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Clinical data warehouses: Sometimes it's worth being lazy

If you are a health organization you probably have or thinking of having a clinical data warehouse. A Clinical Data Warehouse (CDW), sometimes called Clinical Data Repository (CDR), is a database that consolidates data from a variety of clinical sources to form a unified view of a the data for various purposes. Typical data types which are often found within a CDW include: clinical laboratory test results, vital signs, patient demographics, administered meds, hospital admissions, ICD-9 codes and more. Developing and sustaining an effective CDW operations unit is a substantial effort and long-term commitment. The main challenge in designing a CDW is defining its scope and the use cases it should support. In theory a CDW can serve as a basis for reporting, studying and planning. The use case that is often mentioned in relate to CDW is supporting clinical trials. This would allow for researchers to have all the information from a study in one place as well as let other researchers benefit
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FHIR Status Check

 More than 2 years have past since I wrote my article  on the Fast Healthcare Interoperability Resources (FHIR®) standard and it’s time to do a quick status check and revisit the predictions I made back then. The FHIR standard continues the strong trajectory of adoption and is now used across the globe. The application programming interface (i.e. the FHIR API) is available in most major EHR systems today. According to the US Office of the National Coordinator Health Information Technology an estimated 85% of hospitals have FHIR in their systems. The NHS has been quick to adopt FHIR and the adoption curve in the UK is high. The NPfIT (NHS Care Record Service) HL7 V3 interfaces are being redeveloped in FHIR®, and new NHS specifications such as the CareConnect standard for secured Transfer of Care  are being specified in FHIR® by default. Despite the industry enthusiasm about the potential of FHIR still the old and faithful HL7 v2 remains the predominant interoperability standard in use t
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Hospital CXO - A new well deserve seat at the executive table

I once asked the CEO of a large hospital what will be the main KPI to measure how well the hospital is doing. The CEO immediate response was that the best indicator would be how satisfy the patients are. In a stressful and overloaded environment such as a hospital, it is easy to focus on the disease and forget about the patient. A chief experience officers (CXO), or other similar titled leaders, is a new member in a hospital C-suite. The role of a CXOs have gained scope and respect in the C-suite as studies show how experience affects all aspects of care. There is a growing body of evidence supporting that the association between better patient experience and health care quality. For example, a study found that a higher CMS star rating was associated with lower patient mortality and readmission's.  One of the drivers accelerating the adoption was the US government decision to start mandate measuring patient’s perception of their care and tied reimbursement to those scores. Beyond t
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Home grown and die slow systems

The atmosphere got tensed as the meeting went on. We were all started feeling a bit uncomfortable. The meeting took place at headquarters of one of the prestige hospitals in the US. A hospital which constantly ranked in the top 10 best hospitals in the world. A drop of sweat sprout on the brow of the IT executive which was leading the meeting. The participants nodded their heads as they realized that despite the massive investments in developing their home grown systems over the years they are lacking some basic features which typically found in commercially available products, and many of the modules in used are becoming old and need to be replaced. That same realization repeated itself in similar discussions I had with other health organizations around the globe which took the "home grown" path. It seems there was a paradox between how wealthy is the organization and how poor its IT systems are. Selecting a commercially available product is a frustrating task. Typic
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Are we ready for a Cloud First hospital?

I will start this article by defining what I mean by the term a Cloud First hospital. The term cloud has been a buzz word in the past decade which led many organizations to declare their support for the cloud, sometime without understanding its true meaning. For the purpose of this article I am proposing a simple test to decide whether an organization is a cloud first or not. If you are software vendor you must have an IT department which directly in charge of the system up-time at your clients sites. If you are a health organization then you should never have visited the data center where your data resides. A Cloud First hospital is one which more than 50% of its systems reside in data center that none of its staff members ever visited or not even sure where they are. According to a recent survey by Datica, in the US only 17.7 percent of the respondents say they work with healthcare organizations that have more than 50% of the existing software infrastructure remotely hosted or
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The big battle: Best of breed vs One stop shop

The world of economics has decided on this debate a long time ago: monopolies are bad, diversity is good. No matter what a monopoly promises, you can rest assure that over time the lack of competition will cause prices to go up and quality to go down. When it comes to healthcare IT, however, there is one unique factor that flips the coin – interoperability. Despite various attempts the healthcare industry has yet to solve the interoperability challenge in a satisfactory manner which will enable a full continuum of care across different health information systems within a health delivery organization. Taking a common scenario of prescribing a medication order in theatres using a surgical system to be later administered in a ward requires significant investment to achieve, even using the modern Fast Health Interoperability Resource (FHIR) protocol. The investment required to streamline the data flow across systems raise in an exponential order with every new system that is thrown to t
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On vendor lock (or how to turn a customer to an enemy)

All looks perfect when you are in love. The person you're with seems to have all the qualities you were looking for in a partner. He is always there for you, attentive to your needs, promising to fulfill all of your wishes. But as this story goes the statistics kicks in, and you soon find yourself sitting with your friends and moan about very similar things. When it comes to a healthy relationship between clients and suppliers it is good to follow the same advise a psychologist will give you for maintaining the relationship between you and your partner in life: have constant and open communication, align your plans together etc. But there is one very important recommendation that often escapes and is the hardest to implement and that is to keep your independence! The advice is really relevant for all industries and is not specific to healthcare, however, when it comes to healthcare it is much easier, as a customer to lose your independence and without even noticing it. Since he
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