Like many industries, health care is ripe with mergers and acquisitions. The move from a single-hospital perspective to integrated delivery systems (IDSs) and managed care is bringing new challenges in how health care organizations operate. One of the greatest hurdles involves collecting and transforming data from disparate legacy systems into meaningful information. The dynamic and competitive nature of the health care industry requires a quick solution to this complex problem. Johnson City Medical Center (JCMC)--a 407-bed health care facility located in Johnson City, Tennessee--found such a solution in implementing an enterprise-wide data warehouse.

JCMC has operated as a not-for-profit, regional health care system for more than 50 years. With the trend toward establishing an IDS and implementing managed care, the need for JCMC to integrate its disparate information systems became even more pressing. The health care organization had to prepare both internally and externally for this industry shift. Giving multiple users from throughout the enterprise the capability to access information simultaneously was an internal process that needed immediate attention.

The process needed to be user friendly; the data had to be consistent, accurate, timely and from a single source. Historically, like many health care groups, JCMC had been data rich and information poor.

As with any change in conducting business, the path to implementing a data warehouse at JCMC was not without hurdles. While many members of the JCMC organization knew the time was ripe for a data warehouse, our challenge would be to sell this idea to the rest of the organization.

The first step entailed gaining executive sponsorship for the project. This meant first gaining the support of our CEO, Administration and Board of Directors. From this group, we identified an executive sponsor for the project.

JCMC's next challenge was to educate our staff about managed care and how it would affect them in their daily responsibilities. The idea of data warehousing would be introduced as a tool that would enable the JCMC staff to meet new responsibilities and challenges posed by managed care and an IDS. Education of the staff about data warehousing would need to continue throughout the life of the project.

To begin the process at JCMC, a pilot project was launched. The pilot, known as OASIS II, provided immediate "value added" benefits to the organization. In addition, requirements for the enterprise-wide data warehouse were gathered simultaneously with the pilot project.

To achieve enterprise-wide buy-in for the project, JCMC chose to hold a series of consensus-building workshops to allow the users to define the warehouse requirements and to link those requirements to the organization's business processes, goals and objectives.

JCMC enlisted the services of Systems Techniques, Inc., an information technology firm based in Atlanta that provides a whole data warehousing solution to the health care industry. Systems Techniques used its proprietary requirements-gathering process, CONCUR, to develop a comprehensive definition of the information needed to support the future operations at JCMC. This definition was then used to integrate information from disparate operational systems in order to facilitate improved communications, productivity and outcomes of care.

Through the CONCUR process, management determined critical business processes and identified the data that supports those processes.

At a follow-up session, participants defined the detailed information requirements for incorporation into an enterprise-wide data warehouse. JCMC made significant headway by identifying its high impact processes (HIPs) and matching them to the user requirements for the data warehouse.

A business model was developed to guide JCMC in identifying and prioritizing our HIPs. For each HIP, the source of the data was defined, as well as the amount of history needed, the business roles and who needs what information. Following the CONCUR methodology, JCMC was able to define requirements for our warehouse in a matter of weeks, rather than the months required by more traditional methods.

Following the sessions, the participants served as ambassadors to the rest of JCMC in fostering change, the move toward managed care and the idea of data warehousing.

The pilot warehouse project gave JCMC an opportunity to examine the capability and capacity of its technical infrastructure. In executing the fast-payback project, we had the opportunity to note and correct any weaknesses that would impede implementation of the expanded warehouse.

Preparing the technical infrastructure to support the data warehouse was critical to its initial success and long-term survival.

The users quickly identified remote operational systems as a stumbling block in the effort to extract data that is accurate and timely. The advent of managed care was creating the need for client/server systems and, through the use of such systems, the ability to control our destiny.

In deploying the data warehouse, JCMC replaced its existing reporting system, based on an Access repository, using Systems Techniques CONVERGE data warehousing toolset and an Oracle7.2 database. Phase I of the project enabled more timely and complete service line utilization and financial reporting capabilities.

Another essential component of the technical infrastructure necessary to implement and sustain the data warehouse was proper staffing. JCMC had to ensure that a proper mix of technical skill and ability was available in its human resources. Several measures were taken to strengthen the weak points:

  • The job functions of current staff were realigned.
  • Contractors and new recruits were brought on board.
  • Consultants were engaged.

At its inception, JCMC had to ensure we had the appropriate staffing structure to support building, management and maintenance of the warehouse. Commitment to long-term staffing was essential to the warehouse's success. Roles and responsibilities of the warehouse management team were defined, and the people identified to fill those roles were given the proper support and training.
Several measures have been key to the success of JCMC's data warehousing initiative:

  • JCMC realized that its data warehouse would only be as effective as the people who supported it. We have taken great strides to educate the staff about the concept and its benefits, and to identify key individuals to champion the effort.
  • OASIS II, the pilot warehouse, served as a good test of the technical infrastructure. JCMC recognized the need to integrate its clinical, physician and financial data across the enterprise.
  • The hardware platform selected for JCMC's data warehouse consists of an IBM AIX UNIX version 4.1.4, utilizing a TCP/IP networking protocol. The warehouse boasts 20GB of storage. The open platform UNIX environment has been beneficial in respect to its ability to interface with other database platforms.
  • The pilot project also provided a fast payback investment. To garner and retain support for the warehouse, JCMC had to demonstrate interim successes during its implementation.

Perhaps the most critical challenge in successfully executing a data warehousing initiative is a shared vision. Understanding the business needs and requirements is necessary before any data modeling or database design can be productive. Focused meetings involving key users within the organization are paramount to the success of the project. There must be enterprise-wide buy in for the data warehouse and the value it can add to the organization. If the staff--from top to bottom and across all functional lines--can see the benefit, they will accept the challenge!

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