Healthcare Data Warehousing and Quality Assurance

Healthcare Data Warehousing and Quality Assurance T he US allocates nearly a trillion dollars annually to healthcare expenditures—more than any other nation. However, this tremendous expenditure has not secured the US a rank among the healthiest nations. Instead, prolonged public debates on healthcare policy in the US have focused on insurance coverage and medical care financing programs, avoiding serious examination of the nation's true health status. A rigorous examination of individual, national, and global healthcare issues and potential solutions must begin with unbiased, accurate, and timely data. In the US, federal and state regulatory agencies mandate the collection and reporting of data on healthcare events such as births, deaths, hospital admissions and discharges , selected disease occurrences, and other problem specific data sets. This data is stored in diverse formats both logically and physically, and it is typically used for narrow reporting requirements. These characteristics make the healthcare field ripe for the application of data warehousing technology to integrate these data sources and, thereby, support more effective healthcare decision making at both the individual and community levels. Healthcare data warehousing presents unique challenges. The industry is rife with medical standards and coding schemes, many of which are incompatible and require careful translations. Healthcare data comes from many sources and is delivered in many forms, including published books, individual spreadsheets, and several arcane tape or data formats. Results derived from a healthcare data warehouse must be delivered in accessible form to diverse stakeholders, including healthcare regulators, physicians, hospital administrators, consumers, community activists, and members of the popular press. The industry's widely decentralized and largely autonomous data collection efforts make data quality a significant challenge. Finally, the sensitivity of healthcare data makes privacy and security issues paramount. Here, we seek to highlight the research and development decisions made in constructing a healthcare data warehouse, with an emphasis on the critical topics of data staging and quality assurance. An interdisciplinary research team from the Colleges of Public Health and Business Administration at the University of South Florida designed, built, and now operates a comprehensive data warehouse that contains healthcare data from the State of Florida. Originally, we intended the data warehouse to support health assessments of communities throughout the state. However, the healthcare applications of the data warehouse have expanded to many other areas of public health decision making. In addition, we have begun using the data warehouse in clinical applications, such as …