases
From descriptive to prescriptive analytics

From What happened? to What should we do?
Data governance and literacy expands
Advocating greater data access, utilization, and quality
28

Six Phases of Data Governance

You need to move through
these phases in no more
than two years
Level
Level 88
Personalized
Personalized Medicine
Medicine
&
& Prescriptive
Prescriptive Analytics
Analytics
2-4 years
Phase 6: Acquisition of Data

1-2 years
Phase 5: Utilization of Data
Phase 4: Quality of Data
Phase 3: Stewardship of Data
Phase 2: Access to Data
Phase 1: Cultural Tone of Data Driven
Level
Level 11
Enterprise
Enterprise Data
Data Warehouse
Warehouse
3-12 months
29

What Data Are We Governing?
30

Master Data Management

Comprises the processes, governance, policies,
standards and tools that consistently define and
manage the critical data of an organization to
provide a single point of reference.
- Wikipedia
The data that is mastered includes:

Reference data - the dimensions for analysis
Analytical rules supports consistent data binding
31

Data Binding & Data Governance

Analytics
Software
Programming
Pieces of
meaningless
data
Vocabulary
Binds
data to
115
60
systolic &
diastolic
blood pressure
Rules
normal
32

Why Is This Binding Concept

Important?
Knowing when to bind data, and how
tightly, to vocabularies and rules is
CRITICAL to analytic success and agility
Comprehensive
Agreement
Persistent
Agreement
Is the rule or vocabulary widely

accepted as true and accurate in
the organization or industry?
Is the rule or vocabulary stable

and rarely change?
Data Governance needs to look for and facilitate both

33

Vocabulary: Where Do We Start?

Charge code
CPT code
Date & Time
DRG code
In todays environment, about 20 data elements

represent 80-90% of analytic use cases. This will
grow over time, but right now, its fairly simple.
Drug code
Employee ID
Employer ID
Source data
vocabulary Z
(e.g., EMR)
Encounter ID
Gender
ICD diagnosis code
ICD procedure code
Department ID
Facility ID
Lab code
Patient type
Source data
vocabulary Y
(e.g., Claims)
Source data
vocabulary X
(e.g., Rx)
Patient/member ID
Payer/carrier ID
Postal code
Provider ID
34

Where Do We Start, Clinically?

We see consistent opportunities, across the industry,
in the following areas:
CAUTI
CLABSI
Pregnancy management,
elective induction
Glucose management in the

ICU
Knee and hip replacement
Gastroenterology patient
management
Spine surgery patient

management
Discharge medications
adherence for MI/CHF
Prophylactic pre-surgical
antibiotics
Materials management, supply

chain
Heart failure and ischemic

patient management
35

Start Within Your Scope of Influence

We are still learning how to manage outpatient populations
36

In Conclusion
Practice democratic data governance
Find the balance between central and decentralized

governance
Federal vs. States rights is a good metaphor
The Triple Aim of Data Governance
Data Quality, Data Literacy, and Data Exploitation
Analytics gives data governance something to govern
Start within your current scope of influence and data, then

grow from there
37

OBJECTIVE
Obtain unbiased, practical, educational advice on
proven analytics solutions that really work in healthcare.
The future of healthcare requires transformative thinking
by committed leadership willing to forge and adopt new
data-driven processes. If you count yourself among this
group, then HAS 14 is for you.
MOBILE APP
Access to a mobile app
that can be used for
audience response and
participation in real time.
Group-wide and individual
analytic insights will be
shared throughout the
summit, resulting in a more
substantive, engaging
experience while
demonstrating the power
of analytics.
2014 Health 38
Catalyst
Contact Info and Q&A

dale.sanders@healthcatalyst.com
@drsanders
www.linkedin.com/in/dalersanders/
39


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Demystifying Healthcare Data

Creative Commons Copyright

2014 Health Catalyst

to analytics and data warehousing

Creative Commons Copyright

2014 Health Catalyst

A Sampling of My Up & Down Journey

TOO LITTLE DATA

Creative Commons Copyright

2014 Health Catalyst

The Sanders Philosophy of

Govern no data until its time.

Creative Commons Copyright

2014 Health Catalyst

Data Governance Cultures

Creative Commons Copyright

2014 Health Catalyst

Elected or appointed, centralized representatives

Elements of decentralized action

Direct voting and participation, locally

Everyone is expected to participate in developing

Creative Commons Copyright

2014 Health Catalyst

Whats It Look Like?

resources-- human and technology

Inconsistent analytic results from different sources,

attempting to answer the same question

Poor data quality, e.g., duplicate patient records rate is >

10% in the master patient index

When data quality problems are surfaced, there is no formal

body nor process for fixing those problems

Inability to respond to new analytic use cases and

requirements like accountable care

Creative Commons Copyright

2014 Health Catalyst

Whats It Look Like?

Loading new data

Making changes to data models to support new analytic use

Getting access to data

Resolving data quality problems

Developing new reports and analyses

Creative Commons Copyright

2014 Health Catalyst

Creative Commons Copyright

2014 Health Catalyst

2014 Health Catalyst

The Triple Aim of Data Governance

Data Quality = Completeness x Validity

2. Building Data Literacy in the organization

Hiring and training to become a data driven company

3. Maximizing Data Exploitation for the

Pushing the data-driven agenda for cost reduction,

Creative Commons Copyright

2014 Health Catalyst

Keys to Analytic Success

Setting the tone of data driven for the culture

Actively building and recruiting for data literacy

Choosing the right kind of tools to support

Creative Commons Copyright

2014 Health Catalyst

The Data Governance Layers

Creative Commons Copyright

2014 Health Catalyst

The Different Roles in Each Layer