Richard Pham Senior Enterprise Architect Clinical Health and Community Care OI&T Corporate Data Warehouse Architecture

Transcription

1 Richard Pham Senior Enterprise Architect Clinical Health and Community Care OI&T Corporate Data Warehouse Architecture

2 Being Interdisciplinary Is A Double- Edged Source On one hand, the reason why you are all here is because using conventional methods, we can only get so far with progress. Those who can leverage more robust approaches tend to succeed On the other hand, every group you are going to interact with in your interdisciplinary quest has their own conventional concerns and failing to address them in a way that you can get their attention on your concerns is a sure pathway to failure. This is an introduction to the challenging (I outright say antagonistic) relationship that you will have this year with the IT department.

3 ~13% of VistA as of 2015 All Patient Connections Currently

4

5 VHA and OI&T Have An Antagonistic Relationship In Practice Despite what you may hear from the official statements, most of what you will need to accomplish this year would work out better if you adopted the mentality that you will accomplish your work in spite of OI&T! There are some friendly quarters, BISL (my organization) being one of them, but both VHA Privacy and OI&T Security give us rules that we have to follow as well

6 Another Day At The Office

7 VA Does Not Like To Be In The Newspaper For This Reason May 2006 Lost A Laptop Containing Data That You ll Be Getting Access This Month! Birmingham REAP 1 M people affected (~ k veterans, ~600k providers) $10M to send all the free credit report data Getting SSN access for Research is now quite locked down.

8 ODM&T Initial Action Plan To DHCP Development (1980) Ordered that development stop Fired the developers Removed the hardware Cut the DMAS budget so it would never happen again

9 The official history

10 There Is A History About This, Perhaps Another Day VA Data Lifecycle Brown VistA History Article

11 The VA Data Lifecycle

12 National Analytic Systems A list of systems that support policy, planning, and congressional needs There are more extracts than this, but I have chosen the most common ones

13 Systems to Support Planning and Research Corporate Data Warehouse (Major) A near real-time accumulation of much of the same data The result of the Health Data Repository process National Patient Care Database (Retired This Fiscal Year, No Permissions Granted) An integrated set of data that captures a patient s care encounter with the VA Outpatient Deprecation is October this year (25 years in operation) Inpatient working toward deprecation

14 Systems to Support Planning Decision Support System (DSS) Supports accounting and costing for the OIG, GAO, CBO, and other auditing agencies Allocation Resource Center Supports personnel and resource allocation at the medical center level Workload capture, resource allocation Basis for the VERA (VA s Fund Control Point) Model

15 Local VistA File Site 1 Local VistA File Site N Local VistA Installations Local Extract Software Site 1 Local Extract Software Site N DSS Extract Software PBM Extract Software NPCD Extract Software Etc. VistA Extracts DSS Extract Files PBM Extract Files NPCD Extract Files Etc. Host Location DSS Austin, Tx PBM Hines, IL NPCD Austin, Tx Etc. VistA Extracts Load and Translate Software DSS Build Software PBM Build Software NPCD Build Software Etc. DSS Production Database PBM Database NPCD Database Etc. National Database Build SAS Datasets Custom Extract By Database Owner Diagram of Data Sources Available to VA Researchers Research Database DSS NDE SAS Datasets Medical SAS Datasets Etc. SAS Datasets Custom Extract PBM Custom Extract Medicare Data National Death Index Etc. External Data Researchers 15

16 CDW-Production Architecture Regional Source Systems Regional Shadow/Journal Reader/Filer Process Corporate Data Warehouse Facility 1 VistA Facility 2 VistA Regional VistA Shadow Near Real Time Regional Operational Data Store Daily Daily Regional Data Warehouse Facility 3 VistA Shadow Dashboard Cache based Time stamp added VistaCreateDate VistaEditDate SQL Server based SID s added OpCode (I/U/D) added ETLBatchID added Incremental loads based upon VistaEditDate changes Daily VISN Data Warehouse(s) Tightly coupled to existing organization structure. While it would be extremely difficult and risky to adjust RDW/VDW to MyVA, it is already built into the CDW.

17 VA Analytic Ecosystem (2015) Common Data Common Infrastructure Common Tools Common Security REGION 1 REGION 2 REGION 3 REGION 4 R2 R2 R1 R1 R4 R4 R3 R3 CDW System Facts: Source system: Extract tools: VISTA: 130 Other Major Systems: 7 Enterprise FR GP CDW BI Data facts: VISTA NRT Journal Reader VISTA Batch Extractor Domains of information: 63 Rows of data: 900+ billion Columns of data: 22,000+ Tables of data: 840+ Data quality program Active Users: 30,000/Month Vibrant user community CDW Sample Data Facts: Unique Veterans: 20 million Outpatient encounters: 1.6 billion Inpatient admissions: 9 million Clinical orders: 3.2 billion Lab tests: 5.6 billion Pharmacy fills: 1.5 billion Radiology procedures: 162 million Vital signs: 2.3 billion Text notes: 2.0 billion RD AN CDW Analytic Enclaves: GP: General Purpose BI: Business Intelligence AN: Analytics and Informatics RD: Health Services R&D (VINCI) CDW Analytic Capabilities: FR Field Reporting Primary/Secondary/Data Mart Structures Data Standardization Metadata Services Business Intelligence Reporting & Dashboards Tools Geospatial Mapping Tools and Images SAS/Grid High Performance Compute Grid Natural Language Processing Engines Hadoop Cluster

18 VA Analytic Ecosystem (2015) Common Data Common Infrastructure Common Tools Common Security REGION 1 REGION 2 REGION 3 REGION 4 R2 R2 R1 R1 R4 R4 R3 R3 CDW System Facts: Source system: Extract tools: VISTA: 130 Other Major Systems: 7 Enterprise FR GP CDW BI Data facts: VISTA NRT Journal Reader VISTA Batch Extractor Domains of information: 63 Rows of data: 900+ billion Columns of data: 22,000+ Tables of data: 840+ Data quality program Active Users: 30,000/Month Vibrant user community CDW Sample Data Facts: Unique Veterans: 20 million Outpatient encounters: 1.6 billion Inpatient admissions: 9 million Clinical orders: 3.2 billion Lab tests: 5.6 billion Pharmacy fills: 1.5 billion Radiology procedures: 162 million Vital signs: 2.3 billion Text notes: 2.0 billion RD AN CDW Analytic Enclaves: GP: General Purpose BI: Business Intelligence AN: Analytics and Informatics RD: Health Services R&D (VINCI) CDW Analytic Capabilities: FR Field Reporting Primary/Secondary/Data Mart Structures Data Standardization Metadata Services Business Intelligence Reporting & Dashboards Tools Geospatial Mapping Tools and Images SAS/Grid High Performance Compute Grid Natural Language Processing Engines Hadoop Cluster

19 Permissions Separated Between Research and Operations Research aspx Operations ss.aspx CMS VA Joint Data For MMLEADS is Operations Only At this Point! Differing Policies Apply, If You Have Questions, Please Contact Me

20 Reading for Fun Official History VistA*/U.S. Department of Veterans Affairs nationalscale HIS Steven H. Brown, Michael J. Lincoln, Peter J. Groen, Robert M. Kolodner International Journal of Medical Informatics 69 (2003) 135/156 VistA Document Library (VDL) www4.va.gov/vdl

21 Secrets of the VA Data Universe This was an extremely brief introduction to a complicated area I have another presentation on the availability of databases in the VA and how to access them for operations and/or research

22 Working With The Bureaucracy The best advice I can give you is to always have in mind what you endpoint really is, and work with people who know the bureaucracy to frame the request: To the right person For the right reason With the right language This saves lots of time and lowers blood pressure, especially for interdisciplinary.

23

24 The CDW Update Process Production Enclaves (Daily) AITC Austin G P B I A N R D F R Regional Data Warehouses (N=4) > 360 million TPD xdw Staging Systems (N=4) 24-Hr NRT 24-Hr 24-Hr 24-Hr NRT NRT NRT > 100 million TPD VistA Shadows (N=21) NRT NRT NRT NRT >150 million TPD VistA Production Systems (N=130) Database Engine Cache SQL Server Oracle

25 The CDW Update Process Production Enclaves (Daily) Raw (Periodic) AITC Austin G P B I A N R D F R R A W Regional ata Warehouses (N=4) > 360 million TPD xdw Staging Systems (N=4) 24-Hr NRT 24-Hr 24-Hr 24-Hr NRT NRT NRT Batch (Daily-Weekly-Monthly) (On-Demand) > 100 million TPD VistA Shadows (N=21) NRT NRT NRT NRT >150 million TPD VistA Production Systems (N=130) Database Engine Cache SQL Server Oracle

26 The CDW Update Process Production Enclaves (Daily) VX-130 (NRT) Raw (Periodic) AITC Austin G P B I A N R D F R V X R A W Regional Data Warehouses (N=4) > 360 million TPD xdw Staging Systems (N=4) 24-Hr NRT 24-Hr 24-Hr 24-Hr NRT NRT NRT Batch (Daily-Weekly-Monthly) (On-Demand) > 100 million TPD VistA Shadows (N=21) NRT NRT NRT NRT >150 million TPD VistA Production Systems (N=130) Database Engine Cache SQL Server Oracle

27 FY16 CDW Highlights Data Doubled the rows of data (1T -> 2T) under the BISL umbrella (CDW/RDW/VINCI) Released over 200 updates Examples: Fee Basis Claims System, VACAA Eligibility, ICD-10, Inpatient, Microbiology, Surgery, TMS, PCMM-R Infrastructure Implemented Data Enclave Strategy v2 Implemented enterprise scale Geospatial system Surpassed 500 servers Surpassed 3,800 databases Tools Enterprise rollout of Pyramid Analytics (!4k users) SharePoint hosting of > 23k reports Published first Cloud based app (Wait Times) Users and Products CDW/RDW users grew by 33% CDW/RDW report products grew by 20% (Does not include Pyramid) VINCI HSRD projects grew by 33% Data Governance New Corporate Data Governance Council Strategy, Policy, Priorities, Requirements Training Hosted over 125 training events

28 VA Analytic Ecosystem (2015) Common Data Common Infrastructure Common Tools Common Security REGION 1 REGION 2 REGION 3 REGION 4 R2 R2 R1 R1 R4 R4 R3 R3 CDW System Facts: Source system: Extract tools: VISTA: 130 Other Major Systems: 7 Enterprise FR GP CDW BI Data facts: VISTA NRT Journal Reader VISTA Batch Extractor Domains of information: 63 Rows of data: 900+ billion Columns of data: 22,000+ Tables of data: 840+ Data quality program Active Users: 30,000/Month Vibrant user community CDW Sample Data Facts: Unique Veterans: 20 million Outpatient encounters: 1.6 billion Inpatient admissions: 9 million Clinical orders: 3.2 billion Lab tests: 5.6 billion Pharmacy fills: 1.5 billion Radiology procedures: 162 million Vital signs: 2.3 billion Text notes: 2.0 billion RD AN CDW Analytic Enclaves: GP: General Purpose BI: Business Intelligence AN: Analytics and Informatics RD: Health Services R&D (VINCI) CDW Analytic Capabilities: FR Field Reporting Primary/Secondary/Data Mart Structures Data Standardization Metadata Services Business Intelligence Reporting & Dashboards Tools Geospatial Mapping Tools and Images SAS/Grid High Performance Compute Grid Natural Language Processing Engines Hadoop Cluster